Effects of a transitional palliative care model on patients with end-stage heart failure: study protocol for a randomized controlled trial

BACKGROUND: Heart failure (HF) is characterized by high rates of readmission after hospitalization, and readmission is a major contributor to healthcare costs. The transitional care model has proven efficacy in reducing the readmission rate and economic outcomes, and increasing satisfaction with care. However, the effectiveness of the transitional care model has not been evaluated in patients with end-stage HF. This study was designed to compare the customary hospital-based care and a comprehensive transitional care model, namely the Home-based Palliative HF Program (HPHP), in terms of readmission rate, quality of life, and satisfaction with care among end-stage HF patients under palliative care. METHODS/DESIGN: This is a randomized controlled trial taking place in hospitals in Hong Kong. We have been recruiting patients with end-stage HF who are identified as appropriate for palliative care during hospitalization, on referral by their physicians. A set of questionnaires is collected from each participant upon discharge. Participants are randomized to receive usual care (customary hospital-based care) or the intervention (HPHP). The HPHP will be implemented for up to 12 months. Outcome measures will be performed at 1, 3, 6, and 12 months post-discharge. The primary outcome of this study is quality of life measured by the Chronic Heart Failure Questionnaire - Chinese version; secondary outcomes include readmission rate, symptom intensity, functional status, and satisfaction with care. DISCUSSION: This study is original and will provide important information for service development in the area of palliative care. The introduction of palliative care to end-stage organ failure patients is new and has received increasing attention worldwide in the last decade. This study adopts the randomized controlled trial, a vigorous research design, to establish scientific evidence in exploring the best model for end-stage HF patients receiving palliative care. TRIAL REGISTRATION: This trial was registered as NCT02086305 on 7 March 2014 in the United States Clinical Trials Registration, and in the Clinical Trials Registry, Hong Kong University with the trial number UW12202. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1303-7) contains supplementary material, which is available to authorized users

Application of tri-colour, dual fusion fluorescence in situ hybridization (FISH) system for the characterization of BCR-ABL1 fusion in chronic myelogenous leukaemia (CML) and residual disease monitoring

<p>Abstract</p> <p>Background</p> <p>We studied the application of the <it>BCR-ABL1 </it>+ 9q34 tri-colour dual fusion fluorescence <it>in situ </it>hybridization (FISH) system in the characterization of fusion signal pattern and the monitoring of residual disease in chronic myelogenous leukaemia (CML). The signal constellation on metaphases with the tri-colour dual fusion system was defined. The knowledge of various signal patterns obtained from the different genetic rearrangements was further applied to the analysis of hybridization signals on interphase nuclei.</p> <p>Methods</p> <p><it>BCR-ABL1 </it>dual colour, dual fusion FISH (D-FISH) was performed on diagnostic samples of 22 CML patients. The tri-colour FISH system was performed on cases that showed aberrant signal patterns other than the classical 1 green (G) 1 orange (O) 2 fusions (F). Using the aqua band-pass filter, random signal overlap in interphase nuclei would be indicated by the presence of an aqua signal (<it>ASS1</it>), while genuine fusion was represented by the absence of the <it>ASS1 </it>signal.</p> <p>Results</p> <p>Using the D-FISH system, the signal patterns could be categorized into 4 groups: group 1 (n = 17) showed the classical 1G1O2F; group 2 (n = 2) showed 2G1O1F indicating <it>ABL1 </it>deletion; group 3 (n = 1) showed 1G2O1F indicating <it>BCR </it>deletion; group 4 (n = 2) with 1G1O1F indicating reciprocal <it>ABL1-BCR </it>deletion. The tri-colour dual fusion system correlated with the D-FISH system for cases with der(9) deletion. The added aqua-labelled <it>ASS1 </it>probe was useful in differentiating random signal overlap from genuine <it>BCR-ABL1 </it>fusion in the interphase cells (group 4).</p> <p>Conclusion</p> <p>Although the D-FISH probe was valuable in establishing the different patterns of aberrant signals and monitoring patients with the classic 2-fusion signals in CML, the tri-colour dual fusion probe should be used for patients with der(9) deletion to monitor response to treatment.</p

