Dosage plasmatique des medicaments antidépresseurs [Recommendations for therapeutic monitoring of antidepressants].

Therapeutic drug monitoring (TDM), combined in certain situations with pharmacogenetic tests of metabolism, has proven a valuable tool for psychopharmacotherapy. Uncertain drug adherence, suboptimal tolerability, nonresponse at therapeutic doses, or pharmacokinetic drug-drug interactions are typical situations when measurement of medication concentrations is helpful. This article is an adaptation of guidelines recently issued by the AGNP-TDM group (Hiemke et al., www. agnp.de), but its content focuses mainly on the TDM of antidepressants. Finally, the potential benefits of TDM for optimization of pharmacotherapy can only be obtained if the method is adequately integrated into the clinical treatment process.

An Illustrated Guide for Monitoring and Protecting Bridge Waterways Against Scour - Project TR-515 - Final Report, March 2006

This report is a well illustrated and practical Guide intended to aid engineers and engineering technicians in monitoring, maintaining, and protecting bridge waterways so as to mitigate or prevent scour from adversely affecting the structural performance of bridge abutments, piers, and approach road embankments. Described and illustrated here are the scour processes affecting the stability of these components of bridge waterways. Also described and illustrated are methods for monitoring waterways, and the various methods for repairing scour damage and protecting bridge waterways against scour. The Guide focuses on smaller bridges, especially those in Iowa. Scour processes at small bridges are complicated by the close proximity of abutments, piers, and waterway banks, such that scour processes interact in ways difficult to predict and for which reliable design relationships do not exist. Additionally, blockage by woody debris or by ice, along with changes in approach channel alignment, can have greater effects on pier and abutment scour for smaller bridges. These considerations tend to cause greater reliance on monitoring for smaller bridges. The Guide is intended to augment and support, as a source of information, existing procedures for monitoring bridge waterways. It also may prompt some adjustments of existing forms and reports used for bridge monitoring. In accord with increasing emphasis on effective management of public facilities like bridges, the Guide ventures to include an example report format for quantitative risk assessment applied to bridge waterways. Quantitative risk assessment is useful when many bridges have to be evaluated for scour risk and damage, and priorities need to be determined for repair and protection work. Such risk assessment aids comparison of bridges at risk. It is expected that bridge inspectors will implement the Guide as a concise, handy reference available back at the office. The Guide also likely may be implemented as an educational primer for new inspectors who have yet to become acquainted with waterway scour. Additionally, the Guide may be implemented as a part of process to check whether existing bridge-inspection forms or reports adequately encompass bridge-waterway scour.

Analysis of variables that are not directly observable: influence on decision-making during the research process

The sample dimension, types of variables, format used for measurement, and construction of instruments to collect valid and reliable data must be considered during the research process. In the social and health sciences, and more specifically in nursing, data-collection instruments are usually composed of latent variables or variables that cannot be directly observed. Such facts emphasize the importance of deciding how to measure study variables (using an ordinal scale or a Likert or Likert-type scale). Psychometric scales are examples of instruments that are affected by the type of variables that comprise them, which could cause problems with measurement and statistical analysis (parametric tests versus non-parametric tests). Hence, investigators using these variables must rely on suppositions based on simulation studies or recommendations based on scientific evidence in order to make the best decisions.

Developing a Simple and Rapid Test for Monitoring the Heat Evolution of Concrete Mixtures for Both Laboratory and Field Applications, January 2006

