The risk prediction for SPM and its impact on the survival in patients with head and neck squamous cell carcinoma

Head and Neck Squamous Cell Carcinoma (HNSCC) is the sixth common malignancy in the world, with high rates of developing second primary malignancy (SPM) and moderately low survival rates. This disease has become an enormous challenge in the cancer research and treatments. For HNSCC patients, a highly significant cause of post-treatment mortality and morbidity is the development of SPM. Hence, assessment of predicting the risk for the development of SPM would be very helpful for patients, clinicians and policy makers to estimate the survival of patients with HNSCC. In this study, we built a prognostic model to predict the risk of developing SPM in patients with newly diagnosed HNSCC. The dataset used in this research was obtained from The University of Texas MD Anderson Cancer Center. For the first aim, we used stepwise logistic regression to identify the prognostic factors for the development of SPM. Our final model contained cancer site and overall cancer stage as our risk factors for SPM. The Hosmer-Lemeshow test (p-value= 0.15>0.05) showed the final prognostic model fit the data well. The area under the ROC curve was 0.72 that suggested the discrimination ability of our model was acceptable. The internal validation confirmed the prognostic model was a good fit and the final prognostic model would not over optimistically predict the risk of SPM. This model needs external validation by using large data sample size before it can be generalized to predict SPM risk for other HNSCC patients. For the second aim, we utilized a multistate survival analysis approach to estimate the probability of death for HNSCC patients taking into consideration of the possibility of SPM. Patients without SPM were associated with longer survival. These findings suggest that the development of SPM could be a predictor of survival rates among the patients with HNSCC.^

Photosynthetic activity buffers ocean acidification in seagrass meadows

Macrophytes growing in shallow coastal zones characterised by intense metabolic activity have the capacity to modify pH within their canopy and beyond. We observed diel pH changes in shallow (5-12 m) seagrass (Posidonia oceanica) meadows spanning 0.06 pH units in September to 0.24 units in June. The carbonate system (pH, DIC, and aragonite saturation state (omega Ar)) and O2 within the meadows displayed strong diel variability driven by primary productivity, and changes in chemistry were related to structural parameters of the meadow, in particular, the leaf surface area available for photosynthesis (LAI). LAI was positively correlated to mean, max and range pHNBS and max and range omega Ar. In June, vertical mixing (as Turbulent Kinetic Energy) influenced max and min omega Ar, while in September there was no effect of hydrodynamics on the carbonate system within the canopy. Max and range omega Ar within the meadow showed a positive trend with the calcium carbonate load of the leaves, pointing to a possible link between structural parameters, omega Ar and carbonate deposition.

Implementation of the Heated Pulsed Theory using actively heated fiber optics: measurements of soil volumetric water content and soil volumetric heat capacity

