Improving Vaginal Examinations Performed by Midwives

A vaginal examination (VE) is an essential part of midwifery care, and is routinely performed when assessing the progress of labour. As evidence shows that during labour women may find VEs unpleasant, embarrassing and sometimes painful, the aim of this article is to review literature on the use of VEs during labour and to synthesise information from the available literature on how to provide an effective VE. The studies considered were retrieved from three databases (the Cumulative Index to Nursing and Allied Health Literature [CINAHL], SCOPUS and MEDLINE) using the following search terms: “VEs in labour”, “midwives and use of VEs” and “women experiences of VEs in labour”. The literature reviewed suggests that midwives are not careful about VEs. Therefore, a concerted effort is needed to pay attention to the frequency of VEs, the management of pain and distress, information-giving and the preferences of the patient, so that the patient can feel in control during a VE

Inferential Methods to Assess the Difference in the Area Under the Curve From Nested Binary Regression Models

The area under the curve (AUC) is the most common statistical approach to evaluate the discriminatory power of a set of factors in a binary regression model. A nested model framework is used to ascertain whether the AUC increases when new factors enter the model. Two statistical tests are proposed for the difference in the AUC parameters from these nested models. The asymptotic null distributions for the two test statistics are derived from the scenarios: (A) the difference in the AUC parameters is zero and the new factors are not associated with the binary outcome, (B) the difference in the AUC parameters is less than a strictly positive value. A confidence interval for the difference in AUC parameters is developed. Simulations are generated to determine the finite sample operating characteristics of the tests and a pancreatic cancer data example is used to illustrate this approach

Trends in Building Energy Usage in Texas State Agencies

In late 1983, a cost containment program was initiated out of the governor's office directed at the major state agencies. The Energy Management Group at Texas A&M University provided technical expertise in obtaining agency energy usage and cost figures for the fiscal years 1981 to 1983. While there is considerable diversity from agency to agency, the trend is toward dramatically higher energy cost per square foot for virtually all agencies. This alarming trend can be partially explained by rising unit costs for gas and electricity and a lack of incentives for conservation efforts due to the method of utility budget allocations. A building standard signed into law in 1976 could have reduced energy consumption, but was never enforced. Beginning in fiscal year 1986, universities will be allowed to comingle utility money with capital operating money so that conservation can really pay off for them

RAID-2: Design and implementation of a large scale disk array controller

We describe the implementation of a large scale disk array controller and subsystem incorporating over 100 high performance 3.5 inch disk drives. It is designed to provide 40 MB/s sustained performance and 40 GB capacity in three 19 inch racks. The array controller forms an integral part of a file server that attaches to a Gb/s local area network. The controller implements a high bandwidth interconnect between an interleaved memory, an XOR calculation engine, the network interface (HIPPI), and the disk interfaces (SCSI). The system is now functionally operational, and we are tuning its performance. We review the design decisions, history, and lessons learned from this three year university implementation effort to construct a truly large scale system assembly

Pattern discovery and cancer gene identification in integrated cancer genomic data

Large-scale integrated cancer genome characterization efforts including the cancer genome atlas and the cancer cell line encyclopedia have created unprecedented opportunities to study cancer biology in the context of knowing the entire catalog of genetic alterations. A clinically important challenge is to discover cancer subtypes and their molecular drivers in a comprehensive genetic context. Curtis et al. [Nature (2012) 486(7403):346-352] has recently shown that integrative clustering of copy number and gene expression in 2,000 breast tumors reveals novel subgroups beyond the classic expression subtypes that show distinct clinical outcomes. To extend the scope of integrative analysis for the inclusion of somatic mutation data by massively parallel sequencing, we propose a framework for joint modeling of discrete and continuous variables that arise from integrated genomic, epigenomic, and transcriptomic profiling. The core idea is motivated by the hypothesis that diverse molecular phenotypes can be predicted by a set of orthogonal latent variables that represent distinct molecular drivers, and thus can reveal tumor subgroups of biological and clinical importance. Using the cancer cell line encyclopedia dataset, we demonstrate our method can accurately group cell lines by their cell-of-origin for several cancer types, and precisely pinpoint their known and potential cancer driver genes. Our integrative analysis also demonstrates the power for revealing subgroups that are not lineage-dependent, but consist of different cancer types driven by a common genetic alteration. Application of the cancer genome atlas colorectal cancer data reveals distinct integrated tumor subtypes, suggesting different genetic pathways in colon cancer progression

