Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis.

BACKGROUND & AIMS It is not clear whether symptoms alone can be used to estimate the biologic activity of eosinophilic esophagitis (EoE). We aimed to evaluate whether symptoms can be used to identify patients with endoscopic and histologic features of remission. METHODS Between April 2011 and June 2014, we performed a prospective, observational study and recruited 269 consecutive adults with EoE (67% male; median age, 39 years old) in Switzerland and the United States. Patients first completed the validated symptom-based EoE activity index patient-reported outcome instrument and then underwent esophagogastroduodenoscopy with esophageal biopsy collection. Endoscopic and histologic findings were evaluated with a validated grading system and standardized instrument, respectively. Clinical remission was defined as symptom score <20 (range, 0-100); histologic remission was defined as a peak count of <20 eosinophils/mm(2) in a high-power field (corresponds to approximately <5 eosinophils/median high-power field); and endoscopic remission as absence of white exudates, moderate or severe rings, strictures, or combination of furrows and edema. We used receiver operating characteristic analysis to determine the best symptom score cutoff values for detection of remission. RESULTS Of the study subjects, 111 were in clinical remission (41.3%), 79 were in endoscopic remission (29.7%), and 75 were in histologic remission (27.9%). When the symptom score was used as a continuous variable, patients in endoscopic, histologic, and combined (endoscopic and histologic remission) remission were detected with area under the curve values of 0.67, 0.60, and 0.67, respectively. A symptom score of 20 identified patients in endoscopic remission with 65.1% accuracy and histologic remission with 62.1% accuracy; a symptom score of 15 identified patients with both types of remission with 67.7% accuracy. CONCLUSIONS In patients with EoE, endoscopic or histologic remission can be identified with only modest accuracy based on symptoms alone. At any given time, physicians cannot rely on lack of symptoms to make assumptions about lack of biologic disease activity in adults with EoE. ClinicalTrials.gov, Number: NCT00939263.

Is body mass index associated with Barrett esophagus: A systematic literature review

Background. Risk factors underlying the development of Barrett's esophagus (BE) are poorly understood. Recent studies have examined the association between elevated body mass index (BMI) and BE with conflicting results. A systematic review of literature was performed to study this association.^ Methods. Cross-sectional, case control and cohort studies published through April 2007 meeting strict inclusion and exclusion criteria were included. A thorough data abstraction, including that of reported crude or adjusted odds ratios or mean BMI, was performed. Crude odds ratios were estimated from available information in 3 studies.^ Results. Of 630 publications identified by our search items, 59 were reviewed in detail and 12 included in the final analyses. 3 studies showed a statistically significant association between obesity and BE (30-32) while 2 studies found a statistically significant association between overweight and BE (31, 32). Two studies that reported BMI as a continuous variable found BMI in cases to be significantly higher than that in the comparison group (30, 32). Other studies failed to show an significant association between elevated BMI and BE.^ Conclusions. There is conflicting data regarding the association between elevated BMI and BE. It is important to identify other risk factors that in combination with elevated BMI may lead to BE. Further studies are needed to evaluate if the presence of reflux symptoms or any particular pattern of obesity, are independently associated with BE.^ Key words. Barrett's esophagus, obesity, Body Mass Index, gastroesophageal reflux disease, meta-analysis^

A cross-sectional study of human symptomatology and residential formaldehyde concentrations

