Progression of age-related geographic atrophy: role of the fellow eye

PURPOSE. To evaluate the role of fellow eye status in determining progression of geographic atrophy (GA) in patients with age-related macular degeneration (AMD). METHODS. A total of 300 eyes with GA of 193 patients from the prospective, longitudinal, natural history FAM Study were classified into three groups according to the AMD manifestation in the fellow eye at baseline examination: (1) bilateral GA, (2) early/intermediate AMD, and (3) exudative AMD. GA areas were quantified based on fundus autofluorescence images using a semiautomated image-processing method, and progression rates (PR) were estimated using two-level, linear, mixed-effects models. RESULTS. Crude GA-PR in the bilateral GA group (mean, 1.64 mm(2)/y; 95% CI, 1.478-1.803) was significantly higher than in the fellow eye early/intermediate group (0.74 mm(2)/y, 0.146-1.342). Although there was a significant difference in baseline GA size (P = 0.0013, t-test), and there was a significant increase in GA-PR by 0.11 mm(2)/y (0.05-0.17) per 1 disc area (DA; 2.54 mm(2)), an additional mean change of -0.79 (-1.43 to -0.15) was given to the PR beside the effect of baseline GA size. However, this difference was only significant when GA size was ?1 DA at baseline with a GA-PR of 1.70 mm(2)/y (1.54-1.85) in the bilateral and 0.95 mm(2)/y (0.37-1.54) in the early/intermediate group. There was no significant difference in PR compared with that in the fellow eye exudative group. CONCLUSIONS. The results indicate that the AMD manifestation of the fellow eye at baseline serves as an indicator for disease progression in eyes with GA ? 1 DA. Predictive characteristics not only contribute to the understanding of pathophysiological mechanisms, but also are useful for the design of future interventional trials in GA patients.

The Optimal Confidence Region for a Random Parameter

Under a two-level hierarchical model, suppose that the distribution of the random parameter is known or can be estimated well. Data are generated via a fixed, but unobservable realization of this parameter. In this paper, we derive the smallest confidence region of the random parameter under a joint Bayesian/frequentist paradigm. On average this optimal region can be much smaller than the corresponding Bayesian highest posterior density region. The new estimation procedure is appealing when one deals with data generated under a highly parallel structure, for example, data from a trial with a large number of clinical centers involved or genome-wide gene-expession data for estimating individual gene- or center-specific parameters simultaneously. The new proposal is illustrated with a typical microarray data set and its performance is examined via a small simulation study.

Excision of high and mid cervical spinal cord arteriovenous malformations by anterior operation

Symptomatic cervical spinal arteriovenous malformations (AVMs) located on the anterior aspect of the spinal cord are rare and surgical removal of these AVMs presents considerable challenges and risks. Surgical techniques to date have usually been by posterior approach and lateral dissection around the cord or via midline myelotomy, both approaches involving cord manipulation and retraction and in the latter, dissection through the spinal cord. We present two teenage patients with symptomatic anteriorly placed mid to high cervical spinal AVMs and associated aneurysm in which excision of the AVMs and aneurysm was performed by an anterior approach using vertebrectomy/corpectomy. The first case had a small perimedullary glomus-type AVM with an aneurysm on the anterior aspect of the cord at the C3/4 level; excision was performed using a single level vertebrectomy/corpectomy, the patient remaining neurologically intact. The second case had a medium-sized juvenile AVM with an aneurysm, both perimedullary and intramedullary, centred at the C5/6 level; excision was performed using a two-level vertebrectomy/corpectomy with no deterioration in the marked pre-operative tetraparesis, which at long-term follow up had improved and stabilised. Anterior approaches have been recently described for treatment of anteriorly placed cervical arteriovenous fistulas (AVFs) and an intramedullary haemangioblastoma, but not as yet for spinal AVMs. These are the first two reported cases of anteriorly situated cervical AVMs successfully removed surgically by an anterior approach and with good neurological outcomes.

