Congestion Avoidance Testbed Experiments

DARTnet provides an excellent environment for executing networking experiments. Since the network is private and spans the continental United States, it gives researchers a great opportunity to test network behavior under controlled conditions. However, this opportunity is not available very often, and therefore a support environment for such testing is lacking. To help remedy this situation, part of SRI's effort in this project was devoted to advancing the state of the art in the techniques used for benchmarking network performance. The second objective of SRI's effort in this project was to advance networking technology in the area of traffic control, and to test our ideas on DARTnet, using the tools we developed to improve benchmarking networks. Networks are becoming more common and are being used by more and more people. The applications, such as multimedia conferencing and distributed simulations, are also placing greater demand on the resources the networks provide. Hence, new mechanisms for traffic control must be created to enable their networks to serve the needs of their users. SRI's objective, therefore, was to investigate a new queueing and scheduling approach that will help to meet the needs of a large, diverse user population in a "fair" way

The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit.

Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat. Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven approach is to have hospitals in a region coordinate surveillance and infection control measures. Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model and detailed Orange County, California, patient-level data on adult inpatient hospital and nursing home admissions (2011-2012), we simulated the spread of CRE throughout Orange County health-care facilities under 3 scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures), and a coordinated regional effort. Aggressive uncoordinated and coordinated approaches were highly similar, averting 2,976 and 2,789 CRE transmission events, respectively (72.2% and 77.0% of transmission events), by year 5. With moderate control measures, coordinated regional control resulted in 21.3% more averted cases (n = 408) than did uncoordinated control at year 5. Our model suggests that without increased infection control approaches, CRE would become endemic in nearly all Orange County health-care facilities within 10 years. While implementing the interventions in the Centers for Disease Control and Prevention's CRE toolkit would not completely stop the spread of CRE, it would cut its spread substantially, by half

Rubidium and lead abundances in giant stars of the globular clusters M4 and M5

We present measurements of the neutron-capture elements Rb and Pb for bright giants in the globular clusters M4 and M5. The clusters are of similar metallicity ([Fe/H] = -1.2) but M4 is decidedly s-process enriched relative to M5: [Ba/Fe] = +0.6 for M4 but 0.0 for M5. The Rb and Pb abundances were derived by comparing synthetic spectra with high-resolution, high signal-to-noise ratio spectra obtained with MIKE on the Magellan telescope. Abundances of Y, Zr, La, and Eu were also obtained. In M4, the mean abundances from 12 giants are [Rb/Fe] = 0.39 +/- 0.02 (sigma = 0.07), [Rb/Zr] = 0.17 +/- 0.03 (sigma = 0.08), and [Pb/Fe] = 0.30 +/- 0.02 (sigma = 0.07). In M5, the mean abundances from two giants are [Rb/Fe] = 0.00 +/- 0.05 (sigma = 0.06), [Rb/Zr] = 0.08 +/- 0.08 (sigma = 0.11), and [Pb/Fe] = -0.35 +/- 0.02 (sigma = 0.04). Within the measurement uncertainties, the abundance ratios [Rb/Fe], [Pb/Fe] and [Rb/X] for X = Y, Zr, La are constant from star-to-star in each cluster and none of these ratios are correlated with O or Na abundances. While M4 has a higher Rb abundance than M5, the ratios [Rb/X] are similar in both clusters indicating that the nature of the s-products are very similar for each cluster but the gas from which M4's stars formed had a higher concentration of these products.Comment: Accepted for publication in Ap

Regular Topologies for Gigabit Wide-Area Networks

In general terms, this project aimed at the analysis and design of techniques for very high-speed networking. The formal objectives of the project were to: (1) Identify switch and network technologies for wide-area networks that interconnect a large number of users and can provide individual data paths at gigabit/s rates; (2) Quantitatively evaluate and compare existing and proposed architectures and protocols, identify their strength and growth potentials, and ascertain the compatibility of competing technologies; and (3) Propose new approaches to existing architectures and protocols, and identify opportunities for research to overcome deficiencies and enhance performance. The project was organized into two parts: 1. The design, analysis, and specification of techniques and protocols for very-high-speed network environments. In this part, SRI has focused on several key high-speed networking areas, including Forward Error Control (FEC) for high-speed networks in which data distortion is the result of packet loss, and the distribution of broadband, real-time traffic in multiple user sessions. 2. Congestion Avoidance Testbed Experiment (CATE). This part of the project was done within the framework of the DARTnet experimental T1 national network. The aim of the work was to advance the state of the art in benchmarking DARTnet's performance and traffic control by developing support tools for network experimentation, by designing benchmarks that allow various algorithms to be meaningfully compared, and by investigating new queueing techniques that better satisfy the needs of best-effort and reserved-resource traffic. This document is the final technical report describing the results obtained by SRI under this project. The report consists of three volumes: Volume 1 contains a technical description of the network techniques developed by SRI in the areas of FEC and multicast of real-time traffic. Volume 2 describes the work performed under CATE. Volume 3 contains the source code of all software developed under CATE