An integrated genomic analysis of lung cancer reveals loss of DUSP4 in EGFR-mutant tumors.

To address the biological heterogeneity of lung cancer, we studied 199 lung adenocarcinomas by integrating genome-wide data on copy number alterations and gene expression with full annotation for major known somatic mutations in this cancer. This showed non-random patterns of copy number alterations significantly linked to EGFR and KRAS mutation status and to distinct clinical outcomes, and led to the discovery of a striking association of EGFR mutations with underexpression of DUSP4, a gene within a broad region of frequent single-copy loss on 8p. DUSP4 is involved in negative feedback control of EGFR signaling, and we provide functional validation for its role as a growth suppressor in EGFR-mutant lung adenocarcinoma. DUSP4 loss also associates with p16/CDKN2A deletion and defines a distinct clinical subset of lung cancer patients. Another novel observation is that of a reciprocal relationship between EGFR and LKB1 mutations. These results highlight the power of integrated genomics to identify candidate driver genes within recurrent broad regions of copy number alteration and to delineate distinct oncogenetic pathways in genetically complex common epithelial cancers

Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients

ObjectiveThe optimal procedure for resection of malignant pleural mesothelioma is controversial, partly because previous analyses include small numbers of patients. We performed a multi-institutional study to increase statistical power to detect significant differences in outcome between extrapleural pneumonectomy and pleurectomy/decortication.MethodsPatients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy or pleurectomy/decortication at 3 institutions were identified. Survival and prognostic factors were analyzed by the Kaplan–Meier method, log-rank test, and Cox proportional hazards analysis.ResultsFrom 1990 to 2006, 663 consecutive patients (538 men and 125 women) underwent resection. The median age was 63 years (range, 26–93 years). The operative mortality was 7% for extrapleural pneumonectomy (n = 27/385) and 4% for pleurectomy/decortication (n = 13/278). Significant survival differences were seen for American Joint Committee on Cancer stages 1 to 4 (P < .001), epithelioid versus non-epithelioid histology (P < .001), extrapleural pneumonectomy versus pleurectomy/decortication (P < .001), multimodality therapy versus surgery alone (P < .001), and gender (P < .001). Multivariate analysis demonstrated a hazard rate of 1.4 for extrapleural pneumonectomy (P < .001) controlling for stage, histology, gender, and multimodality therapy.ConclusionPatients who underwent pleurectomy/decortication had a better survival than those who underwent extrapleural pneumonectomy; however, the reasons are multifactorial and subject to selection bias. At present, the choice of resection should be tailored to the extent of disease, patient comorbidities, and type of multimodality therapy planned

Trends in Building Energy Usage in Texas State Agencies

In late 1983, a cost containment program was initiated out of the governor's office directed at the major state agencies. The Energy Management Group at Texas A&M University provided technical expertise in obtaining agency energy usage and cost figures for the fiscal years 1981 to 1983. While there is considerable diversity from agency to agency, the trend is toward dramatically higher energy cost per square foot for virtually all agencies. This alarming trend can be partially explained by rising unit costs for gas and electricity and a lack of incentives for conservation efforts due to the method of utility budget allocations. A building standard signed into law in 1976 could have reduced energy consumption, but was never enforced. Beginning in fiscal year 1986, universities will be allowed to comingle utility money with capital operating money so that conservation can really pay off for them