Mathematical analysis for perceived annoyance of impulsive sounds in terms of physical factors

From the customer satisfaction point of view, sound quality of any product has become one of the important factors these days. The primary objective of this research is to determine factors which affect the acceptability of impulse noise. Though the analysis is based on a sample impulse sound file of a Commercial printer, the results can be applied to other similar impulsive noise. It is assumed that impulsive noise can be tuned to meet the accepTable criteria. Thus it is necessary to find the most significant factors which can be controlled physically. This analysis is based on a single impulse. A sample impulsive sound file is tweaked for different amplitudes, background noise, attack time, release time and the spectral content. A two level factorial design of experiments (DOE) is applied to study the significant effects and interactions. For each impulse file modified as per the DOE, the magnitude of perceived annoyance is calculated from the objective metric developed recently at Michigan Technological University. This metric is based on psychoacoustic criteria such as loudness, sharpness, roughness and loudness based impulsiveness. Software called ‘Artemis V11.2’ developed by HEAD Acoustics is used to calculate these psychoacoustic terms. As a result of two level factorial analyses, a new objective model of perceived annoyance is developed in terms of above mentioned physical parameters such as amplitudes, background noise, impulse attack time, impulse release time and the spectral content. Also the effects of the significant individual factors as well as two level interactions are also studied. The results show that all the mentioned five factors affect annoyance level of an impulsive sound significantly. Thus annoyance level can be reduced under the criteria by optimizing the levels. Also, an additional analysis is done to study the effect of these five significant parameters on the individual psychoacoustic metrics.

Effects of depressive symptoms on antecedents of lapses during a smoking cessation attempt: an ecological momentary assessment study

AIMS: To investigate pathways through which momentary negative affect and depressive symptoms affect risk of lapse during smoking cessation attempts. DESIGN: Ecological momentary assessment was carried out during 2 weeks after an unassisted smoking cessation attempt. A 3-month follow-up measured smoking frequency. SETTING: Data were collected via mobile devices in German-speaking Switzerland. PARTICIPANTS: A total of 242 individuals (age 20-40, 67% men) reported 7112 observations. MEASUREMENTS: Online surveys assessed baseline depressive symptoms and nicotine dependence. Real-time data on negative affect, physical withdrawal symptoms, urge to smoke, abstinence-related self-efficacy and lapses. FINDINGS: A two-level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self-efficacy (β = 0.20; β = -0.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (β = 0.09) and lower self-efficacy (β = -0.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person's average negative affect (β = 0.35, all P < 0.001). However, the baseline characteristics influenced smoking frequency 3 months later only indirectly, through influences of average states on the number of lapses during the quit attempt. CONCLUSIONS: Controlling for nicotine dependence, higher depressive symptoms at baseline were associated strongly with a worse longer-term outcome. Negative affect experienced during the quit attempt was the only pathway through which the baseline depressive symptoms were associated with a reduced self-efficacy and increased urges to smoke, all leading to the increased probability of lapses.

What is the influence of randomisation sequence generation and allocation concealment on treatment effects of physical therapy trials? A meta-epidemiological study.

OBJECTIVE To determine if adequacy of randomisation and allocation concealment is associated with changes in effect sizes (ES) when comparing physical therapy (PT) trials with and without these methodological characteristics. DESIGN Meta-epidemiological study. PARTICIPANTS A random sample of randomised controlled trials (RCTs) included in meta-analyses in the PT discipline were identified. INTERVENTION Data extraction including assessments of random sequence generation and allocation concealment was conducted independently by two reviewers. To determine the association between sequence generation, and allocation concealment and ES, a two-level analysis was conducted using a meta-meta-analytic approach. PRIMARY AND SECONDARY OUTCOME MEASURES association between random sequence generation and allocation concealment and ES in PT trials. RESULTS 393 trials included in 43 meta-analyses, analysing 44 622 patients contributed to this study. Adequate random sequence generation and appropriate allocation concealment were accomplished in only 39.7% and 11.5% of PT trials, respectively. Although trials with inappropriate allocation concealment tended to have an overestimate treatment effect when compared with trials with adequate concealment of allocation, the difference was non-statistically significant (ES=0.12; 95% CI -0.06 to 0.30). When pooling our results with those of Nuesch et al, we obtained a pooled statistically significant value (ES=0.14; 95% CI 0.02 to 0.26). There was no difference in ES in trials with appropriate or inappropriate random sequence generation (ES=0.02; 95% CI -0.12 to 0.15). CONCLUSIONS Our results suggest that when evaluating risk of bias of primary RCTs in PT area, systematic reviewers and clinicians implementing research into practice should pay attention to these biases since they could exaggerate treatment effects. Systematic reviewers should perform sensitivity analysis including trials with low risk of bias in these domains as primary analysis and/or in combination with less restrictive analyses. Authors and editors should make sure that allocation concealment and random sequence generation are properly reported in trial reports.

