444 research outputs found
Knee moments of anterior cruciate ligament reconstructed and control participants during normal and inclined walking
Objectives: Prior injury to the knee, particularly
anterior cruciate ligament (ACL) injury, is known to
predispose one to premature osteoarthritis (OA). The
study sought to explore if there was a biomechanical
rationale for this process by investigating changes in
external knee moments between people with a
history of ACL injury and uninjured participants
during walking: (1) on different surface inclines and
(2) at different speeds. In addition we assessed
functional differences between the groups.
Participants: 12 participants who had undergone
ACL reconstruction (ACLR) and 12 volunteers with
no history of knee trauma or injury were recruited
into this study. Peak knee flexion and adduction
moments were assessed during flat (normal and
slow speed), uphill and downhill walking using an
inclined walkway with an embedded Kistler Force
plate, and a ten-camera Vicon motion capture
system. Knee injury and Osteoarthritis Outcome
Score (KOOS) was used to assess function.
Multivariate analysis of variance (MANOVA) was
used to examine statistical differences in gait and
KOOS outcomes.
Results: No significant difference was observed in
the peak knee adduction moment between ACLR and
control participants, however, in further analysis,
MANOVA revealed that ACLR participants with an
additional meniscal tear or collateral ligament
damage (7 participants) had a significantly higher
adduction moment (0.33±0.12 Nm/kg m) when
compared with those with isolated ACLR
(5 participants, 0.1±0.057 Nm/kg m) during gait at
their normal speed ( p<0.05). A similar (nonsignificant)
trend was seen during slow, uphill and
downhill gait.
Conclusions: Participants with an isolated ACLR
had a reduced adductor moment rather an increased
moment, thus questioning prior theories on OA
development. In contrast, those participants who
had sustained associated trauma to other key knee
structures were observed to have an increased
adduction moment. Additional injury concurrent
with an ACL rupture may lead to a higher
predisposition to osteoarthritis than isolated ACL
deficiency alone
Electronic Liquid Crystal Physics of Underdoped Cuprates
Recent observations of broken symmetries have partly demystified the
pseudogap phase. Here we review evidence for long-range intra-unit-cell(IUC)
nematic order and its unexpectedly strong coupling to the phase of the
fluctuating stripes in the pseudogap states of underdoped
BiSrCaCuO. In particular, we focus on the analysis
techniques that reveal this evidence in scanning tunneling spectroscopy data,
the definition of the extracted IUC nematic order parameter, and a
phenomenological theory of the coupling between the IUC nematic order and the
previously reported coexisting fluctuating stripes. We also present a
microscopic mechanism of IUC nematic order driven by on-site and near-neighbor
repulsions. Finally we discuss open questions in the context of these results.Comment: 26 pages, 10 figures. To be published in Physica
Transport Spectroscopy of Symmetry-Broken Insulating States in Bilayer Graphene
The flat bands in bilayer graphene(BLG) are sensitive to electric fields
E\bot directed between the layers, and magnify the electron-electron
interaction effects, thus making BLG an attractive platform for new
two-dimensional (2D) electron physics[1-5]. Theories[6-16] have suggested the
possibility of a variety of interesting broken symmetry states, some
characterized by spontaneous mass gaps, when the electron-density is at the
carrier neutrality point (CNP). The theoretically proposed gaps[6,7,10] in
bilayer graphene are analogous[17,18] to the masses generated by broken
symmetries in particle physics and give rise to large momentum-space Berry
curvatures[8,19] accompanied by spontaneous quantum Hall effects[7-9]. Though
recent experiments[20-23] have provided convincing evidence of strong
electronic correlations near the CNP in BLG, the presence of gaps is difficult
to establish because of the lack of direct spectroscopic measurements. Here we
present transport measurements in ultra-clean double-gated BLG, using
source-drain bias as a spectroscopic tool to resolve a gap of ~2 meV at the
CNP. The gap can be closed by an electric field E\bot \sim13 mV/nm but
increases monotonically with a magnetic field B, with an apparent particle-hole
asymmetry above the gap, thus providing the first mapping of the ground states
in BLG.Comment: 4 figure
Quality assessment of an interferon-gamma release assay for tuberculosis infection in a resource-limited setting
