Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.

RATIONALE: Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these infections. OBJECTIVES: We developed a decision modeling framework to assess the potential cost-effectiveness of a rapid biomarker assay to identify hospital-acquired infection in high-risk patients earlier than standard diagnostic testing. METHODS: The framework includes parameters representing rates of infection, rates of delayed appropriate therapy, and impact of delayed therapy on mortality, along with assumptions about diagnostic test characteristics and their impact on delayed therapy and length of stay. Parameter estimates were based on contemporary, published studies and supplemented with data from a four-site, observational, clinical study. Extensive sensitivity analyses were performed. The base-case analysis assumed 17.6% of ventilated patients and 11.2% of nonventilated patients develop hospital-acquired infection and that 28.7% of patients with hospital-acquired infection experience delays in appropriate antibiotic therapy with standard care. We assumed this percentage decreased by 50% (to 14.4%) among patients with true-positive results and increased by 50% (to 43.1%) among patients with false-negative results using a hypothetical biomarker assay. Cost of testing was set at $110/d. MEASUREMENTS AND MAIN RESULTS: In the base-case analysis, among ventilated patients, daily diagnostic testing starting on admission reduced inpatient mortality from 12.3 to 11.9% and increased mean costs by $1,640 per patient, resulting in an incremental cost-effectiveness ratio of $21,389 per life-year saved. Among nonventilated patients, inpatient mortality decreased from 7.3 to 7.1% and costs increased by $1,381 with diagnostic testing. The resulting incremental cost-effectiveness ratio was $42,325 per life-year saved. Threshold analyses revealed the probabilities of developing hospital-acquired infection in ventilated and nonventilated patients could be as low as 8.4 and 9.8%, respectively, to maintain incremental cost-effectiveness ratios less than $50,000 per life-year saved. CONCLUSIONS: Development and use of serial diagnostic testing that reduces the proportion of patients with delays in appropriate antibiotic therapy for hospital-acquired infections could reduce inpatient mortality. The model presented here offers a cost-effectiveness framework for future test development.

Changes in Brain Resting-state Functional Connectivity Associated with Peripheral Nerve Block: A Pilot Study.

BACKGROUND: Limited information exists on the effects of temporary functional deafferentation (TFD) on brain activity after peripheral nerve block (PNB) in healthy humans. Increasingly, resting-state functional connectivity (RSFC) is being used to study brain activity and organization. The purpose of this study was to test the hypothesis that TFD through PNB will influence changes in RSFC plasticity in central sensorimotor functional brain networks in healthy human participants. METHODS: The authors achieved TFD using a supraclavicular PNB model with 10 healthy human participants undergoing functional connectivity magnetic resonance imaging before PNB, during active PNB, and during PNB recovery. RSFC differences among study conditions were determined by multiple-comparison-corrected (false discovery rate-corrected P value less than 0.05) random-effects, between-condition, and seed-to-voxel analyses using the left and right manual motor regions. RESULTS: The results of this pilot study demonstrated disruption of interhemispheric left-to-right manual motor region RSFC (e.g., mean Fisher-transformed z [effect size] at pre-PNB 1.05 vs. 0.55 during PNB) but preservation of intrahemispheric RSFC of these regions during PNB. Additionally, there was increased RSFC between the left motor region of interest (PNB-affected area) and bilateral higher order visual cortex regions after clinical PNB resolution (e.g., Fisher z between left motor region of interest and right and left lingual gyrus regions during PNB, -0.1 and -0.6 vs. 0.22 and 0.18 after PNB resolution, respectively). CONCLUSIONS: This pilot study provides evidence that PNB has features consistent with other models of deafferentation, making it a potentially useful approach to investigate brain plasticity. The findings provide insight into RSFC of sensorimotor functional brain networks during PNB and PNB recovery and support modulation of the sensory-motor integration feedback loop as a mechanism for explaining the behavioral correlates of peripherally induced TFD through PNB.