The cross-sectional study was performed to quantify the prevalence of symtomatology in residents of mobile homes as a function of indoor formaldehyde concentration. Formaldehyde concentrations were monitored for a seven hour period with an automated wet-chemical colorimetric analyzer. The health status of family members was ascertained by administration of questionnaires and physical exams. This is the first investigation to perform clinical assessments on residents undergoing concurrent exposure assessment in the home.^ Only 22.8% of households eligible for participation chose to cooperate. Monitoring data and health evaluations were obtained from 155 households in four Texas counties. A total of 428 residents (86.1%) were available for examination during the sampling hours. The study population included 45 infants, 126 children, and 257 adults.^ Formaldehyde concentration was not found to be significantly associated with increased risks for symptoms and signs of ocular irritation, dermal anomalies, or malaise. Three associations were identified that warrant further investigation. The relative odds associated with a doubling of formaldehyde concentration was significantly associated with parenchymal rales in adults and children. However, risk was modified by log respirable suspended particulate concentrations. Due to the presence of modification by a continuous variable, prevalence odds ratios (POR) and 95% confidence intervals (95% CI) for these associations are presented in tables. A doubling of formaldehyde concentration was also associated with an increased risk of perceived tightness in the chest in adults. Prevalence odds ratios are presented in a table due to effect modification by the average number of hours spent indoors on weekdays. Furthermore, a doubling of formaldehyde concentration was associated with an increased risk of drowsiness in children (POR = 2.60; 95% CI 1.04-6.51) and adults (POR = 1.94; 95% CI 1.20-3.14). ^

Elevated cystatin C & heart failure prognosis a systematic review

Renal insufficiency is one of the most common co-morbidities present in heart failure (HF) patients. It has significant impact on mortality and adverse outcomes. Cystatin C has been shown as a promising marker of renal function. A systematic review of all the published studies evaluating the prognostic role of cystatin C in both acute and chronic HF was undertaken. A comprehensive literature search was conducted involving various terms of 'cystatin C' and 'heart failure' in Pubmed medline and Embase libraries using Scopus database. A total of twelve observational studies were selected in this review for detailed assessment. Six studies were performed in acute HF patients and six were performed in chronic HF patients. Cystatin C was used as a continuous variable, as quartiles/tertiles or as a categorical variable in these studies. Different mortality endpoints were reported in these studies. All twelve studies demonstrated a significant association of cystatin C with mortality. This association was found to be independent of other baseline risk factors that are known to impact HF outcomes. In both acute and chronic HF, cystatin C was not only a strong predictor of outcomes but also a better prognostic marker than creatinine and estimated glomerular filtration rate (eGFR). A combination of cystatin C with other biomarkers such as N terminal pro B- type natriuretic peptide (NT-proBNP) or creatinine also improved the risk stratification. The plausible mechanisms are renal dysfunction, inflammation or a direct effect of cystatin C on ventricular remodeling. Either alone or in combination, cystatin C is a better, accurate and a reliable biomarker for HF prognosis. ^

Fasting blood glucose and 8-year mortality in the hypertension detection follow-up program population

This study analyzed the relationship between fasting blood glucose (FBG) and 8-year mortality in the Hypertension Detection Follow-up Program (HDFP) population. Fasting blood glucose (FBG) was examined both as a continuous variable and by specified FBG strata: Normal (FBG 60–100 mg/dL), Impaired (FBG ≥100 and ≤125 mg/dL), and Diabetic (FBG>125 mg/dL or pre-existing diabetes) subgroups. The relationship between type 2 diabetes was examined with all-cause mortality. This thesis described and compared the characteristics of fasting blood glucose strata by recognized glucose cut-points; described the mortality rates in the various fasting blood glucose strata using Kaplan-Meier mortality curves, and compared the mortality risk of various strata using Cox Regression analysis. Overall, mortality was significantly greater among Referred Care (RC) participants compared to Stepped Care (SC) {HR = 1.17; 95% CI (1.052,1.309); p-value = 0.004}, as reported by the HDFP investigators in 1979. Compared with SC participants, the RC mortality rate was significantly higher for the Normal FBG group {HR = 1.18; 95% CI (1.029,1.363); p-value = 0.019} and the Impaired FBG group, {HR = 1.34; 95% CI (1.036,1.734); p-value = 0.026,}. However, for the diabetic group, 8-year mortality did not differ significantly between the RC and SC groups after adjusting for race, gender, age, smoking status among Diabetic individuals {HR = 1.03; 95% CI (0.816,1.303); p-value = 0.798}. This latter finding is possibly due to a lack of a treatment difference of hypertension among Diabetic participants in both RC and SC groups. The largest difference in mortality between RC and SC was in the Impaired subgroup, suggesting that hypertensive patients with FBG between 100 and 125 mg/dL would benefit from aggressive antihypertensive therapy.^

