The development of an objective methodology to measure medication adherence to oral thiopurines in paediatric patients with acute lymphoblastic leukaemia - an exploratory study

Aims - To develop a method that prospectively assesses adherence rates in paediatric patients with acute lymphoblastic leukaemia (ALL) who are receiving the oral thiopurine treatment 6-mercaptopurine (6-MP). Methods - A total of 19 paediatric patients with ALL who were receiving 6-MP therapy were enrolled in this study. A new objective tool (hierarchical cluster analysis of drug metabolite concentrations) was explored as a novel approach to assess non-adherence to oral thiopurines, in combination with other objective measures (the pattern of variability in 6-thioguanine nucleotide erythrocyte concentrations and 6-thiouric acid plasma levels) and the subjective measure of self-reported adherence questionnaire. Results - Parents of five ALL patients (26.3%) reported at least one aspect of non-adherence, with the majority (80%) citing “carelessness at times about taking medication” as the primary reason for non-adherence followed by “forgetting to take the medication” (60%). Of these patients, three (15.8%) were considered non-adherent to medication according to the self-reported adherence questionnaire (scored ≥ 2). Four ALL patients (21.1%) had metabolite profiles indicative of non-adherence (persistently low levels of metabolites and/or metabolite levels clustered variably with time). Out of these four patients, two (50%) admitted non-adherence to therapy. Overall, when both methods were combined, five patients (26.3%) were considered non-adherent to medication, with higher age representing a risk factor for non-adherence (P < 0.05). Conclusions - The present study explored various ways to assess adherence rates to thiopurine medication in ALL patients and highlighted the importance of combining both objective and subjective measures as a better way to assess adherence to oral thiopurines.

Income distribution dependence of poverty measure:a theoretical analysis

Using a modified deprivation (or poverty) function, in this paper, we theoretically study the changes in poverty with respect to the 'global' mean and variance of the income distribution using Indian survey data. We show that when the income obeys a log-normal distribution, a rising mean income generally indicates a reduction in poverty while an increase in the variance of the income distribution increases poverty. This altruistic view for a developing economy, however, is not tenable anymore once the poverty index is found to follow a pareto distribution. Here although a rising mean income indicates a reduction in poverty, due to the presence of an inflexion point in the poverty function, there is a critical value of the variance below which poverty decreases with increasing variance while beyond this value, poverty undergoes a steep increase followed by a decrease with respect to higher variance. Identifying this inflexion point as the poverty line, we show that the pareto poverty function satisfies all three standard axioms of a poverty index [N.C. Kakwani, Econometrica 43 (1980) 437; A.K. Sen, Econometrica 44 (1976) 219] whereas the log-normal distribution falls short of this requisite. Following these results, we make quantitative predictions to correlate a developing with a developed economy. © 2006 Elsevier B.V. All rights reserved.

Simple one-electron invariants of molecular chirality

Pseudoscalar measures of electronic chirality for molecular systems are derived using the spectral moment theory applied to the frequency-dependent rotational susceptibility. In this scheme a one-electron chirality operator κ^ naturally emerges as a quantum counterpart of the triple scalar product, involving velocity, acceleration and second acceleration. Averaging κ^ over an electronic state vector gives rise to an additive chirality invariant (κ-index), considered as a quantitative measure of chirality. A simple computational technique for quick calculation of the κ-index is developed and various structural classes (cyclic hydrocarbons, cage-shaped systems, etc.) are studied. Reasonable behaviour of the chirality index is demonstrated. The chirality changes during the β-turn formation in Leu-Enkephalin is presented as a useful example of the chirality analysis for conformational transitions.

A modified semi-oriented radial measure for target setting with negative data

Over the last few years Data Envelopment Analysis (DEA) has been gaining increasing popularity as a tool for measuring efficiency and productivity of Decision Making Units (DMUs). Conventional DEA models assume non-negative inputs and outputs. However, in many real applications, some inputs and/or outputs can take negative values. Recently, Emrouznejad et al. [6] introduced a Semi-Oriented Radial Measure (SORM) for modelling DEA with negative data. This paper points out some issues in target setting with SORM models and introduces a modified SORM approach. An empirical study in bank sector demonstrates the applicability of the proposed model. © 2014 Elsevier Ltd. All rights reserved.

An enhanced functional ability questionnaire (faVIQ) to measure the impact of rehabilitation services on the visually impaired

AIM To develop a short, enhanced functional ability Quality of Vision (faVIQ) instrument based on previous questionnaires employing comprehensive modern statistical techniques to ensure the use of an appropriate response scale, items and scoring of the visual related difficulties experienced by patients with visual impairment. METHODS Items in current quality-of-life questionnaires for the visually impaired were refined by a multi-professional group and visually impaired focus groups. The resulting 76 items were completed by 293 visually impaired patients with stable vision on two occasions separated by a month. The faVIQ scores of 75 patients with no ocular pathology were compared to 75 age and gender matched patients with visual im pairm ent. RESULTS Rasch analysis reduced the faVIQ items to 27. Correlation to standard visual metrics was moderate (r=0.32-0.46) and to the NEI-VFQ was 0.48. The faVIQ was able to clearly discriminate between age and gender matched populations with no ocular pathology and visual impairment with an index of 0.983 and 95% sensitivity and 95% specificity using a cut off of 29. CONCLUSION The faVIQ allows sensitive assessm ent of quality-of-life in the visually im paired and should support studies which evaluate the effectiveness of low vision rehabilitation services. © Copyright International Journal of Ophthalmology Press.

