Von der geographischen Analyse über die Bestandsaufnahme der anzutreffenden Krankheiten und der Anwendung traditioneller Medizin zu einem geomedizinischen Informationssystem am Beispiel einer Bergregion im Kabupaten Sikka (Insel Flores, Indonesien)

Im Rahmen der interdisziplinären Zusammenarbeit zur Durchsetzung des »Menschenrecht Gesundheit« wurde ein geomedizinisches Informationssystem erstellt, das auf die nordexponierten Bergdörfer zwischen 350 m ü. NN und 450 m ü. NN des Kabupaten Sikka auf der Insel Flores in Indonesien anwendbar ist. Es wurde eine Analyse der Zeit-Raum-Dimension der Gesundheitssituation in Wololuma und Napun Lawan - exemplarisch für die nordexponierten Bergdörfer - durchgeführt. Im Untersuchungsraum wurden Gesundheitsgefahren und Gesundheitsrisiken analysiert, Zonen der Gefahren herausgearbeitet und Risikoräume bewertet. Trotz eines El Niño-Jahres waren prinzipielle Bezüge der Krankheiten zum jahreszeitlichen Rhythmus der wechselfeuchten Tropen zu erkennen. Ausgehend von der Vermutung, dass Krankheiten mit spezifischen Klimaelementen korrelieren, wurden Zusammenhänge gesucht. Für jede Krankheit wurden Makro-, Meso- und Mikrorisikoräume ermittelt. Somit wurden Krankheitsherde lokalisiert. Die Generalisierung des geomedizinischen Informationssystems lässt sich auf der Makroebene auf die nordexponierten Bergdörfer zwischen 350 m ü. NN und 450 m ü. NN des Kabupaten Sikka übertragen. Aus einer Vielzahl von angetroffenen Krankheiten wurden sechs Krankheiten selektiert. Aufgrund der Häufigkeitszahlen ergibt sich für das Gesundheitsrisiko der Bevölkerung eine Prioritätenliste:rn- Dermatomykosen (ganzjährig)rn- Typhus (ganzjährig)rn- Infektionen der unteren Atemwege (Übergangszeit)rn- Infektionen der oberen Atemwege (Übergangszeit)rn- Malaria (Regenzeit)rn- Struma (ganzjährig)rnDie Hauptrisikogruppe der Makroebene ist die feminine Bevölkerung. Betroffen sind weibliche Kleinkinder von null bis sechs Jahren und Frauen ab 41 Jahren. Die erstellten Karten des zeitlichen und räumlichen Verbreitungsmusters der Krankheiten und des Zugangs zu Gesundheitsdienstleistungen dienen Entscheidungsträgern als Entscheidungshilfe für den Einsatz der Mittel zur Primärprävention. Die Geographie als Wissenschaft mit ihren Methoden und dem Zeit-Raum-Modell hat gezeigt, dass sie die Basis für die interdisziplinäre Forschung darstellt. Die interdisziplinäre Zusammenarbeit zur Gesundheitsforschung im Untersuchungszeitraum 2009 hat sich bewährt und muss weiter ausgebaut werden. Die vorgeschlagenen Lösungsmöglichkeiten dienen der Minimierung des Gesundheitsrisikos und der Gesundheitsvorsorge. Da die Systemzusammenhänge der Ätiologie der einzelnen Krankheiten sehr komplex sind, besteht noch immer sehr großer Forschungsbedarf. rnDas Ergebnis der vorliegenden Untersuchung zeigt, dass Wasser in jeder Form die primäre Ursache für das Gesundheitsrisiko der Bergdörfer im Kabupaten Sikka auf der Insel Flores in Indonesien ist.rnDer Zugang zu Wasser ist unerlässlich für die Verwirklichung des »Menschenrecht Gesundheit«. Das Recht auf Wasser besagt, dass jeder Mensch Zugang zu nicht gesundheitsgefährdendem, ausreichendem und bezahlbarem Wasser haben soll. Alle Staaten dieser Erde sollten sich dieser Forderung verpflichtet fühlen.rn

