Out Of Range Research Articles

Evaluation of temperature excursions from USP recommendations during mail transit

BackgroundPatients use mail delivery as a convenient alternative to acquiring medications in person. Federal laws require nonspecialty oral medications to be stored at controlled room temperature during distribution; however, no laws or regulations govern temperature requirements for medication transport among patients, which may expose medications to harmful temperature excursions. ObjectiveThe purpose of this study was to evaluate temperature excursions during mail transit based on the shipment method, carrier, and season. MethodsThis prospective study monitored temperature fluctuations during simulated mail transit between New Jersey, California, and Tennessee over winter (December 2019–February 2020) and summer (August–September 2020) time frames. Packages with data-logging thermometers were shipped to 3 U.S. destinations via 3 common mail carriers and 2 popular shipping methods. Three packages were mailed for each combination of season, carrier, and shipping method, representing 36 individual packages. The primary end point was percent of transit time out of range (OOR) based on the United States Pharmacopeia <659> recommended range, 68°F to 77°F. Additional end points include package transit durations and extreme temperatures. ResultsEvaluated packages spent an average of 68.3% of transit time OOR. In winter, 3-day and next business day packages spent similar time OOR (80.1% vs. 78%). In summer, 3-day packages spent more time OOR compared with next business day shipping (43.1% vs. 13.6%). Mean transit time was statistically significantly longer for 3-day packages (406.6 hours vs. 303.1 hours; P < 0.0001). Mean winter transit time was statistically significantly longer than summer (475.7 hours vs. 233.9 hours; P < 0.001) regardless of the shipping method. The minimum and maximum temperatures recorded were 5.1°F and 102.3°F, respectively. ConclusionPackage temperatures were outside of the recommended range for most of the transit time regardless of the shipping method, carrier, or season.

Australia as one big laboratory – are our results good enough?

Patients move around and may be tested at laboratories all around the country. Doctors use the same guidelines and information for interpretation across the country. Ideally, results from all laboratories should be close enough so that a patient can be diagnosed or monitored using results from any laboratory in the country. The starting point here is to be aware of how results vary across the country. Using the results from 2021 RCPAQAP Liquid Serum Chemistry program, which are presumed to be commutable, we have assessed the precision (CVAust) and bias across the country. For 2 out of the 51 tests assessed, the CVAust met the optimal level; 8 desirable; 13 minimal; 13 borderline; 10 poor; and 5 out of range. For tests with AACB/RCPA recommended common reference intervals, 7 tests confirmed sufficiently small bias, however for 12 tests one or more methods showed a significant bias. For tests without recommended common reference intervals, the data suggests that 12 tests could share a reference interval and for 8 tests a method-specific interval is indicated. Data from the Liquid Serum Chemistry program is important to interpret result from different laboratories, to consider common reference intervals and monitor improvements in assay traceability.

Region-specific laboratory reference intervals are important: A systematic review of the data from Africa.

Region-specific laboratory reference intervals (RIs) are important for clinical trials and these data are often sparse in priority areas for research, including Africa. We reviewed data on RIs from Africa to identify gaps in the literature with a systematic review of PubMed for RI studies from Africa published ≥2010. Search focus included clinical analytic chemistry, hematology, immunological parameters and RIs. Data from adults, adolescents, children, pregnant women, and the elderly were included. We excluded manuscripts reporting data from persons with conditions that might preclude clinical trial participation in studies enrolling healthy volunteers. Of 179 identified manuscripts, 80 were included in this review, covering 20 countries with the largest number of studies in Ethiopia (n = 23, 29%). Most studies considered healthy, nonpregnant adults (n = 55, 69%). Nine (11%) studies included pregnant women, 13 (16%) included adolescents and 22 (28%) included children. Recruitment, screening, enrollment procedures and definition of age strata varied across studies. The most common type of RIs reported were hematology (66, 83%); 14 studies (18%) included flow cytometry and/or T cell counts. Other common tests or panels included liver function assays (32, 40%), renal function assays (30, 38%), lipid chemistries (17, 21%) and serum electrolytes (17, 21%). The number of parameters characterized ranged from only one (three studies characterized either CD4+ counts, D-dimer, or hemoglobin), to as many as 40. Statistical methods for calculating RIs varied. 56 (70%) studies compared their results to international RI databases. Though most presented their data side-by-side with international data with little accompanying analysis, nearly all reported deviation from comparator RI data, sometimes with half or more of otherwise healthy participants having an "out of range" result. We found there is limited local RI data available in sub-Saharan Africa. Studies to fill this gap are warranted, including efforts to standardize statistical methods to derive RIs, methods to compare with other RIs, and improve representative participant selection.

