Clinical effectiveness of posaconazole versus fluconazole as antifungal prophylaxis in hematology-oncology patients: a retrospective cohort study.

In preventing invasive fungal disease (IFD) in patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS), clinical trials demonstrated efficacy of posaconazole over fluconazole and itraconazole. However, effectiveness of posaconazole has not been investigated in the United States in real-world setting outside the environment of controlled clinical trial. We performed a single-center, retrospective cohort study of 130 evaluable patients ≥18 years of age admitted to Duke University Hospital between 2004 and 2010 who received either posaconazole or fluconazole as prophylaxis during first induction or first reinduction chemotherapy for AML or MDS. The primary endpoint was possible, probable, or definite breakthrough IFD. Baseline characteristics were well balanced between groups, except that posaconazole recipients received reinduction chemotherapy and cytarabine more frequently. IFD occurred in 17/65 (27.0%) in the fluconazole group and in 6/65 (9.2%) in the posaconazole group (P = 0.012). Definite/probable IFDs occurred in 7 (10.8%) and 0 patients (0%), respectively (P = 0.0013). In multivariate analysis, fluconazole prophylaxis and duration of neutropenia were predictors of IFD. Mortality was similar between groups. This study demonstrates superior effectiveness of posaconazole over fluconazole as prophylaxis of IFD in AML and MDS patients. Such superiority did not translate to reductions in 100-day all-cause mortality.

Local kinetic interpretation of entropy production through reversed diffusion.

The time reversal of stochastic diffusion processes is revisited with emphasis on the physical meaning of the time-reversed drift and the noise prescription in the case of multiplicative noise. The local kinematics and mechanics of free diffusion are linked to the hydrodynamic description. These properties also provide an interpretation of the Pope-Ching formula for the steady-state probability density function along with a geometric interpretation of the fluctuation-dissipation relation. Finally, the statistics of the local entropy production rate of diffusion are discussed in the light of local diffusion properties, and a stochastic differential equation for entropy production is obtained using the Girsanov theorem for reversed diffusion. The results are illustrated for the Ornstein-Uhlenbeck process.

Imaging of musculoskeletal bacterial infections by [124I]FIAU-PET/CT.

BACKGROUND: Traditional imaging techniques for the localization and monitoring of bacterial infections, although reasonably sensitive, suffer from a lack of specificity. This is particularly true for musculoskeletal infections. Bacteria possess a thymidine kinase (TK) whose substrate specificity is distinct from that of the major human TK. The substrate specificity difference has been exploited to develop a new imaging technique that can detect the presence of viable bacteria. METHODOLOGY/PRINCIPAL FINDINGS: Eight subjects with suspected musculoskeletal infections and one healthy control were studied by a combination of [(124)I]FIAU-positron emission tomography and CT ([(124)I]FIAU-PET/CT). All patients with proven musculoskeletal infections demonstrated positive [(124)I]FIAU-PET/CT signals in the sites of concern at two hours after radiopharmaceutical administration. No adverse reactions with FIAU were observed. CONCLUSIONS/SIGNIFICANCE: [(124)I]FIAU-PET/CT is a promising new method for imaging bacterial infections.

Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: a case series.

BACKGROUND: Development of hip adductor, tensor fascia lata, and rectus femoris muscle contractures following total hip arthroplasties are quite common, with some patients failing to improve despite treatment with a variety of non-operative modalities. The purpose of the present study was to describe the use of and patient outcomes of botulinum toxin injections as an adjunctive treatment for muscle tightness following total hip arthroplasty. METHODS: Ten patients (14 hips) who had hip adductor, abductor, and/or flexor muscle contractures following total arthroplasty and had been refractory to physical therapeutic efforts were treated with injection of botulinum toxin A. Eight limbs received injections into the adductor muscle, 8 limbs received injections into the tensor fascia lata muscle, and 2 limbs received injection into the rectus femoris muscle, followed by intensive physical therapy for 6 weeks. RESULTS: At a mean final follow-up of 20 months, all 14 hips had increased range in the affected arc of motion, with a mean improvement of 23 degrees (range, 10 to 45 degrees). Additionally all hips had an improvement in hip scores, with a significant increase in mean score from 74 points (range, 57 to 91 points) prior to injection to a mean of 96 points (range, 93 to 98) at final follow-up. There were no serious treatment-related adverse events. CONCLUSION: Botulinum toxin A injections combined with intensive physical therapy may be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are refractory to standard therapy.