<p>Abstract</p> <p>Background</p> <p>When a test for diagnosis of infectious diseases is introduced in a resource-limited setting, monitoring quality is a major concern. An optimized design of experiment and statistical models are required for this assessment.</p> <p>Methods</p> <p>Interferon-gamma release assay to detect tuberculosis (TB) infection from whole blood was tested in Hanoi, Viet Nam. Balanced incomplete block design (BIBD) was planned and fixed-effect models with heterogeneous error variance were used for analysis. In the first trial, the whole blood from 12 donors was incubated with nil, TB-specific antigens or mitogen. In 72 measurements, two laboratory members exchanged their roles in harvesting plasma and testing for interferon-gamma release using enzyme linked immunosorbent assay (ELISA) technique. After intervention including checkup of all steps and standard operation procedures, the second trial was implemented in a similar manner.</p> <p>Results</p> <p>The lack of precision in the first trial was clearly demonstrated. Large within-individual error was significantly affected by both harvester and ELISA operator, indicating that both of the steps had problems. After the intervention, overall within-individual error was significantly reduced (<it>P </it>< 0.0001) and error variance was no longer affected by laboratory personnel in charge, indicating that a marked improvement could be objectively observed.</p> <p>Conclusion</p> <p>BIBD and analysis of fixed-effect models with heterogeneous variance are suitable and useful for objective and individualized assessment of proficiency in a multistep diagnostic test for infectious diseases in a resource-constrained laboratory. The action plan based on our findings would be worth considering when monitoring for internal quality control is difficult on site.</p
Health Related Quality of Life among Patients with Tuberculosis and HIV in Thailand
INTRODUCTION: Health utilities of tuberculosis (TB) patients may be diminished by side effects from medication, prolonged treatment duration, physical effects of the disease itself, and social stigma attached to the disease. METHODS: We collected health utility data from Thai patients who were on TB treatment or had been successfully treated for TB for the purpose of economic modeling. Structured questionnaire and EuroQol (EQ-5D) and EuroQol visual analog scale (EQ-VAS) instruments were used as data collection tools. We compared utility of patients with two co-morbidities calculated using multiplicative model (U(CAL)) with the direct measures and fitted Tobit regression models to examine factors predictive of health utility and to assess difference in health utilities of patients in various medical conditions. RESULTS: Of 222 patients analyzed, 138 (62%) were male; median age at enrollment was 40 years (interquartile range [IQR], 35-47). Median monthly household income was 6,000 Baht (187 US]). Concordance correlation coefficient between utilities measured using EQ-5D and EQ-VAS (U(EQ-5D) and U(VAS), respectively) was 0.6. U(CAL) for HIV-infected TB patients was statistically different from the measured U(EQ-5D) (p-value<0.01) and U(VAS) (p-value<0.01). In tobit regression analysis, factors independently predictive of U(EQ-5D) included age and monthly household income. Patients aged ≥40 years old rated U(EQ-5D) significantly lower than younger persons. Higher U(EQ-5D) was significantly associated with higher monthly household income in a dose response fashion. The median U(EQ-5D) was highest among patients who had been successfully treated for TB and lowest among multi-drug resistant TB (MDR-TB) patients who were on treatment. CONCLUSIONS: U(CAL) of patients with two co-morbidities overestimated the measured utilities, warranting further research of how best to estimate utilities of patients with such conditions. TB and MDR-TB treatments impacted on patients' self perceived health status. This effect diminished after successful treatment
Batch effect confounding leads to strong bias in performance estimates obtained by cross-validation.
BACKGROUND: With the large amount of biological data that is currently publicly available, many investigators combine multiple data sets to increase the sample size and potentially also the power of their analyses. However, technical differences ("batch effects") as well as differences in sample composition between the data sets may significantly affect the ability to draw generalizable conclusions from such studies.
FOCUS: The current study focuses on the construction of classifiers, and the use of cross-validation to estimate their performance. In particular, we investigate the impact of batch effects and differences in sample composition between batches on the accuracy of the classification performance estimate obtained via cross-validation. The focus on estimation bias is a main difference compared to previous studies, which have mostly focused on the predictive performance and how it relates to the presence of batch effects.