Is There a Connection between the Metabolism of Copper, Sulfur, and Molybdenum in Alzheimer’s Disease? New Insights on Disease Etiology

Alzheimer’s disease (AD) and other forms of dementia was ranked 3rd in both the Americas and Europe in 2019 in a World Health Organization (WHO) publication listing the leading causes of death and disability worldwide. Copper (Cu) imbalance has been reported in AD and increasing evidence suggests metal imbalance, including molybdenum (Mo), as a potential link with AD occurrence.We conducted an extensive literature review of the last 60 years of research on AD and its relationship with Cu, sulfur (S), and Mo at out of range levels.Weanalyzed the interactions among metallic elements’ metabolisms;Cu and Mo are biological antagonists, Mo is a sulfite oxidase and xanthine oxidase co-factor, and their low activities impair S metabolism and reduce uric acid, respectively. We found significant evidence in the literature of a new potential mechanism linking Cu imbalance to Mo and S abnormalities in AD etiology: under certain circumstances, the accumulation of Cu not bound to ceruloplasmin might affect the transport of Mo outside the blood vessels, causing a mild Mo deficiency that might lowerthe activity of Mo and S enzymes essential for neuronal activity. The current review provides an updated discussion of the plausible mechanisms combining Cu, S, and Mo alterations in AD.

Hidden in Plain Sight: Overlooked Results and Other Errors in Evaluating Online Laboratory Results.

People are increasingly accessing their own laboratory (lab) results online. However, Canadians may be expected to use different systems to access their results, depending upon where they are tested (e.g., community lab vs. hospital), and these results may be displayed differently. This study examined the extent to which participants without medical expertise (N = 25) made errors identifying lab results (i.e., missing or mis-identifying abnormal results) in a mock report. Six participants overlooked each of the flagged values, 20 participants missed an abnormal result that was not flagged, and 2 participants mis-identified a normal value as out of range. We describe potential causes of these errors and the implications for the design of consumer-facing lab results.

Toxicological evaluation of the red mold rice extract, ANKASCIN 568-R: 13-week chronic toxicity, and genotoxicity studies

ANKASCIN 568-R is an extract derived from red mold rice (RMR) fermented using Monascus purpureus NTU 568. RMR fermented using M. purpureus NTU 568 prevents cardiovascular diseases and decreases blood lipid levels. This study evaluates the safety of ANKASCIN 568-R, since it has not determined yet. After daily oral ANKASCIN 568-R for 13 consecutive weeks, we evaluated the toxicity tolerance of Sprague-Dawley rats and performed dose formulation analysis on monascin and ankaflavin. The dose formulation analysis showed that ANKASCIN 568-R concentrations were lower than the target concentration and out of range ( ± 15%) at week 8 and on the last dosing day for both monascin (all dose groups) and ankaflavin at the 100 mg/kg dose. The lowest reported concentrations for the low, middle, and high dose formulations were 34.7, 115.2, and 398.1 mg/mL, respectively. We also evaluated the genotoxicity of ANKASCIN 568-R and showed no genotoxicity potential at all ANKASCIN 568-R doses investigated. The no observed adverse effect level of ANKASCIN 568-R was determined to be 796.2 mg/kg/day. This study revealed the first toxicity evaluation data of ANKASICN 568-R, and the data demonstrated ANKASICN 568-R was safe and can be used in daily life.