Existe una creciente necesidad de hacer el mejor uso del agua para regadío. Una alternativa eficiente consiste en la monitorización del contenido volumétrico de agua (θ), utilizando sensores de humedad. A pesar de existir una gran diversidad de sensores y tecnologías disponibles, actualmente ninguna de ellas permite obtener medidas distribuidas en perfiles verticales de un metro y en escalas laterales de 0.1-1,000 m. En este sentido, es necesario buscar tecnologías alternativas que sirvan de puente entre las medidas puntuales y las escalas intermedias. Esta tesis doctoral se basa en el uso de Fibra Óptica (FO) con sistema de medida de temperatura distribuida (DTS), una tecnología alternativa de reciente creación que ha levantado gran expectación en las últimas dos décadas. Específicamente utilizamos el método de fibra calentada, en inglés Actively Heated Fiber Optic (AHFO), en la cual los cables de Fibra Óptica se utilizan como sondas de calor mediante la aplicación de corriente eléctrica a través de la camisa de acero inoxidable, o de un conductor eléctrico simétricamente posicionado, envuelto, alrededor del haz de fibra óptica. El uso de fibra calentada se basa en la utilización de la teoría de los pulsos de calor, en inglés Heated Pulsed Theory (HPP), por la cual el conductor se aproxima a una fuente de calor lineal e infinitesimal que introduce calor en el suelo. Mediante el análisis del tiempo de ocurrencia y magnitud de la respuesta térmica ante un pulso de calor, es posible estimar algunas propiedades específicas del suelo, tales como el contenido de humedad, calor específico (C) y conductividad térmica. Estos parámetros pueden ser estimados utilizando un sensor de temperatura adyacente a la sonda de calor [método simple, en inglés single heated pulsed probes (SHPP)], ó a una distancia radial r [método doble, en inglés dual heated pulsed probes (DHPP)]. Esta tesis doctoral pretende probar la idoneidad de los sistemas de fibra óptica calentada para la aplicación de la teoría clásica de sondas calentadas. Para ello, se desarrollarán dos sistemas FO-DTS. El primero se sitúa en un campo agrícola de La Nava de Arévalo (Ávila, España), en el cual se aplica la teoría SHPP para estimar θ. El segundo sistema se desarrolla en laboratorio y emplea la teoría DHPP para medir tanto θ como C. La teoría SHPP puede ser implementada con fibra óptica calentada para obtener medidas distribuidas de θ, mediante la utilización de sistemas FO-DTS y el uso de curvas de calibración específicas para cada suelo. Sin embargo, la mayoría de aplicaciones AHFO se han desarrollado exclusivamente en laboratorio utilizando medios porosos homogéneos. En esta tesis se utiliza el programa Hydrus 2D/3D para definir tales curvas de calibración. El modelo propuesto es validado en un segmento de cable enterrado en una instalación de fibra óptica y es capaz de predecir la respuesta térmica del suelo en puntos concretos de la instalación una vez que las propiedades físicas y térmicas de éste son definidas. La exactitud de la metodología para predecir θ frente a medidas puntuales tomadas con sensores de humedad comerciales fue de 0.001 a 0.022 m3 m-3 La implementación de la teoría DHPP con AHFO para medir C y θ suponen una oportunidad sin precedentes para aplicaciones medioambientales. En esta tesis se emplean diferentes combinaciones de cables y fuentes emisoras de calor, que se colocan en paralelo y utilizan un rango variado de espaciamientos, todo ello en el laboratorio. La amplitud de la señal y el tiempo de llegada se han observado como funciones del calor específico del suelo. Medidas de C, utilizando esta metodología y ante un rango variado de contenidos de humedad, sugirieron la idoneidad del método, aunque también se observaron importantes errores en contenidos bajos de humedad de hasta un 22%. La mejora del método requerirá otros modelos más precisos que tengan en cuenta el diámetro del cable, así como la posible influencia térmica del mismo. ABSTRACT There is an increasing need to make the most efficient use of water for irrigation. A good approach to make irrigation as efficient as possible is to monitor soil water content (θ) using soil moisture sensors. Although, there is a broad range of different sensors and technologies, currently, none of them can practically and accurately provide vertical and lateral moisture profiles spanning 0-1 m depth and 0.1-1,000 m lateral scales. In this regard, further research to fulfill the intermediate scale and to bridge single-point measurement with the broaden scales is still needed. This dissertation is based on the use of Fiber Optics with Distributed Temperature Sensing (FO-DTS), a novel approach which has been receiving growing interest in the last two decades. Specifically, we employ the so called Actively Heated Fiber Optic (AHFO) method, in which FO cables are employed as heat probe conductors by applying electricity to the stainless steel armoring jacket or an added conductor symmetrically positioned (wrapped) about the FO cable. AHFO is based on the classic Heated Pulsed Theory (HPP) which usually employs a heat probe conductor that approximates to an infinite line heat source which injects heat into the soil. Observation of the timing and magnitude of the thermal response to the energy input provide enough information to derive certain specific soil thermal characteristics such as the soil heat capacity, soil thermal conductivity or soil water content. These parameters can be estimated by capturing the soil thermal response (using a thermal sensor) adjacent to the heat source (the heating and the thermal sources are mounted together in the so called single heated pulsed probe (SHPP)), or separated at a certain distance, r (dual heated pulsed method (DHPP) This dissertation aims to test the feasibility of heated fiber optics to implement the HPP theory. Specifically, we focus on measuring soil water content (θ) and soil heat capacity (C) by employing two types of FO-DTS systems. The first one is located in an agricultural field in La Nava de Arévalo (Ávila, Spain) and employ the SHPP theory to estimate θ. The second one is developed in the laboratory using the procedures described in the DHPP theory, and focuses on estimating both C and θ. The SHPP theory can be implemented with actively heated fiber optics (AHFO) to obtain distributed measurements of soil water content (θ) by using reported soil thermal responses in Distributed Temperature Sensing (DTS) and with a soil-specific calibration relationship. However, most reported AHFO applications have been calibrated under laboratory homogeneous soil conditions, while inexpensive efficient calibration procedures useful in heterogeneous soils are lacking. In this PhD thesis, we employ the Hydrus 2D/3D code to define these soil-specific calibration curves. The model is then validated at a selected FO transect of the DTS installation. The model was able to predict the soil thermal response at specific locations of the fiber optic cable once the surrounding soil hydraulic and thermal properties were known. Results using electromagnetic moisture sensors at the same specific locations demonstrate the feasibility of the model to detect θ within an accuracy of 0.001 to 0.022 m3 m-3. Implementation of the Dual Heated Pulsed Probe (DPHP) theory for measurement of volumetric heat capacity (C) and water content (θ) with Distributed Temperature Sensing (DTS) heated fiber optic (FO) systems presents an unprecedented opportunity for environmental monitoring. We test the method using different combinations of FO cables and heat sources at a range of spacings in a laboratory setting. The amplitude and phase-shift in the heat signal with distance was found to be a function of the soil volumetric heat capacity (referred, here, to as Cs). Estimations of Cs at a range of θ suggest feasibility via responsiveness to the changes in θ (we observed a linear relationship in all FO combinations), though observed bias with decreasing soil water contents (up to 22%) was also reported. Optimization will require further models to account for the finite radius and thermal influence of the FO cables, employed here as “needle probes”. Also, consideration of the range of soil conditions and cable spacing and jacket configurations, suggested here to be valuable subjects of further study and development.

