Intubation rate, duration of noninvasive ventilation and mortality after noninvasive neurally adjusted ventilatory assist (NIV-NAVA).

BACKGROUND: Asynchrony is a common problem in patients treated with noninvasive ventilation (NIV). Neurally adjusted ventilatory assist (NAVA) has shown to improve patient-ventilator interaction. However, it is unknown whether NIV-NAVA improves outcomes compared to noninvasive pressure support (NIV-PS). METHODS: This observational cohort study included patients 18 years or older receiving noninvasive ventilation using an oro-nasal face mask for more than 2 hours in a Danish ICU. The study included a NIV-NAVA cohort (year 2013-2015) and two comparison cohorts: (a) a historical NIV-PS cohort (year 2011-2012) before the implementation of NIV-NAVA at the ICU in 2013, and (b) a concurrent NIV-PS cohort (year 2013-2015). Outcomes of NIV-NAVA (intubation rate, duration of NIV and 90-day mortality) were assessed and compared using multivariable linear and logistic regression adjusted for relevant confounders. RESULTS: The study included 427 patients (91 in the NIV-NAVA, 134 in the historic NIV-PS and 202 in the concurrent NIV-PS cohort). Patients treated with NIV-NAVA did not have improved outcome after adjustment for measured confounders. Actually, there were statistically imprecise higher odds for intubation in NIV-NAVA patients compared with both the historical [OR 1.48, CI (0.74-2.97)] and the concurrent NIV-PS cohort [OR 1.67, CI (0.87-3.19)]. NIV-NAVA might also have a longer length of NIV [63%, CI (19%-125%)] and [139%, CI (80%-213%)], and might have a higher 90-day mortality [OR 1.24, CI (0.69-2.25)] and [OR 1.39, CI (0.81-2.39)]. Residual confounding cannot be excluded. CONCLUSION: This present study found no improved clinical outcomes in patients treated with NIV-NAVA compared to NIV-PS.

Neural networks for image-based wavefront sensing for astronomy.

We study the possibility of using convolutional neural networks for wavefront sensing from a guide star image in astronomical telescopes. We generated a large number of artificial atmospheric wavefront screens and determined associated best-fit Zernike polynomials. We also generated in-focus and out-of-focus point-spread functions. We trained the well-known "Inception" network using the artificial data sets and found that although the accuracy does not permit diffraction-limited correction, the potential improvement in the residual phase error is promising for a telescope in the 2-4 m class.

Effects of live music during chemotherapy in lymphoma patients: a randomized, controlled, multi-center trial.

PURPOSE: Chemotherapy is associated with both somatic and psychological side effects. Music might ease these problems. Several randomized controlled trials have investigated the effect of music, but the results are inconclusive. We aimed to examine whether live or pre-recorded music listening decreases anxiety during chemotherapy in newly diagnosed lymphoma patients. METHODS: A total of 143 patients with non-Hodgkin and Hodgkin lymphomas were randomly assigned into three groups receiving either 30 min of patient-preferred live music (n = 47), 30 min of patient-preferred pre-recorded music (n = 47), or standard care (n = 49) during up to five outpatient chemotherapy sessions. The primary endpoint was anxiety measured by the Spielberger's State Anxiety Inventory. Secondary endpoints included blood pressure, pulse rate, nausea and vomiting, serum catecholamine levels pre- and post-intervention to measure arousal levels, and health-related quality of life. The Musical Ability Test was used to link musical ability to the primary endpoint. RESULTS: When adjusting for age, sex, diagnosis, number of sessions, and baseline anxiety, the linear mixed model showed a borderline statistically significant reduction in the primary outcome anxiety in the live music group compared to standard care (7% (95% CI, - 14% to 0%, p = 0.05), while the effect of pre-recorded music was non-significant (5% (95% CI, - 12% to + 3%, p = 0.18). No intervention effects were seen in secondary outcomes. CONCLUSION: Our findings suggest that patient-preferred live music reduces anxiety among patients with malignant lymphomas undergoing chemotherapy. Musical ability among this group of cancer patients seems not to be a determining factor for effect of music intervention.

