Drought Persistence Errors in Global Climate Models

The persistence of drought events largely determines the severity of socioeconomic and ecological impacts, but the capability of current global climate models (GCMs) to simulate such events is subject to large uncertainties. In this study, the representation of drought persistence in GCMs is assessed by comparing state-of-the-art GCM model simulations to observation-based data sets. For doing so, we consider dry-to-dry transition probabilities at monthly and annual scales as estimates for drought persistence, where a dry status is defined as negative precipitation anomaly. Though there is a substantial spread in the drought persistence bias, most of the simulations show systematic underestimation of drought persistence at global scale. Subsequently, we analyzed to which degree (i) inaccurate observations, (ii) differences among models, (iii) internal climate variability, and (iv) uncertainty of the employed statistical methods contribute to the spread in drought persistence errors using an analysis of variance approach. The results show that at monthly scale, model uncertainty and observational uncertainty dominate, while the contribution from internal variability is small in most cases. At annual scale, the spread of the drought persistence error is dominated by the statistical estimation error of drought persistence, indicating that the partitioning of the error is impaired by the limited number of considered time steps. These findings reveal systematic errors in the representation of drought persistence in current GCMs and suggest directions for further model improvement.

Influence of compressing pressure on macro void formation of carbon monolith for methane adsorption

Carbon monoliths for adsorbed natural gas (ANG) storage were prepared from Mongolian anthracite-based activated carbons using carboxy-methyl cellulose as a binder under different compressing pressures. Nitrogen adsorption/desorption experiments were carried out to obtain the specific surface area, pore volume, and pore size distribution of the monoliths.  Methane adsorption experiments on the carbon monoliths were conducted at different temperatures and pressures up to around 3.5 MPa in a high pressure volumetric adsorption apparatus. As expected, adsorption results indicated that the methane adsorption capacity of the carbon monoliths increased with increasing specific surface area and packing density.  The maximum volumetric adsorption of methane was observed as 163 V/V at 293 K and 3.5 MPa on a carbon monolith sample, PMAC1/2-3-65, that does not have the highest specific surface area but relatively high packing density comparing with other monoliths, which implies that two physical properties contribute contradictorily to the methane adsorption capacity.  Based on experimental results, the carbon monoliths prepared from Mongolian anthracite-based activated carbons can be promising media for ANG storage application.

Use of immune checkpoint inhibitors in a community practice within a vertically integrated health care system

130

Background: Four immune checkpoint inhibitors have been FDA approved from 2011 to 2016. Immune checkpoint inhibitors function differently from chemotherapy and have different benchmarks for response as well as different side effect profiles. This report examines how oncologists in two large medical groups have introduced these new treatments into their practices. Kaiser Permanente is a large HMO which insures 8.5 million members in the state of California and has an exclusive contract with 2 large medical groups to care for its members. There are over 200 medical oncologists caring for KP members practice at over 35 medical centers. The care of the KP members has been documented in an EPIC based medical record systems since 2006. Methods: The Pharmacy Research Outcomes Group has conducted a retrospective cohort study looking at patients who initiated Checkpoint inhibitors between March 2011 and September 2016 for this review and followed the patients till December 2016. Electronically available data collected for this review includes patient characteristics such as but not exclusive to: cancer diagnosis, previous therapies, current therapies, age, sex, ethnicity, immune related adverse events (IRAEs) proxy by diagnosis code, duration of immunotherapy, use of systemic steroids, Charlson Co-morbity Index and survival. Results: We reviewed a total of 1760 users of Checkpoint Inhibitors. We show the uptake of this class of medications aligns with approved checkpoint inhibitors and the new indications of these agents. We were able to electronically pull medical information and define IRAEs. Our data closely matches the expected incidence of IRAEs as reported in clinical trials. We were also able to monitor the use of steroids in response to these events. Conclusions: The ability to collect and track this information has allowed the group to better understand patient selection practices as well as management practices in the community practice setting.

Immune-related adverse events (IrAE) of elderly patients (pts) receiving PD-1 or PDL-1 inhibitors (PDIs) in a community-oncology setting: The experience at Kaiser Permanente California