РЕКОМЕНДАЦІЇ ЩОДО ПРИЗНАЧЕННЯ ЗАВДАНЬ СТРІЛЬБИ АРТИЛЕРІЇ ДЛЯ УРАЖЕННЯ ВИСОКОМАНЕВРЕНИХ ЦІЛЕЙ

Analysis of armed conflicts in recent years shows the widespread use of highly maneuverable firearms, which are characterized by rapid movement during hostilities, frequent changes of position after the fire mission. The effectiveness of defeating a highly maneuverable target and performing a fire task depends on the correct choice and priority in assigning a particular artillery firing task. The main factors influencing the effectiveness of fire damage to highly maneuverable targets are: timeliness, accuracy, suddenness, obtaining complete and accurate data on the position, size and nature of targets, the correct choice of means of hitting the target, the purpose of the fire task and method of firing targets. The primary task of artillery units is to defeat highly maneuverable targets while they are in firing positions. This time is called the effective time to complete the fire task. The timeliness of hitting highly maneuverable targets can be assessed by the ratio of reaction time required to use the artillery unit in combination with additional reconnaissance means allocated for counterbattery combat, to hit the target with the set ammunition consumption and the probable time of target targeting after reconnaissance. The time spent by highly maneuverable targets at the position after their detection by reconnaissance means is random, distributed according to the law of equal probability and depends on the tactical and technical characteristics of weapons, time of fire task, terrain, season, time of day, etc., as well as at what point the target was identified. Fire on the target can be timely only if it is detected and the coordinates are transmitted to the fire units by the time it leaves its positions. When determining the degree of damage to highly maneuverable targets, it is necessary to take into account the probability of timely fire, ie all shells intended to hit the target, spent until the target left the position (out of range). To destroy the battery (platoon) of self-propelled armored guns at the firing position and the platoon of self-propelled armored SAM at the position, the task of firing is to prohibit action, even with the use of two artillery divisions. To defeat the battery (platoon) of MLRS and the battery (platoon) of self-propelled unarmored guns in the firing position, the task of one division is to suppress, and when two divisions are involved in firing on the battery (platoon) of MLRS – destruction. To defeat a platoon of self-propelled armored ATGMs at the deployment line, firing one division, firing task is a ban on action, and if at least two divisions are involved - there may be suppression. Keywords: firing tasks, highly maneuverable targets, effective time, effectiveness of fire damage.

XENON1T solar axion and the Higgs boson emerging from the dark

In a recent letter we proposed a new non-thermal mechanism of Dark Matter production based on vacuum misalignment, where both the Higgs boson and a very light pseudo-scalar $\eta$ emerge from the Dark sector. In this letter, we identify the parameter space in a composite scenario where the light pseudo-scalar can be produced in the sun and explain the XENON1T excess in electron recoil data. The model's Dark Matter candidate has a mass around $50$ TeV and out of range for Direct Detection. Testable predictions include Gravitational waves at frequencies in the Hz range from a cosmological phase transition, an exotic decay $Z \to \gamma + \mbox{inv.}$ with rates $4 \div 16 \cdot 10^{-12}$ testable at a future Tera-Z collider, and an enhancement by $17\div 40$ % of the branching ratio $K_L \to \pi^0 + \mbox{inv.}$, not enough to explain the KOTO anomaly. All these predictions may be confirmed by future experiments.

Evaluating the effects of ocean warming and freshening on the physiological energetics and transcriptomic response of the Antarctic limpet Nacella concinna

In the Southern Ocean, warming and freshening are expected to be prominent signals of climate change and the reduced ability of Antarctic marine organisms to cope with changing environmental conditions could challenge their future survival. The Antarctic limpet Nacella concinna is a macroinvertebrate of rocky ecosystems, which occurs in high densities in the shallow subtidal zone. Subtidal individuals were exposed to a combination of temperatures (1, 4, 8, 11, 14 °C) and salinities (20 and 30 psu) for a 60-day period. A drastic increment in mortality was observed with seawater warming, showing that N. concinna is highly stenothermal, with limited ability to survive at temperatures warmer than 4 °C, although there was some degree of acclimation at 4 °C and ambient salinity (30 psu). This study confirmed the stenohaline characteristic of this species, with mortality reaching 50% and lower scope for growth at low salinity (20 psu) even at the control temperature (1 °C). At the sub-cellular level, limpets' low tolerance to out-of range salinity is illustrated by the activation of cell remodelling processes whereas the down-regulation of chaperones proteins and plasma membrane ATPase suggest that under the combination of warming and freshening N. concinna experiences a severe level of stress and devote much of its energy to somatic maintenance and survival. The drastic effect observed can be explained by its subtidal origin, an environment with more stable conditions. The surviving individuals at 1 °C and lowered salinity (20 psu) were either more tolerant or showing signs of acclimation after 60 days, but the combination of warming and freshening have a greater combined stress. Projections of climate change for end of the century for this part of the Antarctic can, therefore, result in a significant diminution of the subtidal population of N. concinna, affecting ecological interactions and diversity of the food web.

