Peanut Allergen Threshold Study (PATS): validation of eliciting doses using a novel single-dose challenge protocol

Background: The eliciting dose (ED) for a peanut allergic reaction in 5% of the peanut allergic population, the ED05, is 1.5 mg of peanut protein. This ED05 was derived from oral food challenges (OFC) that use graded, incremental doses administered at fixed time intervals. Individual patients’ threshold doses were used to generate population dose-distribution curves using probability distributions from which the ED05 was then determined. It is important to clinically validate that this dose is predictive of the allergenic response in a further unselected group of peanut-allergic individuals. Methods/Aims: This is a multi-centre study involving three national level referral and teaching centres. (Cork University Hospital, Ireland, Royal Children’s Hospital Melbourne, Australia and Massachusetts General Hospital, Boston, U.S.A.) The study is now in process and will continue to run until all centres have recruited 125 participates in each respective centre. A total of 375 participants, aged 1–18 years will be recruited during routine Allergy appointments in the centres. The aim is to assess the precision of the predicted ED05 using a single dose (6 mg peanut = 1.5 mg of peanut protein) in the form of a cookie. Validated Food Allergy related Quality of Life Questionnaires-(FAQLQ) will be self-administered prior to OFC and 1 month after challenge to assess the impact of a single dose OFC on FAQL. Serological and cell based in vitro studies will be performed. Conclusion: The validation of the ED05 threshold for allergic reactions in peanut allergic subjects has potential value for public health measures. The single dose OFC, based upon the statistical dose-distribution analysis of past challenge trials, promises an efficient approach to identify the most highly sensitive patients within any given food-allergic population.

Two-stage no-wait scheduling models with setup and removal times separated

This paper studies two models of two-stage processing with no-wait in process. The first model is the two-machine flow shop, and the other is the assembly model. For both models we consider the problem of minimizing the makespan, provided that the setup and removal times are separated from the processing times. Each of these scheduling problems is reduced to the Traveling Salesman Problem (TSP). We show that, in general, the assembly problem is NP-hard in the strong sense. On the other hand, the two-machine flow shop problem reduces to the Gilmore-Gomory TSP, and is solvable in polynomial time. The same holds for the assembly problem under some reasonable assumptions. Using these and existing results, we provide a complete complexity classification of the relevant two-stage no-wait scheduling models.

Two-machine flowshop scheduling problems with no-wait jobs

We study a two-machine flow shop scheduling problem with no-wait in process, in which one of the machines is not available during a specified time interval. We consider three scenarios of handing the operation affected by the nonavailability interval. Its processing may (i) start from scratch after the interval, or (ii) be resumed from the point of interruption, or (iii) be partially restarted after the interval. The objective is to minimize the makespan. We present an approximation algorithm that for all these scenarios delivers a worst-case ratio of 3/2. For the second scenario, we offer a 4/3-approximation algorithm.

Two-machine flow shop scheduling problems with no-wait jobs

In this paper we provide a fairly complete complexity classification of various versions of the two-machine permutation flow shop scheduling problem to minimize the makespan in which some of the jobs have to be processed with no-wait in process. For some version, we offer a fully polynomial-time approximation scheme and a 43-approximation algorithm.

Biaxial Characterisation of Materials for Thermoforming and Blow Moulding

During free surface moulding processes such as thermoforming and blow moulding heated polymer materials are subjected to rapid biaxial deformation as they are drawn into the shape of a mould. In the development of process simulations it is therefore essential to be able to accurately measure and model this behaviour. Conventional uniaxial test methods are generally inadequate for this purpose and this has led to the development of specialised biaxial test rigs. In this paper the results of several programmes of biaxial tests conducted at Queen’s University are presented and discussed. These have included tests on high impact polystyrene (HIPS), polypropylene (PP) and aPET, and the work has involved a wide variety of experimental conditions. In all cases the results clearly demonstrate the unique characteristics of materials when subjected to biaxial deformation. PP draws the highest stresses and it is the most temperature sensitive of the materials. aPET is initially easier to form but exhibits strain hardening at higher strains. This behaviour is increased with increasing strain rate but at very high strain rates these effects are increasingly mollified by adiabatic heating. Both aPET and PP (to a lesser degree) draw much higher stresses in sequential stretching showing that this behaviour must be considered in process simulations. HIPS showed none of these effects and it is the easiest material to deform.