The differential impact of oxytocin receptor (OXTR) genotypes on the risk of autism spectrum disorder (ASD) and resulting social communication deficits

Background: Autism spectrum disorder (ASD) is multifactorial and is likely the result of complex interactions between multiple environmental and genetic factors. Recently, it has been suggested that each symptom cluster of the disorder, such as poor social communication, may be mediated by different genetic influences. Genes in the oxytocin pathway, which mediates social behaviours in humans, have been studied with single nucleotide polymorphisms (SNPs) in the oxytocin receptor gene (OXTR) being implicated in ASD. This thesis examines the presence of different oxytocin receptor genotypes, and their associations with ASD and resulting social communication deficits. Methods: The relationship between four OXTR variants and ASD was evaluated in 607 ASD simplex (SPX) families. Cases were compared to their unaffected siblings using a conditional logistic approach. Odds ratios and associated 95 percent confidence intervals were obtained. A second sample of 235 individuals with a diagnosis of ASD was examined to evaluate whether these four OXTR variants were associated with social communication scores on the Autism Diagnostic Interview – Revised (ADI-R). Parameter estimates and associated 95 percent confidence intervals were generated using a linear regression approach. Multiple testing issues were addressed using false discovery adjustments. Results: The rs53576 AG genotype was significantly associated with a lower risk of ASD (OR = 0.707, 95% CI: 0.512-0.975). A single genotype (AG) provided by the rs2254298 marker was found to be significantly associated with higher social communication scores (Parameter estimate = 1.833, SE = 0.762, p = 0.0171). This association was also seen in a Caucasian only and mothers as the respondent samples. No association was significant following false discovery rate adjustments. Conclusion: The findings from these studies provide limited support for the role of OXTR SNPs in ASD, especially in social communication skills. The clinical significance of these associations remains unknown, however, it is likely that these associations do not play a role in the severity of symptoms associated with ASD. Rather, they may be important in the appearance of social deficits due to the rs2254298 markers association with enlarged amygdalas.

Heteroduplex analysis of VDJ amplified segments from rearranged IgH genes for clonality assessments in B-cell non-Hodgkin's lymphoma. A comparison between different strategies.

BACKGROUND AND OBJECTIVE: The main difficulty of PCR-based clonality studies for B-cell lymphoproliferative disorders (B-LPD) is discrimination between monoclonal and polyclonal PCR products, especially when there is a high background of polyclonal B cells in the tumor sample. Actually, PCR-based methods for clonality assessment require additional analysis of the PCR products in order to discern between monoclonal and polyclonal samples. Heteroduplex analysis represents an attractive approach since it is easy to perform and avoids the use of radioactive substrates or expensive equipment. DESIGN AND METHODS: We studied the sensitivity and specificity of heteroduplex PCR analysis for monoclonal detection in samples from 90 B-cell non Hodgkin's lymphoma (B-NHL) patients and in 28 individuals without neoplastic B-cell disorders (negative controls). Furthermore, in 42 B-NHL and in the same 28 negative controls, we compared heteroduplex analysis vs the classical PCR technique. We also compared ethidium bromide (EtBr) vs. silver nitrate (AgNO(3)) staining as well as agarose vs. polyacrylamide gel electrophoresis (PAGE). RESULTS: Using two pair consensus primers sited at VH (FR3 and FR2) and at JH, 91% of B-NHL samples displayed monoclonal products after heteroduplex PCR analysis using PAGE and AgNO(3) staining. Moreover, no polyclonal sample showed a monoclonal PCR product. By contrast, false positive results were obtained when using agarose (5/28) and PAGE without heteroduplex analysis: 2/28 and 8/28 with EtBr and AgNO(3) staining, respectively. In addition, false negative results only appeared with EtBr staining: 13/42 in agarose, 4/42 in PAGE without heteroduplex analysis and 7/42 in PAGE after heteroduplex analysis. INTERPRETATION AND CONCLUSIONS: We conclude that AgNO(3) stained PAGE after heteroduplex analysis is the most suitable strategy for detecting monoclonal rearrangements in B-NHL samples because it does not produce false-positive results and the risk of false-negative results is very low.