DATA: We work on simulated data sets. To have realistic intensity distributions, we use real gene expression data as the basis for our simulation. Random samples from this expression matrix are selected and assigned to group 1 (e.g., 'control') or group 2 (e.g., 'treated'). We introduce batch effects and select some features to be differentially expressed between the two groups. We consider several scenarios for our study, most importantly different levels of confounding between groups and batch effects.
METHODS: We focus on well-known classifiers: logistic regression, Support Vector Machines (SVM), k-nearest neighbors (kNN) and Random Forests (RF). Feature selection is performed with the Wilcoxon test or the lasso. Parameter tuning and feature selection, as well as the estimation of the prediction performance of each classifier, is performed within a nested cross-validation scheme. The estimated classification performance is then compared to what is obtained when applying the classifier to independent data
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More frequent, more costly? Health economic modelling aspects of monitoring glaucoma patients in England
BACKGROUND: Chronic open angle glaucoma (COAG) is an age-related eye disease causing irreversible loss of visual field (VF). Health service delivery for COAG is challenging given the large number of diagnosed patients requiring lifelong periodic monitoring by hospital eye services. Yet frequent examination better determines disease worsening and speed of VF loss under treatment. We examine the cost-effectiveness of increasing frequency of VF examinations during follow-up using a health economic model.
METHODS: Two different VF monitoring schemes defined as current practice (annual VF testing) and proposed practice (three VF tests per year in the first 2 years after diagnosis) were examined. A purpose written health economic Markov model is used to test the hypothesis that cost effectiveness improves by implementing proposed practice on groups of patients stratified by age and severity of COAG. Further, a new component of the model, estimating costs of visual impairment, was added. Results were derived from a simulated cohort of 10000 patients with quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) used as main outcome measures.
RESULTS: An ICER of £21,392 per QALY was derived for proposed practice improving to a value of £11,382 once savings for prevented visual impairment was added to the model. Proposed practice was more cost-effective in younger patients. Proposed practice for patients with advanced disease at diagnosis generated ICERs > £60,000 per QALY; these cases would likely be on the most intensive treatment pathway making clinical information on speed of VF loss redundant. Sensitivity analysis indicated results to be robust in relation to hypothetical willingness to pay threshold identified by national guidelines, although greatest uncertainty was allied to estimates of implementation and visual impairment costs.
CONCLUSION: Increasing VF monitoring at the earliest stages of follow-up for COAG appears to be cost-effective depending on reasonable assumptions about implementation costs. Our health economic model highlights benefits of stratifying patients to more or less monitoring based on age and stage of disease at diagnosis; a prospective study is needed to prove these findings. Further, this works highlights gaps in knowledge about long term costs of visual impairment
Azimuthal anisotropy and correlations at large transverse momenta in and Au+Au collisions at = 200 GeV
Results on high transverse momentum charged particle emission with respect to
the reaction plane are presented for Au+Au collisions at =
200 GeV. Two- and four-particle correlations results are presented as well as a
comparison of azimuthal correlations in Au+Au collisions to those in at
the same energy. Elliptic anisotropy, , is found to reach its maximum at
GeV/c, then decrease slowly and remain significant up to
-- 10 GeV/c. Stronger suppression is found in the back-to-back
high- particle correlations for particles emitted out-of-plane compared to
those emitted in-plane. The centrality dependence of at intermediate
is compared to simple models based on jet quenching.Comment: 4 figures. Published version as PRL 93, 252301 (2004
Azimuthal anisotropy in Au+Au collisions at sqrtsNN = 200 GeV
The results from the STAR Collaboration on directed flow (v_1), elliptic flow
(v_2), and the fourth harmonic (v_4) in the anisotropic azimuthal distribution
of particles from Au+Au collisions at sqrtsNN = 200 GeV are summarized and
compared with results from other experiments and theoretical models. Results
for identified particles are presented and fit with a Blast Wave model.
Different anisotropic flow analysis methods are compared and nonflow effects
are extracted from the data. For v_2, scaling with the number of constituent
quarks and parton coalescence is discussed. For v_4, scaling with v_2^2 and
quark coalescence is discussed.Comment: 26 pages. As accepted by Phys. Rev. C. Text rearranged, figures
modified, but data the same. However, in Fig. 35 the hydro calculations are
corrected in this version. The data tables are available at
http://www.star.bnl.gov/central/publications/ by searching for "flow" and
then this pape
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