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Publication
Journal: Annual International Conference of the IEEE Engineering in Medicine and Biology - Proceedings
April/27/2009
Abstract
Single Echo Acquisition (SEA) imaging is a fully parallel imaging method that can be used to image rapid flow at the frame rate as high as 200 frames per second. Previous work has shown that SEA imaging can visualize turbulent flows, and discussed a preliminary tool for quantitatively analyzing 2D rapid fluid flows using SEA imaging and the HARmonic Phase (HARP) method. In this paper, the quantification method was further developed to use physical model to constrain the HARP flow analysis. Specifically, the method uses Navier-Stokes and continuity equations to regularize the flow analysis. The method is applied to the tagged SEA MR image sequence of turbulent flows to test its effectiveness. The results from the new method was demonstrated and compared with the flow field obtained from the conventional HARP method.
Publication
Journal: Internal Medicine Journal
November/14/2018
Abstract
BACKGROUND
Prevention of hospitalisation is an important aspect of type 2 diabetes (T2D) management.
OBJECTIVE
We retrospectively determined the utility of the Hospital Admission Risk Programme (HARP) diabetes risk calculator (HARP tool) in identifying patients with T2D more likely to have unplanned hospital presentations.
METHODS
The HARP tool includes a clinical assessment score (Part A) and a psychosocial and self-management impact score (Part B), and categorises patients into low, medium, high or urgent risk of acute hospitalisation. It was completed for T2D patients attending Royal North Shore Hospital, Sydney, in 2013.
RESULTS
Within the cohort of 278 patients (age 65.3 ± 10.5 years; 62.9% male; diabetes duration 10.7 ± 6.6 years), 67.3% were classified as low risk, 32.7% as medium risk and none as high or urgent risk. Following adjustment for confounders, a medium HARP score was associated with a 3.1-fold increased risk of unplanned hospital presentations in the subsequent 12 months (95% confidence interval: 1.35-7.31; P = 0.008). Part A scores were significantly higher for patients that presented to hospital compared to those that did not (14.2 ± 6.8 vs 11.4 ± 5.5; P = 0.034), whereas there was no difference in Part B scores (P = 0.860).
CONCLUSIONS
In patients with low and medium HARP scores, clinical features were more predictive of hospital presentations than certain psychosocial or self-management factors in the present cohort. Further studies are required to characterise unplanned hospitalisation in patients with higher HARP scores, or whether additional psychosocial assessments could improve the tool's predictability.
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Publication
Journal: Comparative biochemistry and physiology
August/24/1970
Authors
Publication
Journal: Research in social & administrative pharmacy : RSAP
June/8/2019
Abstract
Nearly 80 million people in the United States have contracted the Human Papillomavirus (HPV), and it is currently the most common sexually transmitted disease. Each year approximately 14 million people are newly infected.This study will address increasing the HPV vaccination rates by initiating a research agenda focusing on how best to utilize community pharmacies as Vaccines For Children (VFC) vaccination sites. Community pharmacies are highly accessible when compared to traditional vaccination sites due to extended evening and weekend business hours, no copays for visits, and no appointment required to speak with a pharmacist.We will conduct a Developmental Formative Evaluation using semi-structured interviews with key informants (pharmacists, pharmacy managers, technicians) from 5 Harps pharmacies to identify barriers and facilitators to community pharmacies' provision of HPV vaccine through a mixed methods design with pharmacy staff members and local physicians. We will follow that by selecting a pharmacist-physician collaborative model and identify implementation strategies through an Evidence Based Quality Improvement (EBQI) process with key stakeholders. This will be followed by piloting the selected pharmacist-physician collaborative model and implementation strategies in two Harps pharmacies (1 rural, 1 urban) on relevant implementation outcomes.This study will examine the current model of HPV vaccinations and how to improve HPV vaccination rates among adolescents by utilizing community pharmacy services.