A Loop-mediated Isothermal Amplification Method for Rapid Direct Detection and Differentiation of Non-pathogenic and Verocytotoxigenic Escherichia coli in Beef and Bovine Faeces

The aim of this study was to develop a multiplex loop-mediated isothermal amplification (LAMP) method capable of detecting Escherichia coli generally and verocytotoxigenic E. coli (VTEC) specifically in beef and bovine faeces. The LAMP assay developed was highly specific (100%) and able to distinguish between E. coli and VTEC based on the amplification of the phoA, and stx1 and/or stx2 genes, respectively. In the absence of an enrichment step, the limit of detection 50% (LOD50) of the LAMP assay was determined to be 2.83, 3.17 and 2.83-3.17 log CFU/g for E. coli with phoA, stx1 and stx2 genes, respectively, when artificially inoculated minced beef and bovine faeces were tested. The LAMP calibration curves generated with pure cultures, and spiked beef and faeces, suggested that the assay had good quantification capability. Validation of the assay, performed using retail beef and bovine faeces samples, demonstrated good correlation between counts obtained by the LAMP assay and by a conventional culture method, but suggested the possibility of false negative LAMP results for 12.5-14.7% of samples tested. The multiplex LAMP assay developed potentially represents a rapid alternative to culture for monitoring E.coli levels in beef or faeces and it would provide additional information on the presence of VTEC. However, some further optimisation is needed to improve detection sensitivity.

Flexible strategies for association analysis with genomic phenotypes

Thesis (Ph.D.)--University of Washington, 2016-08

Systems Modeling of Lung Cancer Screening Programs to Improve Quality

Thesis (Master's)--University of Washington, 2016-08

CFAR Adaptive PN Code acquisition for DSSS Systems.

Constant false alarm rate (CFAR) techniques can be used in Pseudo-Noise (PN) code acquisition in Spread Spectrum (SS) communication systems, and all the CFAR techniques perform well in homogeneous background PN code acquisition. However, in non-homogeneous background, some CFAR techniques suffer rapid degradation. GO/SO (Greatest-of/Smallest-of) CFAR and adaptive censored mean level detector (ACMLD) are two adaptive CFAR techniques, which are analyzed and compared with other CFAR techniques. The simulation results show that GO/SO CFAR is superior to other CFAR techniques, it maintains short mean acquisition time (MAT) even at environment with strong clutter noise, and ACMLD is suitable for background with strong interfering targets

A Binary Classifier for Test Case Feasibility Applied to Automatically Generated Tests of Event-Driven Software

Modern software application testing, such as the testing of software driven by graphical user interfaces (GUIs) or leveraging event-driven architectures in general, requires paying careful attention to context. Model-based testing (MBT) approaches first acquire a model of an application, then use the model to construct test cases covering relevant contexts. A major shortcoming of state-of-the-art automated model-based testing is that many test cases proposed by the model are not actually executable. These \textit{infeasible} test cases threaten the integrity of the entire model-based suite, and any coverage of contexts the suite aims to provide. In this research, I develop and evaluate a novel approach for classifying the feasibility of test cases. I identify a set of pertinent features for the classifier, and develop novel methods for extracting these features from the outputs of MBT tools. I use a supervised logistic regression approach to obtain a model of test case feasibility from a randomly selected training suite of test cases. I evaluate this approach with a set of experiments. The outcomes of this investigation are as follows: I confirm that infeasibility is prevalent in MBT, even for test suites designed to cover a relatively small number of unique contexts. I confirm that the frequency of infeasibility varies widely across applications. I develop and train a binary classifier for feasibility with average overall error, false positive, and false negative rates under 5\%. I find that unique event IDs are key features of the feasibility classifier, while model-specific event types are not. I construct three types of features from the event IDs associated with test cases, and evaluate the relative effectiveness of each within the classifier. To support this study, I also develop a number of tools and infrastructure components for scalable execution of automated jobs, which use state-of-the-art container and continuous integration technologies to enable parallel test execution and the persistence of all experimental artifacts.