CABARET: MIRROR OF SOCIETIES

The basic definition of a cabaret is a café that offers live entertainment performed by singers, musicians and dancers and serves food and drink. It is generally housed in small, intimate spaces. Starting in the middle of the nineteenth century, artists, composers and writers met at Parisian cafés and salons to share their works. The cabaret was a suitable place for social activities. Artists could meet, discuss their opinions, and share their art in a relaxed setting. Even though cabaret music was often based on popular idioms, social and political commentary coupled with satirical settings represented the true soul of the genre. This trend flourished in the late nineteenth and early twentieth centuries. The first cabaret in Paris, Le Chat Noir inspired the growth of similar places in major cities throughout Europe besides Paris. The three recitals that comprise this dissertation project were performed at University of Maryland venues: the Robert & Arlene Kogod Theatre on 11 May 2011, Ulrich Recital Hall on 4 December 2011, and Gildenhorn Recital Hall on 4 March 2012. The repertoire for the first recital included works by Erik Satie with mezzo-soprano Monica Soto-Gil, Friedrich Hollaender with soprano Gabrielle DeMers, William Bolcom with baritone Ethan Watermeier and mezzo-soprano Stepanie Sadownik, and Poulenc with baritone Andrew McLaughlin. André Previn‘s Tango Song and Dance with violinist Jennifer Kim served as the instrumental interlude. The second recital included songs by Friedrich Hollaender with mezzo-soprano Monica Soto-Gil, Hanns Eisler and Viktor Ullmann with mezzo-soprano Stephanie Sadownik, and Mischa Spoliansky with soprano CarrieAnne Winter. Victor Hollaender‘s Romance and Albumblatt were the instrumental interludes with violinist Jennifer Kim. The last recital featured works for piano and violin, the Graceful Ghost Rag by William Bolcom with violinist Jenny Wu, Four Souvenirs by Paul Schoenfield with violinist Jennifer Kim, Cabaret Songs by Benjamin Britten with soprano Linda Mabbs, and Souvenirs for piano four-hands by Samuel Barber with pianist Rita Sloan. The recitals were recorded on compact discs and are archived within the Digital Repository at the University of Maryland (DRUM).

RUSSIAN THREADS: THE PRESENCE OF RUSSIAN INFLUENCES IN TWENTIETH­ CENTURY ENGLISH CELLO MUSIC

A cursory glance at cello works by English composers during the twentieth- century yields an unexpected relationship to Russian musicians, history, culture, and religion. One must wonder how this connection or "Russian thread" came to be. When considering the working relationship of Benjamin Britten and Mstislav Rostropovich, the likelihood of such a connection is tangible, since their deeply personal friendship influenced Britten's music for cello. However, what is perhaps more interesting is the emergence of connections to Russia in the works of other English composers of the twentieth-century, featuring works from 1913-1996. This project was conceived after close study and analysis of Benjamin Britten's Third Suite for Solo Cello, Op. 87 (1971). Britten's inclusion of Russian folk tunes and an Orthodox Church hymn signaled the penetrating presence of Russian elements in his works. Britten's First Suite for Solo Cello, Op. 72, Third Suite for Cello, Op. 87, and Sonata for Piano and Cello in C, Op. 65 are presented in this project. Further exploration of works for cello by English composers unveiled similar connections to Russia. The Sonata for Cello and Piano of Frank Bridge is likened to Russian romanticism and the Cello Sonata of Sergei Rachmaninoff. William Walton's Cello Concerto was written for the Russian-American cellist Gregor Piatigorsky. Wake Up ...and die is John Tavener's deeply spiritual work, which is rooted in his Russian Orthodoxy. John Ireland, influenced by models of French and Russian Impressionism, contributed works colored with Russian folk influences, of which his Piano Trio No. 2 is an example. Finally, Arnold Bax traveled to Russia as a young man and his Folk Tale and Legend Sonata are imbued with the spirit of Russian folk music and architecture. This dissertation project is comprised of three recitals featuring English works for cello connected by a "Russian Thread." All events took place on the campus of University of Maryland, College Park: Recital #1 on December 4, 2011 in the Gildenhorn Recital Hall of the Clarice Smith Performing Arts Center, Recital #2 on February 11,2012, and Recital #3 on April 15, 2012, both in the Ulrich Recital Hall.