Knowledge Patterns for the Web: extraction, tranformation and reuse

This thesis aims at investigating methods and software architectures for discovering what are the typical and frequently occurring structures used for organizing knowledge in the Web. We identify these structures as Knowledge Patterns (KPs). KP discovery needs to address two main research problems: the heterogeneity of sources, formats and semantics in the Web (i.e., the knowledge soup problem) and the difficulty to draw relevant boundary around data that allows to capture the meaningful knowledge with respect to a certain context (i.e., the knowledge boundary problem). Hence, we introduce two methods that provide different solutions to these two problems by tackling KP discovery from two different perspectives: (i) the transformation of KP-like artifacts to KPs formalized as OWL2 ontologies; (ii) the bottom-up extraction of KPs by analyzing how data are organized in Linked Data. The two methods address the knowledge soup and boundary problems in different ways. The first method provides a solution to the two aforementioned problems that is based on a purely syntactic transformation step of the original source to RDF followed by a refactoring step whose aim is to add semantics to RDF by select meaningful RDF triples. The second method allows to draw boundaries around RDF in Linked Data by analyzing type paths. A type path is a possible route through an RDF that takes into account the types associated to the nodes of a path. Then we present K~ore, a software architecture conceived to be the basis for developing KP discovery systems and designed according to two software architectural styles, i.e, the Component-based and REST. Finally we provide an example of reuse of KP based on Aemoo, an exploratory search tool which exploits KPs for performing entity summarization.

Original analytical methods for the determination of psychoactive compounds in complex matrices

This thesis work aims to develop original analytical methods for the determination of drugs with a potential for abuse, for the analysis of substances used in the pharmacological treatment of drug addiction in biological samples and for the monitoring of potentially toxic compounds added to street drugs. In fact reliable analytical techniques can play an important role in this setting. They can be employed to reveal drug intake, allowing the identification of drug users and to assess drug blood levels, assisting physicians in the management of the treatment. Pharmacological therapy needs to be carefully monitored indeed in order to optimize the dose scheduling according to the specific needs of the patient and to discourage improper use of the medication. In particular, different methods have been developed for the detection of gamma-hydroxybutiric acid (GHB), prescribed for the treatment of alcohol addiction, of glucocorticoids, one of the most abused pharmaceutical class to enhance sport performance and of adulterants, pharmacologically active compounds added to illicit drugs for recreational purposes. All the presented methods are based on capillary electrophoresis (CE) and high performance liquid chromatography (HPLC) coupled to various detectors (diode array detector, mass spectrometer). Biological samples pre-treatment was carried out using different extraction techniques, liquid-liquid extraction (LLE) and solid phase extraction (SPE). Different matrices have been considered: human plasma, dried blood spots, human urine, simulated street drugs. These developed analytical methods are individually described and discussed in this thesis work.

Bindeprotein-abhängige DctS-Sensorkinasen aus Bacillus subtilis und Geobacillus kaustophilus

