Accuracy of B-type natriuretic peptide tests to exclude congestive heart failure: systematic review of test accuracy studies

BACKGROUND: Congestive heart failure (CHF) is a major public health problem. The use of B-type natriuretic peptide (BNP) tests shows promising diagnostic accuracy. Herein, we summarize the evidence on the accuracy of BNP tests in the diagnosis of CHF and compare the performance of rapid enzyme-linked immunosorbent assay (ELISA) and standard radioimmunosorbent assay (RIA) tests. METHODS: We searched electronic databases and the reference lists of included studies, and we contacted experts. Data were extracted on the study population, the type of test used, and methods. Receiver operating characteristic (ROC) plots and summary ROC curves were produced and negative likelihood ratios pooled. Random-effect meta-analysis and metaregression were used to combine data and explore sources of between-study heterogeneity. RESULTS: Nineteen studies describing 22 patient populations (9 ELISA and 13 RIA) and 9093 patients were included. The diagnosis of CHF was verified by echocardiography, radionuclide scan, or echocardiography combined with clinical criteria. The pooled negative likelihood ratio overall from random-effect meta-analysis was 0.18 (95% confidence interval [CI], 0.13-0.23). It was lower for the ELISA test (0.12; 95% CI, 0.09-0.16) than for the RIA test (0.23; 95% CI, 0.16-0.32). For a pretest probability of 20%, which is typical for patients with suspected CHF in primary care, a negative result of the ELISA test would produce a posttest probability of 2.9%; a negative RIA test, a posttest probability of 5.4%. CONCLUSIONS: The use of BNP tests to rule out CHF in primary care settings could reduce demand for echocardiography. The advantages of rapid ELISA tests need to be balanced against their higher cost.

Bacillus Calmette-Guérin Failure in Patients with Non-Muscle-invasive Urothelial Carcinoma of the Bladder May Be Due to the Urologist's Failure to Detect Urothelial Carcinoma of the Upper Urinary Tract and Urethra

BACKGROUND: Various reasons exist for so-called bacillus Calmette-Guérin (BCG) failure in patients with non-muscle-invasive urothelial bladder carcinoma (NMIBC). OBJECTIVE: To explore whether urothelial carcinoma of the upper urinary tract (UUT) and/or prostatic urethra may be a cause for BCG failure. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 110 patients with high-risk NMIBC repeatedly treated with intravesical BCG, diagnosed with disease recurrence, and followed for a median time of 9.1 yr. INTERVENTION: Two or more intravesical BCG induction courses without maintenance. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome was pattern of disease recurrence (BCG failure) within the urinary tract categorised into UUT and/or urethral carcinoma (with or without intravesical recurrence), and intravesical recurrence alone. Secondary outcome was survival. Predictors of UUT and/or urethral carcinoma and the effect of pattern of disease recurrence on cancer-specific survival were assessed with multivariable Cox regression analysis adjusting for multiple clinical and tumour characteristics. RESULTS AND LIMITATIONS: Of the 110 patients, 57 (52%) had UUT and/or urethral carcinoma (with or without intravesical recurrence), and 53 (48%) had intravesical recurrence alone. In patients with UUT and/or urethral carcinoma, bladder carcinoma in situ (Tis) before the first and second BCG course was present in 42 of 57 (74%) and 47 of 57 (82%) patients, respectively. On multivariable analysis, bladder Tis before the first and/or second BCG course was the only independent predictor of UUT and/or urethral carcinoma. Of the 110 patients, 69 (63%) were alive at last follow-up visit, 18 (16%) had died due to metastatic urothelial carcinoma, and 23 (21%) had died of other causes. Pattern of disease recurrence within the urinary tract was not an independent predictor of cancer-specific survival. Main study limitations were retrospective design and limited power for survival analysis. CONCLUSIONS: In our patients with high-risk NMIBC failing after two or more courses of intravesical BCG, UUT and/or urethral carcinoma was detected in >50% of the cases during follow-up. The vast majority of these patients had bladder Tis before the first and/or second BCG course. In patients experiencing the so-called BCG failure, a diagnostic work-up of UUT and prostatic urethra should always be performed to exclude urothelial carcinoma before additional intravesical therapy or even a radical cystectomy is considered.