Efficient and robust recurrence relations for the Zernike circle polynomials and their derivatives in Cartesian coordinates.

For some time it has been known and recommended that the calculation of Zernike polynomials to radial orders higher than 8 to 10 should be performed using recurrence relations rather than explicit expressions due increasingly large cancellation errors. This paper presents a set of simple recurrence relations that can be used for the unit-normalized Zernike polynomials in polar coordinates and easily adapted to Cartesian coordinates as well. The recurrence relations are also well suited for the calculation of the Cartesian derivatives of the Zernike polynomials. The recurrence relations are easily extended to arbitrarily high orders. Assessments of the precision achievable with standard 64-bit floating point arithmetic show that Zernike polynomials up to radial order 30 can be calculated over the unit disc with errors not exceeding 5E-14, and up to radial order 50 with errors not exceeding 1.2E-13. Comparison with the Zernike capability in OpticStudio (Zemax) shows that the recurrence relations are superior in performance (both speed and precision) over the existing algorithm implemented in the software. General pseudo-code for the calculation of Zernike polynomials and their derivatives is also presented.

The Essential Elements of a Risk Governance Framework for Current and Future Nanotechnologies.

Societies worldwide are investing considerable resources into the safe development and use of nanomaterials. Although each of these protective efforts is crucial for governing the risks of nanomaterials, they are insufficient in isolation. What is missing is a more integrative governance approach that goes beyond legislation. Development of this approach must be evidence based and involve key stakeholders to ensure acceptance by end users. The challenge is to develop a framework that coordinates the variety of actors involved in nanotechnology and civil society to facilitate consideration of the complex issues that occur in this rapidly evolving research and development area. Here, we propose three sets of essential elements required to generate an effective risk governance framework for nanomaterials. (1) Advanced tools to facilitate risk-based decision making, including an assessment of the needs of users regarding risk assessment, mitigation, and transfer. (2) An integrated model of predicted human behavior and decision making concerning nanomaterial risks. (3) Legal and other (nano-specific and general) regulatory requirements to ensure compliance and to stimulate proactive approaches to safety. The implementation of such an approach should facilitate and motivate good practice for the various stakeholders to allow the safe and sustainable future development of nanotechnology.

Cool-Climate Red Wines-Chemical Composition and Comparison of Two Protocols for ¹H-NMR Analysis.

This study investigates the metabolome of 26 experimental cool-climate wines made from 22 grape varieties using two different protocols for wine analysis by proton nuclear magnetic resonance (¹H-NMR) spectroscopy. The wine samples were analyzed as-is (wet) and as dried samples. The NMR datasets were preprocessed by alignment and mean centering. No normalization or scaling was performed. The "wet" method preserved the inherent properties of the samples and provided a fast and effective overview of the molecular composition of the wines. The "dried" method yielded a slightly better sensitivity towards a broader range of the compounds present in wines. A total of 27 metabolites including amino acids, organic acids, sugars, and alkaloids were identified in the ¹H-NMR spectra of the wine samples. Principal component analysis was performed on both NMR datasets evidencing well-defined molecular fingerprints for 'Baco Noir', 'Bolero', 'Cabernet Cantor', 'Cabernet Cortis', 'Don Muscat', 'Eszter', 'Golubok', 'New York Muscat', 'Regent', 'Rondo', 'Triomphe d'Alsace', 'Précose Noir', and 'Vinoslivy' wines. Amongst the identified metabolites, lactic acid, succinic acid, acetic acid, gallic acid, glycerol, and methanol were found to drive sample groupings. The ¹H-NMR data was compared to the absolute concentration values obtained from a reference Fourier transform infrared method, evidencing a high correlation.

Effect of sequential fermentations and grape cultivars on volatile compounds and sensory profiles of Danish wines.