Das Enterobakterium Escherichia coli sowie das Bodenbakterium Bacillus subtilis können C4-Dicarbonsäuren als aerobe Kohlenstoffquelle zur Energiekonservierung nutzen. Die Regulation des C4-Dicarboxylatstoffwechsels erfolgt in E. coli und B. subtilis durch das Zweikomponentensystem DcuSREc bzw. DctSRBs, bestehend aus einer Sensorkinase und einem Responseregulator. Diese kontrollieren die Expression des C4-Dicarboxylat-Transporters DctA. Der Sensor DcuSEc benötigt für seine Funktion im aeroben Stoffwechsel den Transporter DctA als Cosensor. Für das DctSRBs-System gibt es Hinweise aus genetischen Untersuchungen, dass DctSBs das Bindeprotein DctBBs und möglicherweise auch DctABs als Cosensoren für seine Funktion benötigt. In dieser Arbeit sollte ein direkter Nachweis geführt werden, ob DctBBs und DctABs gemeinsam oder nur jeweils eine der Komponenten als Cosensoren für DctSBs fungieren. Sowohl für DctBBs als auch für DctABs wurde eine direkte Protein-Protein-Interaktion mit DctSBs durch zwei in vivo Interaktionsmethoden nachgewiesen. Beide Methoden beruhen auf der Co-Reinigung der Interaktionspartner mittels Affinitätschromatographie und werden je nach Affinitätssäule als mSPINE oder mHPINE (Membrane Strep/His-Protein INteraction Experiment) bezeichnet. Die Interaktion von DctSBs mit DctBBs wurde zusätzlich über ein bakterielles Two-Hybrid System nachgewiesen. Nach Coexpression mit DctSBs interagieren DctABs und DctBBs in mSPINE-Tests gleichzeitig mit der Sensorkinase. DctSBs bildet somit eine sensorische DctS/DctA/DctB-Einheit in B. subtilis und das Bindeprotein DctBBs agiert nur als Cosensor, nicht aber als Transport-Bindeprotein. Eine direkte Interaktion zwischen dem Transporter DctABs und dem Bindeprotein DctBBs besteht nicht. Transportmessungen belegen, dass der DctA-vermittelte Transport von [14C]-Succinat unabhängig ist von DctBBs. Außerdem wurde untersucht, ob Zweikomponentensysteme aus anderen Bakteriengruppen nach einem ähnlichen Schema wie DcuSREc bzw. DctSRBs aufgebaut sind. Das thermophile Bakterium Geobacillus kaustophilus verfügt über ein DctSR-System, welches auf genetischer Ebene mit einem Transporter des DctA-Typs und einem DctB-Bindeprotein geclustert vorliegt. Die Sensorkinase DctSGk wurde in E. coli heterolog exprimiert und gereinigt. Diese zeigt in einer E. coli DcuS-Insertionsmutanten Komplementation der DcuS-Funktion und besitzt dabei Spezifität für die C4-Dicarbonsäuren Malat, Fumarat, L-Tartrat und Succinat sowie für die C6-Tricarbonsäure Citrat. In Liposomen rekonstituiertes DctSGk zeigt Autokinase-Aktivität nach Zugabe von [γ-33P]-ATP. Der KD-Wert für [γ-33P]-ATP der Kinasedomäne von DctSGk liegt bei 43 μM, die Affinität für ATP ist damit etwa 10-fach höher als in DcuSEc.

Chemical exfoliation of graphene and its application in organic electronics and energy storage devices

Graphene, the thinnest two-dimensional material possible, is considered as a realistic candidate for the numerous applications in electronic, energy storage and conversion devices due to its unique properties, such as high optical transmittance, high conductivity, excellent chemical and thermal stability. However, the electronic and chemical properties of graphene are highly dependent on their preparation methods. Therefore, the development of novel chemical exfoliation process which aims at high yield synthesis of high quality graphene while maintaining good solution processability is of great concern. This thesis focuses on the solution production of high-quality graphene by wet-chemical exfoliation methods and addresses the applications of the chemically exfoliated graphene in organic electronics and energy storage devices.rnPlatinum is the most commonly used catalysts for fuel cells but they suffered from sluggish electron transfer kinetics. On the other hand, heteroatom doped graphene is known to enhance not only electrical conductivity but also long term operation stability. In this regard, a simple synthetic method is developed for the nitrogen doped graphene (NG) preparation. Moreover, iron (Fe) can be incorporated into the synthetic process. As-prepared NG with and without Fe shows excellent catalytic activity and stability compared to that of Pt based catalysts.rnHigh electrical conductivity is one of the most important requirements for the application of graphene in electronic devices. Therefore, for the fabrication of electrically conductive graphene films, a novel methane plasma assisted reduction of GO is developed. The high electrical conductivity of plasma reduced GO films revealed an excellent electrochemical performance in terms of high power and energy densities when used as an electrode in the micro-supercapacitors.rnAlthough, GO can be prepared in bulk scale, large amount of defect density and low electrical conductivity are major drawbacks. To overcome the intrinsic limitation of poor quality of GO and/or reduced GO, a novel protocol is extablished for mass production of high-quality graphene by means of electrochemical exfoliation of graphite. The prepared graphene shows high electrical conductivity, low defect density and good solution processability. Furthermore, when used as electrodes in organic field-effect transistors and/or in supercapacitors, the electrochemically exfoliated graphene shows excellent device performances. The low cost and environment friendly production of such high-quality graphene is of great importance for future generation electronics and energy storage devices. rn