Publication
Journal: Revista de medicina de la Universidad de Navarra
July/24/1991
Abstract
The following is a review of the data of hepatitis-B serology study obtained during the last sixteen years in the Blood Bank of Navarra. The prevalence of HBsAg carriers is 0.87% (204 positive cases in 23,409 blood donors studied). The methods used during this period have been: AGD (7 positive donors, i.e. 3.4%), CIEP (4 positive donors, i.e. 1.9%), HARP (78 positive donors, i.e. 38.2%), EIA (93 positive donors, i.e. 45.5%) and RIA (22 positive donors, i.e. 10.7%). The number of previous donations before the detection of HBsAg dropped from 7/8 in the first group of donors to 4/5 in the second and to 1 in the third group. A deeper study has been carried out in 120 of those blood donors, including the detection of anti-HBs, anti-HBc, HBeAg and anti-HBe. A low-infectivity pattern has been found in 92 (76.6%), high infectivity in 4 (3.3%) and seroconversion in 16 (13.3%). It hasn't been possible to interpret the pattern of the remaining 8 (6.6%). Both the sensitivity and the specificity of our actual screening method have been found adequate in a cooperative study carried out in a group of Blood Banks in Spain in 1985.
Publication
Journal: Journal of Wildlife Diseases
August/9/1970
Publication
Journal: Journal of Wildlife Diseases
October/13/2003
Abstract
Beach surveys for harp (Phoca groenlaandica) and hooded (Cystophora cristata) seals documented a dramatic increase in their numbers on Sable Island in mid 1990s. In the 1980s, no more than five animals of both species were observed on this island each year, however, during late 1994 to 1998, 1,191 harp and 870 hooded seals, mostly young animals, were recorded. Although some of these seals had been killed by sharks, most (roughly 75%) were found alive or as intact carcasses on the beach, and some of the live seals were later found dead. Emaciation/starvation was considered the primary cause of death in seals that were not obviously killed by sharks. Factors that may have compounded this poor body condition included gastric impaction with abnormal ingesta, hemorrhagic diathesis possibly induced by parasitic migration and secondary vasculitis, and stomatitis (in hooded seals only). Some harp and hooded seals expanding their range in recent years may be unable to feed successfully, although the reasons for this are unclear.
Publication
Journal: BMJ Open
September/30/2020
Abstract
Objective: To determine data sharing and number of publications coming from research databases that have been given a favourable opinion by UK National Health Service (NHS) Research Ethics Committees (RECs).
Design: Cohort study.
Inclusion criteria & setting: All research databases listed on the UK Health Research Authority's Assessment Review Portal (HARP) that had received a favourable ethics opinion as of January 2018.
Main outcome measures: Publications and data access requests are either listed on HARP or notified through subsequent email correspondence.
Results: Out of 354 eligible databases, 34% had granted access requests and 40% had produced at least one peer-reviewed paper or conference abstract/talk. We could not establish contact with 9% of databases, and 19% reported no access requests or publications. Only 9% of databases were up to date with all annual reports. Email responses from database owners showed a range of attitudes towards data sharing.
Conclusion: Less than half of research databases that have received a favourable opinion from NHS research ethics committees share their data and produce publications. There is also considerable variability in the operation of research databases and understanding of the purpose of research databases. This work was hampered by incomplete records due mainly to researchers not submitting annual reports.
Keywords: audit; ethics (see medical ethics); information management; qualitative research; statistics & research methods.
Publication
Journal: Nippon Hoshasen Gijutsu Gakkai zasshi
July/24/2003
Abstract
The maximum likelihood expectation maximization (ML-EM) algorithm has become available as an alternative to filtered back projection in SPECT. The actual physical performance may be different depending on the manufacturer and model, because of differences in computational details. The purpose of this study was to investigate the characteristics of seven different types of ML-EM algorithms using simple simulation data. Seven ML-EM algorithm programs were used: Genie (GE), esoft (Siemens), HARP-III (Hitachi), GMS-5500UI (Toshiba), Pegasys (ADAC), ODYSSEY-FX (Marconi), and Windows-PC (original software). Projection data of a 2-pixel-wide line source in the center of the field of view were simulated without attenuation or scatter. Images were reconstructed with ML-EM by changing the number of iterations from 1 to 45 for each algorithm. Image quality was evaluated after a reconstruction using full width at half maximum (FWHM), full width at tenth maximum (FWTM), and the total counts of the reconstructed images. In the maximum number of iterations, the difference in the FWHM value was up to 1.5 pixels, and that of FWTM, no less than 2.0 pixels. The total counts of the reconstructed images in the initial few iterations were larger or smaller than the converged value depending on the initial values. Our results for the simplest simulation data suggest that each ML-EM algorithm itself provides a simulation image. We should keep in mind which algorithm is being used and its computational details, when physical and clinical usefulness are compared.