Various test methods exist for measuring heat of cement hydration; however, most current methods require expensive equipment, complex testing procedures, and/or extensive time, thus not being suitable for field application. The objectives of this research are to identify, develop, and evaluate a standard test procedure for characterization and quality control of pavement concrete mixtures using a calorimetry technique. This research project has three phases. Phase I was designed to identify the user needs, including performance requirements and precision and bias limits, and to synthesize existing test methods for monitoring the heat of hydration, including device types, configurations, test procedures, measurements, advantages, disadvantages, applications, and accuracy. Phase II was designed to conduct experimental work to evaluate the calorimetry equipment recommended from the Phase I study and to develop a standard test procedure for using the equipment and interpreting the test results. Phase II also includes the development of models and computer programs for prediction of concrete pavement performance based on the characteristics of heat evolution curves. Phase III was designed to study for further development of a much simpler, inexpensive calorimeter for field concrete. In this report, the results from the Phase I study are presented, the plan for the Phase II study is described, and the recommendations for Phase III study are outlined. Phase I has been completed through three major activities: (1) collecting input and advice from the members of the project Technical Working Group (TWG), (2) conducting a literature survey, and (3) performing trials at the CP Tech Center’s research lab. The research results indicate that in addition to predicting maturity/strength, concrete heat evolution test results can also be used for (1) forecasting concrete setting time, (2) specifying curing period, (3) estimating risk of thermal cracking, (4) assessing pavement sawing/finishing time, (5) characterizing cement features, (6) identifying incompatibility of cementitious materials, (7) verifying concrete mix proportions, and (8) selecting materials and/or mix designs for given environmental conditions. Besides concrete materials and mix proportions, the configuration of the calorimeter device, sample size, mixing procedure, and testing environment (temperature) also have significant influences on features of concrete heat evolution process. The research team has found that although various calorimeter tests have been conducted for assorted purposes and the potential uses of calorimeter tests are clear, there is no consensus on how to utilize the heat evolution curves to characterize concrete materials and how to effectively relate the characteristics of heat evolution curves to concrete pavement performance. The goal of the Phase II study is to close these gaps.

Workloads and strain process in Community Health Agents

ABSTRACT OBJECTIVE To identify the workloads present in the work activities of community health agents (CHAs) and the resulting strain processes. METHOD A descriptive, exploratory, cross-sectional and quantitative study conducted with 137 CHAs. Data were collected through a questionnaire and interview guided by the health surveillance software called SIMOSTE (Health Monitoring System of Nursing Workers), following the ethical codes of the current law. RESULTS In total, were identified 140 workloads involved in 122 strain processes, represented by the occurrence of health problems of the CHAs. The mechanical (55.00%) and biological (16.43%) loads stood out. The most common strain processes were the external causes of morbidity and mortality (62.31%) and diseases of the musculoskeletal system and connective tissue (10.66%). CONCLUSION From the identified overloads, it became evident that all workloads are present in the work process of CHAs, highlighting the mechanical load, represented mainly by external causes of morbidity and mortality that are related to occupational accidents.

Financial intermediation and equity investment with costly monitoring

This paper studies the efficiency of equilibria in a productive OLG economy where the process of financial intermediation is characterized by costly state verification. Both competitive equilibria and Constrained Pareto Optimal allocations are characterized. It is shown that market outcomes can be socially inefficient, even when a weaker notion than Pareto optimality is considered.

Association between the A-2518G polymorphism in the monocyte chemoattractant protein-1 gene and insulin resistance and Type 2 diabetes mellitus.

AIMS/HYPOTHESIS: The molecular mechanisms of obesity-related insulin resistance are incompletely understood. Macrophages accumulate in adipose tissue of obese individuals. In obesity, monocyte chemoattractant protein-1 (MCP-1), a key chemokine in the process of macrophage accumulation, is overexpressed in adipose tissue. MCP-1 is an insulin-responsive gene that continues to respond to exogenous insulin in insulin-resistant adipocytes and mice. MCP-1 decreases insulin-stimulated glucose uptake into adipocytes. The A-2518G polymorphism in the distal regulatory region of MCP-1 may regulate gene expression. The aim of this study was to investigate the impact of this gene polymorphism on insulin resistance. METHODS: We genotyped the Ludwigshafen Risk and Cardiovascular Health (LURIC) cohort ( n=3307). Insulin resistance, estimated by homeostasis model assessment, and Type 2 diabetes were diagnosed in 803 and 635 patients respectively. RESULTS: Univariate analysis revealed that plasma MCP-1 levels were significantly and positively correlated with WHR ( p=0.011), insulin resistance ( p=0.0097) and diabetes ( p<0.0001). Presence of the MCP-1 G-2518 allele was associated with decreased plasma MCP-1 ( p=0.017), a decreased prevalence of insulin resistance (odds ratio [OR]=0.82, 95% CI: 0.70-0.97, p=0.021) and a decreased prevalence of diabetes (OR=0.80, 95% CI: 0.67-0.96, p=0.014). In multivariate analysis, the G allele retained statistical significance as a negative predictor of insulin resistance (OR=0.78, 95% CI: 0.65-0.93, p=0.0060) and diabetes (OR=0.80, 95% CI: 0.66-0.96, p=0.018). CONCLUSIONS/INTERPRETATION: In a large cohort of Caucasians, the MCP-1 G-2518 gene variant was significantly and negatively correlated with plasma MCP-1 levels and the prevalence of insulin resistance and Type 2 diabetes. These results add to recent evidence supporting a role for MCP-1 in pathologies associated with hyperinsulinaemia.