124

Background: Checkpoint inhibitors (CI) are rapidly changing the treatment (Tx) landscape across multiple cancers. They have brought with them a new set of immune-related toxicities and complications . Currently, our knowledge of irAEs has been largely informed by clinical trials enrolling younger and fitter pts. In this study, we report the experience of our large community practice, where many elderly pts of diverse backgrounds received PDIs. Methods: We conducted a retrospective cohort study, including pts who were ≥65 years old (yo) and had received PDIs between FDA approval in 2014 and September 2016, with follow-up through December 2016. Through data-mining of our electronic medical record, we evaluated the incidence of irAE and Tx outcomes, stratified by age, ethnicity, gender, co-morbidity index, and tumor subtype. Results: There were 776 pts included in the analysis. 58% were male and 29% were non-Caucasian. 83% were ages 65 to 79 yo and 17% were ≥80 yo (range 80-94 yo). 28 % of pts had a CCI > 5. Over 55% received PDIs for non-small cell lung cancer (NSCLC), followed by 12% for melanoma. 65-79 yo pts experienced similar incidence of irAE compared to pts ≥80 yo (14% vs 18%, p = 0.26). Notably, incidence was similar for gastrointestinal, pulmonary, and endocrine toxicity, though pts ≥80 yo experienced higher incidence of dermatologic toxicity (p = 0.01). Pts 65-79 yo received PDIs for median 3.3 months (mos), while pts ≥80 yo were on Tx for median 2.8 mos.The rate of irAE that resulted in health care utilization were noted in 15% of pts. Time to onset of irAE was similar between the 2 age groups (p = 0.40). Unadjusted hazard ratio (HR) for survival at the end of study was similar for pts 65-79 yo and ≥80 yo who had melanoma (HR = 0.99, p = 0.97) or NSCLC (HR = 1.32, p = 0.12). Conclusions: This is the first report of Tx outcomes with PDI use in elderly pts in a real-world setting. We found irAE rates and Tx outcomes to be similar for pts age 65-79 yo and those ≥ 80 yo. With rising cancer incidence among an ageing population, it is important for the oncology community to understand how CI therapy affects older pt groups to improve their cancer outcomes.

Computational and Performance Aspects of PCA-Based Face-Recognition Algorithms

Algorithms based on principal component analysis (PCA) form the basis of numerous studies in the psychological and algorithmic face-recognition literature. PCA is a statistical technique and its incorporation into a face-recognition algorithm requires numerous design decisions. We explicitly state the design decisions by introducing a generic modular PCA-algorithm. This allows us to investigate these decisions, including those not documented in the literature. We experimented with different implementations of each module, and evaluated the different implementations using the September 1996 FERET evaluation protocol (the de facto standard for evaluating face-recognition algorithms). We experimented with (i) changing the illumination normalization procedure; (ii) studying effects on algorithm performance of compressing images with JPEG and wavelet compression algorithms; (iii) varying the number of eigenvectors in the representation; and (iv) changing the similarity measure in the classification process. We performed two experiments. In the first experiment, we obtained performance results on the standard September 1996 FERET large-gallery image sets. In the second experiment, we examined the variability in algorithm performance on different sets of facial images. The study was performed on 100 randomly generated image sets (galleries) of the same size. Our two most significant results are (i) changing the similarity measure produced the greatest change in performance, and (ii) that difference in performance of ±10% is needed to distinguish between algorithms.

Predictive models of cytotoxicity as mediated by exposure to chemicals or drugs

Predicting cytotoxicity is a challenging task because of the complex biological mechanisms behind it. Cytotoxicity due to toxin - biologically produced poison - is known to play a substantial role in a disease process. Two objectives in this research are to derive robust general predictive cytotoxicity models to minimize unnecessary toxicity. The first objective is to build accurate predictive statistical models for cytotoxicity data based on lymphoblastoid cell lines obtained from in vitro studies. This could be an important step for accomplishing a goal in biomedecial/biophamarceutical research, by obtaining the best medical outcomes by minimizing toxicity in regard to a person's genetic profile. The second objective is to build predictive models to predict population-level cytotoxicity for unknown compounds based on chemical structural features. These two objectives were accomplished by a proposed variable selection process, the random forests, and the least absolute shrinkage and selection operator method. We achieved an excellent prediction result with the random forests algorithm using SNP markers from the proposed approach, having the smallest root mean squared error among the teams which participated in the DREAM Toxicogenetics Challenge. Since chemical compounds for drugs have great influence on human health, the predictive statistical models for these objectives could be helpful to government agencies in relevant decision-making.

Morphological characteristics and clinical manifestations of orbital emphysema caused by isolated medial orbital wall fractures

PURPOSE

To investigate the morphological characteristics and clinical manifestations of orbital emphysema in patients with isolated medial orbital wall fractures.

METHODS

This was a retrospective observational case series of 348 orbits of 348 patients with isolated medial orbital wall fractures. Medical charts were reviewed, and computed tomographic (CT) images were examined to determine the morphological characteristics of orbital emphysema.

RESULTS

Orbital emphysema was detected in 70 orbits (20.1%). Large and communited type fracture was related with the presence of orbital emphysema (P<0.05). Orbital air pockets were detected in medial or superior extraconal orbital segment in all cases with orbital emphysema. Swollen eyelid with crepitus (90.0%) and supraduction limitation (31.4%) were developed with orbital emphysema. All cases with supraduction limitation accompanied with superior extraconal orbital emphysema and superior rectus muscle deviation, and these eyes were fully recovered with conservative management without surgery.

CONCLUSIONS

Orbital emphysema can be a cause of ocular motility restriction following orbital wall fracture. If supraduction limitation is noted with isolated medial wall fracture and superior orbital emphysema with superior rectus muscle deviation is detected by CT scan, conservative management can be a good choice for spontaneous recovery delaying the surgery.

Bactericidal effects of triclosan in soap both in vitro and in vivo

OBJECTIVES

On December 2013, the US FDA proposed a rule stating that manufacturers must provide data to demonstrate that antibacterial soap is more effective than plain soap or water. The objective of the present study was to examine the in vitro and in vivo bactericidal effect of triclosan (the most widely used antiseptic agent in soap) in soap.

