Evaluation of Prognostic and Predictive Models in the Oncology Clinic.

Predictive and prognostic models hold great potential to support clinical decision making in oncology and could ultimately facilitate a paradigm shift to a more personalised form of treatment. While a large number of models relevant to the field of oncology have been developed, few have been translated into clinical use and assessment of clinical utility is not currently considered a routine part of model development. In this narrative review of the clinical evaluation of prediction models in oncology, we propose a high-level process diagram for the life cycle of a clinical model, encompassing model commissioning, clinical implementation and ongoing quality assurance, which aims to bridge the gap between model development and clinical implementation.

Differential effects on T-cell function following exposure to serum from schizophrenia smokers.

Cigarette smoking is more prevalent in subjects with schizophrenia compared to those with other psychiatric disorders or the general population and could therefore affect molecular pathways that impact the pathophysiology of this disorder. As smoking is also known to suppress immune responses, we investigated the effects of 'smoking-conditioned' serum obtained from schizophrenia and control subjects on healthy T cell in vitro. We found that T-cell proliferation was significantly increased following exposure to serum from smoking schizophrenia patients whereas no effect was observed when using serum from smoking control subjects or non-smoking patients and controls. We eliminated the possibility that these effects were due to quantitative differences in cigarette consumption as serum levels of the stable nicotine metabolite cotinine were similar in schizophrenic and control smokers. Molecular characterization showed that serum from patient smokers increased expression of T-cell activation markers CD69(high), CD25(high), co-stimulatory molecules CD26+, CD27+ and CD28+, and decreased T-cell receptor complex components TCRalpha/beta and CD3. Moreover, analysis of supernatants collected after T-cell exposure to serum from smoking patients showed a time-dependent decline in interleukin (IL)-2 levels, suggesting that the proliferation effect is promoted by enhanced IL-2 processing. These results suggest that cigarette smoking has selective effects on serum components that, in turn, lead to altered immune function in schizophrenia patients relative to healthy subjects. Further studies aimed at characterizing these components could result in a better understanding of the onset and aetiology of schizophrenia and potentially lead to novel therapeutic strategies.

Artifacts in recording immediate mandibular translation: a laboratory investigation.

STATEMENT OF PROBLEM: Even though immediate mandibular translation has been extensively studied and analyzed, and its clinical significance emphasized, there is controversy as to whether it actually exists or whether it is just an artifact of the pantograph. PURPOSE: The aim of this study was to determine whether what appears to be pantographic evidence of immediate mandibular translation can actually be an artifact and, if so, to find a method to avoid it. MATERIAL AND METHODS: The first part of this article explains geometrically with computer vector graphics how pure rotation can produce a pantographic tracing on the horizontal plate that is identical to what would be seen for immediate mandibular translation. The second part of the article presents a technique that uses a modified pantograph that eliminates the rotational artifact and thus permits proper interpretation of true immediate mandibular translation. RESULTS: This study shows that pure rotation about the sagittal axis mimics immediate mandibular translation on a pantographic tracing when the plates are inferior to the transverse horizontal axis, produces scribings in an opposite direction for plates in a superior position, and produces no scribing when the plates are level with it. By modifying the pantograph so the tip of the scribing pin of the horizontal plate is level with the transverse horizontal axis, true immediate mandibular translation can most easily be differentiated from rotational artifact. CONCLUSIONS AND CLINICAL SIGNIFICANCE: Rotation can cause artifacts that mimic immediate mandibular translation. A technique to avoid this problem is presented. This technique provides the foundation for a valid evaluation of patients to determine whether true immediate mandibular translation exists and whether it is clinically important.

Concurrent validity of the OPCRIT diagnostic system. Comparison of OPCRIT diagnoses with consensus best-estimate lifetime diagnoses.

BACKGROUND: OPCRIT (a suite of computer programs that allow data entry and generate diagnoses according to 12 operational diagnostic systems) is used in a wide range of psychiatric research including both European Science Foundation and NIMH research initiatives in the molecular genetics of mental disorders. We examined its concurrent validity in 100 subjects collected for linkage studies of Bipolar Disorder and Schizophrenia. METHOD: We compared diagnoses generated by OPCRIT from data rated by two trained clinicians with diagnoses made according to consensus, best-estimate, lifetime procedures by the same two raters according to DSM-III-R and RDC classifications. RESULTS: Good to excellent agreement was achieved between OPCRIT diagnoses and those made by consensus best-estimate procedures. CONCLUSIONS: OPCRIT provides a convenient, reliable, rapid and valid approach to polydiagnostic assessment that can be used as an adjunct to conventional (but time consulting) best-estimate consensus diagnostic procedures.

Using the oculocephalic reflex to assess effective retrobulbar anesthesia.

In order to confirm effective retrobulbar anesthesia, we attempted to stimulate the oculocephalic reflex (the doll's head phenomenon) in 40 consecutive patients undergoing elective cataract extraction with intravenous sedation. Thirty-nine of these 40 patients had a positive response, exhibiting the reflex in the nonanesthetized eye but not in the anesthetized eye. Using this test in sedated patients obviates interrupting surgery to administer additional block under less than optimal, uncontrolled conditions.

Lung liquid production by in vitro lungs from fetal guinea pigs: effects of arginine vasopressin and arginine vasotocin.