Applying a QSPR correlation to the prediction of surface tensions of ionic liquids

Ionic liquids (ILs) have attracted large amount of interest due to their unique properties. Although large effort has been focused on the investigation of their potential application, characterization of ILs properties and structure–property relationships of ILs are poorly understood. Computer aided molecular design (CAMD) of ionic liquids (ILs) can only be carried if predictive computational methods for the ILs properties are available. The limited availability of experimental data and their quality have been preventing the development of such tools. Based on experimental surface tension data collected from the literature and measured at our laboratory, it is here shown how a quantitative structure–property relationship (QSPR) correlation for parachors can be used along with an estimation method for the densities to predict the surface tensions of ILs. It is shown that a good agreement with literature data is obtained. For circa 40 ionic liquids studied a mean percent deviation (MPD) of 5.75% with a maximum deviation inferior to 16% was observed. A correlation of the surface tensions with the molecular volumes of the ILs was developed for estimation of the surface tensions at room temperature. It is shown that it can describe the experimental data available within a 4.5% deviation. The correlations here developed can thus be used to evaluate the surface tension of ILs for use in process design or in the CAMD of new ionic liquids.

Thermophysical Properties of Amino Acid-Based Ionic Liquids

Ionic liquids (ILs) having either cations or anions derived from naturally occurring amino acids have been synthesized and characterized as amino acid-based ionic liquids (AAILs) In this work, the experimental measurements of the temperature dependence or density. viscosity, heat capacity, and thermal conductivity of several AAILs, namely, tributylmethylammonium serinate ([N-444][Ser], tributylmethylammonium taurmate ([N-444][Tau]) tributylmethylammonium lysinate a [N-444][ Lys]), tributylmethylammonium threonate ([N-444][Thr]), tetrabutylphosphonium serinate ([P-4444][Ser]), tetrabutylphosphonium taurmate ([P-4444][Tau]), tetrabutylphosphonium lysinate ([P-4444][Lys]), tetrabutylphosphonium threonate P-4444 Thr tetrabutylphosphonium prolinate P-4444 ((Pro(), tetrabutylphosphonium valinate ([P-4444][Val]), and tetrabutylphosphonium cysteinate ([P-4444][Cys]), are presented The influence of cations and anions on studied properties is discussed. On the basis of experimental data. the QSPR (quantitative structure property relationship) correlations and group contribution methods for thermophysical properties of AAILs have been developed, which form the basis for the development of the computer-aided molecular design (CAMD) of AAILs It has also been demonstrated that that the predictive data obtained by con elation methods ale in good agreement with the experimental data The correlations developed, herein. can thus be used to evaluate the studied thermophysical properties of AAILs for use in process design or in the CAMD of new AAILs

Extruder Melt Temperature Control with Fuzzy Logic

In polymer extrusion, the delivery of a melt which is homogenous in composition and temperature is paramount for achieving high quality extruded products. However, advancements in process control are required to reduce temperature variations across the melt flow which can result in poor product quality. The majority of thermal monitoring methods provide only low accuracy point/bulk melt temperature measurements and cause poor controller performance. Furthermore, the most common conventional proportional-integral-derivative controllers seem to be incapable of performing well over the nonlinear operating region. This paper presents a model-based fuzzy control approach to reduce the die melt temperature variations across the melt flow while achieving desired average die melt temperature. Simulation results confirm the efficacy of the proposed controller.

Handwritten undergraduate case reports

Background: This article describes a 'back to the future' approach to case 'write-ups', with medical students producing handwritten instead of word-processed case reports during their clinical placements. Word-processed reports had been found to have a number of drawbacks, including the inappropriate use of 'cutting and pasting', undue length and lack of focus. Method: We developed a template to be completed by hand, based on the hospital 'clerking-in process', and matched this to a new assessment proforma. An electronic survey was conducted of both students and assessors after the first year of operation to evaluate impact and utility. Results: The new template was well received by both students and assessors. Most students said they preferred handwriting the case reports (55.6%), although a significant proportion (44.4%) preferred the word processor. Many commented that the template enabled them to effectively learn the structure of a case history and to improve their history-taking skills. Most assessors who had previously marked case reports felt the new system represented an improvement. The average time spent marking each report fell from 23.56 to 16.38minutes using the new proforma. Discussion: Free text comments from the survey have led to the development of a more flexible case report template better suited to certain specialties (e.g. dermatology). This is an evolving process and there will be opportunities for further adaptation as electronic medical records become more common in hospital. © Blackwell Publishing Ltd 2012.

Medical versus surgical interventions for open angle glaucoma.

BACKGROUND: Open angle glaucoma (OAG) is a common cause of blindness.

