Computational prediction of proximal sealing in endovascular abdominal aortic aneurysm repair with unfavorable necks.

BACKGROUND AND OBJECTIVE: Endovascular aortic aneurysm repair (EVAR) has become the standard treatment for abdominal aortic aneurysms in most centers. However, proximal sealing complications leading to endoleaks and migrations sometimes occur, particularly in unfavorable aortic anatomies and are strongly dependent on biomechanical interactions between the aortic wall and the endograft. The objective of the present work is to develop and validate a computational patient-specific model that can accurately predict these complications. METHODS: Based on pre-operative CT-scans, we developed finite element models of the aorta of 10 patients who underwent endovascular aortic aneurysm repair, 7 with standard morphologies and 3 with unfavorable anatomies. We simulated the deployment of stent grafts in each aorta by solving mechanical equilibrium with a virtual shell method. Eventually we compared the actual stent ring positions from post-operative computed-tomography-scans with the predicted simulated positions. RESULTS: A successful deployment simulation could be performed for each patient. Relative radial, transverse and longitudinal deviations were 6.3 ± 4.4%, 2.5 ± 0.9 mm and 1.4 ± 1.1 mm, respectively. CONCLUSIONS: The numerical model predicted accurately stent-graft positions in the aortic neck of 10 patients, even in complex anatomies. This shows the potential of computer simulation to anticipate possible proximal endoleak complications before EVAR interventions.

Estimating Multilevel Models on Data Streams.

Social scientists are often faced with data that have a nested structure: pupils are nested within schools, employees are nested within companies, or repeated measurements are nested within individuals. Nested data are typically analyzed using multilevel models. However, when data sets are extremely large or when new data continuously augment the data set, estimating multilevel models can be challenging: the current algorithms used to fit multilevel models repeatedly revisit all data points and end up consuming much time and computer memory. This is especially troublesome when predictions are needed in real time and observations keep streaming in. We address this problem by introducing the Streaming Expectation Maximization Approximation (SEMA) algorithm for fitting multilevel models online (or "row-by-row"). In an extensive simulation study, we demonstrate the performance of SEMA compared to traditional methods of fitting multilevel models. Next, SEMA is used to analyze an empirical data stream. The accuracy of SEMA is competitive to current state-of-the-art methods while being orders of magnitude faster.

Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort.

BACKGROUND: In search of empirical classifications of depression and anxiety, most subtyping studies focus solely on symptoms and do so within a single disorder. This study aimed to identify and validate cross-diagnostic subtypes by simultaneously considering symptoms of depression and anxiety, and disability measures. METHOD: A large cohort of adults (Lifelines, n = 73 403) had a full assessment of 16 symptoms of mood and anxiety disorders, and measurement of physical, social and occupational disability. The best-fitting subtyping model was identified by comparing different hybrid mixture models with and without disability covariates on fit criteria in an independent test sample. The best model's classes were compared across a range of external variables. RESULTS: The best-fitting Mixed Measurement Item Response Theory model with disability covariates identified five classes. Accounting for disability improved differentiation between people reporting isolated non-specific symptoms ['Somatic' (13.0%), and 'Worried' (14.0%)] and psychopathological symptoms ['Subclinical' (8.8%), and 'Clinical' (3.3%)]. Classes showed distinct associations with clinically relevant external variables [e.g. somatization: odds ratio (OR) 8.1-12.3, and chronic stress: OR 3.7-4.4]. The Subclinical class reported symptomatology at subthreshold levels while experiencing disability. No pure depression or anxiety, but only mixed classes were found. CONCLUSIONS: An empirical classification model, incorporating both symptoms and disability identified clearly distinct cross-diagnostic subtypes, indicating that diagnostic nets should be cast wider than current phenomenology-based categorical systems.

Model-based approaches to synthesize microarray data: a unifying review using mixture of SEMs.

Several statistical methods are nowadays available for the analysis of gene expression data recorded through microarray technology. In this article, we take a closer look at several Gaussian mixture models which have recently been proposed to model gene expression data. It can be shown that these are special cases of a more general model, called the mixture of structural equation models (mixture of SEMs), which has been developed in psychometrics. This model combines mixture modelling and SEMs by assuming that component-specific means and variances are subject to a SEM. The connection with SEM is useful for at least two reasons: (1) it shows the basic assumptions of existing methods more explicitly and (2) it helps in straightforward development of alternative mixture models for gene expression data with alternative mean/covariance structures. Different specifications of mixture of SEMs for clustering gene expression data are illustrated using two benchmark datasets.