Publication
Journal: Science of the Total Environment
August/9/2006
Abstract
Specific activities of the anthropogenic radionuclide, 137Cs, were determined in marine mammals from Svalbard and the Barents and North Greenland Seas. Muscle samples were collected from 12 polar bears, 15 ringed seals, 10 hooded seals, 7 bearded seals, 14 harp seals, one walrus, one white whale and one blue whale in the period 2000-2003. The mean concentrations (+/-SD) of 137Cs were: 0.72+/-0.62 Bq/kg wet weight (w.w.) for polar bears; 0.49+/-0.07 Bq/kg w.w. for ringed seals; 0.25+/-0.10 Bq/kg w.w. for hooded seals; 0.22+/-0.11 Bq/kg w.w. for bearded seals; 0.36+/-0.13 Bq/kg w.w. for harp seals; 0.67 Bq/kg w.w. for the white whale sample; 0.24 Bq/kg w.w. for the blue whale; and below detection limit for the walrus. Significant differences in 137Cs specific activities between some of the species were found. Ringed seals had higher specific activities than the other seal species in the study. Bearded seals and hooded seals had similar values, which were both significantly lower than the harp seal values. The results in the present study are consistent with previous reported results, indicating low specific activities of 137Cs in Arctic marine mammals in the Barents Sea and Greenland Sea region during the last 20 years. The species specific differences found may be explained by varying diet or movement and distribution patterns between species. No age related patterns were found in specific activities for the two species (polar bears and hooded seals) for which sufficient data was available. Concentration factors (CF) of 137Cs from seawater were determined for polar bears, ringed, bearded, harp and hooded seals. Mean CF values ranged from 79+/-32 (SD) for bearded seals sampled in 2002 to 244+/-36 (SD) for ringed seals sampled in 2003 these CF values are higher than those reported for fish and benthic organisms in the literature, suggesting bioaccumulation of 137Cs in the marine ecosystem.
Publication
Journal: Studies in Health Technology and Informatics
May/10/2004
Abstract
Within the European HARP project, a Java-based Open Platform has been specified and implemented to support trustworthy distributed applications for health. Emphasis was put on security services for enabling both communication and application security. The Open Platform is Web-based and comprises the Client environment, Web/Application server, as well as Database and Archive servers. Servlets composed and executed according to the user's authorisation create signed XML messages. From those messages, user-role-related applets are generated. The technical details of the realisation are presented. Possible future enhancements for user-centric, adaptable services based on next-generation mobile service environments are outlined.
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Journal: Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses
June/16/2010
Authors
Publication
Journal: Materials
November/2/2018
Abstract
The long-term mechanical behaviour of a number of fluorocarbon and gut harp strings has been examined, and the results compared with a previous study of rectified nylon strings. The stretching behaviour of the three materials was studied via different measures of the Young's modulus; with test time scales on the order of weeks, minutes, and milliseconds. The strings were subjected to cyclic variations in temperature, enabling various aspects of their thermal behaviour to be investigated. The effects of humidity changes on gut strings were also examined. The behaviour of the fluorocarbon strings was found to be similar in many ways to that of the nylon strings, despite their different chemical formulation and significantly higher density. In particular, the faster measures of Young's modulus were found to show an almost identical strong variation with the applied stress; while the thermal behaviour of both materials was largely determined by the balance between opposing effects associated with thermal contraction and thermal variations in the Young's modulus. The gut strings showed some similarities of behaviour to the synthetic materials, but also major differences. All three measures of the Young's modulus remained constant as the applied stress was increased. The gut strings were far more sensitive to changes in humidity than the synthetic materials, although some of the results, especially the thermal tuning sensitivity of the strings when held at constant length, displayed remarkable stability under changing humidity. The observed behaviour suggests very strongly that there is significant coupling between humidity-related changes in the linear density of a gut string and complementary changes in its tension.
