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Trauma Monthly Aug 2015The main objectives of triage are securing patient safety during the process of emergency diagnosis and treatment, and reduction of waiting time for medical services and... (Review)
Review
CONTEXT
The main objectives of triage are securing patient safety during the process of emergency diagnosis and treatment, and reduction of waiting time for medical services and transport. To date, there is no triage system for nerve agent victims.
EVIDENCE ACQUISITION
This systematic review proposes a new triage system for patients exposed to nerve agents. Information regarding clinical signs and symptoms of intoxication with nerve agents, primary treatments, and classification of patients were extracted from the literature. All related articles were reviewed. Subsequently, specialists from different disciplines were invited to discuss and draft protocols.
RESULTS
Finalized triage tables summarizing the classification methods and required protocols in the field were designed after several meetings.
CONCLUSIONS
The proposed triage protocol encompasses aspects from most of the existing triage systems to create a single overarching guide for unifying the triage process. The proposed protocol can serve as a base for the designing future guidelines.
PubMed: 26543836
DOI: 10.5812/traumamon.16211 -
Scientific Reports Jun 2023Agent-Based Models (ABMs) are used in several fields to study the evolution of complex systems from micro-level assumptions. However, a significant drawback of ABMs is...
Agent-Based Models (ABMs) are used in several fields to study the evolution of complex systems from micro-level assumptions. However, a significant drawback of ABMs is their inability to estimate agent-specific (or "micro") variables, which hinders their ability to make accurate predictions using micro-level data. In this paper, we propose a protocol to learn the latent micro-variables of an ABM from data. We begin by translating an ABM into a probabilistic model characterized by a computationally tractable likelihood. Next, we use a gradient-based expectation maximization algorithm to maximize the likelihood of the latent variables. We showcase the efficacy of our protocol on an ABM of the housing market, where agents with different incomes bid higher prices to live in high-income neighborhoods. Our protocol produces accurate estimates of the latent variables while preserving the general behavior of the ABM. Moreover, our estimates substantially improve the out-of-sample forecasting capabilities of the ABM compared to simpler heuristics. Our protocol encourages modelers to articulate assumptions, consider the inferential process, and spot potential identification problems, thus making it a useful alternative to black-box data assimilation methods.
PubMed: 37286576
DOI: 10.1038/s41598-023-35536-3 -
EuroIntervention : Journal of EuroPCR... Feb 2022Coronary vasomotor dysfunction can be diagnosed in a large proportion of patients with angina in the presence of non-obstructive coronary artery disease (ANOCA) using... (Review)
Review
BACKGROUND
Coronary vasomotor dysfunction can be diagnosed in a large proportion of patients with angina in the presence of non-obstructive coronary artery disease (ANOCA) using comprehensive protocols for coronary vasomotor function testing (CFT). Although consensus on diagnostic criteria for endotypes of coronary vasomotor dysfunction has been published, consensus on a standardised study testing protocol is lacking.
AIMS
In this review we provide an overview of the variations in CFT used and discuss the practical principles and pitfalls of CFT.
METHODS
For the purposes of this review, we assessed study protocols that evaluate coronary vasomotor response as reported in the literature. We compared these protocols regarding a number of procedural aspects and chose six examples to highlight the differences and uniqueness.
RESULTS
Currently, numerous protocols co-exist and vary in vascular domains tested, the manner in which to test these domains (e.g., preprocedural discontinuation of medication, provocative agent, solution, infusion time, and target artery) and techniques used for measurements (e.g., Doppler vs thermodilution technique).
CONCLUSIONS
This lack of consensus on a uniform functional testing protocol hampers both a broader clinical acceptance of the concepts of coronary vasomotor dysfunction, and the widespread adoption of such testing protocols in current clinical practice. Furthermore, the endotype of coronary vasomotor dysfunction might differ among the few specialised centres that perform CFT as a result of the use of different protocols.
Topics: Angina Pectoris; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Heart; Humans; Vasomotor System
PubMed: 34278990
DOI: 10.4244/EIJ-D-21-00402 -
AJNR. American Journal of Neuroradiology Aug 2010Rituximab is a monoclonal antibody that was first approved by the FDA as an antineoplastic agent designed to treat B-cell malignancies. This article will review the... (Review)
Review
Rituximab is a monoclonal antibody that was first approved by the FDA as an antineoplastic agent designed to treat B-cell malignancies. This article will review the mechanism of action and clinical role of this anti-B-cell agent.