Comparative analysis of the visual performance and aberrometric outcomes with a new hybrid and two silicone hydrogel multifocal contact lenses: a pilot study

Background: The aim was to evaluate the visual performance achieved with a new multifocal hybrid contact lens and to compare it with that obtained with two other currently available multifocal soft contact lenses. Methods: This pilot prospective comparative study comprised a total of 16 presbyopic eyes of eight patients ranging in age from 43 to 58 years. All patients were fitted with three different models of multifocal contact lens: Duette multifocal (SynergEyes), Air Optix AQUA multifocal (Alcon) and Biofinity multifocal (CooperVision). Fittings were performed randomly in each patient according to a random number sequence, with a wash-out period between fittings of seven days. At two weeks post-fitting, visual, photopic contrast sensitivity and ocular aberrometry were evaluated. Results: No statistically significant differences were found in distance and near visual acuity achieved with the three different types of multifocal contact lens (p ≥ 0.05). Likewise, no significant differences between lenses were found in the monocular and binocular defocus curve (p ≥ 0.10). Concerning contrast sensitivity, better monocular contrast sensitivities for 6, 12 and 18 cycles per degree were found with the Duette and Air Optix multifocal compared to Biofinity (p = 0.02). Binocularly, differences between lenses were not significant (p ≥ 0.27). Furthermore, trefoil aberration was significantly higher with Biofinity multifocal (p < 0.01) and Air Optix (p = 0.01) multifocal compared to Duette. Conclusions: The Duette multifocal hybrid contact lens seems to provide similar visual quality outcomes in presbyopic patients with low corneal astigmatism, when compared with other soft multifocal contact lenses. This preliminary result should be confirmed in studies with larger samples.

Terrain Controls and Landscape-Scale Susceptibility Modelling of Active-Layer Detachments, Sabine Peninsula, Melville Island, Nunavut

Modelling the susceptibility of permafrost slopes to disturbance can identify areas at risk to future disturbance and result in safer infrastructure and resource development in the Arctic. In this study, we use terrain attributes derived from a digital elevation model, an inventory of permafrost slope disturbances known as active-layer detachments (ALDs) and generalised additive modelling to produce a map of permafrost slope disturbance susceptibility for an area on northern Melville Island, in the Canadian High Arctic. By examining terrain variables and their relative importance, we identified factors important for initiating slope disturbance. The model was calibrated and validated using 70 and 30 per cent of a data-set of 760 mapped ALDs, including disturbed and randomised undisturbed samples. The generalised additive model calibrated and validated very well, with areas under the receiver operating characteristic curve of 0.89 and 0.81, respectively, demonstrating its effectiveness at predicting disturbed and undisturbed samples. ALDs were most likely to occur below the marine limit on slope angles between 3 and 10° and in areas with low values of potential incoming solar radiation (north-facing slopes).