BACKGROUND: There has been an increasing interest in the use of selected non-Saccharomyces yeasts in co-culture with Saccharomyces cerevisiae. In this work, three non-Saccharomyces yeast strains (Metschnikowia viticola, Metschnikowia fructicola and Hanseniaspora uvarum) indigenously isolated in Denmark were used in sequential fermentations with S. cerevisiae on three cool-climate grape cultivars, Bolero, Rondo and Regent. During the fermentations, the yeast growth was determined as well as key oenological parameters, volatile compounds and sensory properties of finished rosé wines. RESULTS: The different non-Saccharomyces strains and cool-climate grape cultivars produced wines with a distinctive aromatic profile. A total of 67 volatile compounds were identified, including 43 esters, 14 alcohols, five acids, two ketones, a C13-norisoprenoid, a lactone and a sulfur compound. The use of M. viticola in sequential fermentation with S. cerevisiae resulted in richer berry and fruity flavours in wines. The sensory plot showed a more clear separation among wine samples by grape cultivars compared with yeast strains. CONCLUSION: Knowledge on the influence of indigenous non-Saccharomyces strains and grape cultivars on the flavour generation contributed to producing diverse wines in cool-climate wine regions. © 2017 Society of Chemical Industry.

Multiplex polymerase chain reaction-based prognostic models in diffuse large B-cell lymphoma patients treated with R-CHOP.

We present a multiplex analysis for genes known to have prognostic value in an attempt to design a clinically useful classification model in patients with diffuse large B-cell lymphoma (DLBCL). Real-time polymerase chain reaction was used to measure transcript levels of 28 relevant genes in 194 de novo DLBCL patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). Including International Prognostic Index (IPI) as a variable in a penalized Cox regression, we investigated the association with disease progression for single genes or gene combinations in four models. The best model was validated in data from an online available R-CHOP treated cohort. With progression-free survival (PFS) as primary endpoint, the best performing IPI independent model incorporated the LMO2 and HLADQA1 as well as gene interactions for GCSAMxMIB1, GCSAMxCTGF and FOXP1xPDE4B. This model assigned 33% of patients (n = 60) to poor outcome with an estimated 3-year PFS of 40% vs. 87% for low risk (n = 61) and intermediate (n = 60) risk groups (P < 0·001). However, a simpler, IPI independent model incorporated LMO2 and BCL2 and assigned 33% of the patients with a 3-year PFS of 35% vs. 82% for low risk group (P < 0·001). We have documented the impact of a few single genes added to IPI for assignment in new drug trials.

LPL gene expression is associated with poor prognosis in CLL and closely related to NOTCH1 mutations.

INTRODUCTION: Chronic lymphocytic leukemia is a heterogeneous yet incurable disease. Whole-genome and whole-exome sequencing studies have revealed recurrently occurring somatic mutations in some genes. Several other prognostic markers have previously been tested for their prognostic value in CLL. LPL is among these markers. AIM: To evaluate LPL gene expression together with the well-established prognostic markers of CLL and investigate correlations with more recently identified prognostic markers, NOTCH1 and TP53 mutations. METHODS: On 149 patients, LPL gene expression was analyzed by real-time RT-PCR. Exon 34 of NOTCH1 was PCR-amplified and directly sequenced. RESULTS: LPL gene expression could be measured as a categorical variable (LPL+/LPL-) and was associated with time to treatment (P < 0.001) and overall survival (P = 0.007). In patients otherwise classified as having a good prognosis according to established and new prognostic markers, 3 of 4 patients, who received treatment within 24 months after diagnosis, were LPL+ (P = 0.03). There was a strong correlation between NOTCH1 mutation and LPL+ (P = 0.005). The unfavorable prognosis of LPL+ was maintained in CLL with wild-type NOTCH1. CONCLUSIONS: NOTCH1 mutations are tightly associated with LPL gene expression. LPL expression is independently associated with poor outcome in CLL and can be measured as a categorical variable.

Angularly symmetric splitting of a light beam upon reflection and refraction at an air-dielectric plane boundary: comment.