Proceedings of the Fifteenth Annual biochemical Engineering Symposium

This work represents the proceedings of the fifteenth symposium which convened at Colorado State University on May 24, 1985. The two day meeting was scheduled one month later than usual, i.e., after the spring semester, so that travelers from the Midwest (Iowa State University, Kansas State University and University of Missouri) could enjoy the unique mountain setting provided at Pingree Park. The background of the photograph on the cover depicts the beauty of the area. ContentsGreg Sinton and S.M. Leo, KSU. Models for the Biodegration of 2.4-D and Related Xenobiotic Compounds. V. Bringi, CSU. Intrinsic Kinetics from a Novel Immobilized Cell CSTR. Steve Birdsell, CU. Novel Microbial Separation Techniques. Mark Smith, MU. Kinetic Characterization of Growth of E. coli on Glucose. Michael M. Meagher, ISU. Kinetic Parameters of Di- and Trisaccharaide Hydrolysis by Glucoamylase II. G.T. Jones and A.K. Ghosh Hajra, KSU. Modeling and Simulation of Legume Modules with Reactive Cores and Inert Shells. S.A. Patel and C.H. Lee, KSU. Energetic Analysis and Liquid Circulation in an Airlift Fermenter. Rod R. Fisher, ISU. The Effects of Mixing during Acid Addition of Fractionally Precipitated Protein. Mark M. Paige, CSU. Fed-batch Fermentations of Clostridium acetobutylicum. Michael K. Dowd, ISU. A Nonequilibirium Thermodynamic Description of the Variation of Contractile Velocity and Energy Use in Muscle. David D. Drury, CSU. Analysis of Hollow Fiber Bioreactor Performance for MAmmalian Cells by On-Line MMR. H.Y. Lee, KSU. Process Analysis of Photosynthetic Continuous Culture Systems. C.J. Wang, MU. Kinetic Consideration in Fermentation of Cheese Whey to Ethanol.

A mathematical model of a criminal-prone society

Criminals are common to all societies. To fight against them the community takes different security measures as, for example, to bring about a police. Thus, crime causes a depletion of the common wealth not only by criminal acts but also because the cost of hiring a police force. In this paper, we present a mathematical model of a criminal-prone self-protected society that is divided into socio-economical classes. We study the effect of a non-null crime rate on a free-of-criminals society which is taken as a reference system. As a consequence, we define a criminal-prone society as one whose free-of-criminals steady state is unstable under small perturbations of a certain socio-economical context. Finally, we compare two alternative strategies to control crime: (i) enhancing police efficiency, either by enlarging its size or by updating its technology, against (ii) either reducing criminal appealing or promoting social classes at risk

Validación de HP UV-LED para la detección en continuo de contaminantes en aguas continentales mediante fluorescencia