Is ultrasound perfusion imaging capable of detecting mismatch? A proof-of-concept study in acute stroke patients.

In this study, we compared contrast-enhanced ultrasound perfusion imaging with magnetic resonance perfusion-weighted imaging or perfusion computed tomography for detecting normo-, hypo-, and nonperfused brain areas in acute middle cerebral artery stroke. We performed high mechanical index contrast-enhanced ultrasound perfusion imaging in 30 patients. Time-to-peak intensity of 10 ischemic regions of interests was compared to four standardized nonischemic regions of interests of the same patient. A time-to-peak >3 s (ultrasound perfusion imaging) or >4 s (perfusion computed tomography and magnetic resonance perfusion) defined hypoperfusion. In 16 patients, 98 of 160 ultrasound perfusion imaging regions of interests of the ischemic hemisphere were classified as normal, and 52 as hypoperfused or nonperfused. Ten regions of interests were excluded due to artifacts. There was a significant correlation of the ultrasound perfusion imaging and magnetic resonance perfusion or perfusion computed tomography (Pearson`s chi-squared test 79.119, p < 0.001) (OR 0.1065, 95% CI 0.06-0.18). No perfusion in ultrasound perfusion imaging (18 regions of interests) correlated highly with diffusion restriction on magnetic resonance imaging (Pearson's chi-squared test 42.307, p < 0.001). Analysis of receiver operating characteristics proved a high sensitivity of ultrasound perfusion imaging in the diagnosis of hypoperfused area under the curve, (AUC = 0.917; p < 0.001) and nonperfused (AUC = 0.830; p < 0.001) tissue in comparison with perfusion computed tomography and magnetic resonance perfusion. We present a proof of concept in determining normo-, hypo-, and nonperfused tissue in acute stroke by advanced contrast-enhanced ultrasound perfusion imaging.

Comparison of IgG concentrations by radial immunodiffusion, electrophoretic gamma globulin concentrations and total globulins in neonatal foals

REASONS FOR PERFORMING STUDY: Failure of transfer of passive immunity (FTPI) in foals is associated with a risk of infection and death. The current diagnostic gold standard is quantification of immunoglobulins using radial immunodiffusion (IgG-RID). Routine diagnosis is often performed using semi-quantitative tests. Concentrations of serum electrophoretic gamma globulins (EGG) and total globulins may be useful to assess FTPI, but few studies have investigated their use. OBJECTIVES: To assess agreement between IgG-RID and EGG, and evaluate the accuracy of total globulin concentration to diagnose FTPI based on both IgG-RID and EGG. STUDY DESIGN: Prospective study. METHODS: 360 serum samples were harvested at 6-24 hours post natum from 60 German Warmblood foals. Concentrations of EGG, IgG-RID and total globulin concentration (calculated from total proteins and albumin) were measured. Agreement between EGG and IgG-RID was assessed using Bland-Altman plots and Passing-Bablok regression. The accuracy of total globulin concentration was assessed using rank correlation and ROC curve analysis. RESULTS: Good agreement was found with slightly lower EGG than IgG-RID concentrations (Bland-Altman systemic bias, -1.9 g/L) which was more pronounced at higher concentrations (regression equation: IgG-RID = -0.78 +1.28xEGG). Correlations between total globulin concentration and EGG, and total globulin concentration and IgG-RID were 0.93 and 0.79, respectively. The area under the curve was 0.982 and 0.952 for EGG <4 g/L and <8 g/L, and 0.953 and 0.899 for IgG-RID <4 g/L and <8 g/L. Sensitivities and specificities of total globulin concentration in the diagnosis of FTPI were comparable to commonly used screening tests, but cut-offs could be selected to achieve sensitivities of >95% with 71.2% (IgG-RID) and 90.5% (EGG) specificity for <4 g/L, and >90% with 66.0% (IgG-RID) and 87.9% (EGG) specificity for <8 g/L. CONCLUSIONS: There is good agreement between EGG and IgG-RID, with slightly more conservative estimates of immunoglobulins obtained using EGG. Total globulins may be a useful and economic quantitative screening test with cut-offs achieving high sensitivities, but analyser-specific cut-offs may be necessary. This article is protected by copyright. All rights reserved. KEYWORDS: IgG; electrophoresis; foal; globulins; horse; radial immunodiffusion. This article is protected by copyright. All rights reserved.