A Flow Trace Generator using Graph-based Traffic Classification Techniques

We propose a novel methodology to generate realistic network flow traces to enable systematic evaluation of network monitoring systems in various traffic conditions. Our technique uses a graph-based approach to model the communication structure observed in real-world traces and to extract traffic templates. By combining extracted and user-defined traffic templates, realistic network flow traces that comprise normal traffic and customized conditions are generated in a scalable manner. A proof-of-concept implementation demonstrates the utility and simplicity of our method to produce a variety of evaluation scenarios. We show that the extraction of templates from real-world traffic leads to a manageable number of templates that still enable accurate re-creation of the original communication properties on the network flow level.

Holocene land-cover reconstructions for studies on land cover-climate feedbacks

The major objectives of this paper are: (1) to review the pros and cons of the scenarios of past anthropogenic land cover change (ALCC) developed during the last ten years, (2) to discuss issues related to pollen-based reconstruction of the past land-cover and introduce a new method, REVEALS (Regional Estimates of VEgetation Abundance from Large Sites), to infer long-term records of past land-cover from pollen data, (3) to present a new project (LANDCLIM: LAND cover – CLIMate interactions in NW Europe during the Holocene) currently underway, and show preliminary results of REVEALS reconstructions of the regional land-cover in the Czech Republic for five selected time windows of the Holocene, and (4) to discuss the implications and future directions in climate and vegetation/land-cover modeling, and in the assessment of the effects of human-induced changes in land-cover on the regional climate through altered feedbacks. The existing ALCC scenarios show large discrepancies between them, and few cover time periods older than AD 800. When these scenarios are used to assess the impact of human land-use on climate, contrasting results are obtained. It emphasizes the need for methods such as the REVEALS model-based land-cover reconstructions. They might help to fine-tune descriptions of past land-cover and lead to a better understanding of how long-term changes in ALCC might have influenced climate. The REVEALS model is demonstrated to provide better estimates of the regional vegetation/land-cover changes than the traditional use of pollen percentages. This will achieve a robust assessment of land cover at regional- to continental-spatial scale throughout the Holocene. We present maps of REVEALS estimates for the percentage cover of 10 plant functional types (PFTs) at 200 BP and 6000 BP, and of the two open-land PFTs "grassland" and "agricultural land" at five time-windows from 6000 BP to recent time. The LANDCLIM results are expected to provide crucial data to reassess ALCC estimates for a better understanding of the land suface-atmosphere interactions.

Timing of progression from Chlamydia trachomatis infection to pelvic inflammatory disease: a mathematical modelling study

Background Pelvic inflammatory disease (PID) results from the ascending spread of microorganisms from the vagina and endocervix to the upper genital tract. PID can lead to infertility, ectopic pregnancy and chronic pelvic pain. The timing of development of PID after the sexually transmitted bacterial infection Chlamydia trachomatis (chlamydia) might affect the impact of screening interventions, but is currently unknown. This study investigates three hypothetical processes for the timing of progression: at the start, at the end, or throughout the duration of chlamydia infection. Methods We develop a compartmental model that describes the trial structure of a published randomised controlled trial (RCT) and allows each of the three processes to be examined using the same model structure. The RCT estimated the effect of a single chlamydia screening test on the cumulative incidence of PID up to one year later. The fraction of chlamydia infected women who progress to PID is obtained for each hypothetical process by the maximum likelihood method using the results of the RCT. Results The predicted cumulative incidence of PID cases from all causes after one year depends on the fraction of chlamydia infected women that progresses to PID and on the type of progression. Progression at a constant rate from a chlamydia infection to PID or at the end of the infection was compatible with the findings of the RCT. The corresponding estimated fraction of chlamydia infected women that develops PID is 10% (95% confidence interval 7-13%) in both processes. Conclusions The findings of this study suggest that clinical PID can occur throughout the course of a chlamydia infection, which will leave a window of opportunity for screening to prevent PID.