Lungs from near-term fetal guinea pigs were supported in vitro for 3 h; lung liquid production rates were measured by a dye dilution technique. Seventy preparations were used to study the effects of arginine vasopressin (AVP) placed in the outer saline for the middle hour, at concentrations reported at birth [fetuses 61 +/- 2 days of gestation; 94.7 +/- 16.2 g (SD) body weight]. At 1200 microU/ml, AVP arrested fluid production (rates, successive hours, 3.03 +/- 0.60, 0.50 +/- 0.14 and 0.02 +/- 0.08 ml/kg body weight per h; falls significant, P < 0.01-0.0005). At 600, 300 and 100 microU/ml there were significant but smaller reductions. Reabsorptions were seen in 8 preparations given 600-1200 microU/ml, AVP. Preparations given 10 microU/ml AVP, AVP carrier or control saline showed no significant change. The responses (% reductions during treatment), were linearly related to the log concentration of AVP (r = 0.99); theoretical threshold, 8 microU/ml). Increasing treatment to 2h did not increase final responses. Preparations from 5 fetuses > 120 g body weight showed significantly greater responses (P < 0.025) [fetuses 64 +/- 2 days of gestation; 135.1 +/- 18.6 g (SD) body weight]. 10(-6) M amiloride abolished responses to AVP [fetuses 62 +/- 1 days of gestation; 93.4 +/- 18.5 g (SD) body weight, n = 30; rates, succeeding hours; AVP alone, 1.78 +/- 0.22, 0.48 +/- 0.09, 0.16 +/- 0.99 (P < 0.01-0.0005); AVP with amiloride, 1.15 +/- 0.07, 0.93 +/- 0.10, 0.86 +/- 0.08 (no significant fall) ml/kg body weight per h]. Thirty-six preparations treated with arginine vasotocin (AVT, 10-600 microU/ml) showed closely similar responses to those from AVP. These studies extend results to fetal guinea pigs, and show that AVP, at concentrations reported at delivery, can slow lung liquid production or cause reabsorption by a direct action on the lung. The effect increases close to term, and is due to activation of amiloride-sensitive Na+ channels.

[Formulation, preparation and evaluation of shortening, laminated and cut biscuits, for diabetic patients]. / Formulación, elaboración y evaluación de galletas de masa corta, laminadas y cortadas, para diabéticos.

Laminated and cut cookies formulated with natural and/or artificial sweeteners as substitutes of sucrose, are presented as a new alternative of choice for persons on a restricted diet. According to data in the literature, market availability and technological and economic limitations involved in the use of pure sweeteners, four mixtures were selected for the formulation of the cookies, instead of sucrose. Their composition and relative sweetness were as follows: (table; see text) After the statistical analysis of results, formulations presenting significantly superior quality characteristics were selected. As observed, all alternatives subjected to evaluation were grade 1. A study of acceptability by diabetic patients was carried out with these products through a ranking test, in order to determine which were the formulations preferred. This revealed a significant preference for the cookies containing saccharin-sorbitol = 0.35:99.65, at a 1% level of significance. Their nutritional and caloric values, as well as the chemical composition of the selected formulations were then determined. The results showed a 10.9% decrease in caloric contribution.

Creative staffing models in medical transcription.

This article is a summary of staffing alternatives for medical transcription developed over the years and proven successful in certain hospital facilities. Creative approaches to staffing the medical transcription unit have proved to be effective tools in the maintenance and even expansion of transcription services on a cost-effective basis in a changing marketplace.

Project work in the medical curriculum.

This paper outlines one component, the project, which in 4 years became an integral part of the Human Ecology course at the Department of Community Medicine at the University of Glasgow. Although it is to be retained in some form, it would seem that the full potential of the device for medical undergraduates has not been realized; instead of retaining it in a token or contracted form, it could have served as the basis for cementing the learning and experience gained in the two halves of the division between the pre-clinical and the clinical years.

Community medicine in the medical curriculum: a statistical analysis of a professional examination.

This paper analyses the examination results of two cohorts of medical students at the University of Glasgow. It discusses the usefulness of Scottish higher grades as predictors of ability to pass examinations in medicine. Further correlations are made between the results from community medicine and other fourth- and fifth-year medical school examinations.

Basic and applied research at the TRIUMF meson factory.

The TRIUMF 520 MeV H- cyclotron produces intense beams of protons, pions and muons supporting basic research in nuclear, particle and solid-state physics, nuclear chemistry and biomedicine, and applied research in electromagnetic breeding of nuclear fuel, proton radiography, radioisotope production and cancer treatment.

Characterization of an unusual strain of proteus rettgeri associated with an outbreak of nosocomial urinary-tract infection.

An outbreak of nosocomial urinary-tract infection was caused by a strain of Proteus rettgeri that fermented lactose overnight and was resistant to all antimicrobial drugs tested. The nonmotile isolates shared an O (somatic) antigen that differed from those of wild-type P. rettgeri. The organisms proved markedly serum-sensitive. In rats, the isolates elicited an acute interstitial nephritis with associated transient bacteriuria. Attempts to transfer the lac(+) trait and drug-resistance markers to recipient strains of Escherichia coli K-12 failed; exposure of the isolates to acridine orange yielded small numbers of non-lactose-fermenting variants which, however, were still as drug-resistant as before. Epidemiological studies failed to uncover the source of this unique strain and appeared to indicate exogenous spread of infection.