High-order dynamic Bayesian network learning with hidden common causes for causal gene regulatory network

Background: Inferring gene regulatory network (GRN) has been an important topic in Bioinformatics. Many computational methods infer the GRN from high-throughput expression data. Due to the presence of time delays in the regulatory relationships, High-Order Dynamic Bayesian Network (HO-DBN) is a good model of GRN. However, previous GRN inference methods assume causal sufficiency, i.e. no unobserved common cause. This assumption is convenient but unrealistic, because it is possible that relevant factors have not even been conceived of and therefore un-measured. Therefore an inference method that also handles hidden common cause(s) is highly desirable. Also, previous methods for discovering hidden common causes either do not handle multi-step time delays or restrict that the parents of hidden common causes are not observed genes. Results: We have developed a discrete HO-DBN learning algorithm that can infer also hidden common cause(s) from discrete time series expression data, with some assumptions on the conditional distribution, but is less restrictive than previous methods. We assume that each hidden variable has only observed variables as children and parents, with at least two children and possibly no parents. We also make the simplifying assumption that children of hidden variable(s) are not linked to each other. Moreover, our proposed algorithm can also utilize multiple short time series (not necessarily of the same length), as long time series are difficult to obtain. Conclusions: We have performed extensive experiments using synthetic data on GRNs of size up to 100, with up to 10 hidden nodes. Experiment results show that our proposed algorithm can recover the causal GRNs adequately given the incomplete data. Using the limited real expression data and small subnetworks of the YEASTRACT network, we have also demonstrated the potential of our algorithm on real data, though more time series expression data is needed

Observation of a Smoothly Tunable Dirac Point in Ge(BixSb1−x)2Te4Ge(Bi_{x}Sb_{1-x})_{2}Te_{4}

State-of-the-art topological devices require the use topological surface states to drive electronic transport. In this study, we examine a tunable topological system, $Ge(Bi_{x}Sb_{1-x})_{2}Te_{4}$, for a range of 'x' values from 0 to 1, using a combination of Fourier Transform Scanning Tunneling Spectroscopy (FT-STS) and Angle-Resolved Photoemission Spectroscopy (ARPES). Our results show that the Dirac point shifts linearly with 'x', crossing the Fermi energy near x = 0.7. This novel observation of a smoothly tunable, isolated Dirac point crossing through the topological transport regime and having strong linear dependence with substitution can be critical for future topological spintronics applications.Comment: 18 Pages, 9 Figures, including Appendi

Semi-Unsupervised Lifelong Learning for Sentiment Classification: Less Manual Data Annotation and More Self-Studying

Lifelong machine learning is a novel machine learning paradigm which can continually accumulate knowledge during learning. The knowledge extracting and reusing abilities enable the lifelong machine learning to solve the related problems. The traditional approaches like Na\"ive Bayes and some neural network based approaches only aim to achieve the best performance upon a single task. Unlike them, the lifelong machine learning in this paper focuses on how to accumulate knowledge during learning and leverage them for further tasks. Meanwhile, the demand for labelled data for training also is significantly decreased with the knowledge reusing. This paper suggests that the aim of the lifelong learning is to use less labelled data and computational cost to achieve the performance as well as or even better than the supervised learning

Gametogenesis, Embryogenesis, and Fertilization Ecology of Platygyra acuta

Understanding the reproductive biology of dominant coral species in subtropical nonreefal coral communities is critical in providing important information on the processes underlying the distribution limits of coral species and communities. This is the first study that investigates the reproduction cycle, gametogenesis, and fertilization ecology of Platygyra acuta. Results indicated that P. acuta is hermaphroditic and exhibits a single annual gametogenic cycle. Oogenic and spermatogenic cycle occurs for 6-7 months and for 2 months, respectively, prior to annual mass spawning event in May to June in Hong Kong. It took 18 hours for P. acuta to complete embryonic development, develop cilia, and start to rotate. High (>70%) fertilization success can be achieved under a broad range of sperm concentrations from 104 to 107 sperms mL−1. Fertilization success remained consistently high 6 h after spawning, indicating a prolonged viability of its gametes that is much longer than that recorded for other coral species. Significantly higher percentage of fertilization success was recorded in the first of the two consecutive nights of spawning, suggesting differences in the quality of the eggs and/or sperms between days of spawning. These results serve as important baseline information for better understanding of corals in marginal communities