In a recent paper, conditions for achieving equal and opposite angular deflections of a light beam by reflection and refraction at an interface between air and a dielectric were determined [J. Opt. Soc. Am. A32, 2436 (2015)JOAOD60740-323210.1364/JOSAA.32.002436]. The paper gives plots of angles of incidence and refraction as a function of the prism refractive index as well as plots of reflectances and incident linear-polarization azimuth angles as functions of the refractive index. We show here that it is possible to express these quantities as simple algebraic functions of the refractive index.

Accurate calculation of diffraction-limited encircled and ensquared energy.

Mathematical properties of the encircled and ensquared energy functions for the diffraction-limited point-spread function (PSF) are presented. These include power series and a set of linear differential equations that facilitate the accurate calculation of these functions. Asymptotic expressions are derived that provide very accurate estimates for the relative amount of energy in the diffraction PSF that fall outside a square or rectangular large detector. Tables with accurate values of the encircled and ensquared energy functions are also presented.

Influence of Pre-Fermentation Treatments on Wine Volatile and Sensory Profile of the New Disease Tolerant Cultivar Solaris.

Solaris is a new disease tolerant cultivar increasingly cultivated in cool climate regions. In order to explore the winemaking processes' potential to make different styles of Solaris wines, the effects of different pre-fermentation treatments (direct press after crushing, whole cluster press, cold maceration, and skin fermentation) on the volatile profile, chemical, and sensory properties of Solaris wines were investigated. Cold maceration treatment for 24 h and fermentation on skin led to wines with lower acidity and higher glycerol and total polyphenol indexes. Sensory analysis showed that cold maceration enhanced "apricot" and "apple" flavor while skin fermentation gave rise to increased "rose" and "elderflower" flavor. The PLS regression model revealed that fruity flavor of cold macerated wines was related to a combination of esters while ß-damascenone and linalool were correlated to the "rose" and "elderflower" flavor. This study provides information about pre-fermentation techniques that allowed the possibility of obtaining wines with different styles.

Wider institutional research cultures and their influence on patient and public involvement and engagement in health research - An institutional ethnography.

Focus on patient and public involvement and engagement (PPIE) is increasing in health policy and research governance. PPIE is considered by some to be a democratic right, and by others to be a way to improve health care and research outcomes and implementation. Most recently, policy makers, funders and (clinical) research institutions are making PPIE a strategic requirement for health research urging researchers to invite patients and relatives into their research activities. Our study is based in a Danish university hospital where PPIE has been introduced as one of five strategic research goals. We investigated how researchers experienced this new practice and how their research practices connect to the wider context of the Danish health care system. Ten cases were studied during a year using observations, interviews, and document analysis. As our method of inquiry, we used institutional ethnography to look at researchers' work from their perspective and to understand how PPIE practices are part of a larger institutional research culture reaching far beyond the individual. We found that current research culture has implications for the selection of patients and relatives and for what they are asked to do. Researchers who experienced that PPIE outcomes aided their existing research practices felt motivated. Researchers who engaged patients and relatives before it was a strategy, were ideologically driven and their approaches resulted in an increased diversity of inclusion and researcher assimilation. These findings add to the current knowledge on PPIE practices and help us understand that further development towards collaborative research practices require a change in key performance indicators and training and perhaps call for attention to our shared acceptance of knowledge generation in research.

A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia.

The impact of first-line treatment with the anti-CD 20 chimeric monoclonal antibody rituximab in patients with warm-antibody reactive autoimmune haemolytic anaemia (WAIHA) is unknown. We report the first randomized study of 64 patients with newly diagnosed WAIHA who received prednisolone and rituximab combined (N = 32) or prednisolone monotherapy (N = 32). After 12 months, a satisfactory response was observed in 75% of the patients treated with rituximab and prednisolone but in a significantly smaller proportion (36%) of those given prednisolone alone (P = 0·003). Furthermore, relapse-free survival was significantly better after the combined therapy than after prednisolone monotherapy (P = 0·02). After 36 months, about 70% of the patients were still in remission in the rituximab-prednisolone group, whereas only about 45% were still in complete or partial remission in the prednisolone group. There was no significant difference between the two groups regarding adverse reactions to the studied medications. Likewise, serious adverse events were equally distributed, and no allergic reactions to rituximab were recorded. In conclusion, our data show that using rituximab and prednisolone combined rather than prednisolone alone as first-line treatment in WAIHA increases both the rate and the duration of the response.

