Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration.

AIM: To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement. METHODS: We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ(2) test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group. RESULTS: Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5% (427/8110) resolved HBV, 8% (628/8110) likely prior HBV vaccination, and 76% (6022/7903) were HBV negative. In those with chronic HBV infection, ≤ 37% received HBV antiviral treatment during the high risk period while 21% to 23% of those with past or resolved HBV, respectively, received HBV antiviral treatment. During and 12 mo after anti-CD20 Ab, the rate of hepatitis was significantly greater in those HBV positive vs negative (P = 0.001). The mortality rate was 35%-40% in chronic or past hepatitis B and 26%-31% in hepatitis B negative. In those pretreatment HBV negative, 16 (0.3%) developed acute hepatitis B of 4947 tested during anti-CD20Ab treatment and follow-up. CONCLUSION: While HBV testing of Veterans has increased prior to anti-CD20 Ab, few HBV+ patients received HBV antivirals, suggesting electronic health record algorithms may enhance health outcomes.

The development of an advanced ship evacuation simulation software product and associated large scale testing facility for the collection of human shipboard behaviour data

When designing a new passenger ship or modifying an existing design, how do we ensure that the proposed design and crew emergency procedures are safe from an evacuation point of view? In the wake of major maritime disasters such as the Herald of Free Enterprise and the Estonia and in light of the growth in the numbers of high density, high-speed ferries and large capacity cruise ships, issues concerned with the evacuation of passengers and crew at sea are receiving renewed interest. In the maritime industry, ship evacuation models offer the promise to quickly and efficiently bring evacuation considerations into the design phase, while the ship is "on the drawing board". maritimeEXODUS-winner of the BCS, CITIS and RINA awards - is such a model. Features such as the ability to realistically simulate human response to fire, the capability to model human performance in heeled orientations, a virtual reality environment that produces realistic visualisations of the modelled scenarios and with an integrated abandonment model, make maritimeEXODUS a truly unique tool for assessing the evacuation capabilities of all types of vessels under a variety of conditions. This paper describes the maritimeEXODUS model, the SHEBA facility from which data concerning passenger/crew performance in conditions of heel is derived and an example application demonstrating the models use in performing an evacuation analysis for a large passenger ship partially based on the requirements of MSC circular 1033.

Acoustic emission testing of paper

Using Acoustic Emission Testing (AET) to determine the onset of paper damage will be demonstrated on tensile coupons made from mechanical pulp. This technique is part of an EU funded project named the Fifth Frame Program. Its aim is to develop methods for determining specific damage mechanisms through AET. Various such techniques of damage detection will be demonstrated in the coming work.

Report on the Testing and Systematic Evaluation of the airEXODUS Aircraft Evacuation Model

This report covers the testing and evaluation of the airEXODUS evacuation model. airEXODUS has been developed for evacuation certification testing, crew training and aircraft design. The report demonstrates the effectiveness of the model.

Towards policy-based self-configuration of embedded systems

This paper describes work towards the deployment of flexible self-management into real-time embedded systems. A challenging project which focuses specifically on the development of a dynamic, adaptive automotive middleware is described, and the specific self-management requirements of this project are discussed. These requirements have been identified through the refinement of a wide-ranging set of use cases requiring context-sensitive behaviours. A sample of these use-cases is presented to illustrate the extent of the demands for self-management. The strategy that has been adopted to achieve self-management, based on the use of policies is presented. The embedded and real-time nature of the target system brings the constraints that dynamic adaptation capabilities must not require changes to the run-time code (except during hot update of complete binary modules), adaptation decisions must have low latency, and because the target platforms are resource-constrained the self-management mechanism have low resource requirements (especially in terms of processing and memory). Policy-based computing is thus and ideal candidate for achieving the self-management because the policy itself is loaded at run-time and can be replaced or changed in the future in the same way that a data file is loaded. Policies represent a relatively low complexity and low risk means of achieving self-management, with low run-time costs. Policies can be stored internally in ROM (such as default policies) as well as externally to the system. The architecture of a designed-for-purpose powerful yet lightweight policy library is described. A suitable evaluation platform, supporting the whole life-cycle of feasibility analysis, concept evaluation, development, rigorous testing and behavioural validation has been devised and is described.

Start-up and running forces on bulk solids feeders: experimental findings versus available models

Many different models have been postulated over the years for sizing of feeder drives; these models have different bases, some rationally based and others more rule-of-thumb. Experience of Jenike & Johanson and likewise of The Wolfson Centre in trouble-shooting feeder drives has shown that drive powers are often poorly matched, so there is clearly still some way to go towards establishing a universally-used reliable approach. This paper presents an on-going programme of work designed to measure feeder forces experimentally on a purpose designed testing rig, and to compare these against some of the best known available models, and also against a full size installation. One aspect which is novel is the monitoring of the transition between the “filling stress field” load on the feeder and the “flowing stress field” load.

Investigation into a modular rule-based testing method for testing business rules in scheduling applications

Rule testing in transport scheduling is a complex and potentially costly business problem. This paper proposes an automated method for the rule-based testing of business rules using the extensible Markup Language for rule representation and transportation. A compiled approach to rule execution is also proposed for performance-critical scheduling systems.

Towards Real-time Speech Emotion Recognition for Affective E-Learning

The original article is available as an open access file on the Springer website in the following link: http://link.springer.com/article/10.1007/s10639-015-9388-2

RAGE Architecture for Reusable Serious Gaming Technology Components

For seizing the potential of serious games, the RAGE project - funded by the Horizon-2020 Programme of the European Commission - will make available an interoperable set of advanced technology components (software assets) that support game studios at serious game development. This paper describes the overall software architecture and design conditions that are needed for the easy integration and reuse of such software assets in existing game platforms. Based on the component-based software engineering paradigm the RAGE architecture takes into account the portability of assets to different operating systems, different programming languages and different game engines. It avoids dependencies on external software frameworks and minimizes code that may hinder integration with game engine code. Furthermore it relies on a limited set of standard software patterns and well-established coding practices. The RAGE architecture has been successfully validated by implementing and testing basic software assets in four major programming languages (C#, C++, Java and Typescript/JavaScript, respectively). A demonstrator implementation of asset integration with an existing game engine was created and validated. The presented RAGE architecture paves the way for large scale development and application of cross-engine reusable software assets for enhancing the quality and diversity of serious gaming.