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Publication
Journal: American Journal of Forensic Medicine and Pathology
November/19/1995
Abstract
Bullets or bullet fragments that are recovered during forensic autopsy and examined later as evidence may present hazards to both pathologists and forensic scientists due to sharp edges or jagged projections created by the deformation or fragmentation of a bullet upon impact with its target. The recent introduction of the Black Talon bullet has increased this hazard by its design, which produces a controlled expansion upon target impact that raises six harp edges from its copper jacket. We describe the appearance of the bullet along with methods for detection and recovery that can be applied as universal precautions of safe bullet handling.
Publication
Journal: Zhurnal Obshchei Biologii
April/1/1992
Abstract
Histological structure of adrenal gland is studied in four age groups of the harp seal: in adults, in two juvenile groups (6 and 1-1.5 months), and in newborns (1-1.5 days). Development of the adrenal gland in this species is analogous to that of terrestrial mammals, but also has some peculiarities of its own. Differentiation of the definitive cortex occur in the prenatal development. In the newborns it is, though weakly developed, clearly differentiated into arched, fascicle and reticular zones. The foetal cortex is discovered in newborns, which further develops in juveniles and is present (without any signs of involution and degeneration) in adults. Adrenal gland persistence was previously known in horses only, but in that case the foetal cortex was partly degenerated in adults. Chromaffin cells undergo differentiation in embryonic development, as newborns already possess two types of such cells. The final differentiation ends in juvenile of 1.5 months old.
Publication
Journal: Physiological and Biochemical Zoology
April/6/2016
Abstract
Ontogenetic changes in physiological performance often exemplify the development of adaptations to environmental challenges. For mammals in polar regions, the extreme cold of the environment presents a constant challenge to thermal homeostasis. The harp seal (Pagophilus groenlandicus) is an Arctic species that shifts its thermoregulatory strategy with ontogeny. Adult harp seals primarily use blubber for insulation, but newborn harp seals instead rely on their fur coat while their blubber layer develops. Harp seal pups are weaned abruptly, less than 2 wk after birth, and must subsequently learn to swim and dive in frigid waters on their own. This study examined how the morphological characteristics of harp seal fur change with ontogeny. We compared hair length, hair circularity, and hair density for neonates (1 d old; n = 7), early-nursing pups (4 d old; n = 3), late-nursing pups (9 d old; n = 4), newly weaned (molting) pups (2 wk old; n = 5), late-weaned (molted) pups (3 wk old; n = 4), and adult harp seals (n = 4). Hairs were shorter (P < 0.001) and flatter (P < 0.001) in older animals. Additionally, hair density decreased with age (P < 0.001), in terms of both the average number of hair bundles per unit area and the average number of underhairs present in any given bundle. These morphological changes were associated with a reduced thermal resistance of the pelt in late-weaned (molted) pups and adults (P < 0.001). Results are consistent with known evolutionary patterns of fur morphology associated with the transition from fur to blubber in aquatic species, yet this is the first time such morphological differences have been demonstrated across age classes within a single species. Thus, the ontogenetic patterns described here for harp seals recapitulate the convergent phylogenetic patterns observed across secondarily aquatic species. Overall, the timing of these ontogenetic changes may limit the ability of harp seals to adapt to the deterioration of sea ice in the Arctic, as predicted with continued climate change.
Publication
Journal: International Journal of Surgery
May/22/2017
Abstract
OBJECTIVE
We performed this meta-analysis to compare hand-assisted retroperitoneoscopic (HARP) and traditional laparoscopic (TLS) techniques for living donor nephrectomy.
METHODS
We searched PubMed, Cochrane Central, EMBASE, and Web of science for prospective studies, comparing HARP and TLS techniques. Data were extracted from eligible studies and pooled as risk ratios (RR) or standardized mean difference (SMD), using RevMan software (version 5.3 for windows). We performed a sensitivity analysis to test the robustness of our evidence and a subgroup analysis to stratify intraoperative complications on Clavien-Dindo score.
RESULTS
Seven studies (498 patients) were included in the final analysis. HARP was superior to TLS in terms of shortening the operative duration (SMD = -0.84, 95% CI [-1.18 to -0.50]) and warm ischemia time (SMD = -0.93, 95% CI [-1.13 to -0.72]). There was no significant difference between HARP and TLS in terms of blood loss (SMD = 0.13, 95% CI [-0.50 to 0.76]), hospital stay (SMD = -0.27, 95% CI [-0.70 to 0.15]) or graft survival (RR = 0.97, 95% CI [0.92 to 1.02]). The overall risk ratio of intraoperative complications did not differ significantly between the two groups (RR = 0.62, 95% CI [0.31 to 1.21]).