Genome-wide association study of perioperative myocardial infarction after coronary artery bypass surgery.

OBJECTIVES: Identification of patient subpopulations susceptible to develop myocardial infarction (MI) or, conversely, those displaying either intrinsic cardioprotective phenotypes or highly responsive to protective interventions remain high-priority knowledge gaps. We sought to identify novel common genetic variants associated with perioperative MI in patients undergoing coronary artery bypass grafting using genome-wide association methodology. SETTING: 107 secondary and tertiary cardiac surgery centres across the USA. PARTICIPANTS: We conducted a stage I genome-wide association study (GWAS) in 1433 ethnically diverse patients of both genders (112 cases/1321 controls) from the Genetics of Myocardial Adverse Outcomes and Graft Failure (GeneMAGIC) study, and a stage II analysis in an expanded population of 2055 patients (225 cases/1830 controls) combined from the GeneMAGIC and Duke Perioperative Genetics and Safety Outcomes (PEGASUS) studies. Patients undergoing primary non-emergent coronary bypass grafting were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was perioperative MI, defined as creatine kinase MB isoenzyme (CK-MB) values ≥10× upper limit of normal during the first postoperative day, and not attributable to preoperative MI. Secondary outcomes included postoperative CK-MB as a quantitative trait, or a dichotomised phenotype based on extreme quartiles of the CK-MB distribution. RESULTS: Following quality control and adjustment for clinical covariates, we identified 521 single nucleotide polymorphisms in the stage I GWAS analysis. Among these, 8 common variants in 3 genes or intergenic regions met p<10(-5) in stage II. A secondary analysis using CK-MB as a quantitative trait (minimum p=1.26×10(-3) for rs609418), or a dichotomised phenotype based on extreme CK-MB values (minimum p=7.72×10(-6) for rs4834703) supported these findings. Pathway analysis revealed that genes harbouring top-scoring variants cluster in pathways of biological relevance to extracellular matrix remodelling, endoplasmic reticulum-to-Golgi transport and inflammation. CONCLUSIONS: Using a two-stage GWAS and pathway analysis, we identified and prioritised several potential susceptibility loci for perioperative MI.

SELECTED TWENTIETH-CENTURY BRITISH & AMERICAN ENGLISH SONG REPERTOIRE WRITTEN FOR SOPRANO

English language song (both British and American) is influenced by a variety of cultures, races, and musical forms and has produced a broad range of song repertoire. Like songs in all countries and throughout history, these songs can be classified into three categories: imitative songs, experimental songs, and songs of individuality. Music experimentation, necessary and welcome as it is, can hardly command broad international attention. Thus, the songs of this dissertation performance project are chosen from the first and third categories: imitative songs and individual songs in the composer's own unique style. This project concentrates its exploration on twentieth-century solo songs written in English. Although twentieth-century British & American composers also produced solos and chamber music in other languages, this dissertation focuses upon their English repertoire. This performance project consists of three programs: one British repertoire and two American. The first program titled An Evening of British Song examines twentieth-century British song written by Roger Quilter, Peter Warlock, William Walton, Benjamin Britten, Thomas F. Dunhill, Ivor Gurney, and Frank Bridge. It was presented on December 12, 2001, in Homer Ulrich Recital Hall with the collaborative pianist Meriel Owen. The second program titled An Evening of American Song I comprises music written by Dominick Argento, Samuel Barber, Ned Rorem, Leonard Bernstein, and Lee Hoiby. It was presented on October 23, 2002, in Joseph & Alma Gildenhorn Recital Hall with the collaborative pianist R. Timothy McReynolds. The third program titled An Evening of American Song II written by John Duke, John Corigliano, Charles Ives, Richard Hundley, Lori Laitman, Frederick Loewe, George Gershwin, and Jerome Kern was presented on December 18, 2003, again in Joseph & Alma Gildenhorn Recital Hall with the collaborative pianist R. Timothy McReynolds and the flutist Jessica Dunnavant. Each of these three dissertation recitals occurred at the University of Maryland in College Park and was recorded. These CD recordings are held by the Michelle Smith Performing Arts Library at the University of Maryland.