Comparison of four algorithms on establishing continuous reference intervals for pediatric analytes with age-dependent trend

BackgroundContinuous reference intervals (RIs) allow for more precise consideration of the dynamic changes of physiological development, which can provide new strategies for the presentation of laboratory test results. Our study aimed to establish continuous RIs using four different simulation methods so that the applicability of different methods could be further understood.MethodsThe data of alkaline phosphatase (ALP) and serum creatinine (Cr) were obtained from the Pediatric Reference Interval in China study (PRINCE), in which healthy children aged 0–19 years were recruited. The improved non-parametric method, the radial smoothing method, the General Additive Model for Location Scale and Shape (GAMLSS), and Lambda-Median-Sigma (LMS) were used to develop continuous RIs. The accuracy and goodness of fit of the continuous RIs were evaluated based on the out of range (OOR) and Akaike Information Criterion (AIC) results.ResultsSamples from 11,517 and 11,544 participants were used to estimate the continuous RIs of ALP and Cr, respectively. Time frames were partitioned to fulfill the following two criteria: sample size = 120 in each subgroup and mean difference = 2 between adjacent time frames. Cubic spline or penalized spline was used for curve smoothing. The RIs estimated by the four methods approximately overlapped. However, more obvious edge effects were shown in the curves fit by the non-parametric methods than the semi-parametric method, which may be attributed to insufficient sample size. The OOR values of all four methods were smaller than 10%.ConclusionsAll four methods could be used to establish continuous RIs. GAMLSS and LMS are more reliable than the other two methods for dealing with edge effects.

Contribution of Isotopic Techniques in the Hydrological Study of the Aquifers of Ica, Villacuri and Lanchas

Ica Aquifer located at the coastal zone of Ica River Valley, supplies 40% of the water to a number of farms of Ica Region which is one of the most productive valley of Peru that covers an area of 30,000 hectares of area, in which a diverse agricultural product are grown for local and external market. In the last 15 years, water-table of the aquifer was lowering at an elevated rate that concerned to farmers and authorities of the Peruvian Government, so a number of studies was carried out to increase the water supply to the agriculture areas.The main purpose of the study using isotope techniques, was to have a first insight of the hydrodynamics of Ica, Villacuri and Lanchas Aquifers and the possible interconnection between them and with Pisco River. For such purpose, 31 wells, lakes, rivers and springs of Ica and Pisco Basin where sampled during the years 2014 to 2016 both in rain and dry seasons, getting 189 samples for isotope and chemical analysis. The sampling schedule didn’t include rain sampling, instead of it, selected springs were sampled and nearby basin rain data was used.18O,2H and 13C stable isotopes and 3H, 14C radioactive isotopes of the water samples were analyzed in the laboratory of “Isotope Tracer Technologies INC”; the results of the stable isotope analysis confirm the hydraulic interconnection of the three aquifers mentioned above; it also was confirmed that the main source of recharge was provided by Ica River and evidences were found about the contribution of Pisco River in the recharge of Villacuri and Lanchas Aquifers.Analysis of 14C reveals that some wells are overexploited. All the results of 3H analysis were out of range, so it was not useful for the conclusions of the study, and a new sampling of water is required; the reason of this out of range result should be the possible contamination of the samples with no environmental Tritium.

Design and implementation of a mobile health electronic data capture platform that functions in fully-disconnected settings: a pilot study in rural Liberia

BackgroundMobile phones and personal digital assistants have been used for data collection in developing world settings for over three decades, and have become increasingly common. However, the use of electronic data capture (EDC) through mobile phones is limited in many areas by inconsistent network connectivity and poor access to electricity, which thwart data transmission and device usage. This is the case in rural Liberia, where many health workers live and work in areas without any access to cellular connectivity or reliable power. Many existing EDC mobile software tools are built for occasionally-disconnected settings, allowing a user to collect data while out of range of a cell tower and transmit data to a central server when he/she regains a network connection. However, few tools exist that can be used indefinitely in fully-disconnected settings, where a user will never have access to the internet or a cell network. This led us to create and implement an EDC software tool that allows for completely offline data transfer and application updating.ResultsWe designed, pilot-tested, and scaled an open-source fork of Open Data Kit Collect (an Android application that can be used to create EDC systems) that allows for offline Bluetooth-based bidirectional data transfer, enabling a system in which permanently-offline users can collect data and receive application updates. We implemented this platform among a cohort of 317 community health workers and 28 supervisors in a remote area of rural Liberia with incomplete cellular connectivity and low access to power sources.ConclusionsRunning a fully-offline EDC program that completely bypasses the cellular network was found to be feasible; the system is still running, over 4 years after the initial pilot program. The users of this program can theoretically collect data offline for months or years, assuming they receive hardware support when needed. Fully-offline EDC has applications in settings where cellular network coverage is poor, as well as in disaster relief settings in which portions of the communications infrastructure may be temporarily nonfunctional.