Estrutura e dinâmica de populações de Hydrochoerus hydrochaeris (Linnaeus, 1766) (Rodentia) em duas áreas urbanas no norte do Paraná, Brasil

This study aimed to evaluate the population ecology of Hydrochoerus hydrochaeris (Linnaeus, 1766) in two urban areas in the north of Paraná, an open and other protected by assessing the effects of these two different types of environments on the structure and dynamics of the population and its implications for conservation of the species. The monitoring of the populations were performed monthly between June 2014 and March 2015 in Jaboti Lake Park (Apucarana / PR) and Conservation Unit Parque Arthur Thomas (Londrina / PR). To conduct the survey population data was used the methodology of total census (direct counting of individuals).They were evaluated ecological parameters of the populations of capybaras, such as ecological density, abundance, age distribution and birth rate, as well as performed the analysis of the landscape. It was applied to analysis of variance (ANOVA) to test the differences between the averages of the abundance of each age group per year of observation, as well as the differences between the average ecological density over the years of observation. The standard relationship between the use of classes and land use in the landscape and the ecological parameters of the capybara populations was evaluated by Principal Component Analysis (PCA). The trend of variation of average abundance over time to Thomas Arthur Park revealed abrupt decrease of the population in a short period of time (2014 16 ± 9, 14 ± 1 and 2015 7±1) as well as ecological density in 2015 (0.05 ind./ha). On the other hand, the Jaboti Lake Park, showed an increase in absolute abundance, with marked recovery of the population in the same period (2014 38±8,30 and 2015 45±1,73) and coming up with an ecological density in 2015 (2 ind ./ha). The birth rate found Lake Park Jaboti was superior to Arthur Thomas Park, which had a negative rate between 2012 and 2015. The use and land cover analysis showed significant differences from the point of view of the relative contribution of landscape elements in the spatial heterogeneity. Arthur Thomas Park shows areas of dense vegetation and urban areas relatively higher than those observed in Jaboti Lake Park that revealed relatively higher proportions of the areas of agriculture / field and exposed soil. Thus, the present study revealed that the local population structure is directly related to the spatial characteristics of both studied landscapes, as can be seen by the greater abundance and density seen in Jaboti Lake Park compared to Arthur Thomas Park in recent years of study.

A more reliable PCR for detection of Mycobacterium tuberculosis in clinical samples

Diagnostic techniques based on PCR have two major problems: false-positive reactions due to contamination with DNA fragments from previous PCRs (amplicons) and false-negative reactions caused by inhibitors that interfere with the PCR. We have improved our previously reported PCR based on the amplification of a fragment of the Mycobacterium tuberculosis complex-specific insertion element IS6110 with respect to both problems. False-positive reactions caused by amplicon contamination were prevented by the use of uracil-N-glycosylase and dUTP instead of dTTP. We selected a new set of primers outside the region spanned by the formerly used primers to avoid false-positive reactions caused by dTTP-containing amplicons still present in the laboratory. With this new primer set, 16 copies of the IS6110 insertion element, the equivalent of two bacteria, could be amplified 10(10) times in 40 cycles, resulting in a mean efficiency of 77% per cycle. To detect the presence of inhibitors of the Taq polymerase, which may cause false-negative reactions, part of each sample was spiked with M. tuberculosis DNA. The DNA purification method using guanidinium thiocyanate and diatoms effectively removed most or all inhibitors of the PCR. However, this was not suitable for blood samples, for which we developed a proteinase K treatment followed by phenol-chloroform extraction. This method permitted detection of 20 M. tuberculosis bacteria per ml of whole blood. Various laboratory procedures were introduced to reduce failure or inhibition of PCR and avoid DNA cross contamination. We have tested 218 different clinical specimens obtained from patients suspected of having tuberculosis. The samples included sputum (n=145), tissue biopsy samples (n=25), cerebrospinal fluid (n=15), blood (n=14), pleural fluid (n=9), feces, (n=7), fluid from fistulae (n=2), and pus from a wound (n=1). The results obtained by PCR were consistent with those obtained with culture, which is the "gold standard." We demonstrate that PCR is a useful technique for the rapid diagnosis of tuberculosis at various sites.