Carboplatin pharmacokinetics following a single-dose infusion in sulphur-crested cockatoos (Cacatua galerita)

Objective To determine the pharmacokinetics of carboplatin in sulphur-crested cockatoos, so that its use in clinical studies in birds can be considered. Design A pharmacokinetic study of carboplatin, following a single intravenous (IV) or intraosseus (10) infusion over 3 min, was performed in six healthy sulphur-crested cockatoos (Cacatua galerita). Procedure Birds were anaesthetised and a jugular vein cannulated for blood collection. Carboplatin (5 mg/kg) was infused over 3 min by the IV route in four birds via the contralateral jugular vein, and by the 10 route in two birds via the ulna. Serial blood samples were collected for 96 h after initiation of the infusion. Tissue samples from 11 organs were obtained at necropsy, 96 h after carboplatin administration. Total Pt and filterable Pt in plasma and tissue Pt concentrations were assayed by inductively coupled plasma-mass spectrometry. A noncompartmental pharmacokinetic analysis was performed on the plasma data. Results The mean +/- SD for the C-max of filterable Pt was 27.3 +/- 4.06 mg/L and in all six birds occurred at the end of the 3 min infusion, thenceforth declining exponentially over the next 6 h to an average concentration of 0.128 +/- 0.065 mg/L. The terminal half-life (T-1/2) was 1.0 +/- 0.17 h, the systemic clearance (CI) was 5.50 +/- 1.06 mL/min/kg and the volume of distribution (Vss) was 0.378 +/- 0.073 L/kg. The extrapolated area under the curve (AUC(0-x)) was 0.903 +/- 0.127 mg/mL.min; the area extrapolated past the last (6 h) data point to infinite time averaged only 1.25% of the total AUC(0-x). The kidneys had the greatest accumulation of Pt (7.04 +/- 3.006 mug/g), followed by the liver (3.08 +/- 1.785 mug/g DM). Conclusions and clinical relevance Carboplatin infusion in sulphur-crested cockatoos produced mild, transient alimentary tract signs and the Pt plasma concentration was similar whether carboplatin was given intravenously or intraosseously. Filterable plasma Pt concentrations for carboplatin persisted longer than for cisplatin, due mostly to the difference in systemic clearance between these drugs in sulphur-crested cockatoos. The distribution of tissue Pt after carboplatin administration was similar to that reported for cisplatin in sulphur-crested cockatoos. Despite anatomical, physiological and biochemical differences among animal species, the pharmacokinetic disposition of filterable Pt in the sulphur-crested cockatoo shares some features with the kinetics reported previously in other animals and human beings.

Free mycophenolic acid should be monitored in renal transplant recipients with hypoalbuminemia

The current approach for therapeutic drug monitoring in renal transplant recipients receiving mycophenolate mofetil (MMF) is measurement of total mycophenolic acid (MPA) concentration. Because MPA is highly bound, during hypoalbuminemia the total concentration no longer reflects the free (pharmacologically active) concentration. The authors investigated what degree of hypoalbuminemia causes a significant change in protein binding and thus percentage free MPA. Forty-two renal transplant recipients were recruited for the study. Free and total concentrations of MPA (predose, and 1, 3, and 6 hours post-MMF dose samples) and plasma albumin concentrations were determined on day 5 posttransplantation. Six-hour area under the concentration-time curve (AUC(0-6)) values were calculated for free and total MPA, and percentage free MPA was determined for each patient. The authors found a significant relationship between low albumin concentrations and increased percentage free MPA (Spearman correlation = -0.54, P < 0.0001). Receiver operating characteristic (ROC) curve analysis was performed on the albumin versus percentage free MPA data. The cutoff value of albumin determined from the ROC analysis that differentiated normal from elevated percentage free MPA (defined as greater than or equal to3%) in this patient population was 31 g/L. At this cutoff value albumin was found to be a good predictor of altered free MPA percentage, with a sensitivity and specificity of 0.75 and 0.80, respectively, and an area under the ROC curve of 0.79. To rationalize MMF dosing regimens in hypoalbuminemic patients (plasma albumin less than or equal to 31 g/L), clinicians should consider monitoring the free MPA concentration.