Measuring ecological niche overlap from occurrence and spatial environmental data

1. Aim - Concerns over how global change will influence species distributions, in conjunction with increased emphasis on understanding niche dynamics in evolutionary and community contexts, highlight the growing need for robust methods to quantify niche differences between or within taxa. We propose a statistical framework to describe and compare environmental niches from occurrence and spatial environmental data.¦2. Location - Europe, North America, South America¦3. Methods - The framework applies kernel smoothers to densities of species occurrence in gridded environmental space to calculate metrics of niche overlap and test hypotheses regarding niche conservatism. We use this framework and simulated species with predefined distributions and amounts of niche overlap to evaluate several ordination and species distribution modeling techniques for quantifying niche overlap. We illustrate the approach with data on two well-studied invasive species.¦4. Results - We show that niche overlap can be accurately detected with the framework when variables driving the distributions are known. The method is robust to known and previously undocumented biases related to the dependence of species occurrences on the frequency of environmental conditions that occur across geographic space. The use of a kernel smoother makes the process of moving from geographical space to multivariate environmental space independent of both sampling effort and arbitrary choice of resolution in environmental space. However, the use of ordination and species distribution model techniques for selecting, combining and weighting variables on which niche overlap is calculated provide contrasting results.¦5. Main conclusions - The framework meets the increasing need for robust methods to quantify niche differences. It is appropriate to study niche differences between species, subspecies or intraspecific lineages that differ in their geographical distributions. Alternatively, it can be used to measure the degree to which the environmental niche of a species or intraspecific lineage has changed over time.

Progress monitoring for teachers of students who have visual disabilities, Fall 2006.

Description and process of monitoring students with visual disabilities.

Statistical Brief on the Agricultural Research of Cape Verde

The primary purpose of this brief is to provide various statistical and institutional details on the development and current status of the public agricultural research system in Cape Verde. This information has been collected and presented in a systematic way in order to inform and thereby improve research policy formulation with regard to the Cape Verdean NARS. Most importantly, these data are assembled and reported in a way that makes them directly comparable with the data presented in the other country briefs in this series. And because institutions take time to develop and there are often considerable lags in the agricultural research process, it is necessary for many analytical and policy purposes to have access to longer-run series of data. NARSs vary markedly in their institutional structure and these institutional aspects can have a substantial and direct effect on their research performance. To provide a basis for analysis and cross-country, over-time comparisons, the various research agencies in a country have been grouped into five general categories; government, semi-public, private, academic, and supranational. A description of these categories is provided in table 1.

Statistical Brief on the Agricultural Research of Cape Verde

The primary purpose of this brief is to provide various statistical and institutional details on the development and current status of the public agricultural research system in Cape Verde. This information has been collected and presented in a systematic way in order to inform and thereby improve research policy formulation with regard to the Cape Verdean NARS. Most importantly, these data are assembled and reported in a way that makes them directly comparable with the data presented in the other country briefs in this series. And because institutions take time to develop and there are often considerable lags in the agricultural research process, it is necessary for many analytical and policy purposes to have access to longer-run series of data. NARSs vary markedly in their institutional structure and these institutional aspects can have a substantial and direct effect on their research performance. To provide a basis for analysis and cross-country, over-time comparisons, the various research agencies in a country have been grouped into five general categories; government, semi-public, private, academic, and supranational. A description of these categories is provided in table 1.

