Inter-observer variability in chemotherapy trials for pancreatic cancer

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Background: No studies have examined differences in imaging assessment of drug response for unresectable pancreatic cancer between investigators and independent central review panels. This study reports such discrepancies. Methods: 133 patients in two multi-center, randomized Phase II drug trials had their response assessed by measurement of tumor size or new lesions on serial CT scans. Protocols specified techniques for tumor measurement and defined responses as complete (CR) or partial responses (PR), stable (SD) or progressive disease (PD). Objective responses were confirmed by repeat imaging evaluations after an interval > 4 weeks. Cases of PR or SD withdrawn from the study <8 weeks after enrollment were scored as non-evaluable (NE). The same images were then blindly reviewed by protocol trained radiologists at an Independent Core Lab. Cases of discordance in the interpretation of best response between investigators and reviewers were then blindly re-reviewed by an independent adjudicator. Results: In 50/133 cases (38%), there was sufficient discrepancy between investigators and reviewers to result in a change in overall response. In 10 cases (8%), investigators reported responses inconsistent with protocol standards for their tumor measurements. In 40 cases (30%), reviewers disagreed with the radiological findings of the investigators. In 47 of the 50 cases, the films were available for a second review by the adjudicator who confirmed the reviewers’ assessment of response in 39/47 (83%) of cases. Discrepancies in assessment of response were not randomly distributed. Investigators reported significantly more confirmed objective responses (CR + PR) than reviewers even after investigators’ response coding errors were corrected. As shown in Table 1 , investigators reported favorable responses in 21/133 (16%) cases compared with 6/133 (5%) responses noted by reviewers (p=0.01). Conclusions: The results support the use of independent review of trial data when the endpoint of the trial (response rate) is based on imaging data.

[Table: see text]

Search for electron neutrino appearance at the Delta m2 approximately 1 eV2 scale

The MiniBooNE Collaboration reports first results of a search for nu e appearance in a nu mu beam. With two largely independent analyses, we observe no significant excess of events above the background for reconstructed neutrino energies above 475 MeV. The data are consistent with no oscillations within a two-neutrino appearance-only oscillation model.

Observation of muon neutrino disappearance with the MINOS detectors in the NuMI neutrino beam

This Letter reports results from the MINOS experiment based on its initial exposure to neutrinos from the Fermilab NuMI beam. The rates and energy spectra of charged current nu(mu) interactions are compared in two detectors located along the beam axis at distances of 1 and 735 km. With 1.27 x 10(20) 120 GeV protons incident on the NuMI target, 215 events with energies below 30 GeV are observed at the Far Detector, compared to an expectation of 336+/-14 events. The data are consistent with nu(mu) disappearance via oscillations with |Delta(m)2/32|=2.74 +0.44/-0.26 x10(-3)eV(2) and sin(2)(2theta(23))>0.87 (68% C.L.).

The Use of Negative-Pressure Therapy and Skin Grafting in the Treatment of Soft-Tissue Defects Over the Achilles Tendon

Management of soft-tissue defects over the Achilles tendon presents specific challenges to the plastic surgeon. Primary closure or local flaps are often not feasible repair options for such wounds, and many of these patients may be poor candidates for free-tissue transfer secondary to their comorbidity. In this case series, the use of negative-pressure therapy in the preoperative period to prepare the wound bed for placement of a split-thickness skin graft and in the immediate postoperative period as a dressing for the graft was successfully used in 3 patients with soft-tissue defects over the Achilles tendon with exposed tendon. All 3 patients had stable wounds at 48 to 80 months postoperatively. Negative-pressure therapy and skin grafting was found to be a reliable method of repair that provided stable coverage for such wounds.