Topics: Aged; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Female; Humans; Lymphoma, B-Cell; Rituximab
PubMed: 20448016
DOI: 10.3174/ajnr.A2142 -
Journal of Andrology 1990Techniques for freezing bull sperm developed over the past 40 years have not yielded protocols for preserving sperm from other species. Recent advances in our... (Review)
Review
Techniques for freezing bull sperm developed over the past 40 years have not yielded protocols for preserving sperm from other species. Recent advances in our understanding of cell membrane structure function and metabolism now permit alternative modes of investigation. These data will allow development of unique studies which should have a higher probability of yielding successful protocols for sperm from other species. In this review the authors will: (1) provide a general overview of cryopreservation; (2) review emerging concepts of membrane structure and the relationship of membrane composition to water and cryoprotectant movement; (3) emphasize how these parameters affect cell volume and surface areas; (4) focus attention on the concept that cryoprotectants will alter membrane structure and function in addition to their well-recognized effects on bulk solvent; and (5) emphasize the effect of the processing protocol on metabolic balance. These concepts are reintroduced in the context of the established and successful protocol for freezing bull sperm to illustrate the molecular responses that may be necessary to survive a freeze-thaw cycle.
Topics: Animals; Cattle; Cell Survival; Cryopreservation; Cryoprotective Agents; Male; Spermatozoa
PubMed: 2179184
DOI: No ID Found -
Systematic Reviews Jan 2018Neoadjuvant (chemo-)radiation has proven to improve local control compared to surgery alone, but this improvement did not translate into better overall or... (Meta-Analysis)
Meta-Analysis Review
Addition of platinum derivatives to neoadjuvant single-agent fluoropyrimidine chemoradiotherapy in patients with stage II/III rectal cancer: protocol for a systematic review and meta-analysis (PROSPERO CRD42017073064).
BACKGROUND
Neoadjuvant (chemo-)radiation has proven to improve local control compared to surgery alone, but this improvement did not translate into better overall or disease-specific survival. The addition of oxaliplatin to fluoropyrimidine-based neoadjuvant chemoradiotherapy holds the potential of positively affecting survival in this context since it has been proven effective in the palliative and adjuvant setting of colorectal cancer. Thus, the objective of this systematic review is to assess the efficacy, safety, and quality of life resulting from adding a platinum derivative to neoadjuvant single-agent fluoropyrimidine-based chemoradiotherapy in patients with Union for International Cancer Control stage II and III rectal cancer.
METHODS
MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials will be systematically searched to identify all randomized controlled trials comparing single-agent fluoropyrimidine-based chemoradiotherapy to combined neoadjuvant therapy including a platinum derivative. Predefined data on trial design, quality, patient characteristics, and endpoints will be extracted. Quality of included trials will be assessed according to the Cochrane Risk of Bias Tool, and the GRADE recommendations will be applied to judge the quality of the resulting evidence. The main outcome parameter will be survival, but also treatment toxicity, perioperative morbidity, and quality of life will be assessed.
DISCUSSION
The findings of this systematic review and meta-analysis will provide novel insights into the efficacy and safety of combined neoadjuvant chemoradiotherapy including a platinum derivative and may form a basis for future clinical decision-making, guideline evaluation, and research prioritization.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42017073064.
Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Humans; Neoadjuvant Therapy; Oxaliplatin; Quality of Life; Rectal Neoplasms; Survival
PubMed: 29357929
DOI: 10.1186/s13643-018-0678-9 -
Formal Methods in System Design 2021Population protocols are a well established model of computation by anonymous, identical finite-state agents. A protocol is well-specified if from every initial...
Population protocols are a well established model of computation by anonymous, identical finite-state agents. A protocol is well-specified if from every initial configuration, all fair executions of the protocol reach a common consensus. The central verification question for population protocols is the : deciding if a given protocol is well-specified. Esparza et al. have recently shown that this problem is decidable, but with very high complexity: it is at least as hard as the Petri net reachability problem, which is TOWER-hard, and for which only algorithms of non-primitive recursive complexity are currently known. In this paper we introduce the class of well-specified strongly-silent protocols and we prove that it is suitable for automatic verification. More precisely, we show that has the same computational power as general well-specified protocols, and captures standard protocols from the literature. Moreover, we show that the membership and correctness problems for reduce to solving boolean combinations of linear constraints over . This allowed us to develop the first software able to automatically prove correctness for of the infinitely many possible inputs.