Quantitative monitoring of tamoxifen in human plasma extended to 40 metabolites using liquid-chromatography high-resolution mass spectrometry: new investigation capabilities for clinical pharmacology.

Liquid-chromatography (LC) high-resolution (HR) mass spectrometry (MS) analysis can record HR full scans, a technique of detection that shows comparable selectivity and sensitivity to ion transitions (SRM) performed with triple-quadrupole (TQ)-MS but that allows de facto determination of "all" ions including drug metabolites. This could be of potential utility in in vivo drug metabolism and pharmacovigilance studies in order to have a more comprehensive insight in drug biotransformation profile differences in patients. This simultaneous quantitative and qualitative (Quan/Qual) approach has been tested with 20 patients chronically treated with tamoxifen (TAM). The absolute quantification of TAM and three metabolites in plasma was realized using HR- and TQ-MS and compared. The same LC-HR-MS analysis allowed the identification and relative quantification of 37 additional TAM metabolites. A number of new metabolites were detected in patients' plasma including metabolites identified as didemethyl-trihydroxy-TAM-glucoside and didemethyl-tetrahydroxy-TAM-glucoside conjugates corresponding to TAM with six and seven biotransformation steps, respectively. Multivariate analysis allowed relevant patterns of metabolites and ratios to be associated with TAM administration and CYP2D6 genotype. Two hydroxylated metabolites, α-OH-TAM and 4'-OH-TAM, were newly identified as putative CYP2D6 substrates. The relative quantification was precise (<20 %), and the semiquantitative estimation suggests that metabolite levels are non-negligible. Metabolites could play an important role in drug toxicity, but their impact on drug-related side effects has been partially neglected due to the tremendous effort needed with previous MS technologies. Using present HR-MS, this situation should evolve with the straightforward determination of drug metabolites, enlarging the possibilities in studying inter- and intra-patients drug metabolism variability and related effects.

Statistical learning theory for geospatial data. Case study: Aral sea

In recent years there has been an explosive growth in the development of adaptive and data driven methods. One of the efficient and data-driven approaches is based on statistical learning theory (Vapnik 1998). The theory is based on Structural Risk Minimisation (SRM) principle and has a solid statistical background. When applying SRM we are trying not only to reduce training error ? to fit the available data with a model, but also to reduce the complexity of the model and to reduce generalisation error. Many nonlinear learning procedures recently developed in neural networks and statistics can be understood and interpreted in terms of the structural risk minimisation inductive principle. A recent methodology based on SRM is called Support Vector Machines (SVM). At present SLT is still under intensive development and SVM find new areas of application (www.kernel-machines.org). SVM develop robust and non linear data models with excellent generalisation abilities that is very important both for monitoring and forecasting. SVM are extremely good when input space is high dimensional and training data set i not big enough to develop corresponding nonlinear model. Moreover, SVM use only support vectors to derive decision boundaries. It opens a way to sampling optimization, estimation of noise in data, quantification of data redundancy etc. Presentation of SVM for spatially distributed data is given in (Kanevski and Maignan 2004).