Induction of apoptosis and differentiation by Na/H exchanger 1 modulation in acute myeloid leukemia cells

We investigated the effect of the modulation of Na/H exchanger 1 (NHE1) on apoptosis, differentiation, and chemoresistance in acute myeloid leukemia (AML) cells to evaluate the possibility of NHE1 modulation as a novel therapeutic strategy for AML. The pHi of leukemia cell lines except KG1a was higher than that of normal bone marrow mononuclear cells (BM MNCs). Notably, in K562, cytarabine (AraC)-resistant OCI-AML2, and primary leukemia cells, pHi was significantly higher than that of normal BM MNCs. Western blotting and real-time quantitative PCR confirmed that the increased NHE1 expression was responsible for the higher pHi. Specifically, compared to CD34+CD38+ leukemia cells, the mean fluorescence intensity of NHE1 was significantly higher in CD34+CD38− leukemic stem cells. The out of range in pHi by treatment with an NHE inhibitor, the amiloride analogue 5-(N,N-hexamethylene) amiloride (HMA), or an NHE activator, phorbol 12-myristate 13-acetate (PMA), resulted in dose- and time-dependent inhibition of leukemia cell proliferation. PMA induced CD14+ differentiation of leukemia cells, whereas HMA induced cell cycle arrest at the G1 phase. HMA could induce apoptosis of leukemia cells even in AraC-resistant cells and showed an additive effect on apoptosis in AraC-sensitive cells. Our result revealed that AML cells prefer more alkalic intracellular moiety than normal BM MNCs following increased NHE1 expression and that NHE1 modulation can induce apoptosis and differentiation of AML cells. These findings imply that NHE1 is a potential target in cytotoxic or differentiation-induction treatment for AML.

Studies of the Poltava seismic-tidal records during the period of explosions events in Balakliya and Kalynivka

The seismic-tidal records obtained at the Poltava gravimetric observatory of the IGF NAS of Ukraine (PGO) studied before, during and after events in Balaklija (March 22—23) and in Kalinovka (September 26—27) 2017 (explosions in ammunition dumps). Digital records were obtained with seismotiltmeters of compensating type and vertical seismometer (horizontal and vertical components), with thermal barograph and upgraded GS-11 gravimeter. Data analysis is performed by filtration, spectral, correlation and other methods, and the results are presented by graphs. The study of seismic deformation effects during explosions in military depots is a geophysical problem, the solution of which allows parameterize such dangerous events. However, despite its importance and social significance, it is not developed yet and needs additional studies. The analysis of the current-interval correlation functions and spectra shows that in the records up to 23:00 UTC 22.03.17 and 19:00 UTC on 26.09.17 (before the explosoins), the correlation coefficients (K) for short test correlator sections are smaller than 0.2. That is, no significant correlation on the selected interval correlators is observed. The number of pulse-wave seismic packets after a specified time, increases substantially, and seismic packets become clearer in current-interval correlation functions. They also appear in places where because of the noise they are not visible on the primary records. The correlation co-efficient between seismic packets in certain case, increases (K > 0.6 ¸ 0.8). This indicates the similarity of the pulsed wave packets and that they are generated in one place and have the same physical origin: obviously it is an explosion. The research has revealed the characteristic singularity of the seismodeformation signals during these events. A methodology for studying them has been developed. Many fundamental and applied problems have remained out-of range and must be investigated. Earth’s crust interaction — atmospheric explosion, energy of charges and their influence on spectra, residual jumps — deformations, etc. have not been investigated because of limited resources.