Phase 1b/2a trial of the superoxide dismutase mimetic GC4419 to reduce chemoradiotherapy-induced oral mucositis in patients with oral cavity or oropharyngeal carcinoma

PURPOSE: To assess the safety of the superoxide dismutase mimetic GC4419 in combination with radiation and concurrent cisplatin for patients with oral cavity or oropharyngeal cancer (OCC) and to assess the potential of GC4419 to reduce severe oral mucositis (OM). PATIENTS AND METHODS: Patients with locally advanced OCC treated with definitive or postoperative intensity modulated radiation therapy (IMRT) plus cisplatin received GC4419 by 60-minute intravenous infusion, ending \u3c60 minutes before IMRT, Monday through Friday for 3 to 7 weeks, in a dose and duration escalation study. Oral mucositis was assessed twice weekly during and weekly after IMRT. RESULTS: A total of 46 patients received GC4419 in 11 separate dosing and duration cohorts: dose escalation occurred in 5 cohorts receiving 15 to 112 mg/d over 3 weeks (n=20), duration escalation in 3 cohorts receiving 112 mg/d over 4 to 6 weeks (n=12), and then 3 additional cohorts receiving 30 or 90 mg/d over 6 to 7 weeks (n=14). A maximum tolerated dose was not reached. One dose-limiting toxicity (grade 3 gastroenteritis and vomiting with hyponatremia) occurred in each of 2 separate cohorts at 112 mg. Nausea/vomiting and facial paresthesia during infusion seemed to be GC4419 dose-related. Severe OM occurred through 60 Gy in 4 of 14 patients (29%) dosed for 6 to 7 weeks, with median duration of only 2.5 days. CONCLUSIONS: The safety of GC4419 concurrently with chemoradiation for OCC was acceptable. Toxicities included nausea/vomiting and paresthesia. Doses of 30 and 90 mg/d administered for 7 weeks were selected for further study. In an exploratory analysis, severe OM seemed less frequent and briefer than expected

Long-Term Care Facilities: Important Participants of the Acute Care Facility Social Network?

Background: Acute care facilities are connected via patient sharing, forming a network. However, patient sharing extends beyond this immediate network to include sharing with long-term care facilities. The extent of long-term care facility patient sharing on the acute care facility network is unknown. The objective of this study was to characterize and determine the extent and pattern of patient transfers to, from, and between long-term care facilities on the network of acute care facilities in a large metropolitan county. Methods/Principal Findings: We applied social network constructs principles, measures, and frameworks to all 2007 annual adult and pediatric patient transfers among the healthcare facilities in Orange County, California, using data from surveys and several datasets. We evaluated general network and centrality measures as well as individual ego measures and further constructed sociograms. Our results show that over the course of a year, 66 of 72 long-term care facilities directly sent and 67 directly received patients from other long-term care facilities. Long-term care facilities added 1,524 ties between the acute care facilities when ties represented at least one patient transfer. Geodesic distance did not closely correlate with the geographic distance among facilities. Conclusions/Significance: This study demonstrates the extent to which long-term care facilities are connected to the acute care facility patient sharing network. Many long-term care facilities were connected by patient transfers and further added many connections to the acute care facility network. This suggests that policy-makers and health officials should account for patient sharing with and among long-term care facilities as well as those among acute care facilities when evaluating policies and interventions. © 2011 Lee et al

Antitumor activity and safety of the PARP inhibitor rucaparib in patients with high grade ovarian carcinoma and a germline or somatic BRCA1 or BRCA2 mutation: integrated analysis of data from Study 10 and ARIEL2

