Benchmarking therapeutic drug monitoring software: A systematic evaluation of available computer tools

Introduction: Therapeutic drug monitoring (TDM) aims at optimizing treatment by individualizing dosage regimen based on measurement of blood concentrations. Maintaining concentrations within a target range requires pharmacokinetic and clinical capabilities. Bayesian calculation represents a gold standard in TDM approach but requires computing assistance. In the last decades computer programs have been developed to assist clinicians in this assignment. The aim of this benchmarking was to assess and compare computer tools designed to support TDM clinical activities.¦Method: Literature and Internet search was performed to identify software. All programs were tested on common personal computer. Each program was scored against a standardized grid covering pharmacokinetic relevance, user-friendliness, computing aspects, interfacing, and storage. A weighting factor was applied to each criterion of the grid to consider its relative importance. To assess the robustness of the software, six representative clinical vignettes were also processed through all of them.¦Results: 12 software tools were identified, tested and ranked. It represents a comprehensive review of the available software's characteristics. Numbers of drugs handled vary widely and 8 programs offer the ability to the user to add its own drug model. 10 computer programs are able to compute Bayesian dosage adaptation based on a blood concentration (a posteriori adjustment) while 9 are also able to suggest a priori dosage regimen (prior to any blood concentration measurement), based on individual patient covariates, such as age, gender, weight. Among those applying Bayesian analysis, one uses the non-parametric approach. The top 2 software emerging from this benchmark are MwPharm and TCIWorks. Other programs evaluated have also a good potential but are less sophisticated (e.g. in terms of storage or report generation) or less user-friendly.¦Conclusion: Whereas 2 integrated programs are at the top of the ranked listed, such complex tools would possibly not fit all institutions, and each software tool must be regarded with respect to individual needs of hospitals or clinicians. Interest in computing tool to support therapeutic monitoring is still growing. Although developers put efforts into it the last years, there is still room for improvement, especially in terms of institutional information system interfacing, user-friendliness, capacity of data storage and report generation.

Benchmarking therapeutic drug monitoring software: A systematic evaluation of available computer tools

Objectives: Therapeutic drug monitoring (TDM) aims at optimizing treatment by individualizing dosage regimen based on blood concentrations measurement. Maintaining concentrations within a target range requires pharmacokinetic (PK) and clinical capabilities. Bayesian calculation represents a gold standard in TDM approach but requires computing assistance. The aim of this benchmarking was to assess and compare computer tools designed to support TDM clinical activities.¦Methods: Literature and Internet were searched to identify software. Each program was scored against a standardized grid covering pharmacokinetic relevance, user-friendliness, computing aspects, interfacing, and storage. A weighting factor was applied to each criterion of the grid to consider its relative importance. To assess the robustness of the software, six representative clinical vignettes were also processed through all of them.¦Results: 12 software tools were identified, tested and ranked. It represents a comprehensive review of the available software characteristics. Numbers of drugs handled vary from 2 to more than 180, and integration of different population types is available for some programs. Nevertheless, 8 programs offer the ability to add new drug models based on population PK data. 10 computer tools incorporate Bayesian computation to predict dosage regimen (individual parameters are calculated based on population PK models). All of them are able to compute Bayesian a posteriori dosage adaptation based on a blood concentration while 9 are also able to suggest a priori dosage regimen, only based on individual patient covariates. Among those applying Bayesian analysis, MM-USC*PACK uses a non-parametric approach. The top 2 programs emerging from this benchmark are MwPharm and TCIWorks. Others programs evaluated have also a good potential but are less sophisticated or less user-friendly.¦Conclusions: Whereas 2 software packages are ranked at the top of the list, such complex tools would possibly not fit all institutions, and each program must be regarded with respect to individual needs of hospitals or clinicians. Programs should be easy and fast for routine activities, including for non-experienced users. Although interest in TDM tools is growing and efforts were put into it in the last years, there is still room for improvement, especially in terms of institutional information system interfacing, user-friendliness, capability of data storage and automated report generation.