CONCLUSIONS
Our meta-analysis shows that HARP was associated with a shorter surgery duration and less warm ischemia time than TLS. However, no significant differences were found between the two groups in terms of graft survival or intraoperative complication rates. We recommend HARP over TLS for living donor nephrectomy; however, future studies with larger sample sizes are recommended to compare both techniques in terms of operative safety and quality of life outcomes.
Publication
Journal: Clinical Transplantation
September/29/2011
Abstract
The retroperitoneoscopic (RP) approach to live donor nephrectomy (LDN) may be advantageous for the donor because it avoids mobilization of peritoneal organs and provides direct access to the renal vessels. Notwithstanding, this approach is not popular, likely because of the steeper learning curve. We feel that hand-assistance (HA) can reduce the learning curve and in this study, we present our experience with a novel hand-assist approach to retroperitoneoscopic live donor nephrectomy (HARP-LDN). Over a one-yr period, 10 consecutive patients underwent left HARP-LDN with a mean body mass index of 29 and three with prior left abdomen surgery. The surgical technique utilizes a 7 cm, muscle-sparing incision for the hand-port with two endoscopic ports. Operative time was an average of 155 min., with no open conversions. Mean blood loss was 68 mL, and warm ischemia time was 2.5 min. Hospital stay averaged 2.7 d with postoperative complications limited to one urinary retention. Our modified HARP approach to left LDN is safe, effective and can be performed expeditiously. Our promising initial results require a larger patient cohort to confirm the advantages of the hand-assisted retroperitoneal technique.
Publication
Journal: Zoo Biology
January/14/2014
Abstract
Cataracts and ocular disease are common lesions of marine mammals in zoological collections. Lutein, an oxygenated carotenoid, may have therapeutic or prophylactic effects on ocular disorder. Therefore, this study examined the ability of marine mammals to absorb dietary lutein. Two preliminary trials examined lutein in two forms (beadlet or ester) in a small sample size of marine mammals representing pinnipeds and cetaceans. Lutein was fed daily in tablets providing 0.89-3.6 mg lutein/kg body weight(0.75) per day for 15 days to 2 years. A third study was conducted using lutein beadlet fed at 3.6 mg lutein/kg body weight(0.75) per day for 15-21 days. Blood was analyzed for lutein pre- and postsupplementation. In the preliminary trials, lutein beadlet was observed to result in greater blood lutein levels than lutein esters, and cetaceans had more noticeable responses than pinnipeds. In Study 3, serum lutein and zeaxanthin increased postsupplementation in beluga whales (P < 0.05), and serum lutein tended to increase postsupplementation in dolphins (P < 0.10), but little change was seen in serum lutein in pinnipeds or manatee. Opportunistic retinal samples demonstrated some detectable lutein in the retina of a dolphin and several harp seals. The lutein levels in dolphins after supplementation are similar to those reported in free-ranging animals. Ocular lutein in harp seals demonstrates that ocular deposition occurs despite low circulating lutein levels.
Publication
Journal: Magnetic Resonance Imaging
July/8/2021
Abstract
We addressed comprehensively the performance of Shortest-Path HARP Refinement (SP-HR), SinMod, and DENSEanalysis using 2D slices of synthetic CSPAMM and DENSE images with realistic contrasts obtained from 3D phantoms. The three motion estimation techniques were interrogated under ideal and no-ideal conditions (with MR induced artifacts, noise, and through-plane motion), considering several resolutions and noise levels. Under noisy conditions, and for isotropic pixel sizes of 1.5 mm and 3.0 mm in CSPAMM and DENSE images respectively, the nRMSE obtained for the circumferential and radial strain components were 10.7 ± 10.8% and 25.5 ± 14.8% using SP-HR, 11.9 ± 2.5% and 29.3 ± 6.5% using SinMod, and 6.4 ± 2.0% and 18.2 ± 4.6% using DENSEanalysis. Overall, the results showed that SP-HR tends to fail for large tissue motions, whereas SinMod and DENSEanalysis gave accurate displacement and strain field estimations, being the last which performed the best.