The Intersection of Economics and Politics in a Small OPEC Country: the Case of Ecuador, 1990 - March 2014

Today, crude oil remains a vital resource all around the world. This non-renewable resource powers countries worldwide. Besides serving as an energy source, crude oil is also the most important component for different world economies, especially in developing countries. Ecuador, a small member of the OPEC oil cartel, presents a case where its economy is oil dependent. A great percentage of the country¿s GDP and government¿s budget comes from oil revenues. Ecuador has always been a primary exporter of raw materials. In the last centuries, the country experienced three important economic booms: cacao, bananas, and, ultimately, crude oil. In this sense, the country has not been able to fully industrialize and begin to export manufactured goods, i.e., Ecuador suffers from the Dutch disease. The latter has deterred Ecuador from achieving broad-based economic development. Given crude oil¿s importance for the Ecuadorian economy, the government has always tried to influence the oil industry in search of profits and benefits. Therefore, this thesis, explores the question: how and to what extent have political interventions affected the oil industry in Ecuador from 1990 until March 2014? In general, this thesis establishes an economic history context during the last twenty-four years, attempting to research how political interventions have shaped Ecuador¿s oil industry and economy. In the analysis, it covers a period where political instability prevailed, until Rafael Correa became president. The thesis examines Ecuador¿s participation in OPEC, trying to find explanations as to why the country voluntarily left the organization in 1992, only to rejoin in 2007 when Correa rose to power. During the ¿Revolución Ciudadana¿ period, the thesis researches reforms to the Law of Hydrocarbons, variations in the relations with other nations, the controversy surrounding the Yasuní-ITT oil block, and the ¿Refinería del Pacífico¿ construction. The thesis is an Industrial Organization detailed case study that analyzes, updates, and evaluates the intersection of economics and politics in Ecuador¿s crude oil industry during the last 24 years. In this sense I have consulted past theses, newspaper articles, books, and other published data about the petroleum industry, both from a global and Ecuadorian perspective. In addition to published sources, I was able to interview sociologists, public figures, history and economics academics, and other experts, accessing unique unpublished data about Ecuador¿s oil industry. I made an effort to collect information that shows the private and public side of the industry, i.e., from government-related and independent sources. I attempted to remain as objective as possible to make conclusions about the appropriate Industrial Organization policy for Ecuador¿s oil industry, addressing the issue from an economic, social, political, and environmental point of view. I found how Ecuador¿s political instability caused public policy to fail, molding the conduct and market structure of the crude oil industry. Throughout history, developed nations have benefited from low oil prices, but things shifted since oil prices began to rise, which is more beneficial for the developing nations that actually possess and produce the raw material. Nevertheless, Ecuador, a victim of the Dutch disease due to its heavy reliance on crude oil as a primary product, has not achieved broad-based development.

Monte Carlo simulation of a dynamic MLC: implementation and applications

PURPOSE: Study of behavior and influence of a multileaf collimator (MLC) on dose calculation, verification, and portal energy spectra in the case of intensity-modulated fields obtained with a step-and-shoot or a dynamic technique. METHODS: The 80-leaf MLC for the Varian Clinac 2300 C/D was implemented in a previously developed Monte Carlo (MC) based multiple source model (MSM) for a 6 MV photon beam. Using this model and the MC program GEANT, dose distributions, energy fluence maps and energy spectra at different portal planes were calculated for three different MLC applications. RESULTS: The comparison of MC-calculated dose distributions in the phantom and portal plane, with those measured with films showed an agreement within 3% and 1.5 mm for all cases studied. The deviations mainly occur in the extremes of the intensity modulation. The MC method allows to investigate, among other aspects, dose components, energy fluence maps, tongue-and-groove effects and energy spectra at portal planes. CONCLUSION: The MSM together with the implementation of the MLC is appropriate for a number of investigations in intensity-modulated radiation therapy (IMRT).