Performance anxiety : cardiorespiratory activity in high- and low-anxious professional music students in a performance situation

Questionnaire studies indicate that high-anxious musicians may suffer from hyperventilation symptoms before and/or during performance. Reported symptoms include amongst others shortness of breath, fast or deep breathing, dizziness and thumping heart. A self-report study by Widmer, Conway, Cohen and Davies (1997) shows that up to seventy percent of the tested highly anxious musicians are hyperventilators during performance. However, no study has yet tested if these self-reported symptoms reflect actual cardiorespiratory changes just before and during performance. Disturbances in breathing patterns and hyperventilation may negatively affect the performance quality in stressful performance situations. The main goal of this study is to determine if music performance anxiety is manifest physiologically in specific correlates of cardiorespiratory activity. We studied 74 professional music students of Swiss Music Universities divided into two groups (high- and lowanxious) based on their self-reported performance anxiety (State-Trait Anxiety Inventory by Spielberger). The students were tested in three distinct situations: baseline, performance without audience, performance with audience. We measured a) breathing patterns, end-tidal carbon dioxide, which is a good non-invasive estimator for hyperventilation, and cardiac activation and b) self-perceived emotions and self-perceived physiological activation. Analyses of heart rate, respiratory rate, self-perceived palpitations, self-perceived shortness of breath and self-perceived anxiety for the 15 most and the 15 least anxious musicians show that high-anxious and low-anxious music students have a comparable physiological activation during the different measurement periods. However, highanxious music students feel significantly more anxious and perceive significantly stronger palpitations and significantly stronger shortness of breath just before and during a public performance. The results indicate that low- and high-anxious music students a) do not differ in the considered physiological responses and b) differ in the considered self-perceived physiological symptoms and the selfreported anxiety before and/or during a public performance.

Experimental analysis and computer prediction of CTF/NFI transcription factor DNA binding sites.

Accurate prediction of transcription factor binding sites is needed to unravel the function and regulation of genes discovered in genome sequencing projects. To evaluate current computer prediction tools, we have begun a systematic study of the sequence-specific DNA-binding of a transcription factor belonging to the CTF/NFI family. Using a systematic collection of rationally designed oligonucleotides combined with an in vitro DNA binding assay, we found that the sequence specificity of this protein cannot be represented by a simple consensus sequence or weight matrix. For instance, CTF/NFI uses a flexible DNA binding mode that allows for variations of the binding site length. From the experimental data, we derived a novel prediction method using a generalised profile as a binding site predictor. Experimental evaluation of the generalised profile indicated that it accurately predicts the binding affinity of the transcription factor to natural or synthetic DNA sequences. Furthermore, the in vitro measured binding affinities of a subset of oligonucleotides were found to correlate with their transcriptional activities in transfected cells. The combined computational-experimental approach exemplified in this work thus resulted in an accurate prediction method for CTF/NFI binding sites potentially functioning as regulatory regions in vivo.

Data Acquisition and Computer Plotting of Delamtect Data, HR-269, 1985

The overall system is designed to permit automatic collection of delamination field data for bridge decks. In addition to measuring and recording the data in the field, the system provides for transferring the recorded data to a personal computer for processing and plotting. This permits rapid turnaround from data collection to a finished plot of the results in a fraction of the time previously required for manual analysis of the analog data captured on a strip chart recorder. In normal operation the Delamtect provides an analog voltage for each of two channels which is proportional to the extent of any delamination. These voltages are recorded on a strip chart for later visual analysis. An event marker voltage, produced by a momentary push button on the handle, is also provided by the Delamtect and recorded on a third channel of the analog recorder.