PubMed: 34866798
DOI: 10.1007/s10703-021-00367-3 -
Health Technology Assessment... Dec 2011Multiple myeloma (MM) is the second most common haematological cancer in the UK. MM is not curable but can be treated with a combination of supportive measures and... (Review)
Review
The clinical effectiveness and cost-effectiveness of bortezomib and thalidomide in combination regimens with an alkylating agent and a corticosteroid for the first-line treatment of multiple myeloma: a systematic review and economic evaluation.
BACKGROUND
Multiple myeloma (MM) is the second most common haematological cancer in the UK. MM is not curable but can be treated with a combination of supportive measures and chemotherapy that aim to extend the duration and quality of survival. The majority of patients are not able to withstand intensive treatment, such as high-dose chemotherapy with autologous stem cell transplantation (SCT), and so they are offered single-agent or combination chemotherapy. Combination therapies typically include chemotherapy with an alkylating agent and a corticosteroid. More recently, combination therapies have incorporated drugs such as thalidomide (Thalidomide Celgene®, Celgene) and bortezomib (Velcade®, Janssen-Cilag).
OBJECTIVE
To assess the clinical effectiveness and cost-effectiveness of bortezomib or thalidomide in combination chemotherapy regimens with an alkylating agent and a corticosteroid for the first-line treatment of MM.
DATA SOURCES
Electronic bibliographic databases, including MEDLINE, EMBASE and The Cochrane Library, were searched from 1999 to 2009 for English-language articles. Bibliographies of articles, grey literature sources and manufacturers' submissions were also searched. Experts in the field were asked to identify additional published and unpublished references.
REVIEW METHODS
Titles and abstracts were screened for eligibility by two reviewers independently. The inclusion criteria specified in the protocol were applied to the full text of retrieved papers by one reviewer and checked independently by a second reviewer. Data extraction and quality assessment were undertaken by one reviewer and checked by a second reviewer. Differences in opinion were resolved through discussion at each stage. A cost-utility decision-analytic model was used to compare the cost-effectiveness estimates of bortezomib in combination with melphalan and prednisolone/prednisone (VMP), thalidomide in combination with cyclophosphamide and attenuated dexamethasone (CTDa), and thalidomide in combination with melphalan and prednisolone/prednisone (MPT) versus melphalan and prednisolone/prednisone (MP).
RESULTS
A total of 1436 records were screened and 40 references were retrieved for the systematic review of clinical effectiveness. Five randomised controlled trials (RCTs) met the inclusion criteria for the review: one RCT evaluated VMP, three evaluated MPT and one evaluated CTDa. The comparator in all of the included trials was MP. The review found that VMP and MPT can both be considered more clinically effective than MP for the first-line treatment of MM in people for whom high-dose therapy and SCT would not be appropriate. CTDa was more effective than MP in terms of complete response but data on survival outcomes did not meet the inclusion criteria. Cost-effectiveness analysis indicated that MPT has a greater probability of being cost-effective than either VMP or CTDa.
LIMITATIONS
For most RCTs, details needed to judge study quality were incompletely reported. All studies stated that the analyses followed intention-to-treat principles but none adequately reported data censoring. Only one RCT contributed data on VMP and the published peer-reviewed follow-up data were immature. For MPT, overall survival data from two trials were eligible for inclusion but the doses of thalidomide differed between the trials and the treatment period was not reflective of current UK practice so the generalisability of the findings was uncertain. Two RCTs had a maintenance phase with thalidomide that did not meet the inclusion criteria so some of these results were not eligible for the review. Limited evidence on health-related quality of life (HRQoL) was provided by the single trial of VMP versus MP.
CONCLUSIONS
Service provision is unlikely to change greatly. As uncertainties remain, further research is needed regarding the use of bortezomib- and thalidomide-containing combination regimens. Head-to-head trials of bortezomib- and thalidomide-containing combination regimes are required, including assessments of patient HRQoL in response to treatment.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Adrenal Cortex Hormones; Alkylating Agents; Antineoplastic Combined Chemotherapy Protocols; Boronic Acids; Bortezomib; Cost-Benefit Analysis; Cyclophosphamide; Humans; Immunosuppressive Agents; Melphalan; Multiple Myeloma; Pyrazines; Quality of Life; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Survival Analysis; Thalidomide
PubMed: 22146234
DOI: 10.3310/hta15410 -
Blood Cancer Journal Jul 2016The treatment of multiple myeloma (MM) is rapidly evolving. In the United States, four drugs (panobinostat, ixazomib, daratumumab and elotuzumab) were approved for the... (Review)
Review
The treatment of multiple myeloma (MM) is rapidly evolving. In the United States, four drugs (panobinostat, ixazomib, daratumumab and elotuzumab) were approved for the treatment of MM in 2015. As a result of improved diagnosis and therapy, there has been a dramatic improvement in the outcome of MM in the last decade, probably more than any other malignancy. Numerous agents continue to be studied in preclinical models and in clinical trials, with many demonstrating clinical efficacy that appears promising enough to have a trajectory for regulatory approval. The purpose of this article is to summarize the current data and provide perspective on new investigational agents with promising single-agent activity in MM. The agents reviewed include Isatuximab, an anti-CD38 monoclonal antibody; marizomib, a new proteasome inhibitor; oprozomib, an oral proteasome inhibitor; filanesib (ARRY-520), a kinesin spindle protein inhibitor; dinaciclib, a cyclin-dependent kinase inhibitor; venetoclax (ABT-199), a selective BCL-2 inhibitor; and LGH-447, pan PIM kinase inhibitor.