The effect of hurricane Ivan on emergency department operations at the University Hospital of the West Indies

The objective of this study was to determine the impact of Hurricane Ivan on the operations of the Emergency Department (ED) at the University Hospital of the West Indies (UHWI). Hurricane Ivan,--a category four Hurricane--traversed the south coast of the island of Jamaica on September 10, 2004, causing damage to several parishes. The study design is a descriptive retrospective record-based incidence study of all admissions to the ED commencing at 8:00 am September 10, 2004 and ending at 12 midnight September 11, 2004, covering the period of the entire duration of the hurricane as well as immediately after. Injuries that took place during the hurricane, inclusive of gun-shot wounds (GSWs) represented 40% of the total patients seen. The types of admission are listed categorically as well as specific items to be considered in planning for potential disasters of higher magnitude. Overall, the coping mechanism of the ED at UHWI was adequate for this magnitude of disaster.

Resistance to Ascochyta rabiei (Pass.) Lab. in a wild Cicer germplasm collection

Cultivated chickpea germplasm collections contain a low frequency of ascochyta blight resistant accessions. This might lead to limitations on the future progress of chickpea breeding worldwide. In an effort to identify novel sources of resistance to ascochyta blight, 56 unique accessions, comprising 8 annual wild Cicer species, were evaluated under a controlled environment that was optimal for infection with an aggressive Australian isolate of Ascochyta rabiei (Pass.) Labrousse. The majority of wild Cicer accessions were either susceptible or highly susceptible to A. rabiei 21 days after inoculation; however, 11 accessions, of which 7 were Cicer judaicum, were resistant. The most resistant accession detected in this study, ATC 46934, together with accessions ATC 46892 and ATC 46935, which were resistant in this and another study, should be targeted for use in future interspecific resistance breeding programs.

Construction of a linkage map based on a Lathyrus sativus backcross population and preliminary investigation of QTLs associated with resistance to ascochyta blight

A linkage map of the Lathyrus sativus genome was constructed using 92 backcross individuals derived from a cross between an accession resistant (ATC 80878) to ascochyta blight caused by Mycosphaerella pinodes and a susceptible accession (ATC 80407). A total of 64 markers were mapped on the backcross population, including 47 RAPD, seven sequence-tagged microsatellite site and 13 STS/CAPS markers. The map comprised nine linkage groups, covered a map distance of 803.1 cM, and the average spacing between markers was 15.8 cM. Quantitative trait loci (QTL) associated with ascochyta blight resistance were detected using single-point analysis and simple and composite interval mapping. The backcross population was evaluated for stem resistance in temperature-controlled growth room trials. One significant QTL, QTL1, was located on linkage group 1 and explained 12% of the phenotypic variation in the backcross population. A second suggestive QTL, QTL2, was detected on linkage group 2 and accounted for 9% of the trait variation. The L. sativus R-QTL regions detected may be targeted for future intergenus transfer of the trait into accessions of the closely related species Pisum sativum.

A determination of the Cabibbo-Kobayashi-Maskawa parameter |V us| using KL decays

We present a determination of the Cabibbo-Kobayashi-Maskawa parameter |V(us)| based on new measurements of the six largest K(L) branching fractions and semileptonic form factors by the KTeV (E832) experiment at Fermilab. We find |V(us)|=0.2252+/-0.0008(KTeV)+/-0.0021(ext), where the errors are from KTeV measurements and from external sources. We also use the measured branching fractions to determine the CP violation parameter |eta(+-)|=(2.228+/-0.005(KTeV)+/-0.009(ext))x10(-3).

Search for the rare decay K(L)-->pi(0)e(+)e(-)

The KTeV/E799 experiment at Fermilab has searched for the rare kaon decay K(L)-->pi(0)e(+)e(-). This mode is expected to have a significant CP violating component. The measurement of its branching ratio could support the standard model or could indicate the existence of new physics. This Letter reports new results from the 1999-2000 data set. One event is observed with an expected background at 0.99+/-0.35 events. We set a limit on the branching ratio of 3.5x10(-10) at the 90% confidence level. Combining with the previous result based on the data set taken in 1997 yields the final KTeV result: BR(K(L)-->pi(0)e(+)e(-))<2.8x10(-10) at 90% C.L.