Structural capacity of steel tubular cast-in-place piling

Steel tubular cast-in-place pilings are used throughout the country for many different project types. These piles are a closed-end pipe with varying wall thicknesses and outer diameters, that are driven to depth and then the core is filled with concrete. These piles are typically used for smaller bridges, or secondary structures. Mostly the piling is designed based on a resistance based method which is a function of the soil properties of which the pile is driven through, however there is a structural capacity of these members that is considered to be the upper bound on the loading of the member. This structural capacity is given by the AASHTO LRFD (2010), with two methods. These two methods are based on a composite or non-composite section. Many state agencies and corporations use the non-composite equation because it is requires much less computation and is known to be conservative. However with the trends of the time, more and more structural elements are being investigated to determine ways to better understand the mechanics of the members, which could lead to more efficient and safer designs. In this project, a set of these piling are investigated. The way the cross section reacts to several different loading conditions, along with a more detailed observation of the material properties is considered as part of this research. The evaluation consisted of testing stub sections of pile with varying sizes (10-¾”, 12-¾”), wall thicknesses (0.375”, 0.5”), and testing methods (whole compression, composite compression, push through, core sampling). These stub sections were chosen as they would represent a similar bracing length to many different soils. In addition, a finite element model was developed using ANSYS to predict the strains from the testing of the pile cross sections. This model was able to simulate the strains from most of the loading conditions and sizes that were tested. The bond between the steel shell and the concrete core, along with the concrete strength through the depth of the cross section were some of the material properties of these sections that were investigated.

Genetic association studies under the population stratification, family pedigree and application to genome-wide association studies

This dissertation has three separate parts: the first part deals with the general pedigree association testing incorporating continuous covariates; the second part deals with the association tests under population stratification using the conditional likelihood tests; the third part deals with the genome-wide association studies based on the real rheumatoid arthritis (RA) disease data sets from Genetic Analysis Workshop 16 (GAW16) problem 1. Many statistical tests are developed to test the linkage and association using either case-control status or phenotype covariates for family data structure, separately. Those univariate analyses might not use all the information coming from the family members in practical studies. On the other hand, the human complex disease do not have a clear inheritance pattern, there might exist the gene interactions or act independently. In part I, the new proposed approach MPDT is focused on how to use both the case control information as well as the phenotype covariates. This approach can be applied to detect multiple marker effects. Based on the two existing popular statistics in family studies for case-control and quantitative traits respectively, the new approach could be used in the simple family structure data set as well as general pedigree structure. The combined statistics are calculated using the two statistics; A permutation procedure is applied for assessing the p-value with adjustment from the Bonferroni for the multiple markers. We use simulation studies to evaluate the type I error rates and the powers of the proposed approach. Our results show that the combined test using both case-control information and phenotype covariates not only has the correct type I error rates but also is more powerful than the other existing methods. For multiple marker interactions, our proposed method is also very powerful. Selective genotyping is an economical strategy in detecting and mapping quantitative trait loci in the genetic dissection of complex disease. When the samples arise from different ethnic groups or an admixture population, all the existing selective genotyping methods may result in spurious association due to different ancestry distributions. The problem can be more serious when the sample size is large, a general requirement to obtain sufficient power to detect modest genetic effects for most complex traits. In part II, I describe a useful strategy in selective genotyping while population stratification is present. Our procedure used a principal component based approach to eliminate any effect of population stratification. The paper evaluates the performance of our procedure using both simulated data from an early study data sets and also the HapMap data sets in a variety of population admixture models generated from empirical data. There are one binary trait and two continuous traits in the rheumatoid arthritis dataset of Problem 1 in the Genetic Analysis Workshop 16 (GAW16): RA status, AntiCCP and IgM. To allow multiple traits, we suggest a set of SNP-level F statistics by the concept of multiple-correlation to measure the genetic association between multiple trait values and SNP-specific genotypic scores and obtain their null distributions. Hereby, we perform 6 genome-wide association analyses using the novel one- and two-stage approaches which are based on single, double and triple traits. Incorporating all these 6 analyses, we successfully validate the SNPs which have been identified to be responsible for rheumatoid arthritis in the literature and detect more disease susceptibility SNPs for follow-up studies in the future. Except for chromosome 13 and 18, each of the others is found to harbour susceptible genetic regions for rheumatoid arthritis or related diseases, i.e., lupus erythematosus. This topic is discussed in part III.