The association of area socioeconomic status and cancer screening: A systematic review and multilevel study

Background. The gap between actual and ideal rates of routine cancer screening in the U.S., particularly for colorectal cancer screening (CRCS) (1;2), is responsible for an unnecessary burden of morbidity and mortality, particularly for disadvantaged groups. Knowledge about the effects of individual and area influences is being advanced by a growing body of research that has examined the association of area socioeconomic status (SES) and cancer screening after controlling for individual SES. The findings from this emerging and heterogeneous research in the cancer screening literature have been mixed. Moreover, multilevel studies in this area have not yet adequately explored the possibility of differential associations by population subgroup, despite some evidence suggesting gender-specific effects. ^ Objectives and methods. This dissertation reports on a systematic review of studies on the association of area SES and cancer screening and a multilevel study of the association between area SES and CRCS. The specific aims of the systematic review are to: (1) describe the study designs, constructs, methods, and measures; (2) describe the association of area SES and cancer screening; and (3) identify neglected areas of research. ^ The empiric study linked a pooled sample of respondents aged ≥50 years without a personal history of colorectal cancer from the 2003 and 2005 California Health Interview Surveys with a comprehensive set of census-tract level area SES measures from the 2000 U.S. Census. Two-level random intercept models were used to test 2 hypotheses: (1) area SES will be associated with adherence to two modalities of CRCS after controlling for individual SES; and (2) gender will moderate the relationship between area socioeconomic status and adherence to both modalities of CRCS. ^ Results. The systematic review identified 19 eligible studies that demonstrated variability in study designs, methods, constructs, and measures. The majority of tested associations were either not statistically significant or significant and in the positive direction, indicating that as area SES increased, the odds of CRCS increased. The multilevel study demonstrated that while multiple aspects of area SES were associated with CRCS after controlling for individual SES, associations differed by screening modality and in the case of endoscopy, they also differed by gender. ^ Conclusions. Conceptual and methodologic heterogeneity and weaknesses in the literature to date limit definitive conclusions about the underlying relationships between area SES and cancer screening. The multilevel study provided partial support for both hypotheses. Future research should continue to explore the role of gender as a moderating influence with the aim of identifying the mechanisms linking area SES and cancer prevention behaviors. ^

Concentration profiles in batch fermentation of hydrolyzed lignocellulose

Experimental data was obtained for profiling changes in concentrations of two inhibiting compounds in batch fermentation of a synthesized liquor resembling hydrolyzed lignocellulose, a furan (furfural) and a phenolic compound (vanillin), along with standard fermentation data, i.e. substrate, biomass and ethanol concentrations. The initial inhibitor concentrations and fermentation temperatures in the 18 experiments were varied according to a two-level complete center composite experimental design. Based upon these observed variations in the fermentative behavior, the fermentation kinetics were modeled, as published in the corresponding article, including microbial conversion rates of the inhibitive compounds into their less toxic derivatives.

Adaptive Multi-Camera System for Real Time Object Detection

In this paper we present an adaptive multi-camera system for real time object detection able to efficiently adjust the computational requirements of video processing blocks to the available processing power and the activity of the scene. The system is based on a two level adaptation strategy that works at local and at global level. Object detection is based on a Gaussian mixtures model background subtraction algorithm. Results show that the system can efficiently adapt the algorithm parameters without a significant loss in the detection accuracy.