Objective: An integrated analysis was undertaken to characterize the antitumor activity and safety profile of the oral poly(ADP-ribose) polymerase inhibitor rucaparib in patients with relapsed high-grade ovarian carcinoma (HGOC). Methods: Eligible patients from Study 10 (NCT01482715) and ARIEL2 (NCT01891344) who received a starting dose of oral rucaparib 600 mg twice daily (BID) with or without food were included in these analyses. The integrated efficacy population included patients with HGOC and a deleterious germline or somatic BRCA1 or BRCA2 (BRCA1/2) mutation who received at least two prior chemotherapies and were sensitive, resistant, or refractory to platinum-based chemotherapy. The primary endpoint was investigator-assessed confirmed objective response rate (ORR). Secondary endpoints included duration of response (DOR) and progression-free survival (PFS). The integrated safety population included patients with HGOC who received at least one dose of rucaparib 600 mg BID, irrespective of BRCA1/2 mutation status and prior treatments. Results: In the efficacy population (n = 106), ORR was 53.8% (95% confidence interval [CI], 43.8–63.5); 8.5% and 45.3% of patients achieved complete and partial responses, respectively. Median DOR was 9.2 months (95% CI, 6.6–11.6). In the safety population (n = 377), the most frequent treatment-emergent adverse events (AEs) were nausea, asthenia/fatigue, vomiting, and anemia/hemoglobin decreased. The most common grade ≥ 3 treatment-emergent AE was anemia/hemoglobin decreased. Treatment-emergent AEs led to treatment interruption, dose reduction, and treatment discontinuation in 58.6%, 45.9%, and 9.8% of patients, respectively. No treatment-related deaths occurred. Conclusions: Rucaparib has antitumor activity in advanced BRCA1/2-mutated HGOC and a manageable safety profile

Extracellular Vesicles from Pseudomonas aeruginosa Suppress MHC-Related Molecules in Human Lung Macrophages

Pseudomonas aeruginosa, a Gram-negative bacterium, is one of the most common pathogens colonizing the lungs of cystic fibrosis patients. P. aeruginosa secrete extracellular vesicles (EVs) that contain LPS and other virulence factors that modulate the host\u27s innate immune response, leading to an increased local proinflammatory response and reduced pathogen clearance, resulting in chronic infection and ultimately poor patient outcomes. Lung macrophages are the first line of defense in the airway innate immune response to pathogens. Proper host response to bacterial infection requires communication between APC and T cells, ultimately leading to pathogen clearance. In this study, we investigate whether EVs secreted from P. aeruginosa alter MHC Ag expression in lung macrophages, thereby potentially contributing to decreased pathogen clearance. Primary lung macrophages from human subjects were collected via bronchoalveolar lavage and exposed to EVs isolated from P. aeruginosa in vitro. Gene expression was measured with the NanoString nCounter gene expression assay. DNA methylation was measured with the EPIC array platform to assess changes in methylation. P. aeruginosa EVs suppress the expression of 11 different MHC-associated molecules in lung macrophages. Additionally, we show reduced DNA methylation in a regulatory region of gene complement factor B (CFB) as the possible driving mechanism of widespread MHC gene suppression. Our results demonstrate MHC molecule downregulation by P. aeruginosa-derived EVs in lung macrophages, which is consistent with an immune evasion strategy employed by a prokaryote in a host-pathogen interaction, potentially leading to decreased pulmonary bacterial clearance

Field-deployable, quantitative, rapid identification of active Ebola virus infection in unprocessed blood

The West African Ebola virus outbreak underlined the importance of delivering mass diagnostic capability outside the clinical or primary care setting in effectively containing public health emergencies caused by infectious disease. Yet, to date, there is no solution for reliably deploying at the point of need the gold standard diagnostic method, real time quantitative reverse transcription polymerase chain reaction (RT- qPCR), in a laboratory infrastructure-free manner. In this proof of principle work, we demonstrate direct performance of RT-qPCR on fresh blood using far-red fluorophores to resolve fluorogenic signal inhibition and controlled, rapid freeze/thawing to achieve viral genome extraction in a single reaction chamber assay. The resulting process is entirely free of manual or automated sample pre-processing, requires no microfluidics or magnetic/mechanical sample handling and thus utilizes low cost consumables. This enables a fast, laboratory infrastructure-free, minimal risk and simple standard operating procedure suited to frontline, field use. Developing this novel approach on recombinant bacteriophage and recombinant human immunodeficiency virus (HIV; Lentivirus), we demonstrate clinical utility in symptomatic EBOV patient screening using live, infectious Filoviruses and surrogate patient samples. Moreover, we evidence assay co-linearity independent of viral particle structure that may enable viral load quantification through pre-calibration, with no loss of specificity across an 8 log- linear maximum dynamic range. The resulting quantitative rapid identification (QuRapID) molecular diagnostic platform, openly accessible for assay development, meets the requirements of resource- limited countries and provides a fast response solution for mass public health screening against emerging biosecurity threats