Doxorubicin pharmacokinetics following a single-dose infusion to sulphur-crested cockatoos (Cacatua galerita)

Objective To determine the pharmacokinetics of doxorubicin in sulphur-crested cockatoos, so that its use in clinical studies in birds can be considered. Design A pharmacokinetic study of doxorubicin, following a single intravenous (IV) infusion over 20 min, was performed in four healthy sulphur-crested cockatoos (Cacatua galerita). Procedure Birds were anaesthetised and both jugular veins were cannulated, one for doxorubicin infusion and the other for blood collection. Doxorubicin hydrochloride (2 mg/kg) in normal saline was infused IV over 20 min at a constant rate. Serial blood samples were collected for 96 h after initiation of the infusion. Plasma doxorubicin concentrations were assayed using an HPLC method involving ethyl acetate extraction, reverse-phase chromatography and fluorescence detection. The limit of quantification was 20 ng/mL. Established non-parametric methods were used for the analysis of plasma doxorubicin data. Results During the infusion the mean +/- SD for the C-max of doxorubicin was 4037 +/- 2577 ng/mL. Plasma concentrations declined biexponentially immediately after the infusion was ceased. There was considerable intersubject variability in all pharmacokinetic variables. The terminal (beta-phase) half-life was 41.4 +/- 18.5 min, the systemic clearance (Cl) was 45.7 +/- 18.0 mL/min/kg, the mean residence time (MRT) was 4.8 +/- 1.4 min, and the volume of distribution at steady state (V-SS) was 238 131 mL/kg. The extrapolated area under the curve (AUC(0-infinity)) was 950 +/- 677 ng/mL.h. The reduced metabolite, doxorubicinol, was detected in the plasma of all four parrots but could be quantified in only one bird with the profile suggesting formation rate-limited pharmacokinetics of doxorubicinol. Conclusions and clinical relevance Doxorubicin infusion in sulphur-crested cockatoos produced mild, transient inappetence. The volume of distribution per kilogram and terminal half-life were considerably smaller, but the clearance per kilogram was similar to or larger than reported in the dog, rat and humans. Traces of doxorubicinol, a metabolite of doxorubicin, were detected in the plasma.

Changes of corneal biomechanics with keratoconus

PURPOSE: To perform advanced analysis of the corneal deformation response to air pressure in keratoconics compared with age- and sex-matched controls. METHODS: The ocular response analyzer was used to measure the air pressure-corneal deformation relationship of 37 patients with keratoconus and 37 age (mean 36 ± 10 years)- and sex-matched controls with healthy corneas. Four repeat air pressure-corneal deformation profiles were averaged, and 42 separate parameters relating to each element of the profiles were extracted. Corneal topography and pachymetry were performed with the Orbscan II. The severity of the keratoconus was graded based on a single metric derived from anterior corneal curvatures, difference in astigmatism in each meridian, anterior best-fit sphere, and posterior best-fit sphere. RESULTS: Most of the biomechanical characteristics of keratoconic eyes were significantly different from normal eyes (P <0.001), especially during the initial corneal applanation. With increasing keratoconus severity, the cornea was thinner (r = -0.407, P <0.001), the speed of corneal concave deformation past applanation was quicker (dive; r = -0.314, P = 0.01), and the tear film index was lower (r = -0.319, P = 0.01). The variance in keratoconus severity could be accounted for by the corneal curvature and central corneal thickness (r = 0.80) with biomechanical characteristics contributing an additional 4% (total r = 0.84). The area under the receiver operating characteristic curve was 0.919 ± 0.025 for keratometry alone, 0.965 ± 0.014 with the addition of pachymetry, and 0.972 ± 0.012 combined with ocular response analyzer biomechanical parameters. CONCLUSIONS: Characteristics of the air pressure-corneal deformation profile are more affected by keratoconus than the traditionally extracted corneal hysteresis and corneal resistance factors. These biomechanical metrics slightly improved the detection and severity prediction of keratoconus above traditional keratometric and pachymetric assessment of corneal shape.