Is 'oil pulling' a 'snake oil'? : a clinical trial

The traditional Ayurveda practice of ‘oil pulling’ has become a recent phenomenon and concerns about its efficacy have been raised. Objectives: (1) to determine awareness about the practice of ‘oil pulling’ among a group of young adults, and to determine variations in awareness with respect to socio-demographic factors, oral health behaviours (oral hygiene and dental attendance) and use of natural health products; (2) to determine the effectiveness of ‘oil pulling’ and conventional oral hygiene practice compared to the use of conventional oral hygiene practice alone in terms of oral hygiene and (3) to determine the effectiveness of ‘oil pulling’ and conventional oral hygiene practice compared to the use of conventional oral hygiene practice alone in terms of gingival health. Methods: Group members recruited seventy-four young adults to participate in a clinical trial over a two-month period comparing the effectiveness of (a) ‘oil pulling’ and conventional oral hygiene methods (toothbrush and toothpaste) versus (b) conventional oral hygiene methods alone. Oral hygiene was assessed using the Plaque Index - PI (Silness and Löe, 1964) and the proportion of sites with visible plaque (PVP). Gingival health was assessed using the Gingival Index – GI (Silness and Löe,1963) and the proportion of sites with gingival bleeding (PGB). Participants were block randomized in groups of four to a cross over clinical trial and assessments were conducted at one-month and two-months. Results: Approximately a quarter (28.4%, 21) of participants was aware of the practice of ‘oil pulling’. Awareness of the practice was associated with reported use of natural dental/oral health products (p0.05). There were observed significant differences in gingival health among both the test and control groups from baseline to one-month (p0.05). No significant differences were observed in oral health parameters from one-month to two-month among neither the test nor control groups (p>0.05). Conclusion: Awareness of the practice of ‘oil pulling’ is relatively common and is associated with use of natural dental/oral health products. Findings from the clinical trial failed to support the adjunct use of ‘oil pulling’ in addition to conventional oral hygiene practices.published_or_final_versio

Leukotriene signaling via ALOX5 and cysteinyl leukotriene receptor 1 is dispensable for in vitro growth of CD34 (+)CD38(-) stem and progenitor cells in chronic myeloid leukemia

Tyrosine kinase inhibitors targeting the BCR-ABL oncoprotein in chronic myeloid leukemia (CML) are remarkably effective inducing deep molecular remission in most patients. However, they are less effective to eradicate the leukemic stem cells (LSC), resulting in disease persistence. Therefore, there is great need to develop novel therapeutic strategies to specifically target the LSC. In an experimental mouse CML model system, the leukotriene pathway, and specifically, the expression ALOX5, encoding 5-lipoxygenase (5-LO), has been reported as a critical regulator of the LSC. Based on these results, the 5-LO inhibitor zileuton has been introduced in clinical trials as a therapeutic option to target the LSC although its effect on primary human CML LSC has not been studied. We have here by using multiplex single cell PCR analyzed the expression of the mediators of the leukotriene pathway in bone marrow (BM) BCR-ABL(+)CD34(+)CD38(-) cells at diagnosis, and found low or undetectable expression of ALOX5. In line with this, zileuton did not exert significant overall growth inhibition in the long-term culture-initiating cell (LTC-IC) and colony (CFU-C) assays of BM CD34(+)CD38(-) cells from 7 CML patients. The majority of the single leukemic BCR-ABL(+)CD34(+)CD38(-) cells expressed cysteinyl leukotriene receptors CYSLTI and CYSLT2. However, montelukast, an inhibitor of CYSLTI, also failed to significantly suppress CFU-C and LTC-IC growth. These findings indicate that targeting ALOX5 or CYSLTI signaling with leukotriene antagonists, introduced into the clinical practice primarily as prophylaxis and treatment for asthma, may not be a promising pharmacological strategy to eradicate persisting LSC in CML patients. (C) 2017 The Author(s). Published by Elsevier Inc.Peer reviewe