Memory performance of and-parallel prolog on shared-memory architectures

The goal of the RAP-WAM AND-parallel Prolog abstract architecture is to provide inference speeds significantly beyond those of sequential systems, while supporting Prolog semantics and preserving sequential performance and storage efficiency. This paper presents simulation results supporting these claims with special emphasis on memory performance on a two-level sharedmemory multiprocessor organization. Several solutions to the cache coherency problem are analyzed. It is shown that RAP-WAM offers good locality and storage efficiency and that it can effectively take advantage of broadcast caches. It is argued that speeds in excess of 2 ML IPS on real applications exhibiting medium parallelism can be attained with current technology.

Adapting mode switches into the hierarchical scheduling

Mode switches are used to partition the system’s behavior into different modes to reduce the complexity of large embedded systems. Such systems operate in multiple modes in which each one corresponds to a specific application scenario; these are called Multi-Mode Systems (MMS). A different piece of software is normally executed for each mode. At any given time, the system can be in one of the predefined modes and then be switched to another as a result of a certain condition. A mode switch mechanism (or mode change protocol) is used to shift the system from one mode to another at run-time. In this thesis we have used a hierarchical scheduling framework to implement a multi-mode system called Multi-Mode Hierarchical Scheduling Framework (MMHSF). A two-level Hierarchical Scheduling Framework (HSF) has already been implemented in an open source real-time operating system, FreeRTOS, to support temporal isolation among real-time components. The main contribution of this thesis is the extension of the HSF featuring a multimode feature with an emphasis on making minimal changes in the underlying operating system (FreeRTOS) and its HSF implementation. Our implementation uses fixed-priority preemptive scheduling at both local and global scheduling levels and idling periodic servers. It also now supports different modes of the system which can be switched at run-time. Each subsystem and task exhibit different timing attributes according to mode, and upon a Mode Change Request (MCR) the task-set and timing interfaces of the entire system (including subsystems and tasks) undergo a change. A Mode Change Protocol specifies precisely how the system-mode will be changed. However, an application may not only need to change a mode but also a different mode change protocol semantic. For example, the mode change from normal to shutdown can allow all the tasks to be completed before the mode itself is changed, while changing a mode from normal to emergency may require aborting all tasks instantly. In our work, both the system mode and the mode change protocol can be changed at run-time. We have implemented three different mode change protocols to switch from one mode to another: the Suspend/resume protocol, the Abort protocol, and the Complete protocol. These protocols increase the flexibility of the system, allowing users to select the way they want to switch to a new mode. The implementation of MMHSF is tested and evaluated on an AVR-based 32 bit board EVK1100 with an AVR32UC3A0512 micro-controller. We have tested the behavior of each system mode and for each mode change protocol. We also provide the results for the performance measures of all mode change protocols in the thesis. RESUMEN Los conmutadores de modo son usados para particionar el comportamiento del sistema en diferentes modos, reduciendo así la complejidad de grandes sistemas empotrados. Estos sistemas tienen multiples modos de operación, cada uno de ellos correspondiente a distintos escenarios y para distintas aplicaciones; son llamados Sistemas Multimodales (o en inglés “Multi-Mode Systems” o MMS). Normalmente cada modo ejecuta una parte de código distinto. En un momento dado el sistema, que está en un modo concreto, puede ser cambiado a otro modo distinto como resultado de alguna condicion impuesta previamente. Los mecanismos de cambio de modo (o protocolos de cambio de modo) son usados para mover el sistema de un modo a otro durante el tiempo de ejecución. En este trabajo se ha usado un modelo de sistema operativo para implementar un sistema multimodo llamado MMHSF, siglas en inglés correspondientes a (Multi-Mode Hierarchical Scheduling Framework). Este sistema está basado en el HSF (Hierarchical Scheduling Framework), un modelo de sistema operativo con jerarquía de dos niveles, implementado en un sistema operativo en tiempo real de libre distribución llamado FreeRTOS, capaz de permitir el aislamiento temporal entre componentes. La principal contribución de este trabajo es la ampliación del HSF convirtiendolo en un sistema multimodo realizando los cambios mínimos necesarios sobre el sistema operativo FreeRTOS y la implementación ya existente del HSF. Esta implementación usa un sistema de planificación de prioridad fija para ambos niveles de jerarquía, ocupando el tiempo entre tareas con un “modo reposo”. Además el sistema es capaz de cambiar de un modo a otro en tiempo de ejecución. Cada subsistema y tarea son capaces de tener distintos atributos de tiempo (prioridad, periodo y tiempo de ejecución) en función del modo. Bajo una demanda de cambio de modo (Mode Change Request MCR) se puede variar el set de tareas en ejecución, así como los atributos de los servidores y las tareas. Un protocolo de cambio de modo espeficica precisamente cómo será cambiado el sistema de un modo a otro. Sin embargo una aplicación puede requerir no solo un cambio de modo, sino que lo haga de una forma especifica. Por ejemplo, el cambio de modo de “normal” a “apagado” puede permitir a las tareas en ejecución ser finalizadas antes de que se complete la transición, pero sin embargo el cambio de “normal” a “emergencia” puede requerir abortar todas las tareas instantaneamente. En este trabajo ambas características, tanto el modo como el protocolo de cambio, pueden ser cambiadas en tiempo de ejecución, pero deben ser previamente definidas por el desarrollador. Han sido definidos tres protocolos de cambios: el protocolo “suspender/continuar”, protocolo “abortar” y el protocolo “completar”. Estos protocolos incrementan la flexibilidad del sistema, permitiendo al usuario seleccionar de que forma quieren cambiar hacia el nuevo modo. La implementación del MMHSF ha sido testada y evaluada en una placa AVR EVK1100, con un micro-controlador AVR32UC3A0. Se ha comprobado el comportamiento de los distintos modos para los distintos protocolos, definidos previamente. Como resultado se proporcionan las medidades de rendimiento de los distintos protocolos de cambio de modo.