Genetics of resistance to Mycosphaerella pinodes in Lathyrus sativus

Three Lathyrus sativus accessions were screened for their reaction to Mycosphaerella pinodes infection. Accession ATC 80878 displayed the lowest percentage stem lesion values (%SL) and was significantly more resistant to M. pinodes than ATC 80407 and ATC 80053. Accession ATC 80407 was the most susceptible, displaying the severest disease symptoms. A backcross and an F2 population were generated using accessions ATC 80878 and ATC 80407 as the resistant and susceptible parents, respectively. The backcross and F2 progeny segregated in a 3 : 1 and 7 : 9 ratio, respectively, for resistance/susceptibility, using the 99% confidence intervals for the means of the parental controls in each assay to determine the point of discontinuity. The segregation data from both populations fitted a Mendelian segregation model that suggested that resistance in the L. sativus accession ATC 80878 may be controlled by 2 independently segregating genes, operating in a complementary epistatic manner.

QTL analysis for ascochyta blight resistance in an intraspecific population of chickpea (Cicer arietinum L.)

In both controlled environment and the field, six QTLs for ascochyta blight resistance were identified in three regions of the genome of an intraspecific population of chickpea using the IDS and AUDPC disease scoring systems. One QTL-region was detected from both environments, whereas the other two regions were detected from each environment. All the QTL-regions were significantly associated with ascochyta blight resistance using either of the disease scoring systems. The QTLs were verified by multiple interval mapping, and a two-QTL genetic model with considerable epistasis was established for both environments. The major QTLs generally showed additive gene action, as well as dominance inter-locus interaction in the multiple genetic model. All the QTLs were mapped near a RGA marker. The major QTLs were located on LG III, which was mapped with five different types of RGA markers. A CLRR-RGA marker and a STMS marker flanked QTL 6 for controlled environment resistance at 0.06 and 0.04 cM, respectively. Other STMS markers flanked QTL 1 for field resistance at a 5.6 cM interval. After validation, these flanking markers may be used in marker-assisted selection to breed for elite chickpea cultivars with durable resistance to ascochyta blight. The tight linkage of RGA markers to the major QTL on LG III will allow map-based cloning of the underlying resistance genes.

Construction of an intraspecific linkage map of lentil ( Lens culinaris ssp. culinaris)

The first intraspecific linkage map of the lentil genome was constructed with 114 molecular markers (100 RAPD, 11 ISSR and three RGA) using an F(2) population developed from a cross between lentil cultivars ILL5588 and ILL7537 which differed in resistance for ascochyta blight. Linkage analysis at a LOD score of 4.0 and a maximum recombination fraction of 0.25 revealed nine linkage groups comprising between 6 and 18 markers each. The intraspecific map spanned a total length of 784.1 cM. The markers were distributed throughout the genome, however markers were clustered in the middle or near the middle of the linkage groups, suggesting the location of centromeres. Of 114 mapped markers, 16 (14.0%) were distorted, usually at the end or middle of the linkage groups. The utility of ISSR and RGA markers for mapping in lentil was explored, and the primer with an (AC) repeat motif was found to be useful.

Mapping the mating type locus of Ascochyta rabiei, the causal agent of ascochyta blight of chickpea