An OMNeT++ Framework to Evaluate Video Transmission in Mobile Wireless Multimedia Sensor Networks

The development and evaluation of new algorithms and protocols for Wireless Multimedia Sensor Networks (WMSNs) are usually supported by means of a discrete event network simulator, where OMNeT++ is one of the most important ones. However, experiments involving multimedia transmission, video flows with different characteristics, genres, group of pictures lengths, and coding techniques must be evaluated based also on Quality of Experience (QoE) metrics to reflect the user's perception. Such experiments require the evaluation of video-related information, i.e., frame type, received/lost, delay, jitter, decoding errors, as well as inter and intra-frame dependency of received/distorted videos. However, existing OMNeT++ frameworks for WMSNs do not support video transmissions with QoE-awareness, neither a large set of mobility traces to enable evaluations under different multimedia/mobile situations. In this paper, we propose a Mobile MultiMedia Wireless Sensor Network OMNeT++ framework (M3WSN) to support transmission, control and evaluation of real video sequences in mobile WMSNs.

Lack of efficacy of low-dose spironolactone as adjunct treatment to conventional congestive heart failure treatment in dogs.

Aldosterone plays an important role in the pathophysiology of heart failure. Aldosterone receptor blockade has been shown to reduce morbidity and mortality in human patients with advanced congestive left ventricular heart failure. This study was designed to assess the efficacy and tolerance of long-term low-dose spironolactone when added to conventional heart failure treatment in dogs with advanced heart failure. Eighteen client-owned dogs with advanced congestive heart failure due to either degenerative valve disease (n=11) or dilated cardiomyopathy (n=7) were included in this prospective, placebo-controlled, double-blinded, randomized clinical study. After initial stabilization including furosemide, angiotensin-converting enzyme inhibitors, pimobendan and digoxin, spironolactone at a median dose of 0.52 mg/kg (range 0.49-0.8 mg/kg) once daily (n=9) or placebo (n=9) was added to the treatment, and the dogs were reassessed 3 and 6 months later. Clinical scoring, echocardiography, electrocardiogram, systolic blood pressure measurement, thoracic radiography, sodium, potassium, urea, creatinine, alanine aminotransferase, aldosterone and aminoterminal atrial natriuretic propeptide were assessed at baseline, 3 and 6 months. Survival times were not significantly different between the two treatment groups. Spironolactone was well tolerated when combined with conventional heart failure treatment.

Multiple Hashing Integration for Real-Time Large Scale Part-to-Part Video Matching

A real-time large scale part-to-part video matching algorithm, based on the cross correlation of the intensity of motion curves, is proposed with a view to originality recognition, video database cleansing, copyright enforcement, video tagging or video result re-ranking. Moreover, it is suggested how the most representative hashes and distance functions - strada, discrete cosine transformation, Marr-Hildreth and radial - should be integrated in order for the matching algorithm to be invariant against blur, compression and rotation distortions: (R; _) 2 [1; 20]_[1; 8], from 512_512 to 32_32pixels2 and from 10 to 180_. The DCT hash is invariant against blur and compression up to 64x64 pixels2. Nevertheless, although its performance against rotation is the best, with a success up to 70%, it should be combined with the Marr-Hildreth distance function. With the latter, the image selected by the DCT hash should be at a distance lower than 1.15 times the Marr-Hildreth minimum distance.

IRS connections : a companion to the video magazine IRS connections : viewer's guide.

Caption title.

The Bumpy Road to Democracy: Success and Failure in the Integration of Ethnic Armenians in the Republic of Georgia

Thesis (Master's)--University of Washington, 2016-06

From marine ecology to crime analysis: improving the detection of serial sexual offences using a taxonomic similarity measure

Jaccard has been the choice similarity metric in ecology and forensic psychology for comparison of sites or offences, by species or behaviour. This paper applies a more powerful hierarchical measure - taxonomic similarity (s), recently developed in marine ecology - to the task of behaviourally linking serial crime. Forensic case linkage attempts to identify behaviourally similar offences committed by the same unknown perpetrator (called linked offences). s considers progressively higher-level taxa, such that two sites show some similarity even without shared species. We apply this index by analysing 55 specific offence behaviours classified hierarchically. The behaviours are taken from 16 sexual offences by seven juveniles where each offender committed two or more offences. We demonstrate that both Jaccard and s show linked offences to be significantly more similar than unlinked offences. With up to 20% of the specific behaviours removed in simulations, s is equally or more effective at distinguishing linked offences than where Jaccard uses a full data set. Moreover, s retains significant difference between linked and unlinked pairs, with up to 50% of the specific behaviours removed. As police decision-making often depends upon incomplete data, s has clear advantages and its application may extend to other crime types. Copyright © 2007 John Wiley & Sons, Ltd.