A phase II study of vorinostat (MK-0683) in patients with polycythaemia vera and essential thrombocythaemia.

Inhibition of histone deacetylases may be an important target in patients with myeloproliferative neoplasms. This investigator-initiated, non-randomized, open-label phase II multi-centre study included 63 patients (19 essential thrombocythaemia, 44 polycythaemia vera) from 15 centres. The primary objective was to evaluate if vorinostat was followed by a decline in clonal myeloproliferation as defined by European Leukaemia Net. Thirty patients (48%) completed the intervention period (24 weeks of therapy). An intention-to-treat response rate of 35% was identified. Pruritus was resolved [19% to 0% (P = 0·06)] and the prevalence of splenomegaly was lowered from 50% to 27% (P = 0·03). Sixty-five per cent of the patients experienced a decrease in JAK2 V617F allele burden (P = 0·006). Thirty-three patients (52% of patients) discontinued study drug before end of intervention due to adverse events (28 patients) or lack of response (5 patients). In conclusion, vorinostat showed effectiveness by normalizing elevated leucocyte and platelet counts, resolving pruritus and significantly reducing splenomegaly. However, vorinostat was associated with significant side effects resulting in a high discontinuation rate. A lower dose of vorinostat in combination with conventional and/or novel targeted therapies may be warranted in future studies.

A sampling approach for predicting the eating quality of apples using visible-near infrared spectroscopy.

BACKGROUND: Visible-near infrared spectroscopy remains a method of increasing interest as a fast alternative for the evaluation of fruit quality. The success of the method is assumed to be achieved by using large sets of samples to produce robust calibration models. In this study we used representative samples of an early and a late season apple cultivar to evaluate model robustness (in terms of prediction ability and error) on the soluble solids content (SSC) and acidity prediction, in the wavelength range 400-1100 nm. RESULTS: A total of 196 middle-early season and 219 late season apples (Malus domestica Borkh.) cvs 'Aroma' and 'Holsteiner Cox' samples were used to construct spectral models for SSC and acidity. Partial least squares (PLS), ridge regression (RR) and elastic net (EN) models were used to build prediction models. Furthermore, we compared three sub-sample arrangements for forming training and test sets ('smooth fractionator', by date of measurement after harvest and random). Using the 'smooth fractionator' sampling method, fewer spectral bands (26) and elastic net resulted in improved performance for SSC models of 'Aroma' apples, with a coefficient of variation CVSSC = 13%. The model showed consistently low errors and bias (PLS/EN: R(2) cal = 0.60/0.60; SEC = 0.88/0.88°Brix; Biascal = 0.00/0.00; R(2) val = 0.33/0.44; SEP = 1.14/1.03; Biasval = 0.04/0.03). However, the prediction acidity and for SSC (CV = 5%) of the late cultivar 'Holsteiner Cox' produced inferior results as compared with 'Aroma'. CONCLUSION: It was possible to construct local SSC and acidity calibration models for early season apple cultivars with CVs of SSC and acidity around 10%. The overall model performance of these data sets also depend on the proper selection of training and test sets. The 'smooth fractionator' protocol provided an objective method for obtaining training and test sets that capture the existing variability of the fruit samples for construction of visible-NIR prediction models. The implication is that by using such 'efficient' sampling methods for obtaining an initial sample of fruit that represents the variability of the population and for sub-sampling to form training and test sets it should be possible to use relatively small sample sizes to develop spectral predictions of fruit quality. Using feature selection and elastic net appears to improve the SSC model performance in terms of R(2), RMSECV and RMSEP for 'Aroma' apples.

Enhancing public sector enterprise risk management through interactive information processing.