Salivary C-reactive protein among at-risk adolescents: A methods investigation of out of range immunoassay data

Inflammatory markers including C-Reactive Protein (CRP) are increasingly used within research and clinical settings. Yet, varying methodologies for cleaning immunoassay data with out of range (OOR) samples may alter characteristic levels of CRP, thereby obscuring interpretation and reliability. This study investigated the influence of eight immunoassay OOR data treatment techniques on salivary CRP (sCRP) samples from at-risk adolescents. Participants from the ‘Sleep and Education: learning New Skills Early’ (SENSE) Study were 86 adolescents at-risk for depression (50 female), aged 14.29 years (SD = 1.04). ANOVA results showed no statistically significant differences in average morning (F(7, 590) = 1.24, p = .28) and evening (F(7, 599)=1.29, p = .25) values produced by each OOR data cleaning technique. However, varying techniques produced differences in the magnitude of Pearson’s correlations between consecutive saliva samples (r’s between 0.27–0.78), and influenced the significance of a sCRP diurnal pattern; two techniques produced statistically higher morning than evening sCRP levels (t(85) = 2.70, p = .01 and t(85) = 2.67, p = .01), whereas six techniques failed to find statistical differences between morning and evening sCRP levels (p’s >.05). Varying techniques also produced statistically divergent associations between sCRP and age and depressive symptoms. Results from this study provide evidence for the temporal stability of sCRP among adolescents, show winsorization as an effective OOR data management technique, and highlight the influence of methodological decisions in cleaning salivary biomarker data and the need for consistency within the field.

Layer-by-layer assembly of graphene on polyimide films via thermal imidization and synchronous reduction of graphene oxide

To investigate the effects of holding time after deposition of polyethylenimine (PEI) solution and molecular weight of PEI on the surface morphology of multi-layer films prepared by layer-by-layer (LbL) method, polyamic acid (PAA)/PEI/graphene oxide (GO) films were prepared using different holding times and different molecular weights of PEI. To convert PAA into polyimide (PI), the films were thermally imidized after film deposition. In this process, GO was also converted into partially reduced GO (rGO). The effects of holding time and molecular weight of PEI on the surface morphology and the sheet resistance of PI/PEI/rGO films were investigated. Also, to investigate the effect of rGO on the barrier properties of PI based multilayer films, (PI/PEI/rGO/PEI)6 films were prepared by LbL method. Longer holding time (10 min) and smaller molecular weight (25,000) of PEI lead to relatively flat surfaces, but shorter holding time (5 min) and larger molecular weight (75,000) result in wrinkled and overlapped surfaces. The sheet resistance of PI/PEI25K/rGO films prepared with holding time 10 and 5 min is 502.1 kΩ/sq and out of range (> 2000 kΩ/sq), respectively. The sheet resistance of PI/PEI75K/rGO films prepared with holding time 10 min is out of range (> 2000 kΩ/sq). Gas transmission rate (GTR) and permeability coefficient of (PI/PEI25K/rGO/PEI25K)6 are lower than those of (PI/PEI75K/rGO/PEI75K)6, respectively.

Abstract 253: Out of Range INR Results Lead to Increased Health Care Utilization in Four Large Anticoagulation Clinics

Background: The impact on healthcare utilization of a single out of range (OOR) INR value not associated with any bleeding or thromboembolic complication among chronic warfarin-treated patients is not well described. Methods: At four large phone-based anticoagulation clinics in Michigan, warfarin-treated patients with atrial fibrillation (AF) or venous thromboembolism (VTE) were identified and data collected via medical chart abstraction. Propensity score matching was used to identify two groups closely matched on patient characteristics: the OOR INR group (INR value &lt; 1.8 or &gt; 3.2 if target range was 2-3) and the control group (INR value between 1.8 and 3.2). Data for each anticoagulation clinic interaction and INR lab test were abstracted until the patient had 2 subsequent and sequential in-range INR values. Methods and frequency of interactions between the anticoagulation clinic and patient were recorded, described as median and interquartile ranges (IQR) and compared using Poisson regression with adjusted means. Results: Demographics were similar for the 116 OOR INR patients and the 58 control patients studied (mean±SD age 72.1±13.0 and 74.3±11.3 years, respectively). Indications for warfarin were more commonly venous thromboembolism in the OOR versus in-range patients (42.2% vs. 27.6%, p=0.06). OOR and in-range INR patients experienced a median of 3 (IQR 3-5) and 3 (IQR 3-3) with adjusted means of 4.2 and 3.2 (p&lt;0.001) INR lab draws until two sequential tests were in-range. OOR INR patients required a median 5 (IQR 3-6) with adjusted means of 5.3 and 3.7 interactions with the anticoagulation clinic versus 3 (IQR 3-4) for in-range INR patients (p&lt;0.001). OOR INR patients more often required phone calls (adjusted means 2.9 versus 0.9, p&lt;0.001) but fewer mailed letters (adjusted means 1.3 versus 2.3, p&lt;0.001) than in-range INR patients. OOR INR patients more often required multiple types of contact than in-range INR patients (83.6% versus 55.2%, p&lt;0.001). Contact was most frequently performed by registered nurses (adjusted means 3.4 versus 2.9, p=0.059) and administrative assistants (adjusted means 1.3 versus 0.5, p&lt;0.001) for both OOR and in-range INR patients. Blood count and renal function lab test were similarly rare for both groups (mean 0.4, median 0, p=0.74 for each). Conclusions: Warfarin-treated patients who experience OOR INR values without any bleeding or thromboembolic complication require more frequent interactions with the anticoagulation clinic, including more telephone calls and multiple types of contact.