Ascorbic acid for amelioration of reperfusion injury in a lung autotransplantation model in sheep

BACKGROUND: Reperfusion injury is the leading cause of early graft dysfunction after lung transplantation. Activation of neutrophilic granulocytes with generation of free oxygen radicals appears to play a key role in this process. The efficacy of ascorbic acid as an antioxidant in the amelioration of reperfusion injury after lung transplantation has not been studied yet. METHODS: An in situ autotransplantation model in sheep is presented. The left lung was flushed (Euro-Collins solution) and reperfused; after 2 hours of cold storage, the right hilus was then clamped (group R [reference], n = 6). Group AA animals (n = 6) were treated with 1 g/kg ascorbic acid before reperfusion. Controls (group C, n = 6) underwent hilar preparation and instrumentation only. RESULTS: In group R, arterio-alveolar oxygen difference (AaDO2) and pulmonary vascular resistance (PVR) were significantly elevated after reperfusion. Five of 6 animals developed frank alveolar edema. All biochemical parameters showed significant PMN activation. In group AA, AaDO2, PVR, work of breathing, and the level of PMN activation were significantly lower. CONCLUSIONS: The experimental model reproduces all aspects of lung reperfusion injury reliably. Ascorbic acid was able to weaken reperfusion injury in this experimental setup.

Individual patient data meta-analysis of diagnostic and prognostic studies in obstetrics, gynaecology and reproductive medicine

BACKGROUND: In clinical practice a diagnosis is based on a combination of clinical history, physical examination and additional diagnostic tests. At present, studies on diagnostic research often report the accuracy of tests without taking into account the information already known from history and examination. Due to this lack of information, together with variations in design and quality of studies, conventional meta-analyses based on these studies will not show the accuracy of the tests in real practice. By using individual patient data (IPD) to perform meta-analyses, the accuracy of tests can be assessed in relation to other patient characteristics and allows the development or evaluation of diagnostic algorithms for individual patients. In this study we will examine these potential benefits in four clinical diagnostic problems in the field of gynaecology, obstetrics and reproductive medicine. METHODS/DESIGN: Based on earlier systematic reviews for each of the four clinical problems, studies are considered for inclusion. The first authors of the included studies will be invited to participate and share their original data. After assessment of validity and completeness the acquired datasets are merged. Based on these data, a series of analyses will be performed, including a systematic comparison of the results of the IPD meta-analysis with those of a conventional meta-analysis, development of multivariable models for clinical history alone and for the combination of history, physical examination and relevant diagnostic tests and development of clinical prediction rules for the individual patients. These will be made accessible for clinicians. DISCUSSION: The use of IPD meta-analysis will allow evaluating accuracy of diagnostic tests in relation to other relevant information. Ultimately, this could increase the efficiency of the diagnostic work-up, e.g. by reducing the need for invasive tests and/or improving the accuracy of the diagnostic workup. This study will assess whether these benefits of IPD meta-analysis over conventional meta-analysis can be exploited and will provide a framework for future IPD meta-analyses in diagnostic and prognostic research.