A management model for closed-loop supply chains of reusable articles

This PhD dissertation is framed in the emergent fields of Reverse Logistics and ClosedLoop Supply Chain (CLSC) management. This subarea of supply chain management has gained researchers and practitioners' attention over the last 15 years to become a fully recognized subdiscipline of the Operations Management field. More specifically, among all the activities that are included within the CLSC area, the focus of this dissertation is centered in direct reuse aspects. The main contribution of this dissertation to current knowledge is twofold. First, a framework for the so-called reuse CLSC is developed. This conceptual model is grounded in a set of six case studies conducted by the author in real industrial settings. The model has also been contrasted with existing literature and with academic and professional experts on the topic as well. The framework encompasses four building blocks. In the first block, a typology for reusable articles is put forward, distinguishing between Returnable Transport Items (RTI), Reusable Packaging Materials (RPM), and Reusable Products (RP). In the second block, the common characteristics that render reuse CLSC difficult to manage from a logistical standpoint are identified, namely: fleet shrinkage, significant investment and limited visibility. In the third block, the main problems arising in the management of reuse CLSC are analyzed, such as: (1) define fleet size dimension, (2) control cycle time and promote articles rotation, (3) control return rate and prevent shrinkage, (4) define purchase policies for new articles, (5) plan and control reconditioning activities, and (6) balance inventory between depots. Finally, in the fourth block some solutions to those issues are developed. Firstly, problems (2) and (3) are addressed through the comparative analysis of alternative strategies for controlling cycle time and return rate. Secondly, a methodology for calculating the required fleet size is elaborated (problem (1)). This methodology is valid for different configurations of the physical flows in the reuse CLSC. Likewise, some directions are pointed out for further development of a similar method for defining purchase policies for new articles (problem (4)). The second main contribution of this dissertation is embedded in the solutions part (block 4) of the conceptual framework and comprises a two-level decision problem integrating two mixed integer linear programming (MILP) models that have been formulated and solved to optimality using AIMMS as modeling language, CPLEX as solver and Excel spreadsheet for data introduction and output presentation. The results obtained are analyzed in order to measure in a client-supplier system the economic impact of two alternative control strategies (recovery policies) in the context of reuse. In addition, the models support decision-making regarding the selection of the appropriate recovery policy against the characteristics of demand pattern and the structure of the relevant costs in the system. The triangulation of methods used in this thesis has enabled to address the same research topic with different approaches and thus, the robustness of the results obtained is strengthened.