The Many Faces of Paul Hindemith

The purpose of this project is to present selected violin pieces by Paul Hindemith (1895-1963) against a backdrop of the diverse styles and traditions that he integrated in his music. For this dissertation project, selected violin sonatas by Hindemith were performed in three recitals alongside pieces by other German and Austro-German composers. These recitals were also recorded for archival purposes. The first recital, performed with pianist David Ballena on December 10, 2005, in Gildenhorn Recital Hall at the University of Maryland, College Park, included Violin Sonata Op.11, No. 1 (1918) by Paul Hindemith, Sonatina in D Major, Op. 137 (1816) by Franz Schubert, and Sonata in E-flat Major, Op.18 (1887) by Richard Strauss. The second recital, performed with pianist David Ballena on May 9, 2006, in Gildenhorn Recital Hall at the University of Maryland, included Sonata in E Minor, KV 304 (1778) by Wolfgang Amadeus Mozart, Sonata in E (1935) by Paul Hindemith, Romance for Violin and Orchestra No.1 in G Major (1800-1802) by Ludwig Van Beethoven, and Sonata for Violin and Piano in A minor, Op. 105 (1851) by Robert Schumann. The third recital, performed with David Ballena and Kai-Ching Chang on November 10, 2006 in Ulrich Recital Hall at the University of Maryland, included Violin Sonata Op.12 No.1 in D Major (1798) by Ludwig Van Beethoven, Sonata for Violin and Harpsichord No.4 in C Minor BWV 1017 (1720) by J.S. Bach, and Violin Sonata Op.11 No.2 (1918) by Paul Hindemith. For each of my dissertation recitals, I picked a piece by Hindemith as the core of the program then picked pieces by other composers that have similar key, similar texture, same number of movements or similar feeling to complete my program. Although his pieces used some classical methods of composition, he added his own distinct style: extension of chromaticism; his prominent use of interval of the fourth; his chromatic alteration of diatonic scale degrees; and his non-traditional cadences. Hindemith left behind a legacy of multi-dimensional, and innovative music capable of expressing both the old and the new aesthetics.

Role of DNA binding sites and slow unbinding kinetics in titration-based oscillators.

Genetic oscillators, such as circadian clocks, are constantly perturbed by molecular noise arising from the small number of molecules involved in gene regulation. One of the strongest sources of stochasticity is the binary noise that arises from the binding of a regulatory protein to a promoter in the chromosomal DNA. In this study, we focus on two minimal oscillators based on activator titration and repressor titration to understand the key parameters that are important for oscillations and for overcoming binary noise. We show that the rate of unbinding from the DNA, despite traditionally being considered a fast parameter, needs to be slow to broaden the space of oscillatory solutions. The addition of multiple, independent DNA binding sites further expands the oscillatory parameter space for the repressor-titration oscillator and lengthens the period of both oscillators. This effect is a combination of increased effective delay of the unbinding kinetics due to multiple binding sites and increased promoter ultrasensitivity that is specific for repression. We then use stochastic simulation to show that multiple binding sites increase the coherence of oscillations by mitigating the binary noise. Slow values of DNA unbinding rate are also effective in alleviating molecular noise due to the increased distance from the bifurcation point. Our work demonstrates how the number of DNA binding sites and slow unbinding kinetics, which are often omitted in biophysical models of gene circuits, can have a significant impact on the temporal and stochastic dynamics of genetic oscillators.

A new instrument for measuring anticoagulation-related quality of life: development and preliminary validation.