OBJECTIVES: To assess the effects of medication compared with initial surgery in adults with OAG.

SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2012), EMBASE (January 1980 to August 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to August 2012), Biosciences Information Service (BIOSIS) (January 1969 to August 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to August 2012), OpenGrey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), Zetoc, the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 1 August 2012. The National Research Register (NRR) was last searched in 2007 after which the database was archived. We also checked the reference lists of articles and contacted researchers in the field.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing medications with surgery in adults with OAG.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for missing information.

MAIN RESULTS: Four trials involving 888 participants with previously untreated OAG were included. Surgery was Scheie's procedure in one trial and trabeculectomy in three trials. In three trials, primary medication was usually pilocarpine, in one trial it was a beta-blocker.The most recent trial included participants with on average mild OAG. At five years, the risk of progressive visual field loss, based on a three unit change of a composite visual field score, was not significantly different according to initial medication or initial trabeculectomy (odds ratio (OR) 0.74, 95% confidence interval (CI) 0.54 to 1.01). In an analysis based on mean difference (MD) as a single index of visual field loss, the between treatment group difference in MD was -0.20 decibel (dB) (95% CI -1.31 to 0.91). For a subgroup with more severe glaucoma (MD -10 dB), findings from an exploratory analysis suggest that initial trabeculectomy was associated with marginally less visual field loss at five years than initial medication, (mean difference 0.74 dB (95% CI -0.00 to 1.48). Initial trabeculectomy was associated with lower average intraocular pressure (IOP) (mean difference 2.20 mmHg (95% CI 1.63 to 2.77) but more eye symptoms than medication (P = 0.0053). Beyond five years, visual acuity did not differ according to initial treatment (OR 1.48, 95% CI 0.58 to 3.81).From three trials in more severe OAG, there is some evidence that medication was associated with more progressive visual field loss and 3 to 8 mmHg less IOP lowering than surgery. In the longer-term (two trials) the risk of failure of the randomised treatment was greater with medication than trabeculectomy (OR 3.90, 95% CI 1.60 to 9.53; hazard ratio (HR) 7.27, 95% CI 2.23 to 25.71). Medications and surgery have evolved since these trials were undertaken.In three trials the risk of developing cataract was higher with trabeculectomy (OR 2.69, 95% CI 1.64 to 4.42). Evidence from one trial suggests that, beyond five years, the risk of needing cataract surgery did not differ according to initial treatment policy (OR 0.63, 95% CI 0.15 to 2.62).Methodological weaknesses were identified in all the trials.

AUTHORS' CONCLUSIONS: Primary surgery lowers IOP more than primary medication but is associated with more eye discomfort. One trial suggests that visual field restriction at five years is not significantly different whether initial treatment is medication or trabeculectomy. There is some evidence from two small trials in more severe OAG, that initial medication (pilocarpine, now rarely used as first line medication) is associated with more glaucoma progression than surgery. Beyond five years, there is no evidence of a difference in the need for cataract surgery according to initial treatment.The clinical and cost-effectiveness of contemporary medication (prostaglandin analogues, alpha2-agonists and topical carbonic anhydrase inhibitors) compared with primary surgery is not known.Further RCTs of current medical treatments compared with surgery are required, particularly for people with severe glaucoma and in black ethnic groups. Outcomes should include those reported by patients. Economic evaluations are required to inform treatment policy.

Choosing appropriate patient-reported outcomes instrument for glaucoma research: a systematic review of vision instruments

PURPOSE: To identify vision Patient-Reported Outcomes instruments relevant to glaucoma and assess their content validity.

METHODS: MEDLINE, MEDLINE in Process, EMBASE and SCOPUS (to January 2009) were systematically searched. Observational studies or randomised controlled trials, published in English, reporting use of vision instruments in glaucoma studies involving adults were included. In addition, reference lists were scanned to identify additional studies describing development and/or validation to ascertain the final version of the instruments. Instruments' content was then mapped onto a theoretical framework, the World Health Organization International Classification of Functioning, Disability and Health. Two reviewers independently evaluated studies for inclusion and quality assessed instrument content.

RESULTS: Thirty-three instruments were identified. Instruments were categorised into thirteen vision status, two vision disability, one vision satisfaction, five glaucoma status, one glaucoma medication related to health status, five glaucoma medication side effects and six glaucoma medication satisfaction measures according to each instruments' content. The National Eye Institute Visual Function Questionnaire-25, Impact of Vision Impairment and Treatment Satisfaction Survey-Intraocular Pressure had the highest number of positive ratings in the content validity assessment.