An objective approach to measuring video playback quality in lossy networks using TCP

In this work, we investigate a new objective measurement for assessing the video playback quality for services delivered in networks that use TCP as a transport layer protocol. We define the new metric as pause intensity to characterize the quality of playback in terms of its continuity since, in the case of TCP, data packets are protected from losses but not from delays. Using packet traces generated from real TCP connections in a lossy environment, we are able to simulate the playback of a video and monitor buffer behaviors in order to calculate pause intensity values. We also run subjective tests to verify the effectiveness of the metric introduced and show that the results of pause intensity and the subjective scores made over the same real video clips are closely correlated.

Volatile Blood Pressure Due To Baroreflex and Autonomic Failure

An 85-year-old male was hospitalized because of deterioration of his general condition and infection of the tracheostoma. He had had laryngectomy, bilateral neck dissection and radiation therapy for a laryngeal carcinoma 5 years earlier. Despite a good recovery, he could not get up because of a new onset of postural symptoms (dizziness, lightheadedness, collapse). Late onset of baroreflex failure and autonomic nervous system failure were diagnosed. Volatility of blood pressure (supine hypertension, upright hypotension) was treated with NaCl supplement during the day and a short-acting antihypertensive (clonidine) at night. With this regimen, the patient could walk without support.

Non-contact under-mattress sleep monitoring

Sleep quality and duration are increasingly recognised as being important prognostic parameters in the assessment of an individual's health. However, reliable non-invasive long-term monitoring of sleep in a non-clinical setting remains a challenging problem. This paper describes the validation of a novel under mattress pressure sensing sleep monitoring modality that can be seamlessly integrated into existing home environments and provides a pervasive and distributed solution for monitoring long-term changes in sleep patterns and sleep disorders in adults. 410 minutes of concomitant Under Mattress Bed Sensor (UMBS) and strain gauge data were analysed from eight healthy adults lying passively. In this analysis, customised respirations rate detection algorithms yielded a mean difference of −0.12 breaths per five minutes and a mean percentage error (MPE) of 0.16% when the sensor was placed beneath the mattress. 1,491 minutes of UMBS and video data were recorded simultaneously from four participants in order to assess the movement detection efficacy of customised UMBS algorithms. These algorithms yielded accuracies, sensitivities and specificities of over 90% when compared to a video-based movement detection gold standard. A reduced data set (267 minutes) of wrist actigraphy, the gold standard ambulatory sleep monitor, was recorded. The UMBS was shown to outperform the movement detection ability of wrist actigraphy and has the added advantage of not requiring active subject participation.

On the Implementation of a Streaming Video over Peer to Peer network using Middleware Components

Video streaming applications have hitherto been supported by single server systems. A major drawback of such a solution is that it increases the server load. The server restricts the number of clients that can be simultaneously supported due to limitation in bandwidth. The constraints of a single server system can be overcome in video streaming if we exploit the endless resources available in a distributed and networked system. We explore a P2P system for streaming video applications. In this paper we build a P2P streaming video (SVP2P) service in which multiple peers co-operate to serve video segments for new requests, thereby reducing server load and bandwidth used. Our simulation shows the playback latency using SVP2P is roughly 1/4th of the latency incurred when the server directly streams the video. Bandwidth consumed for control messages (overhead) is as low as 1.5% of the total data transfered. The most important observation is that the capacity of the SVP2P grows dynamically.

