Comparative effectiveness studies to improve clinical outcomes in end stage renal disease: the DEcIDE patient outcomes in end stage renal disease study.

BACKGROUND: Evidence is lacking to inform providers' and patients' decisions about many common treatment strategies for patients with end stage renal disease (ESRD). METHODS/DESIGN: The DEcIDE Patient Outcomes in ESRD Study is funded by the United States (US) Agency for Health Care Research and Quality to study the comparative effectiveness of: 1) antihypertensive therapies, 2) early versus later initiation of dialysis, and 3) intravenous iron therapies on clinical outcomes in patients with ESRD. Ongoing studies utilize four existing, nationally representative cohorts of patients with ESRD, including (1) the Choices for Healthy Outcomes in Caring for ESRD study (1041 incident dialysis patients recruited from October 1995 to June 1999 with complete outcome ascertainment through 2009), (2) the Dialysis Clinic Inc (45,124 incident dialysis patients initiating and receiving their care from 2003-2010 with complete outcome ascertainment through 2010), (3) the United States Renal Data System (333,308 incident dialysis patients from 2006-2009 with complete outcome ascertainment through 2010), and (4) the Cleveland Clinic Foundation Chronic Kidney Disease Registry (53,399 patients with chronic kidney disease with outcome ascertainment from 2005 through 2009). We ascertain patient reported outcomes (i.e., health-related quality of life), morbidity, and mortality using clinical and administrative data, and data obtained from national death indices. We use advanced statistical methods (e.g., propensity scoring and marginal structural modeling) to account for potential biases of our study designs. All data are de-identified for analyses. The conduct of studies and dissemination of findings are guided by input from Stakeholders in the ESRD community. DISCUSSION: The DEcIDE Patient Outcomes in ESRD Study will provide needed evidence regarding the effectiveness of common treatments employed for dialysis patients. Carefully planned dissemination strategies to the ESRD community will enhance studies' impact on clinical care and patients' outcomes.

The Evolution of Rachmaninov's Pianistic Style from 1892 to 1941 as Seen in Selected Original Works and Transcriptions for Piano

Unlike some other major composer-pianists (Franz Liszt and Alexander Scriabin being the most notable examples), Sergei Rachmaninov did not experience any dramatic changes in his compositional style; one can, however, notice certain stylistic differences between piano works composed during different periods of his long creative life. This dissertation argues that a clear evolution of Rachmaninov's pianistic style through his three creative periods can be traced by examining a selection of his compositions, from his first significant cycle for piano, 5 Marceaux de fantaisie, Op. 3 (1892), all the way through to his last piano work, a transcription of P.I.Tchakovsky's Lullaby, Op. 16, No. 1 (1941). Rachmaninov's life as a composer can be divided into three periods. His early period was ended abruptly by the disastrous premiere ofhis First Symphony in 1897, which caused a deep psychological crisis in the life of the young composer. Piano works of this period are often characterized by relatively simple homophonic texture, when Rachmaninov was clearly influenced by some of his Russian predecessors, most notably Tchaikovsky. His second and most productive period, also known as the period of"Russian maturity," started in 1900, when he began working on the Second Suite for two pianos, Op. 17, and the Second Concerto, Op. 18; this phase ended with the Russian Bolshevik revolution of 1917. Works of this time exhibit a mature style of piano writing, with rich, virtuosic - often considered excessive by many critics - texture and ever-increasing use of chromatic harmonies. Rachmaninov's works of the third period are limited in number owing to the composer's preoccupation with a career as pianist. Original works for piano now give way to revisions of earlier compositions and transcriptions: Rachmaninov's piano writing becomes more efficient and economical without losing any of its virtuosic brilliance. This dissertation project examines in detail, over the course of three piano recitals, a variety of works composed during the "Russian maturity" period, from several Preludes from Op. 23 (1903), the first major cycle for solo piano of the period, to 9 Etudes-Tableaux, Op.39 (1917), the last one; the early period is represented by 3 of 5 Marceaux defantaisie, Op. 3 (1892), while the late period is shown through several piano transcriptions and revised versions of the remaining 2 pieces from Op. 3.