Keywords: CSPAMM; Cardiac MRI; Cardiac strain; DENSE MRI; DENSEAnalysis; HARP; SP-HR; SinMod; Tagging MRI.
Publication
Journal: International Journal for Parasitology: Parasites and Wildlife
April/25/2021
Abstract
The West Kalimantan province in Borneo island, Indonesia belongs to endemic area of Japanese encephalitis (JE) that accounts for approximately 30% of total cases yearly. As the presence of pig holdings is uncommon in West Kalimantan, another reservoir host might have played a role in the local transmission of JE virus in this area. Current study aimed to identify the potential role of bats in the local transmission of JE by performing molecular detection of JE virus in bats and mosquitoes using RT-PCR. Sample collection was performed in 3 districts in West Kalimantan, covering 3 different ecosystems: forest, coastal, and residential areas. Bat collection was performed using mist net and harp net, while mosquito collection was carried out using animal-baited trap and human landing collection. A total of 373 blood samples from bats were tested for JE virus, among which 21 samples (5.6%) showed positive results, mainly from Cynopterus brachyotis (lesser short-nosed fruit bat) found in residential areas. Out of 53 mosquito pools, 3 JE-positive pools of Culex tritaeniorhynchus and Cx. vishnui were collected at the same location as JE-positive bats. Current study showed the first evidence of JE virus detection in several species of Megachiropteran bats in Indonesia, demonstrated the potential role of frugivorous bats in local transmission of JE in West Kalimantan. More aggressive measures are required in JE risk mitigation, particularly in initiating JE vaccination campaign and in avoiding disruption of bats' natural habitats through changes in land-use.
Keywords: Bats; Chiroptera; Indonesia; Japanese encephalitis; Transmission; Zoonosis.
Publication
Journal: Southampton (UK): NIHR Journals Library
June/30/2021
Abstract
Background: Sepsis and acute respiratory distress syndrome are two heterogeneous acute illnesses with high risk of death and for which there are many ‘statistically negative’ randomised controlled trials. We hypothesised that negative randomised controlled trials occur because of between-participant differences in response to treatment, illness manifestation (phenotype) and risk of outcomes (heterogeneity).
Objectives: To assess (1) heterogeneity of treatment effect, which tests whether or not treatment effect varies with a patient’s pre-randomisation risk of outcome; and (2) whether or not subphenotypes explain the treatment response differences in sepsis and acute respiratory distress syndrome demonstrated in randomised controlled trials.
Study population: We performed secondary analysis of two randomised controlled trials in patients with sepsis [i.e. the Vasopressin vs Noradrenaline as Initial Therapy in Septic Shock (VANISH) trial and the Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis (LeoPARDS) trial] and one acute respiratory distress syndrome multicentre randomised controlled trial [i.e. the Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in Acute lung injury to Reduce Pulmonary dysfunction (HARP-2) trial], conducted in the UK. The VANISH trial is a 2 × 2 factorial randomised controlled trial of vasopressin (Pressyn AR®; Ferring Pharmaceuticals, Saint-Prex, Switzerland) and hydrocortisone sodium phosphate (hereafter referred to as hydrocortisone) (EfcortesolTM; Amdipharm plc, St Helier, Jersey) compared with placebo. The LeoPARDS trial is a two-arm-parallel-group randomised controlled trial of levosimendan (Simdax®; Orion Pharma, Espoo, Finland) compared with placebo. The HARP-2 trial is a parallel-group randomised controlled trial of simvastatin compared with placebo.
Methods: To test for heterogeneity of the effect on 28-day mortality of vasopressin, hydrocortisone and levosimendan in patients with sepsis and of simvastatin in patients with acute respiratory distress syndrome. We used the total Acute Physiology And Chronic Health Evaluation II (APACHE II) score as the baseline risk measurement, comparing treatment effects in patients with baseline APACHE II scores above (high) and below (low) the median using regression models with an interaction between treatment and baseline risk. To identify subphenotypes, we performed latent class analysis using only baseline clinical and biomarker data, and compared clinical outcomes across subphenotypes and treatment groups.