A mixture model with random-effects components for classifying sibling pairs.

In healthy aging research, typically multiple health outcomes are measured, representing health status. The aim of this paper was to develop a model-based clustering approach to identify homogeneous sibling pairs according to their health status. Model-based clustering approaches will be considered on the basis of linear mixed effect model for the mixture components. Class memberships of siblings within pairs are allowed to be correlated, and within a class the correlation between siblings is modeled using random sibling pair effects. We propose an expectation-maximization algorithm for maximum likelihood estimation. Model performance is evaluated via simulations in terms of estimating the correct parameters, degree of agreement, and the ability to detect the correct number of clusters. The performance of our model is compared with the performance of standard model-based clustering approaches. The methods are used to classify sibling pairs from the Leiden Longevity Study according to their health status. Our results suggest that homogeneous healthy sibling pairs are associated with a longer life span. Software is available for fitting the new models.

Fetal growth trajectories in Type-1 diabetic pregnancy.

OBJECTIVE: To describe the individual intrauterine growth patterns of fetuses of insulin-dependent (Type-1) diabetic women and to examine determinants of overgrowth (macrosomia) and its timing. METHODS: This retrospective longitudinal study examined the developmental trajectories of fetal abdominal circumference (AC) and biparietal diameter in 76 Type-1 diabetic women with singleton pregnancies. Latent class analysis was used to identify subgroups of patients with a shared fetal AC growth trajectory. Subsequently, maternal factors, including glycemic control as assessed by glycosylated hemoglobin (HbA1c), were examined to see whether they had any effect on fetal growth. RESULTS: Four subgroups with different AC growth patterns were identified. Differences in birth weight between the distinct subgroups were related to the shape of the AC growth velocity curve over gestation. Acceleration of AC growth commencing before or after 25 weeks' gestation was associated with the birth of a heavy or large-for-dates baby in 94 and 56% of cases, respectively. Poor glycemic control (HbA1c > 7.0%) during the periconception period or before 12 weeks' gestation was a modest predictor of midtrimester growth in AC. Other diabetes-related factors, fetal sex, parity, or maternal weight/obesity were unrelated to the fetal growth pattern. CONCLUSION: The findings suggest that an individual fetus's growth trajectory is set early in gestation and that the contemporaneous degree of maternal glycemia plays a role in determining birth weight.

Beyond symptom dimensions: schizophrenia risk factors for patient groups derived by latent class analysis.

INTRODUCTION: Patients grouped by latent class analysis of symptoms show some consensus between studies, and may be less etiologically heterogeneous than current diagnoses. If so, the effect size of 'neurodevelopmental' risk factors may be greater than in equivalent DSMIV diagnostic groups. METHOD: Two hundred fifty six individuals with neurodevelopmental risk factors recorded in the National Child Development Study (1958) UK birth cohort were grouped by data-driven illness subtypes, derived previously in over 1000 individuals. The effect sizes of these risks were compared between data-derived and DSMIV schizophrenia (295.x) groups. RESULTS: Compared to DSMIV schizophrenia, the data-driven subtype broadly characterized by the presence of psychotic symptoms in the absence of affective symptoms showed significantly greater effect sizes in eight out of thirteen continuously-rated risk factors: birth weight, cognition, childhood behavioural problems, and neurological softsigns including handedness. CONCLUSION: A data-driven subgroup of schizophrenia patients, characterized as lacking co-morbid depressive symptoms, is less heterogeneous with respect to neurodevelopmental etiology.

Incidence and completeness of notification of Legionnaires' disease in The Netherlands: covariate capture-recapture analysis acknowledging regional differences.

To estimate incidence and completeness of notification of Legionnaires' disease (LD) in The Netherlands in 2000 and 2001, we performed a capture-recapture analysis using three registers: Notifications, Laboratory results and Hospital admissions. After record-linkage, 373 of the 780 LD patients identified were notified. Ascertained under-notification was 52.2%. Because of expected and observed regional differences in the incidence rate of LD, alternatively to conventional log-linear capture-recapture models, a covariate (region) capture-recapture model, not previously used for estimating infectious disease incidence, was specified and estimated 886 LD patients (95% confidence interval 827-1022). Estimated under-notification was 57.9%. Notified, ascertained and estimated average annual incidence rates of LD were 1.15, 2.42 and 2.77/100 000 inhabitants respectively, with the highest incidence in the southern region of The Netherlands. Covariate capture-recapture analysis acknowledging regional differences of LD incidence appears to reduce bias in the estimated national incidence rate.

Clinical and bacteriological response to treatment of clinical mastitis with one of three intramammary antibiotics.