CONCLUSION: This study provides a descriptive catalogue of vision-specific PRO instruments, to inform the choice of an appropriate measure of patient-reported outcomes in a glaucoma context.

A New Principal Curve Algorithm for Nonlinear Principal Component Analysis

This paper emerged from work supported by EPSRC grant GR/S84354/01 and proposes a method of determining principal curves, using spline functions, in principal component analysis (PCA) for the representation of non-linear behaviour in process monitoring. Although principal curves are well established, they are difficult to implement in practice if a large number of variables are analysed. The significant contribution of this paper is that the proposed method has minimal complexity, assuming simple spline geometry, thus enabling efficient computation. The paper provides a foundation for further work where multiple curves may be required to represent underlying non-linear information in complex data.

Drug treatment of macular oedema secondary to central retinal vein occlusion: a network meta-analysis

Objective
To indirectly compare aflibercept, bevacizumab, dexamethasone, ranibizumab and triamcinolone for treatment of macular oedema secondary to central retinal vein occlusion using a network meta-analysis (NMA).

Design
NMA.

Data sources
The following databases were searched from January 2005 to March 2013: MEDLINE, MEDLINE In-process, EMBASE; CDSR, DARE, HTA, NHSEED, CENTRAL; Science Citation Index and Conference Proceedings Citation Index-Science.

Eligibility criteria for selecting studies
Only randomised controlled trials assessing patients with macular oedema secondary to central retinal vein occlusion were included. Studies had to report either proportions of patients gaining ≥3 lines, losing ≥3 lines, or the mean change in best corrected visual acuity. Two authors screened titles and abstracts, extracted data and undertook risk of bias assessment. Bayesian NMA was used to compare the different interventions.

Results
Seven studies, assessing five drugs, were judged to be sufficiently comparable for inclusion in the NMA. For the proportions of patients gaining ≥3 lines, triamcinolone 4 mg, ranibizumab 0.5 mg, bevacizumab 1.25 mg and aflibercept 2 mg had a higher probability of being more effective than sham and dexamethasone. A smaller proportion of patients treated with triamcinolone 4 mg, ranibizumab 0.5 mg or aflibercept 2 mg lost ≥3 lines of vision compared to those treated with sham. Patients treated with triamcinolone 4 mg, ranibizumab 0.5 mg, bevacizumab 1.25 mg and aflibercept 2 mg had a higher probability of improvement in the mean best corrected visual acuity compared to those treated with sham injections.

Conclusions
We found no evidence of differences between ranibizumab, aflibercept, bevacizumab and triamcinolone for improving vision. The antivascular endothelial growth factors (VEGFs) are likely to be favoured because they are not associated with steroid-induced cataract formation. Aflibercept may be preferred by clinicians because it might require fewer injections.

Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review

The purpose is to study the diagnostic performance of optical coherence tomography (OCT) and alternative diagnostic tests for neovascular age-related macular degeneration (nAMD). Methods employed are as follows:systematic review and meta-analysis; Index test: OCT including time-domain (TD-OCT) and the most recently developed spectral domain (SD-OCT); comparator tests: visual acuity, clinical evaluation (slit lamp), Amsler chart, colour fundus photographs, infra-red reflectance, red-free images/blue reflectance, fundus autofluorescence imaging (FAF), indocyanine green angiography (ICGA), preferential hyperacuity perimetry (PHP), and microperimetry; reference standard: fundus fluorescein angiography. Databases searched included MEDLINE, MEDLINE In Process, EMBASE, Biosis, SCI, the Cochrane Library, DARE, MEDION, and HTA database. Last literature searches: March 2013. Risk of bias assessed using QUADAS-2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic (HSROC) curves. Twenty-two studies (2 abstracts and 20 articles) enrolling 2124 participants were identified, reporting TD-OCT (12 studies), SD-OCT (1 study), ICGA (8 studies), PHP (3 studies), Amsler grid, colour fundus photography and FAF (1 study each). Most studies were considered to have a high risk of bias in the patient selection (55%, 11/20), and flow and timing (40%, 8/20) domains. In a meta-analysis of TD-OCT studies, sensitivity and specificity (95% CI) were 88% (46–98%) and 78% (64–88%), respectively. There was insufficient information to undertake meta-analysis for other tests. TD-OCT is a sensitive test for detecting nAMD, although specificity was only moderate. Data on SD-OCT are sparse. Diagnosis of nAMD should not rely solely on OCT.