Results: The odds of death in the highest APACHE II quartile compared with the lowest quartile ranged from 4.9 to 7.4, across the three trials. We did not observe heterogeneity of treatment effect for vasopressin, hydrocortisone and levosimendan. In the HARP-2 trial, simvastatin reduced mortality in the low-APACHE II group and increased mortality in the high-APACHE II group. In the VANISH trial, a two-subphenotype model provided the best fit for the data. Subphenotype 2 individuals had more inflammation and shorter survival. There were no treatment effect differences between the two subphenotypes. In the LeoPARDS trial, a three-subphenotype model provided the best fit for the data. Subphenotype 3 individuals had the greatest inflammation and lowest survival. There were no treatment effect differences between the three subphenotypes, although survival was lowest in the levosimendan group for all subphenotypes. In the HARP-2 trial, a two-subphenotype model provided the best fit for the data. The inflammatory subphenotype was associated with fewer ventilator-free days and higher 28-day mortality.
Limitations: The lack of heterogeneity of treatment effect and any treatment effect differences between sepsis subphenotypes may be secondary to the lack of statistical power to detect such effects, if they truly exist.
Conclusions: We highlight lack of heterogeneity of treatment effect in all three trial populations. We report three subphenotypes in sepsis and two subphenotypes in acute respiratory distress syndrome, with an inflammatory phenotype with greater risk of death as a consistent finding in both sepsis and acute respiratory distress syndrome.
Future work: Our analysis highlights the need to identify key discriminant markers to characterise subphenotypes in sepsis and acute respiratory distress syndrome with an observational cohort study.
Funding: This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.
Publication
Journal: Hippocampus
February/14/2020
Abstract
The uncal apex is an anatomical landmark frequently used for segmenting the hippocampus into its anterior and posterior segments, a necessary step for computing many measurements of its long axis. It functions well, as it is both local to the hippocampus and easy to identify. However, in spite of widespread use and definition in the EADC-ADNI Harmonized Hippocampal Protocol (HarP), how the uncal apex is influenced by gross hippocampal changes during normal aging has not been established, nor has the possible impact on measures of anterior hippocampus (aHPC) and posterior hippocampus (pHPC) volume. Here I drew upon three large data sets to describe and confirm these relationships, investigating them in one large data set and replicating my findings in the two others, evaluating a total of 4,434 hippocampi. I found the uncal apex fell in an increasingly more anterior position with increasing age. This age-related retraction of the uncus began after age 36, with the sharpest effects arising after age 60. This phenomenon exaggerates age-related aHPC volume decreases while simultaneously underestimating age-related pHPC volume decreases, a pattern I confirmed by juxtaposing uncal apex and MNI space-based landmarking. A hippocampally based reference frame was also rendered unstable by age-related shifts in the posterior extent of the hippocampus. Both the uncal apex and hippocampal reference frame should therefore be used with caution in aging research, or in research involving other demographic or disease factors known to evoke gross changes in the hippocampus. Instead, MNI coordinate-based heuristics may be appropriate for segmenting the hippocampus in study designs involving such factors. Apex-based segmentation is still attractive, however, in study designs where advanced age and atrophy are not used as regressors, including investigations into long-axis effects in healthy young adults. Progress toward localizing functional divisions within the hippocampus is needed to identify best practices for the field.
Publication
Journal: Marine Pollution Bulletin
October/6/2011
Abstract
Nineteen trace elements were determined in liver, muscle, kidney, gonads, and hair of 18 harp seals (Phoca groenlandica) from Pangnirtung in the Baffin Island, Canada. Concentrations of V, Mn, Fe, Cu, Mo, Ag, and Hg in the liver, Co, Cd, and Tl in the kidney, and Ba and Pb in the hair were significantly higher than those in other tissues. Significant positive correlations between Hg concentrations in the hair, and liver, kidney and testis imply usefulness of the hair sample for non-destructive monitoring of Hg in the harp seals. It is suggested that whereas Hg preferentially accumulates in the liver, the accumulation in other tissues is induced at higher hepatic Hg levels. In contrast, Se may not be accumulated in other tissues compared with the liver even at higher hepatic Hg levels because of the presence of excess Se for Hg detoxification in other tissues.
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