Spectral diffusion and the energy landscape of a protein

We present a novel type of spectral diffusion experiment in the millikelvin range to characterize the energy landscape of a protein as compared with that of a glass. We measure the time evolution of spectral holes for more than 300 hr after well-defined initial nonequilibrium conditions. We show that the model of noninteracting two-level systems can describe spectral diffusion in the glass, but fails for the protein. Our results further demonstrate that randomness in the energy landscape of a protein shows features of organization. There are “deep minimum” states separated by barriers, the heights of which we are able to estimate. The energy landscape of a glass is featureless by comparison.

Chinese Intellectuals and China`s Policy toward Japan

This dissertation aims at integrating two scholarships: state-society relation studies and Chinese foreign policy analysis. I created Two-level Perception Gap Model to analyze different intellectual groups' relations with party-state by confirming Chinese intellectuals play a role in CFP making in general, China's Japan policy in particular. This model is an alternative approach, instead of conventional wisdom patron-client approach, to explain and analyze the pluralized intellectual-state relations in China. This model first analyzed the role of two intellectual groups, namely think tank scholars and popular nationalist, in China's Japan policy making, and then based on these analyses it explains the interactional patterns between these two intellectual groups and party-state. I used three case studies, which represented different types of issue, Chinese attitude toward the U.S.-Japan alliance and the Japanese defense policy, the controversy over the Yasukuni Shrine Visit, and the territorial dispute over the Diaoyu/Senkaku Islands, to examine this model. First, I examined think tank scholar groups and the extent they influenced "core interest issue and sensitive issue (Issue 1)," Chinese attitude toward the U.S.-Japan alliance and the Japanese defense policy, and their international patterns with party-state. Chapter 3 compares the responses of Chinese officials to the changes in the defense policy of Japan to the analyses from the think tank scholars. As the model assumes, results show that think tank scholars' analyses are consistent with China's policy position; nevertheless, it is difficult to confirm their analyses have influence on Chinese attitude toward the U.S.-Japan alliance and the Japanese defense policy. Based on the analysis of journal articles, most articles do not provide policy suggestions or simply provide suggestions that do not deviate from the policy. As Gu's theory of pluralist institutionalism and my hypothesis points out, most think tank scholars are establishment intellectuals so they tend to be self-disciplined. Second, this model provide a new concept "patriotic dilemma" for analyzing the challenge and constraints brought by popular nationalist discourses and public mobilization to Chinese foreign policy decision makers. Chapter 4 investigated the cases study of the controversy over the Yasukuni Shrine Visit, defined as "major/minor interest issue/ sensitive issue (Issue 3)," and the discourses from the popular nationalist, mainly focusing on anti-Japanese activists. The chapter also observes their influence on nationalist public opinions and analyzes how the nationalist public opinions constrain the policy choices among decision makers. Results strongly supported the hypothesis of patriotic dilemma that, although the popular nationalist group and public opinions constrained the policy choices of Chinese decision makers in the short term, they were unable to change the fundamental policy direction. Third, chapter 5 also focuses on anti-Japanese activists and examines the model with the case of the territorial dispute over the Diaoyu/Senkaku Islands. The result supported that hypothesis that China's policy change was not because of the influence from popular nationalist's discourses or public opinions but because of the change of priority of this issue, from major/minor interest issue to core interest issue. These two chapters also indicate that the patron-client model is unable to describe the popular nationalist. An alternative approach, such as the concept "patriotic dilemma" is needed to describe the relations between the popular nationalist and the government.