Introduction: Federal agencies are increasingly expected to adopt enterprise risk management (ERM). However, public sector adoption of ERM has typically focused on the economic efficiency of tax-financed activities based on control-based practices. This reflects an emphasis on quantifiable concerns that invariably directs attention to risk, that (by definition) relates to identifiable and measurable events, thereby downplaying uncertain and unknown aspects of public exposures. This is a potentially serious shortcoming as government entities often act as society's risk managers of last resort. When extreme events happen what were previously considered private matters can quickly turn into public obligations. Hence, there is a need for proactive assessments of the evolving public risk landscape to discern unpredictable-even unknowable-developments. Methods: The article reviews recent empirical studies on public risk management practices, effects of digitalization in public sector institutions, current strategic management research, and insights uncovered from a recent study of risk management practices in federal agencies. On this basis, the article explains how the ability to generate value from ERM can be enhanced when it intertwines with local responsive initiatives and central strategic risk analyses. It can form a dynamic adaptive risk management process where insights from dispersed actors inform updated risk analyses based on local autonomy and open exchange of information. This approach builds on specific structural features embedded in culture-driven aspirations to generate collaborative solutions. Its functional mode is an interactive control system with open discussions across levels and functions in contrast to conventional diagnostic controls that monitor predetermined key performance indicators (KPIs) and key risk indicators (KRIs). Findings: Backed by theoretical rationales and empirical research evidence, it is found that applications of ERM frameworks can produce positive results but is unable to deal with a public risk landscape characterized by uncertain unpredictable conditions with potentially extreme outcome effects. It is shown how interactive exchange of fast local insights and slow integrated strategic risk analyses supported by digitized data processing can form a dynamic adaptive system that enable public sector institutions to deal with emergent high-scale exposures. It is explained how the requirement for conducive organizational structures and supportive values require a new strategic risk leadership approach, which is contrasted to observed practices in federal agencies that are constrained by prevailing public governance requirements. Discussion: The need to deal with uncertainty and unknown conditions demands a cognitive shift in current thinking from a primary focus on risk to also appraise complexity and prepare for the unexpected where data-driven methods can uncover emergent exposures through dynamic information processing. This requires strategic risk leaders that recognize the significance of complex public exposures with many unknowns and a willingness to facilitate digitalized information processing rooted in a collaborative organizational climate. If handled properly, adoption of ERM in public risk management can consider emergent dimensions in complex public exposures applying interactive information processing as a dynamic adaptive risk management approach incorporating digitized methods to solicit collective intelligence for strategic risk updating.

Roles, outcomes, and enablers within research partnerships: A rapid review of the literature on patient and public involvement and engagement in health research.

BACKGROUND: Recent studies mention a need to investigate partnership roles and dynamics within patient and public involvement and engagement (PPIE) in health research, and how impact and outcomes are achieved. Many labels exist to describe involvement processes, but it is unknown whether the label has implications on partnerships and outcomes. This rapid review investigates how roles between patients, relatives and researchers in a broad variety of PPIE activities in health research are described in peer reviewed papers and explores what enables these partnerships. METHODS: Rapid review of articles published between 2012 and February 2022 describing, evaluating, or reflecting on experiences of PPIE in health research. All research disciplines and research areas were eligible. Four databases (Medline, Embase, PsychInfo and CINAHL) were searched between November 2021 and February 2022. We followed PRISMA guidelines and extracted descriptive factors: year, origin, research area and discipline, study focus, framework used and co-authorship. On a selection of articles, we performed a narrative analysis of partnership roles using Smits et al.'s. Involvement Matrix. Lastly, we performed a meta synthesis of reported enablers and outcomes of the partnerships. Patients and Relatives (PRs) have been involved in the whole rapid review process and are co-authors of this article. RESULTS: Seventy articles from various research disciplines and areas were included. Forty articles were selected for a narrative analysis of the role description of PRs and researchers, and a meta synthesis of enablers and outcomes. Most articles described researchers as decision-makers throughout the research cycle. PRs most often were partners when they were included as co-authors; they were mostly partners in the design, analysis, write-up, and dissemination stages. Enablers of partnerships included: PR training, personality of PRs and communication skills, trust, remuneration and time. CONCLUSIONS: Researchers' decision-making roles gives them control of where and when to include PRs in their projects. Co-authorship is a way of acknowledging patients' contributions which may lead to legitimation of their knowledge and the partnership. Authors describe common enablers, which can help future partnership formation.