Adjunctive albuterol enhances the response to enzyme replacement therapy in late-onset Pompe disease.

Effective dosages for enzyme replacement therapy (ERT) in Pompe disease are much higher than for other lysosomal storage disorders, which has been attributed to low cation-independent mannose-6-phosphate receptor (CI-MPR) in skeletal muscle. We have previously demonstrated the benefit of increased CI-MPR-mediated uptake of recombinant human acid-α-glucosidase during ERT in mice with Pompe disease following addition of albuterol therapy. Currently we have completed a pilot study of albuterol in patients with late-onset Pompe disease already on ERT for >2 yr, who were not improving further. The 6-min walk test (6MWT) distance increased in all 7 subjects at wk 6 (30±13 m; P=0.002), wk 12 (34±14 m; P=0.004), and wk 24 (42±37 m; P=0.02), in comparison with baseline. Grip strength was improved significantly for both hands at wk 12. Furthermore, individual subjects reported benefits; e.g., a female patient could stand up from sitting on the floor much more easily (time for supine to standing position decreased from 30 to 11 s), and a male patient could readily swing his legs out of his van seat (hip abduction increased from 1 to 2+ on manual muscle testing). Finally, analysis of the quadriceps biopsies suggested increased CI-MPR at wk 12 (P=0.08), compared with baseline. With the exception of 1 patient who succumbed to respiratory complications of Pompe disease in the first week, only mild adverse events have been reported, including tremor, transient difficulty falling asleep, and mild urinary retention (requiring early morning voiding). Therefore, this pilot study revealed initial safety and efficacy in an open label study of adjunctive albuterol therapy in patients with late-onset Pompe disease who had been stable on ERT with no improvements noted over the previous several years.

The Voyage of Impressionism in Three Violin Recitals: To See the World in Different Colors

Impressionism serves as the transition between romantic and modern music. This dissertation examines the varying characteristics and colors of Impressionism in the works of late-romantic French composers, French Impressionistic composers, and composers with Impressionistic influence from countries other than France. Violin Sonata in g minor, L. 140 (1917) is the last work composed by Claude Debussy. The impressionistic characters in this work includes the ambiguous yet innovative and variant sonority and form. As a work also written in 1917, Ottorino Respighi's Violin Sonata in b minor is deeply rooted in Italian Romanticism. Some of the Impressionistic characters can be found in the second movement where the harmonies are in parallel motion. César Franck, a forerunner of impressionism, heavily influenced Debussy with the use of cyclic form. The Violin Sonata in A major (1886) is rich in harmonic language. Ernest Chausson's works mark the transition between Franck and Debussy. The Poème portrays a love story, Song of Love Triumphant by Turgenev. The work is a symphonic poem for violin and orchestra. The Mythes, Op. 30 (1915) by Karol Szymanowski is based on Greek mythology. Ravel's Sonata for Violin and Cello (1922), dedicated to Debussy, points to the future with a sophisticated harmonic language extending into atonality, spare texture, and expanded palate of impressionistic colors and techniques. Ernest Bloch's Violin Sonata No. 1 (1920) portrays the feeling of torment. Beneath the soaring cries of the violin, the harmonic sonority of Impressionism are present. Gabriel Fauré's Violin Sonata No. 1 in A major, op. 13 (1876) is the earliest work of this project. The scherzo movement became a prototype for future scherzo movements for Ravel and Debussy. Ravel's Tzigane (1924), at once a paragon of French impressionism, a delightful gypsy-style dance-fantasy, and a breathtaking virtuoso piece, is the perfect conclusion to my dissertation project. The pieces discussed above were presented in three recitals. Compact disc recordings of these recitals are available in the Michelle Smith Performing Arts Library of the Clarice Smith Performing Arts Center at the University of Maryland.