La preservación del medio ambiente, el avance en las técnicas para que el impacto de la actividad humana sobre la fauna y flora sea lo menor posible, hacen que se deban monitorizar los diversos indicadores de calidad. El presente estudio viene motivado debido a que actualmente existen sistemas de medida y control en continuo de la calidad de las aguas, al margen de los estudios de laboratorio por toma de muestras, a través de los cuales se obtienen indicadores de calidad. El desarrollo tecnológico en analizadores en continuo para la medida de fósforo, amonio, DBO y otros, hacen que cada vez se consiga un control más exhaustivo de la calidad en tiempo real. Sin embargo, la detección temprana de contaminantes que no deben encontrarse presentes en el agua, hacen que el desarrollo de sensores de detección de estos contaminantes sea de gran utilidad. A este respecto, las técnicas mediante fluorescencia presentan enormes ventajas, ya que no existe contacto directo con la muestra, reduciéndose el desgaste y alargando el tiempo entre mantenimientos, como se ha comprobado en numerosos desarrollos con tecnología láser. Para la producir fluorescencia, tradicionalmente se vienen utilizando en el laboratorio principalmente lámparas de gas y monocromadores. Los nuevos LED de alta potencia en el espectro ultravioleta son una alternativa muy interesante que además puede ser aplicada en los mencionados sistemas de medición en continuo. En este trabajo se realiza un estudio de viabilidad de estos dispositivos como fuentes de excitación para la producción de fluorescencia tomando como contaminantes los hidrocarburos. El funcionamiento en estaciones en continuo hace que se tenga que realizar además ensayos de vida acelerados, así como estudios de modos de trabajo. Al respecto de la fluorescencia producida, se estudia la influencia de factores que pueden afectar a las medidas, tales como la temperatura. El estudio del espectro y su análisis para la identificación del contaminante es otro de los puntos desarrollados en este trabajo. Por último, y dado que la monitorización se realiza en modo continuo, es necesario un sistema de comunicaciones compacto y fiable: en este apartado se analizan los metamateriales como solución tecnológica, ya que se adapta perfectamente a la filosofía de estas estaciones de medición. ABSTRACT Currently the monitoring of quality indicators is a need to preserve the environment and minimize the impact of human activity on the fauna and flora. Currently there are measuring systems and continuous monitoring of water quality, regardless of sampling laboratory studies, through which quality indicators are obtained. Technological development in continuous analyzers for the measurement of phosphorus, ammonia, BOD and others increasingly make a more comprehensive real-time quality control is achieved. However, early detection of contaminants that should not be present in the water, make the development of sensors for detecting these contaminants is very useful. In this regard, fluorescence techniques have huge advantages, since there is no direct contact with the sample, reducing wear and extending the time between maintenance, as has been demonstrated in numerous developments in laser technology. To produce fluoresce, traditionally are being used mainly gas lamps and monochromators at the laboratory. The new high-power LEDs in the ultraviolet spectrum are a very interesting alternative that can also be applied in the above continuous measurement systems. In this paper a viability study of these devices as excitation sources to produce fluorescence using hydrocarbon as contaminants is performed. The stations in continuous operation makes it necessary to also perform accelerated life tests and studies operating modes. In regard to the fluorescence produced, the influence of factors that may affect the measurements, such as temperature is studied. The study of the spectrum and analysis to identify the contaminant is another of the points developed in this work. Finally, since the monitoring is carried out in continuous mode, a compact and reliable communication is necessary: in this section metamaterials as a technological solution is analyzed since it fits perfectly with the philosophy of these measuring stations.

Coherent analysis of quantum optical sideband modes

We demonstrate a device that allows for the coherent analysis of a pair of optical frequency sidebands in an arbitrary basis. We show that our device is quantum noise limited, and hence applications for this scheme may be found in discrete and continuous variable optical quantum information experiments. (c) 2005 Optical Society of America.

Coherent-state quantum key distribution without random basis switching

The random switching of measurement bases is commonly assumed to be a necessary step of quantum key distribution protocols. In this paper we present a no-switching protocol and show that switching is not required for coherent-state continuous-variable quantum key distribution. Further, this protocol achieves higher information rates and a simpler experimental setup compared to previous protocols that rely on switching. We propose an optimal eavesdropping attack against this protocol, assuming individual Gaussian attacks. Finally, we investigate and compare the no-switching protocol applied to the original Bennett-Brassard 1984 scheme.

Innovation, productivity and growth in US business services:a firm-level analysis

This paper examines the impact of innovation on the performance of US business service firms. We distinguish between different levels of innovation (new-to-market and new-to-firm) in our analysis, and allow explicitly for sample selection issues. Reflecting the literature, which highlights the importance of external interaction in service innovation, we pay particular attention to the role of external innovation linkages and their effect on business performance. We find that the presence of service innovation and its extent has a consistently positive effect on growth, but no effect on productivity. There is evidence that the growth effect of innovation can be attributed, at least in part, to the external linkages maintained by innovators in the process of innovation. External linkages have an overwhelmingly positive effect on (innovator) firm performance, regardless of whether innovation is measured as a discrete or continuous variable, and regardless of the level of innovation considered.