This article investigates how other articles describe the roles patients, relatives and researchers have in patient and public involvement activities in health research. It also investigates which factors are supportive of creating these research partnerships. We searched four health research databases and found 70 relevant articles which somehow evaluated patient involvement activities in research. From these 70 articles we chose 40 which we closely investigated for descriptions of roles in the partnerships between researchers and patients and relatives. For this, we used a tool called the Involvement Matrix which uses five different roles: Listener (who is given information), Co-thinker (who is asked to give opinion), Advisor (who gives (un)solicited advice), Partner (who works as an equal partner) and Decision-maker (Who takes initiative and (final) decisions). We found that it is often researchers who take on the role of Decision-maker and that involvement often happens on their terms. We noticed that patients and relatives most often had the role of partner, when they were listed as co-authors of the article. This shows co-authorship as an authorization of their work during patient and public involvement activities. We found that patient and relative training, patients' and relatives' personality and communication skills, trust, financial reimbursement, and time were mentioned most often as enablers of good research partnerships.

Augmenting clozapine with sertindole: a double-blind, randomized, placebo-controlled study.

Clozapine augmentation with antipsychotic drugs is widely used despite sparse evidence supporting this strategy. Sertindole is a nonsedating atypical antipsychotic drug with low affinity for cholinergic receptors, which makes it potentially suitable for augmentation of clozapine. The study design was a 12-week, double-blind, randomized, placebo-controlled study including patients with International Statistical Classification of Diseases, 10th Revision schizophrenia (F20.0-F20.3) and treated with clozapine for at least 6 months who had not achieved sufficient response. Patients were randomized 1:1 to either sertindole 16 mg or placebo, and assessment was done at baseline and after 6 and 12 weeks. Assessment included the Positive and Negative Syndrome Scale, Clinical Global Impression, Udvalg for Kliniske Undersøgelser, World Health Organization Quality of Life Brief, Drug Attitude Inventory, fasting glucose, lipids, and electrocardiogram. Clozapine augmentation with sertindole was not superior to placebo regarding total score or subscale score of the Positive and Negative Syndrome Scale, Clinical Global Impression, World Health Organization Quality of Life Brief, or Drug Attitude Inventory. No increased adverse effects compared with placebo were found. Four patients randomized to sertindole experienced a significant worsening of psychosis, and 2 of them required psychiatric admission. Metabolic parameters were unchanged during the study, but augmentation of clozapine with sertindole was associated with a 12-millisecond (SD, 20-millisecond) QTc prolongation compared with 0 millisecond (SD, 20 milliseconds) in the placebo group (P < 0.03). Augmentation with sertindole showed no benefits compared with placebo. Psychiatrists should be aware that augmentation might not add any benefits for the patients and in some cases worsen psychosis.

Concept, modeling, and performance prediction of a low-cost, large deformable mirror.

While it is attractive to integrate a deformable mirror (DM) for adaptive optics (AO) into the telescope itself rather than using relay optics within an instrument, the resulting large DM can be expensive, particularly for extremely large telescopes. A low-cost approach for building a large DM is to use voice-coil actuators connected to the back of the DM through suction cups. Use of such inexpensive voice-coil actuators leads to a poorly damped system with many structural modes within the desired bandwidth. Control of the mirror dynamics using electro-mechanical sensors is thus required for integration within an AO system. We introduce a distributed control approach, and we show that the "inner" back sensor control loop does not need to function at low frequencies, leading to significant cost reduction for the sensors. Incorporating realistic models of low-cost actuators and sensors together with an atmospheric seeing model, we demonstrate that the low-cost mirror strategy is feasible within a closed-loop AO system.