Development of a near activity visual questionnaire to assess accommodating intraocular lenses

Purpose: To develop a questionnaire that subjectively assesses near visual function in patients with 'accommodating' intraocular lenses (IOLs). Methods: A literature search of existing vision-related quality-of-life instruments identified all questions relating to near visual tasks. Questions were combined if repeated in multiple instruments. Further relevant questions were added and item interpretation confirmed through multidisciplinary consultation and focus groups. A preliminary 19-item questionnaire was presented to 22 subjects at their 4-week visit post first eye phacoemulsification with 'accommodative' IOL implantation, and again 6 and 12 weeks post-operatively. Rasch Analysis, Frequency of Endorsement, and tests of normality (skew and kurtosis) were used to reduce the instrument. Cronbach's alpha and test-retest reliability (intraclass correlation coefficient, ICC) were determined for the final questionnaire. Construct validity was obtained by Pearson's product moment correlation (PPMC) of questionnaire scores to reading acuity (RA) and to Critical Print Size (CPS) reading speed. Criterion validity was obtained by receiver operating characteristic (ROC) curve analysis and dimensionality of the questionnaire was assessed by factor analysis. Results: Rasch Analysis eliminated nine items due to poor fit statistics. The final items have good separation (2.55), internal consistency (Cronbach's α = 0.97) and test-retest reliability (ICC = 0.66). PPMC of questionnaire scores with RA was 0.33, and with CPS reading speed was 0.08. Area under the ROC curve was 0.88 and Factor Analysis revealed one principal factor. Conclusion: The pilot data indicates the questionnaire to be internally consistent, reliable and a valid instrument that could be useful for assessing near visual function in patients with 'accommodating' IOLS. The questionnaire will now be expanded to include other types of presbyopic correction. © 2007 British Contact Lens Association.

A tree-based decision model to support prediction of the severity of asthma exacerbations in children

This paper describes the development of a tree-based decision model to predict the severity of pediatric asthma exacerbations in the emergency department (ED) at 2 h following triage. The model was constructed from retrospective patient data abstracted from the ED charts. The original data was preprocessed to eliminate questionable patient records and to normalize values of age-dependent clinical attributes. The model uses attributes routinely collected in the ED and provides predictions even for incomplete observations. Its performance was verified on independent validating data (split-sample validation) where it demonstrated AUC (area under ROC curve) of 0.83, sensitivity of 84%, specificity of 71% and the Brier score of 0.18. The model is intended to supplement an asthma clinical practice guideline, however, it can be also used as a stand-alone decision tool.

A Geometrical Interpretation to Define Contradiction Degrees between Two Fuzzy Sets

For inference purposes in both classical and fuzzy logic, neither the information itself should be contradictory, nor should any of the items of available information contradict each other. In order to avoid these troubles in fuzzy logic, a study about contradiction was initiated by Trillas et al. in [5] and [6]. They introduced the concepts of both self-contradictory fuzzy set and contradiction between two fuzzy sets. Moreover, the need to study not only contradiction but also the degree of such contradiction is pointed out in [1] and [2], suggesting some measures for this purpose. Nevertheless, contradiction could have been measured in some other way. This paper focuses on the study of contradiction between two fuzzy sets dealing with the problem from a geometrical point of view that allow us to find out new ways to measure the contradiction degree. To do this, the two fuzzy sets are interpreted as a subset of the unit square, and the so called contradiction region is determined. Specially we tackle the case in which both sets represent a curve in [0,1]2. This new geometrical approach allows us to obtain different functions to measure contradiction throughout distances. Moreover, some properties of these contradiction measure functions are established and, in some particular case, the relations among these different functions are obtained.