A long term clinical outcome of the Medial Pivot Knee Arthroplasty System

BackgroundThe ideal total knee arthroplasty (TKA) should provide maximum range of motion and functional stability for all desired daily activities and, if possible, to replicate normal knee kinematics and function. The ADVANCE® Medial Pivot (AMP) Knee System was designed with a highly congruent medial compartment and a less conforming lateral compartment to more closely mimic the kinematics of the normal knee and to offer more stability through out of range of motion (ROM). The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of this TKA system. MethodsThree hundred and twenty-five (325) patients (347 knees) with knee osteoarthritis underwent a TKA using the AMP prosthesis in our Department. For evaluation, objective and subjective clinical rating systems along with radiograph series were used. The average follow-up was 15.2years. ResultsAll patients showed a statistically significant improvement (p<0.0005) in the Knee Society clinical rating system, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, SF-12® questionnaire, and Oxford knee score. The majority of patients (94%) were able to perform age-appropriate activities with a mean knee flexion of 120° (range, 105°–135°) at final follow-up. Survival analysis showed a cumulative success rate of 98.8% at 17years. ConclusionThe obtained results demonstrate excellent long-term clinical outcome for this knee design.

치과용 Co-Cr sinter metal의 소결 후 변형비교

Purpose: Currently advanced in Dental CAD/CAM technology increase a use of Co-Cr sinter metal block at Dental CAD/CAM part traditionally it has been being used with metal casting method. There is an advantage that can leave out a step of investment and casting as well as reducing a working time to compare with conventional casting method in a dry milling. Methods: In this research, compare a deformation of before and after sinter result of Co-Cr sinter metal block. Design a specimen figure by 3D CAD software and transformed it to a STL file can be used at Dental CAD/CAM. With a transformed STL file, milled a Co-Cr sinter metal specimen by using a Dental CAD/CAM dry milling machine. It arrived at the following conclusions after measuring an outer form and thickness of a machined specimen and then after sinter measure it again in a way of before sinter measurement method. Results: It is confirmed that there is no error while a 3D design figure specimen is transformed to a Dental CAD data. It is observed that there is no error at Co-Cr sinter metal specimen which consider a length of single coping and bridge. Conclusion: It is observed that there is no deformation at a specimen of AS05 and AB05 are made of 0,5mm thickness. On the other hand, the out of range of deformation is observed at a specimen of AS10 and AB10 which are made of 1mm thickness.

Comparable dose estimates of blinded whole blood samples are obtained independently of culture conditions and analytical approaches. Second RENEB gene expression study

Purpose: This collaboration of five established European gene expression labs investigated the potential impact of culture conditions on the transcriptional response of peripheral blood to radiation exposure.Materials and methods: Blood from one healthy donor was exposed ex vivo to a Cobalt 60 source to produce a calibration curve in addition to four unknown doses. After exposure, the blood samples were either diluted with RPMI medium or left untouched. After 24-h incubation at 37 °C the diluted blood samples were lysed, while the undiluted samples were mixed with the preservative RNALater and all samples were shipped frozen to the participating labs. Samples were processed by each lab using microarray (one lab) and QRT-PCR (four labs).Results: We show that although culture conditions affect the total amount of RNA recovered (p < .0001) and its integrity (p < .0001), it does not significantly affect dose estimates (except for the true dose at 1.1 Gy). Most importantly, the different analysis approaches provide comparable mean absolute difference of estimated doses relative to the true doses (p = .9) and number of out of range (>0.5 Gy) measurements (p = .6).Conclusion: This study confirms the robustness of gene expression as a method for biological dosimetry.