AIM: To compare the proportions of clinical and bacteriological cure of glands of dairy cows diagnosed with clinical mastitis, following treatment with one of three different intramammary antibiotic preparations. METHODS: Cows from dairy cow herds (n=28) across New Zealand which were diagnosed with clinical mastitis in one or more glands at any stage of lactation were randomly assigned at the cow level within sequentially presented groups of three animals to be treated with one of three intramammary antibiotics. The treatments were 1 g procaine penicillin, 0.25 g cefuroxime, and a combination of 1 g procaine penicillin and 0.5 g dihydrostreptomycin (DHS). All treatments were infused on three occasions at 12-hourly intervals. Duplicate milk samples were collected for bacteriology before initial treatment, and 21-42 days later. Logistic regression or generalised linear mixed models were used to analyse the proportion of cows or quarters retreated for mastitis within 30 days of initial treatment ('clinical treatment failure'), and the proportion of glands from which bacteria were isolated initially but from which the same bacterial species was not re-isolated ('bacteriological cure'). RESULTS: The annual herd average cumulative incidence rate of clinical mastitis was 12.7 cases/100 cows. The incidence rate was higher in young (2-year-old) and old (> or = 9-year-old) cows relative to 3- and 4-year-old cows, and was higher in Friesian than Jersey or crossbred cows. Streptococcus uberis was the pathogen most commonly isolated, and its relative prevalence declined with time postpartum. Cows treated with cefuroxime were more likely (p<0.01) to be re-treated for clinical mastitis in the 30 days after initial treatment than cows treated with procaine penicillin or procaine penicillin and DHS. Bacteriological cure occurred in 74% of treated glands and there was no difference in the proportion of cures among the treatments (p=0.4). The proportion of cures was lower when treatment occurred 28-72 days after calving (p<0.01) and if a major pathogen was isolated (p<0.001). CONCLUSIONS AND CLINICAL RELEVANCE: There was no benefit in terms of clinical or bacteriological cure rate in treating clinical mastitis cases with the combination of procaine penicillin and DHS compared to treatment with procaine penicillin alone. The proportion of clinical mastitis cases re-treated differed among herds, and more cows treated with cefuroxime were retreated within 30 days of initial treatment. However, the bacteriological cure proportion was the same among the treatments. Cure proportions were lower in cows from which major mastitis pathogens were isolated and when treatment commenced 28-72 days after calving.

Non-systemic erosive stomatitis of unknown aetiology in a dairy cow herd in New Zealand.

CASE HISTORY: Veterinarians from the Investigation and Diagnostic Centre (IDC), Wallaceville, New Zealand, investigated a novel vesicular disease in a 397-cow dairy herd, characterised by erosive stomatitis. CLINICAL AND PATHOLOGICAL FINDINGS: The investigation commenced with a report of erosive stomatitis in four dairy cows. The herd was examined that day and 30/397 (8%) adult cows were found to be affected. Two weeks later, the oral cavity of 180 cows from one management group were re-examined, and it was estimated that 80% of this group had healing erosive lesions. During the course of the investigation, intact vesicles were observed on the muzzle of two affected animals. None of the affected animals was systemically ill and there was no decrease in milk production. DIAGNOSIS: No infectious aetiological agent was detected using virus isolation, polymerase chain reaction (PCR), electron microscopy (EM) and serological tests, for any exotic infectious vesicular disease or any endemic cause of vesicular disease. CLINICAL RELEVANCE: Lesions of erosive stomatitis occurring in cattle must be differentiated from vesicular disease during exotic disease investigations.

The use of qualitative research criteria for portfolio assessment as an alternative to reliability evaluation: a case study.

AIM: Because it deals with qualitative information, portfolio assessment inevitably involves some degree of subjectivity. The use of stricter assessment criteria or more structured and prescribed content would improve interrater reliability, but would obliterate the essence of portfolio assessment in terms of flexibility, personal orientation and authenticity. We resolved this dilemma by using qualitative research criteria as opposed to reliability in the evaluation of portfolio assessment. METHODOLOGY/RESEARCH DESIGN: Five qualitative research strategies were used to achieve credibility and dependability of assessment: triangulation, prolonged engagement, member checking, audit trail and dependability audit. Mentors read portfolios at least twice during the year, providing feedback and guidance (prolonged engagement). Their recommendation for the end-of-year grade was discussed with the student (member checking) and submitted to a member of the portfolio committee. Information from different sources was combined (triangulation). Portfolios causing persistent disagreement were submitted to the full portfolio assessment committee. Quality assurance procedures with external auditors were used (dependability audit) and the assessment process was thoroughly documented (audit trail). RESULTS: A total of 233 portfolios were assessed. Students and mentors disagreed on 7 (3%) portfolios and 9 portfolios were submitted to the full committee. The final decision on 29 (12%) portfolios differed from the mentor's recommendation. CONCLUSION: We think we have devised an assessment procedure that safeguards the characteristics of portfolio assessment, with credibility and dependability of assessment built into the judgement procedure. Further support for credibility and dependability might be sought by means of a study involving different assessment committees.