The primary cellular immune responses to B. pertussis antigens in infants

info:eu-repo/semantics/nonPublished

The primary cellular immune responses to B. pertussis antigens in infants

info:eu-repo/semantics/nonPublished

Seroprotection against tetanus in patients présenting to an emergency department in Belgium and evaluation of a bedside immunotest (Tetanos Quick Stick R): A prospective observational study

info:eu-repo/semantics/published

Antibody deficiency due to a missense mutation in CD19 demonstrates the importance of the conserved tryptophan 41 in immunoglobulin superfamily domain formation.

Immunoglobulin superfamily (IgSF) domains are conserved structures present in many proteins in eukaryotes and prokaryotes. These domains are well-capable of facilitating sequence variation, which is most clearly illustrated by the variable regions in immunoglobulins (Igs) and T cell receptors (TRs). We studied an antibody-deficient patient suffering from recurrent respiratory infections and with impaired antibody responses to vaccinations. Patient's B cells showed impaired Ca(2+) influx upon stimulation with anti-IgM and lacked detectable CD19 membrane expression. CD19 sequence analysis revealed a homozygous missense mutation resulting in a tryptophan to cystein (W52C) amino acid change. The affected tryptophan is CONSERVED-TRP 41 located on the C-strand of the first extracellular IgSF domain of CD19 and was found to be highly conserved, not only in mammalian CD19 proteins, but in nearly all characterized IgSF domains. Furthermore, the tryptophan is present in all variable domains in Ig and TR and was not mutated in 117 Ig class-switched transcripts of B cells from controls, despite an overall 10% amino acid change frequency. In vitro complementation studies and CD19 western blotting of patient's B cells demonstrated that the mutated protein remained immaturely glycosylated. This first missense mutation resulting in a CD19 deficiency demonstrates the crucial role of a highly conserved tryptophan in proper folding or stability of IgSF domains.

Analysis of the utility of QuantiFERON-TB gold in tube and measurement of IFNgamma release by peripheral mononuclear cells in response to different mycobacterium antigen in the work-up of patients with uveitis.

Evaluation Studies

Fundamental Amplitude Noise Limitations to Supercontinuum Spectra Generated in a Microstructured Fiber

Broadband supercontinuum spectra are generated in a microstructured fiber using femtosecond laser pulses. Noise properties of these spectra are studied through experiments and numerical simulations based on a generalized stochastic nonlinear Schrödinger equation. In particular, the relative intensity noise as a function of wavelength across the supercontinuum is measured over a wide range of input pulse parameters, and experimental results and simulations are shown to be in good quantitative agreement. For certain input pulse parameters, amplitude fluctuations as large as 50% are observed. The simulations clarify that the intensity noise on the supercontinuum arises from the amplification of two noise inputs during propagation - quantum-limited shot noise on the input pulse, and spontaneous Raman scattering in the fiber. The amplification factor is a sensitive function of the input pulse parameters. Short input pulses are critical for the generation of very broad supercontinua with low noise.

Fundamental Amplitude Noise Limitations to Supercontinuum Spectra Generated in a Microstructured Fiber: Erratum

0

Erratum: Fundamental amplitude noise limitations to supercontinuum spectra generated in a microstructured fiber (Appl. Phys. B (2003) 77 (269-277))

SCOPUS: er.j

A computational modelling framework to predict macroscopic phenomena in solder joint formation

A computational model of solder joint formation and the subsequent cooling behaviour is described. Given the rapid changes in the technology of printed circuit boards, there is a requirement for comprehensive models of solder joint formation which permit detailed analysis of design and optimization options. Solder joint formation is complex, involving a range of interacting phenomena. This paper describes a model implementation (as part of a more comprehensive framework) to describe the shape formation (conditioned by surface tension), heat transfer, phase change and the development of elastoviscoplastic stress. The computational modelling framework is based upon mixed finite element and finite volume procedures, and has unstructured meshes enabling arbitrarily complex geometries to be analysed. Initial results for both through-hole and surface-mount geometries are presented.