Identificación de puntos de pesca en los viajes pesqueros de anchoveta monitoreados por satélites mediante redes neuronales artificiales

La sostenibilidad de los recursos marinos y de su ecosistema hace necesario un manejo responsable de las pesquerías. Conocer la distribución espacial del esfuerzo pesquero y en particular de las operaciones de pesca es indispensable para mejorar el monitoreo pesquero y el análisis de la vulnerabilidad de las especies frente a la pesca. Actualmente en la pesquería de anchoveta peruana, se recoge información del esfuerzo y capturas mediante un programa de observadores a bordo, pero esta solo representa una muestra de 2% del total de viajes pesqueros. Por otro lado, se dispone de información por cada hora (en promedio) de la posición de cada barco de la flota gracias al sistema de seguimiento satelital de las embarcaciones (VMS), aunque en estos no se señala cuándo ni dónde ocurrieron las calas. Las redes neuronales artificiales (ANN) podrían ser un método estadístico capaz de inferir esa información, entrenándose en una muestra para la cual sí conocemos las posiciones de calas (el 2% anteriormente referido), estableciendo relaciones analíticas entre las calas y ciertas características geométricas de las trayectorias observadas por el VMS y así, a partir de las últimas, identificar la posición de las operaciones de pesca. La aplicación de la red neuronal requiere un análisis previo que examine la sensibilidad de la red a variaciones en sus parámetros y bases de datos de entrenamiento, y que nos permita desarrollar criterios para definir la estructura de la red e interpretar sus resultados de manera adecuada. La problemática descrita en el párrafo anterior, aplicada específicamente a la anchoveta (Engraulis ringens) es detalllada en el primer capítulo, mientras que en el segundo se hace una revisión teórica de las redes neuronales. Luego se describe el proceso de construcción y pre-tratamiento de la base de datos, y definición de la estructura de la red previa al análisis de sensibilidad. A continuación se presentan los resultados para el análisis en los que obtenemos una estimación del 100% de calas, de las cuales aproximadamente 80% están correctamente ubicadas y 20% poseen un error de ubicación. Finalmente se discuten las fortalezas y debilidades de la técnica empleada, de métodos alternativos potenciales y de las perspectivas abiertas por este trabajo.

Monitoring de l'immunosuppression par les thiopurines dans les maladies inflammatoires chroniques de l'intestin par le suivi de la macrocytose

Background¦Erythrocyte MCV might be used as an inexpensive marker to predict and¦optimize the efficacy and tolerability of thiopurine therapy in IBD patients.¦Aim and methods¦This retrospective observational study aimed to assess the monitoring¦performances of MCV in patients under 3 months or more thiopurine treatment followed up¦in the Swiss IBD Cohort Study. All available MCV, white blood cells (WBC) and 6¦thioguanine nucleotide (6TGN) measurements, among others, were recorded. An IBD¦"flare" was defined as a composite outcome encompassing treatment change,¦colonoscopy, histology, CT scan or MRI reports showing active IBD lesions, occurrence of¦intestinal surgery and IBD-related hospitalisations. Whether MCV measurements predicted¦efficacy of thiopurine treatment was investigated by assessing the statistical association¦between the occurrence of IBD "flares", and the current or recent MCV values, taking into¦account the patient clustering and longitudinal aspect of data.¦Results¦140 patients (77 women), mean age 38 years (17-74), 104 diagnosed with¦Crohn's disease, 36 with ulcerative colitis, mean disease duration 8 years (0.25-36),¦receiving either azathioprine (n=125) or 6-mercaptopurine (n=15) were included, most of¦them over 3-year follow up.¦Thiopurines increased mean patient MCV by an average 5.8±5.2 fL, while¦patientsfluctuated by ±4.3 fL around their individual mean (p<0.001). They decreased¦WBC by an average of 2.4+/- 2.6 G/L (p<0.001).¦Significant associations were observed between the probability of flare occurrence and low¦current MVC (p=0.017) or high current WBC (p=0.009) and, with a relative risk of 3.7% for¦every fL of MCV decrease or 8% for every G/L of WBC increase. Both markers revealed¦some memory effect.¦Despite this, the performance of MCV and WBC to predict IBD "flare" remained rather¦limited, as it is less accurate than the 6-TGN-level , although only determined in a¦subgroup of patients in this study.¦Conclusion¦MCV and WBC deserve to be observed to check and monitor therapeutic¦exposure to thiopurine agents in IBD patients. Unfortunately, their predictive performance¦precludes their privileged use for optimization of therapy. Further prospective studies¦should suitably include the systematic measurement of metabolite concentration.