Institutions and firm ownership structure:evidence from Central and Eastern Europe

FDI plays a key role in development, particularly in resource-constrained transition economies of Central and Eastern Europe with relatively low savings rates. Gains from technology transfer play a critical role in motivating FDI, yet potential for it may be hampered by a large technology gap between the source and host country. While the extent of this gap has traditionally been attributed to education, skills and capital intensity, recent literature has also emphasized the possible role of institutional environment in this respect. Despite tremendous interest among policy-makers and academics to understand the factors attracting FDI (Bevan and Estrin, 2000; Globerman and Shapiro, 2003) our knowledge about the effects of institutions on the location choice and ownership structure of foreign firms remains limited. This paper attempts to fill this gap in the literature by examining the link between institutions and foreign ownership structures. To the best of our knowledge, Javorcik (2004) is the only papers, which use firm-level data to analyse the role of institutional quality on an outward investor’s entry mode in transition countries. Our paper extends Javorcik (2004) in a number of ways: (a) rather than a cross-section, we use panel data for the period 1997-2006; (b) rather than a binary variable, we use the percentage foreign ownership as continuous variable; (c) we consider multi-dimensional institutional variables, such as corruption, intellectual property rights protection and government stability. We also use factor analysis to generate a composite index of institutional quality and see how stronger institutional environment could affect foreign ownership; (d) we explore how the distance between institutional environment in source and host countries affect foreign ownership in a host country. The firm-level data used includes both domestic and foreign firms for the period 1997-2006 and is drawn from ORBIS, a commercially available dataset provided by Bureau van Dijk. In order to examine the link between institutions and foreign ownership structures, we estimate four log-linear ownership equations/specifications augmented by institutional and other control variables. We find evidence that the decision of a foreign firm to either locate its subsidiary or acquire an existing domestic firm depends not only on factor cost differences but also on differences in institutional environment between the host and source countries.

Exploiting uncertainty in nonlinear stochastic control problem

This work introduces a novel inversion-based neurocontroller for solving control problems involving uncertain nonlinear systems which could also compensate for multi-valued systems. The approach uses recent developments in neural networks, especially in the context of modelling statistical distributions, which are applied to forward and inverse plant models. Provided that certain conditions are met, an estimate of the intrinsic uncertainty for the outputs of neural networks can be obtained using the statistical properties of networks. More generally, multicomponent distributions can be modelled by the mixture density network. Based on importance sampling from these distributions a novel robust inverse control approach is obtained. This importance sampling provides a structured and principled approach to constrain the complexity of the search space for the ideal control law. The developed methodology circumvents the dynamic programming problem by using the predicted neural network uncertainty to localise the possible control solutions to consider. Convergence of the output error for the proposed control method is verified by using a Lyapunov function. Several simulation examples are provided to demonstrate the efficiency of the developed control method. The manner in which such a method is extended to nonlinear multi-variable systems with different delays between the input-output pairs is considered and demonstrated through simulation examples.

External Characterization of I-Favorable Spaces

1991 AMS Math. Subj. Class.:Primary 54C10; Secondary 54F65

Surprises and Insights from Long-Term Aquatic Data Sets and Experiments

long-term research on freshwater ecosystems provides insights that can be difficult to obtain from other approaches. Widespread monitoring of ecologically relevant water-quality parameters spanning decades can facilitate important tests of ecological principles. Unique long-term data sets and analytical tools are increasingly available, allowing for powerful and synthetic analyses across sites. long-term measurements or experiments in aquatic systems can catch rare events, changes in highly variable systems, time-lagged responses, cumulative effects of stressors, and biotic responses that encompass multiple generations. Data are available from formal networks, local to international agencies, private organizations, various institutions, and paleontological and historic records; brief literature surveys suggest much existing data are not synthesized. Ecological sciences will benefit from careful maintenance and analyses of existing long-term programs, and subsequent insights can aid in the design of effective future long-term experimental and observational efforts. long-term research on freshwaters is particularly important because of their value to humanity.