Student teachers' beliefs about mentoring and learning to teach during teaching practice.

BACKGROUND: Various interpretations of mentor roles, by teacher educators and mentors, have been described in the literature on mentoring, while those of student teachers have received less attention. Therefore, this study focuses on student teachers' expectations of mentors and their own contributions to their learning process while they are supervised by a mentor. AIMS: The main aims of this study were: (1) bridging the research on mentoring and the research on higher education students' learning conceptions by investigating student teachers' beliefs about mentoring and learning to teach, and (2) comparing these beliefs to mentors' ones and recent views on mentoring and learning in order to make suggestions for improving learning to teach. SAMPLE: Thirty student teachers, graduates in various academic disciplines, participated. They were attending a one-year teacher education programme at Leiden University in the Netherlands. METHODS: Structured interviews with the student teachers were audio-taped. Firstly, categories of mentor roles and learning activities were derived from the data. These were linked, secondly, by their focus of attention and, thirdly, empirically by a homogeneity analysis (HOMALS). RESULTS: Six mentor roles, ten learning activities, and one regulation activity were combined in six foci: (1) affective aspects of learning to teach, (2) mentors' teaching styles, (3) assessment of student teachers' performance, (4) reflecting on students' lessons, (5) school context, and (6) self-regulation of learning. The HOMALS analysis yielded a process-product dimension. CONCLUSION: In this study, the student teachers' beliefs about mentoring were similar to those of mentors. Furthermore, a third of the student teachers expected themselves as thinking critically about their lessons, but nobody expected their mentors to explicate their practical knowledge underlying their teaching. Therefore, the articulation of this knowledge is indicated as an additional mentor role and will be elaborated.

Comparative efficacy of three dry-cow antibiotic formulations in spring-calving New Zealand dairy cows.

AIM: To evaluate the efficacy of a dry-cow antibiotic preparation containing cloxacillin plus ampicillin in a formulation that gives a 10-week duration of action, in comparison to products containing cephalonium (10-week action) or cloxacillin alone (7-week action). METHODS: A total of 493 cows were selected from 6 spring-calving dairy herds in the Manawatu region of New Zealand, according to the criteria of the SAMM plan, to receive intramammary antibiotic therapy at the end of lactation (drying off). Cows were randomly allocated to receive 1 of the 3 dry-cow antibiotic products under investigation. Cows were examined twice during the dry period and twice daily during the first 10 days of their subsequent lactation for the presence of mastitis. Milk samples were collected from individual quarters at the time of drying off and at 7 and 28-35 days after calving, for determination of milk somatic cell counts (SCC). Bacteriology was carried out on milk samples taken from cows that developed mastitis during the first 10 days after calving. RESULTS: No cows developed mastitis during the dry period. Sixteen cows developed clinical mastitis within 10 days of calving; there was no difference in incidence between treatments. Streptococcus uberis was the most commonly isolated organism. Mean SCC on Day 7 were lower (p = 0.019) in cephalonium-treated quarters (189.9+/-28.4 x 10(3) cells/ml) than in cloxacillin-treated quarters (388.7+/-71.2 x 10(3) cells/ml); values in quarters receiving cloxacillin plus ampicillin were intermediate (252.0+/-47.0 x 10(3) cells/ml). SCC were similar between treatment groups on Day 28-35. CONCLUSIONS: The use of a combination of cloxacillin plus ampicillin was effective for the prevention of mastitis during the dry and peri-calving-periods in pastured dairy cattle.

Unusual congenital deformities of the lower limb in two calves.

Congenital deformities of the lower limb were observed in 2 calves from different properties. One was a newborn Holstein-Friesian bull calf with polydactyly and polypodia of the right fore-limb. The other was an 8-month-old Friesian/Jersey crossbred heifer calf, which had a mirror image duplication of the plantar/palmar half of the distal portion of the digits. The abnormalities in the second calf have not previously been described in cattle. This paper presents details of the clinical, radiological and necropsy findings in these 2 calves.