Aufftrittsangst : kardiorespiratorische Aktivität bei ängstlichen und nichtängstlichen Musikstudenten in einer Auftrittssituation = Performance anxiety : cardiorespiratory activity in high- and low-anxious professional music students in a performance situation

Fragebogenstudien haben gezeigt, dass ängstliche Musiker vor und/oder während eines Auftritts möglicherweise unter Hyperventilationssymptomen leiden. Berichtete Symptome beinhalten Kurzatmigkeit, schnelles oder tiefes Einatmen, Schwindelgefühl und Herzklopfen. Bisher hat jedoch noch keine Studie getestet, ob diese selbstberichteten Symptome tatsächlich kardiorespiratorische Veränderungen widerspiegeln. Das Hauptziel dieser Studie ist es, zu bestimmen, ob sich Auftrittsangst bei Musikern physiologisch über kardiorespiratorische Muster äußert. Wir haben insgesamt 74 Musikstudenten von Schweizer Musikhochschulen getestet. Diese Studenten wurden aufgrund ihrer selbstberichteten Auftrittsangst (STAI-S) in zwei Gruppen unterteilt: ängstliche Musiker und nichtängstliche Musiker. Die Studenten wurden in drei unterschiedlichen Situationen getestet: Ausgangszustand, Auftritt ohne Publikum, Auftritt mit Publikum. Wir haben folgende Parameter gemessen: a) kardiorespiratorische Muster und endexpiratorisches CO2, welches eine gute nichtinvasive Schätzung des Hyperventilationsgrades liefert und b) subjektiv wahrgenommene Emotionen und subjektiv wahrgenommene physiologische Aktivität. Das Poster zeigt die ersten Resultate der 15 ängstlichsten und der 15 am wenigsten ängstlichen Musiker. Das Hauptinteresse gilt den folgenden Punkten: Herz- und Atemfrequenz, subjektiv wahrgenommenes Herzklopfen, subjektiv wahrgenommene Kurzatmigkeit und subjektiv wahrgenommenes Angstgefühl. Die Resultate dieser Studie zeigen erstens, dass ängstliche und nichtängstliche Musikstudenten zu den verschiedenen Messzeitpunkten eine vergleichbare physiologische Aktivität aufweisen und zweitens, dass ängstliche Musikstudenten ein signifikant höheres Angstgefühl haben und signifikant mehr Herzklopfen und Kurzatmigkeit wahrnehmen vor und/oder während eines Auftritts mit Publikum. Dies deutet darauf hin, dass sich ängstliche und nichtängstliche Musikstudenten a) bezüglich der subjektiv wahrgenommenen physiologischen Symptome und des selbst berichteten Angstgefühls vor und/oder während eines öffentlichen Auftritts unterscheiden und sich b) bezüglich der untersuchten physiologischen Reaktionen nicht unterscheiden.

Consumer Advisory: The Drive to Destroy: Removing data from computer hard drives, storage devices & wireless phones, June 2014

The Attorney General’s Consumer Protection Division receives hundreds of calls and consumer complaints every year. Follow these tips to avoid unexpected expense and disappointments. This record is about: The Drive to Destroy: Removing data from computer hard drives, storage devices & wireless phones

Micro-Computer Based Linear Scheduling Application for Highway Construction Project Control, HR-339A, 1995

This report describes a new approach to the problem of scheduling highway construction type projects. The technique can accurately model linear activities and identify the controlling activity path on a linear schedule. Current scheduling practices are unable to accomplish these two tasks with any accuracy for linear activities, leaving planners and manager suspicious of the information they provide. Basic linear scheduling is not a new technique, and many attempts have been made to apply it to various types of work in the past. However, the technique has never been widely used because of the lack of an analytical approach to activity relationships and development of an analytical approach to determining controlling activities. The Linear Scheduling Model (LSM) developed in this report, completes the linear scheduling technique by adding to linear scheduling all of the analytical capabilities, including computer applications, present in CPM scheduling today. The LSM has tremendous potential, and will likely have a significant impact on the way linear construction is scheduled in the future.