Topics: Antibodies, Monoclonal; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Drugs, Investigational; Humans; Molecular Targeted Therapy; Multiple Myeloma; Treatment Outcome
PubMed: 27471867
DOI: 10.1038/bcj.2016.53 -
Investigative Radiology Oct 2018To validate in vitro the capability of a high-spatial-resolution prototype spectral photon-counting computed tomography (SPCCT) scanner to differentiate between 2...
OBJECTIVES
To validate in vitro the capability of a high-spatial-resolution prototype spectral photon-counting computed tomography (SPCCT) scanner to differentiate between 2 contrast agents and to assess in vivo the image quality and the feasibility to image the peritoneal cavity in rats using the 2 contrast agents simultaneously within the vascular and peritoneal compartments.
MATERIALS AND METHODS
The authors performed SPCCT imaging (100 mAs, 120 kVp) with energy bin thresholds set to 30, 51, 64, 72, and 85 keV in vitro on a custom-made polyoxymethylene cylindrical phantom consisting of tubes with dilutions of both contrast agents and in vivo on 2 groups of adult rats using 2 injection protocols. Approval from the institutional animal ethics committee was obtained. One group received macrocylic gadolinium chelate intraperitoneal (IP) and iodine intravenous (IV) injections (protocol A, n = 3), whereas the second group received iodine IP and gadolinium IV (protocol B, n = 3). Helical scans were performed 35 minutes after IP injection and 20 seconds after IV injection. The SPCCT and contrast material images, that is, iodine and gadolinium maps, were reconstructed with a field of view of 160 mm, an isotropic voxel size of 250 μm, and a matrix size of 640 × 640 pixels using a soft reconstruction kernel. The SPCCT images were reconstructed with 2 different spatial resolutions to compare the image quality (sharpness, diagnostic quality, and organ visualization) of SPCCT (250 μm) with single-energy computed tomography (CT) (600 μm). Two radiologists evaluated the peritoneal opacification index in 13 regions (score = 0-3 per region) on each type of image. Concentrations of contrast agents were measured in the organs of interest.
RESULTS
In vitro, the concentration measurements correlated well with the expected concentrations. The linear regressions both had R values of 0.99, slopes of 0.84 and 0.87, and offsets at -0.52 and -0.38 mg/mL for iodine and gadolinium, respectively. In vivo, the SPCCT images were of better diagnostic quality, with increased sharpness compared with the CT-like images (P < 0.0001). Intraperitoneal diffusion was excellent, with similar peritoneal opacification index on SPCCT images and overlay of contrast material maps (P = 1) without a significant difference between protocol A (37.0 ± 1.7) and protocol B (35.3 ± 1.5) (P = 0.34). Only the contrast material maps demonstrated clear visual separation of the contrast agents, allowing specific quantification of the physiological enhancement in the liver, spleen, and kidney and the urinary clearance in the renal pelvis and bladder. Renal excretion of the contrast agents injected IP was observed and was consistent with blood diffusion.
CONCLUSIONS
Spectral photon-counting CT can be used to perform a complete peritoneal dual-contrast protocol, enabling a good assessment of the peritoneal cavity and abdominal organs in rats.
Topics: Abdomen; Animals; Contrast Media; Gadolinium; Humans; Image Processing, Computer-Assisted; Iodine; Linear Models; Male; Models, Animal; Peritoneal Cavity; Phantoms, Imaging; Photons; Radiographic Image Enhancement; Rats; Rats, Sprague-Dawley; Reproducibility of Results; Tomography, Emission-Computed, Single-Photon
PubMed: 29794948
DOI: 10.1097/RLI.0000000000000483