Architectures for Video-on-Demand content distribution in managed networks

La demanda de contenidos de vídeo ha aumentado rápidamente en los últimos años como resultado del gran despliegue de la TV sobre IP (IPTV) y la variedad de servicios ofrecidos por los operadores de red. Uno de los servicios que se ha vuelto especialmente atractivo para los clientes es el vídeo bajo demanda (VoD) en tiempo real, ya que ofrece una transmisión (streaming) inmediata de gran variedad de contenidos de vídeo. El precio que los operadores tienen que pagar por este servicio es el aumento del tráfico en las redes, que están cada vez más congestionadas debido a la mayor demanda de contenidos de VoD y al aumento de la calidad de los propios contenidos de vídeo. Así, uno de los principales objetivos de esta tesis es encontrar soluciones que reduzcan el tráfico en el núcleo de la red, manteniendo la calidad del servicio en el nivel adecuado y reduciendo el coste del tráfico. La tesis propone un sistema jerárquico de servidores de streaming en el que se ejecuta un algoritmo para la ubicación óptima de los contenidos de acuerdo con el comportamiento de los usuarios y el estado de la red. Debido a que cualquier algoritmo óptimo de distribución de contenidos alcanza un límite en el que no se puede llegar a nuevas mejoras, la inclusión de los propios clientes del servicio (los peers) en el proceso de streaming puede reducir aún más el tráfico de red. Este proceso se logra aprovechando el control que el operador tiene en las redes de gestión privada sobre los equipos receptores (Set-Top Box) ubicados en las instalaciones de los clientes. El operador se reserva cierta capacidad de almacenamiento y streaming de los peers para almacenar los contenidos de vídeo y para transmitirlos a otros clientes con el fin de aliviar a los servidores de streaming. Debido a la incapacidad de los peers para sustituir completamente a los servidores de streaming, la tesis propone un sistema de streaming asistido por peers. Algunas de las cuestiones importantes que se abordan en la tesis son saber cómo los parámetros del sistema y las distintas distribuciones de los contenidos de vídeo en los peers afectan al rendimiento general del sistema. Para dar respuesta a estas preguntas, la tesis propone un modelo estocástico preciso y flexible que tiene en cuenta parámetros como las capacidades de enlace de subida y de almacenamiento de los peers, el número de peers, el tamaño de la biblioteca de contenidos de vídeo, el tamaño de los contenidos y el esquema de distribución de contenidos para estimar los beneficios del streaming asistido por los peers. El trabajo también propone una versión extendida del modelo matemático mediante la inclusión de la probabilidad de fallo de los peers y su tiempo de recuperación en el conjunto de parámetros del modelo. Estos modelos se utilizan como una herramienta para la realización de exhaustivos análisis del sistema de streaming de VoD asistido por los peers para la amplia gama de parámetros definidos en los modelos. Abstract The demand of video contents has rapidly increased in the past years as a result of the wide deployment of IPTV and the variety of services offered by the network operators. One of the services that has especially become attractive to the customers is real-time Video on Demand (VoD) because it offers an immediate streaming of a large variety of video contents. The price that the operators have to pay for this convenience is the increased traffic in the networks, which are becoming more congested due to the higher demand for VoD contents and the increased quality of the videos. Therefore, one of the main objectives of this thesis is finding solutions that would reduce the traffic in the core of the network, keeping the quality of service on satisfactory level and reducing the traffic cost. The thesis proposes a system of hierarchical structure of streaming servers that runs an algorithm for optimal placement of the contents according to the users’ behavior and the state of the network. Since any algorithm for optimal content distribution reaches a limit upon which no further improvements can be made, including service customers themselves (the peers) in the streaming process can further reduce the network traffic. This process is achieved by taking advantage of the control that the operator has in the privately managed networks over the Set-Top Boxes placed at the clients’ premises. The operator reserves certain storage and streaming capacity on the peers to store the video contents and to stream them to the other clients in order to alleviate the streaming servers. Because of the inability of the peers to completely substitute the streaming servers, the thesis proposes a system for peer-assisted streaming. Some of the important questions addressed in the thesis are how the system parameters and the various distributions of the video contents on the peers would impact the overall system performance. In order to give answers to these questions, the thesis proposes a precise and flexible stochastic model that takes into consideration parameters like uplink and storage capacity of the peers, number of peers, size of the video content library, size of contents and content distribution scheme to estimate the benefits of the peer-assisted streaming. The work also proposes an extended version of the mathematical model by including the failure probability of the peers and their recovery time in the set of parameters. These models are used as tools for conducting thorough analyses of the peer-assisted system for VoD streaming for the wide range of defined parameters.

Failure analysis of laminated glass panels subjected to blast loads

This paper presents a rigorous and a reliable analytical procedure using finite element (FE) techniques to study the blast response of laminated glass (LG) panel and predict the failure of its components. The 1st principal stress (σ11) is used as the failure criterion for glass and the von mises stress (σv) is used for the interlayer and sealant joints. The results from the FE analysis for mid-span deflection, energy absorption and the stresses at critical locations of glass, interlayer and structural sealant are presented in the paper. These results compared well with those obtained from a free field blast test reported in the literature. The tensile strength (T) of the glass has a significant influence on the behaviour of the LG panel and should be treated carefully in the analysis. The glass panes absorb about 80% of the blast energy for the treated blast load and this should be minimised in the design.