Hierarchically grouped 2D local features applied to edge contour localisation

One of the most significant research topics in computer vision is object detection. Most of the reported object detection results localise the detected object within a bounding box, but do not explicitly label the edge contours of the object. Since object contours provide a fundamental diagnostic of object shape, some researchers have initiated work on linear contour feature representations for object detection and localisation. However, linear contour feature-based localisation is highly dependent on the performance of linear contour detection within natural images, and this can be perturbed significantly by a cluttered background. In addition, the conventional approach to achieving rotation-invariant features is to rotate the feature receptive field to align with the local dominant orientation before computing the feature representation. Grid resampling after rotation adds extra computational cost and increases the total time consumption for computing the feature descriptor. Though it is not an expensive process if using current computers, it is appreciated that if each step of the implementation is faster to compute especially when the number of local features is increasing and the application is implemented on resource limited ”smart devices”, such as mobile phones, in real-time. Motivated by the above issues, a 2D object localisation system is proposed in this thesis that matches features of edge contour points, which is an alternative method that takes advantage of the shape information for object localisation. This is inspired by edge contour points comprising the basic components of shape contours. In addition, edge point detection is usually simpler to achieve than linear edge contour detection. Therefore, the proposed localization system could avoid the need for linear contour detection and reduce the pathological disruption from the image background. Moreover, since natural images usually comprise many more edge contour points than interest points (i.e. corner points), we also propose new methods to generate rotation-invariant local feature descriptors without pre-rotating the feature receptive field to improve the computational efficiency of the whole system. In detail, the 2D object localisation system is achieved by matching edge contour points features in a constrained search area based on the initial pose-estimate produced by a prior object detection process. The local feature descriptor obtains rotation invariance by making use of rotational symmetry of the hexagonal structure. Therefore, a set of local feature descriptors is proposed based on the hierarchically hexagonal grouping structure. Ultimately, the 2D object localisation system achieves a very promising performance based on matching the proposed features of edge contour points with the mean correct labelling rate of the edge contour points 0.8654 and the mean false labelling rate 0.0314 applied on the data from Amsterdam Library of Object Images (ALOI). Furthermore, the proposed descriptors are evaluated by comparing to the state-of-the-art descriptors and achieve competitive performances in terms of pose estimate with around half-pixel pose error.

Caracterización de señales sísmicas del Volcán Cotopaxi utilizando estimadores espectrales clásicos y de máxima entropía

Se presenta un estudio de detección y caracterización de eventos sísmicos del tipo volcano tectónicos y largo periodo de registros sísmicos generados por el volcán Cotopaxi. La estructura secuencial de detección propuesta permite en un registro sísmico maximizar la probabilidad de presencia de un evento y minimizar la ausencia de este. La detección se la realiza en el dominio del tiempo en cuasi tiempo real manteniendo una tasa constante de falsa alarma para posteriormente realizar un estudio del contenido espectral de los eventos mediante el uso de estimadores espectrales clásicos como el periodograma y paramétricos como el método de máxima entropía de Burg, logrando así, categorizar a los eventos detectados como volcano tectónicos, largo periodo y otros cuando no poseen características pertenecientes a los otros dos tipos como son los rayos.

Chilean IPNV isolates: Robustness analysis of PCR detection

Background: The genomes of several infectious pancreatic necrosis viruses (IPNVs) isolated in Chile were sequenced with a single amplification approach for both segments A and B. The resulting sequences were then used to determine the conservation of the primer-binding regions used in polymerase chain reaction (PCR)-based diagnostic methods proposed in the literature. Thus, the robustness of each technique was studied, particularly the eventual effect of further mutations within the primer-binding sites. Results: On analysis, most methods currently used to detect Chilean IPNV varieties were deemed adequate. However, the primers were designed to be genogroup specific, implying that most detection methods pose some risk of detecting all strains prevalent in the country, due to the coexistence of genogroups 1 and 5. Conclusions: Negative resultsmust be interpreted carefully given the high genomic variability of IPNVs. Detection techniques (quantitative reverse transcription (qRT)-PCR) based on degenerate primers can be used to minimize the possibilities of false-negative detections.