BACKGROUND: Anticoagulation can reduce quality of life, and different models of anticoagulation management might have different impacts on satisfaction with this component of medical care. Yet, to our knowledge, there are no scales measuring quality of life and satisfaction with anticoagulation that can be generalized across different models of anticoagulation management. We describe the development and preliminary validation of such an instrument - the Duke Anticoagulation Satisfaction Scale (DASS). METHODS: The DASS is a 25-item scale addressing the (a) negative impacts of anticoagulation (limitations, hassles and burdens); and (b) positive impacts of anticoagulation (confidence, reassurance, satisfaction). Each item has 7 possible responses. The DASS was administered to 262 patients currently receiving oral anticoagulation. Scales measuring generic quality of life, satisfaction with medical care, and tendency to provide socially desirable responses were also administered. Statistical analysis included assessment of item variability, internal consistency (Cronbach's alpha), scale structure (factor analysis), and correlations between the DASS and demographic variables, clinical characteristics, and scores on the above scales. A follow-up study of 105 additional patients assessed test-retest reliability. RESULTS: 220 subjects answered all items. Ceiling and floor effects were modest, and 25 of the 27 proposed items grouped into 2 factors (positive impacts, negative impacts, this latter factor being potentially subdivided into limitations versus hassles and burdens). Each factor had a high degree of internal consistency (Cronbach's alpha 0.78-0.91). The limitations and hassles factors consistently correlated with the SF-36 scales measuring generic quality of life, while the positive psychological impact scale correlated with age and time on anticoagulation. The intra-class correlation coefficient for test-retest reliability was 0.80. CONCLUSIONS: The DASS has demonstrated reasonable psychometric properties to date. Further validation is ongoing. To the degree that dissatisfaction with anticoagulation leads to decreased adherence, poorer INR control, and poor clinical outcomes, the DASS has the potential to help identify reasons for dissatisfaction (and positive satisfaction), and thus help to develop interventions to break this cycle. As an instrument designed to be applicable across multiple models of anticoagulation management, the DASS could be crucial in the scientific comparison between those models of care.

Computational modelling of multi-physics and multi-scale processes in parallel

This paper provides an overview of the developing needs for simulation software technologies for the computational modelling of problems that involve combinations of interactions amongst varying physical phenomena over a variety of time and space scales. Computational modelling of such problems requires software tech1nologies that enable the mathematical description of the interacting physical phenomena together with the solution of the resulting suites of equations in a numerically consistent and compatible manner. This functionality requires the structuring of simulation modules for specific physical phenomena so that the coupling can be effectively represented. These multi-physics and multi-scale computations are very compute intensive and the simulation software must operate effectively in parallel if it is to be used in this context. An approach to these classes of multi-disciplinary simulation in parallel is described, with some key examples of application to2 challenging engineering problems.

Assessment of the origin and stability of Nifedipine polymorph IV by differential scanning calorimetry (DSC)

Purpose. To examine the thermal transition(s) between different polymorphic forms of Nifedipine and to define experimental conditions that lead to the generation of polymorph IV. Methods. Experiments were performed using a DSC 823e (Mettler Toledo). Nifedipine exists in four polymorphic forms, as well as an amorphous state. Examination of Nifedipine was conducted using the following method(s): cycle 1: 25ºC to 190ºC, 190ºC to 25ºC (formation of amorphous Nifedipine); cycle 2: 25ºC to X (60,70,80...150ºC), X to 25ºC; cycle 3: 25ºC to 190ºC and holding isothermally for 5 min between cycles (heating/cooling rate of 10ºC/min). Results. The amorphous state Nifedipine can sustain heating up to 90ºC without significant changes in its composition. Cycle 2 of amorphous material heated up to 90ºC shows only the glass transition at ~44ºC. In cycle 3 of the same material, a glass transition has been recorded at ~44ºC, followed by two exotherms (~100 and ~115ºC (crystallisation of polymorph III and II, respectively) and an endotherm (169ºC (melting of polymorphs I/II)). Samples that have been heated to temperatures between 100ºC and 120ºC in the second cycle showed a glass transition at ~44ºC and an additional exotherm at ~95ºC (crystallisation of polymorph III) on cooling a exotherm was observed at ~40ºC (crystallisation of polymorph IV). The same material showed no glass transition in cycle 3 but an endotherm at around 62ºC (melting of polymorph IV) an exotherm (~98ºC) and an endotherm (169ºC) melting of polymorph I/II. Heating the sample to a temperatures greater than 130ºC in cycle two results in a glass transition at ~44ºC, and two exotherms at ~102 and 125ºC (crystallisation of polymorphs III and I, respectively). Conclusions. DSC data suggests that polymorph IV can only be produced from amorphous or polymorph III samples. The presence of polymorph I or II drives the conversion of the less stable polymorphic form IV into the most stable form, I. Although form IV of Nifedipine can easily be created, following defined experimental conditions, it may only coexist with amorphous or polymorph III states. When polymorphs I and II are present in the sample polymorph IV cannot be etected.