Classifying flexible measures in data envelopment analysis:a slack-based measure

Data envelopment analysis (DEA) has gained a wide range of applications in measuring comparative efficiency of decision making units (DMUs) with multiple incommensurate inputs and outputs. The standard DEA method requires that the status of all input and output variables be known exactly. However, in many real applications, the status of some measures is not clearly known as inputs or outputs. These measures are referred to as flexible measures. This paper proposes a flexible slacks-based measure (FSBM) of efficiency in which each flexible measure can play input role for some DMUs and output role for others to maximize the relative efficiency of the DMU under evaluation. Further, we will show that when an operational unit is efficient in a specific flexible measure, this measure can play both input and output roles for this unit. In this case, the optimal input/output designation for flexible measure is one that optimizes the efficiency of the artificial average unit. An application in assessing UK higher education institutions used to show the applicability of the proposed approach. © 2013 Elsevier Ltd. All rights reserved.

Rotation invariant iris feature extraction using Gaussian Markov random fields with non-separable wavelet

Rotation invariance is important for an iris recognition system since changes of head orientation and binocular vergence may cause eye rotation. The conventional methods of iris recognition cannot achieve true rotation invariance. They only achieve approximate rotation invariance by rotating the feature vector before matching or unwrapping the iris ring at different initial angles. In these methods, the complexity of the method is increased, and when the rotation scale is beyond the certain scope, the error rates of these methods may substantially increase. In order to solve this problem, a new rotation invariant approach for iris feature extraction based on the non-separable wavelet is proposed in this paper. Firstly, a bank of non-separable orthogonal wavelet filters is used to capture characteristics of the iris. Secondly, a method of Markov random fields is used to capture rotation invariant iris feature. Finally, two-class kernel Fisher classifiers are adopted for classification. Experimental results on public iris databases show that the proposed approach has a low error rate and achieves true rotation invariance. © 2010.

A new slacks-based measure of Malmquist-Luenberger index in the presence of undesirable outputs

In the majority of production processes, noticeable amounts of bad byproducts or bad outputs are produced. The negative effects of the bad outputs on efficiency cannot be handled by the standard Malmquist index to measure productivity change over time. Toward this end, the Malmquist-Luenberger index (MLI) has been introduced, when undesirable outputs are present. In this paper, we introduce a Data Envelopment Analysis (DEA) model as well as an algorithm, which can successfully eliminate a common infeasibility problem encountered in MLI mixed period problems. This model incorporates the best endogenous direction amongst all other possible directions to increase desirable output and decrease the undesirable outputs at the same time. A simple example used to illustrate the new algorithm and a real application of steam power plants is used to show the applicability of the proposed model.

Slow-phase onset influence on waveform identification and foveation time measure in congenital nystagmus

Congenital nystagmus (CN) is an ocular-motor disorder characterised by involuntary, conjugated ocular oscillations and its pathogenesis is still under investigation. This kind of nystagmus is termed congenital (or infantile) since it could be present at birth or it can arise in the first months of life. Most of CN patients show a considerable decrease of their visual acuity: image fixation on the retina is disturbed by nystagmus continuous oscillations, mainly horizontal. However, the image of a given target can still be stable during short periods in which eye velocity slows down while the target image is placed onto the fovea (called foveation intervals). To quantify the extent of nystagmus, eye movement recording are routinely employed, allowing physicians to extract and analyse nystagmus main features such as waveform shape, amplitude and frequency. Using eye movement recording, it is also possible to compute estimated visual acuity predictors: analytical functions which estimates expected visual acuity using signal features such as foveation time and foveation position variability. Use of those functions extend the information from typical visual acuity measurement (e.g. Landolt C test) and could be a support for therapy planning or monitoring. This study focuses on detection of CN patients' waveform type and on foveation time measure. Specifically, it proposes a robust method to recognize cycles corresponding to the specific CN waveform in the eye movement pattern and, for those cycles, evaluate the exact signal tracts in which a subject foveates. About 40 eyemovement recordings, either infrared-oculographic or electrooculographic, were acquired from 16 CN subjects. Results suggest that the use of an adaptive threshold applied to the eye velocity signal could improve the estimation of slow phase start point. This can enhance foveation time computing and reduce influence of repositioning saccades and data noise on the waveform type identification.

Three Spaces Problem for Lyapunov Theorem on Vector Measure

It is proved that a Banach space X has the Lyapunov property if its subspace Y and the quotient space X/Y have it.

New Symmetric (61,16,4) Designs Invariant Under the Dihedral Group of Order 10

∗ This work has been partially supported by the Bulgarian NSF under Contract No. I-506/1995.

Measure Refutations and Metrics on Statements of Experts (Logical Formulas) in the Models for Some Theory

* This work was financially supported by the Russian Foundation for Basic Research, project no. 04-01-00858a.