METHODS

Twenty bacterial strains (proposed by the FDA) were exposed to plain and antibacterial soaps (the same formulation as plain soap, but containing 0.3% triclosan) for 20 s at 22°C (room temperature) and 40°C (warm temperature). The temperature and time were selected to simulate the hand washing conditions and procedures used by consumers. The triclosan concentration of 0.3% is the maximum allowed by law. The decontamination efficacy of plain soap and antibacterial soap was also examined in vivo: the hands of volunteers were artificially inoculated with Serratia marcescens.

RESULTS

There was no significant difference (P > 0.05) in bactericidal activity between plain soap and antibacterial soap at either test temperature. However, antibacterial soap showed significantly greater bactericidal effects after 9 h. These results suggest that although triclosan-containing soap does have antibacterial activity, the effects are not apparent during the short time required for hand washing.

CONCLUSIONS

Antibacterial soap containing triclosan (0.3%) was no more effective than plain soap at reducing bacterial contamination when used under 'real-life' conditions. The present study provides practical information that may prove useful for both industry and governments.

A pharmacist based intervention to improve the care of patients with CKD: a pragmatic, randomized, controlled trial

BACKGROUND

Primary care providers do not routinely follow guidelines for the care of patients with chronic kidney disease (CKD). Multidisciplinary efforts may improve care for patients with chronic disease. Pharmacist based interventions have effectively improved management of hypertension. We performed a pragmatic, randomized, controlled trial to evaluate the effect of a pharmacist based quality improvement program on 1) outcomes for patients with CKD and 2) adherence to CKD guidelines in the primary care setting.

METHODS

Patients with moderate to severe CKD receiving primary care services at one of thirteen community-based Veterans Affairs outpatient clinics were randomized to a multifactorial intervention that included a phone-based pharmacist intervention, pharmacist-physician collaboration, patient education, and a CKD registry (n = 1070) or usual care (n = 1129). The primary process outcome was measurement of parathyroid hormone (PTH) during the one year study period. The primary clinical outcome was blood pressure (BP) control in subjects with poorly controlled hypertension at baseline.

RESULTS

Among those with poorly controlled baseline BP, there was no difference in the last recorded BP or the percent at goal BP during the study period (42.0% vs. 41.2% in the control arm). Subjects in the intervention arm were more likely to have a PTH measured during the study period (46.9% vs. 16.1% in the control arm, P <0.001) and were on more classes of antihypertensive medications at the end of the study (P = 0.02).

CONCLUSIONS

A one-time pharmacist based intervention proved feasible in patients with CKD. While the intervention did not improve BP control, it did improve guideline adherence and increased the number of antihypertensive medications prescribed to subjects with poorly controlled BP. These findings can inform the design of quality improvement programs and future studies which are needed to improve care of patients with CKD.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01290614.

PTRF/cavin-1 neutralizes non-caveolar caveolin-1 microdomains in prostate cancer

Caveolin-1 has a complex role in prostate cancer and has been suggested to be a potential biomarker and therapeutic target. As mature caveolin-1 resides in caveolae, invaginated lipid raft domains at the plasma membrane, caveolae have been suggested as a tumor-promoting signaling platform in prostate cancer. However, caveola formation requires both caveolin-1 and cavin-1 (also known as PTRF; polymerase I and transcript release factor). Here, we examined the expression of cavin-1 in prostate epithelia and stroma using tissue microarray including normal, non-malignant and malignant prostate tissues. We found that caveolin-1 was induced without the presence of cavin-1 in advanced prostate carcinoma, an expression pattern mirrored in the PC-3 cell line. In contrast, normal prostate epithelia expressed neither caveolin-1 nor cavin-1, while prostate stroma highly expressed both caveolin-1 and cavin-1. Utilizing PC-3 cells as a suitable model for caveolin-1-positive advanced prostate cancer, we found that cavin-1 expression in PC-3 cells inhibits anchorage-independent growth, and reduces in vivo tumor growth and metastasis in an orthotopic prostate cancer xenograft mouse model. The expression of α-smooth muscle actin in stroma along with interleukin-6 (IL-6) in cancer cells was also decreased in tumors of mice bearing PC-3-cavin-1 tumor cells. To determine whether cavin-1 acts by neutralizing caveolin-1, we expressed cavin-1 in caveolin-1-negative prostate cancer LNCaP and 22Rv1 cells. Caveolin-1 but not cavin-1 expression increased anchorage-independent growth in LNCaP and 22Rv1 cells. Cavin-1 co-expression reversed caveolin-1 effects in caveolin-1-positive LNCaP cells. Taken together, these results suggest that caveolin-1 in advanced prostate cancer is present outside of caveolae, because of the lack of cavin-1 expression. Cavin-1 expression attenuates the effects of non-caveolar caveolin-1 microdomains partly via reduced IL-6 microenvironmental function. With circulating caveolin-1 as a potential biomarker for advanced prostate cancer, identification of the molecular pathways affected by cavin-1 could provide novel therapeutic targets.