SUMMARY A genome linkage map was developed for Ascochyta rabiei (Pass.) Labrousse, (teleomorph) Didymella rabiei (Kovachevski), an important pathogen causing ascochyta blight in chickpea (Cicer arietinum L.). The map was constructed using 96 progeny generated from a single pseudothecium produced from a cross between a USA MAT-2 isolate and an Australian MAT-1 isolate. The map comprised 126 molecular markers of which 69 were random amplified polymorphic DNA (RAPD) markers, 46 were amplified fragment length polymorphic (AFLP) markers, 10 were sequence-tagged microsatellite site (STMS) markers, and one was a sequence characterized amplified region (SCAR) marker. Eighteen large and 10 small linkage groups (LG) were characterized and the mating-type locus was mapped on to LGd. The map spanned 1271 cM with an average spacing between markers of 15.1 cM. The SCAR marker, specific for mating type 2, was designed to amplify a region of the MAT locus and was used to identify the mating type of A. rabiei isolates. One AFLP marker, derived from the MAT-1 parent, was closely linked to the mating-type locus (9.6 cM). The linkage map provides a framework for the future identification of the locations of other important traits such as virulence/avirulence and fungicide resistance. Findings from this study suggest that the MAT-2 isolates of D. rabiei should be renamed to MAT-1 isolates because the alpha-box, specific for MAT-1 from other ascomycetes, was amplified from A. rabiei MAT-2 isolates.

An intraspecific linkage map of the chickpea ( Cicer arietinum L.) genome based on sequence tagged microsatellite site and resistance gene analog markers

An intraspecific linkage map of the chickpea genome based on STMS as anchor markers, was established using an F(2) population of chickpea cultivars with contrasting disease reactions to Ascochyta rabiei (Pass.) Lab. At a LOD-score of 2.0 and a maximum recombination distance of 20 cM, 51 out of 54 chickpea-STMS markers (94.4%), three ISSR markers (100%) and 12 RGA markers (57.1%) were mapped into eight linkage groups. The chickpea-derived STMS markers were distributed throughout the genome, while the RGA markers clustered with the ISSR markers on linkage groups LG I, II and III. The intraspecific linkage map spanned 534.5 cM with an average interval of 8.1 cM between markers. Sixteen markers (19.5%) were unlinked, while l1 chickpea-STMS markers (20.4%) deviated significantly ( P < 0.05) from the expected Mendelian segregation ratio and segregated in favor of the maternal alleles. However, ten of the distorted chickpea-STMS markers were mapped and clustered mostly on LG VII, suggesting the association of these loci in the preferential transmission of the maternal germ line. Preliminary comparative mapping revealed that chickpea may have evolved from Cicer reticulatum, possibly via inversion of DNA sequences and minor chromosomal translocation. At least three linkage groups that spanned a total of approximately 79.2 cM were conserved in the speciation process.

Measurements of the Decay KL-->e+ e- mu+ mu-

The KTeV experiment at Fermilab has isolated a total of 132 events from the rare decay K(L)-->e+ e- mu+ mu-, with an estimated background of 0.8 events. The branching ratio of this mode is determined to be [2.69+/-0.24(stat)+/-0.12(syst)]x10(-9), with a radiative cutoff of M(2)(ee mu mu)/M(2)(K)>0.95. The first measurement using this mode of the parameter alpha from the D'Ambrosio-Isidori-Portolès (DIP) model of the K(L)gamma*gamma* vertex yields a result of -1.59+/-0.37, consistent with values obtained from other decay modes. Because of the limited statistics, no sensitivity is found to the DIP parameter beta. We use this decay mode to set limits on CP and lepton violation.

Search for the KL-->pi 0 pi 0 e+e- decay in the KTeV experiment

The recent discovery of a large CP violating asymmetry in KL-->pi+pi-e+e- mode has prompted us to seach for the associated KL-->pi 0 pi 0 e+e- decay mode in the KTeV-E799 experiment at Fermilab. In 2.7 x 10(11) K(L) decays, one candidate event has been observed with an expected background of 0.3 event, resulting in an upper limit for the KL-->pi 0 pi 0 e+e- branching ratio of 6.6 x 10(-9) at the 90% C.L.

Radiative decay width measurements of neutral kaon excitations using the primakoff effect

We use K(L)'s in the 100-200 GeV energy range to produce 147 candidate events of the axial vector pair K1(1270)-K1(1400) in the nuclear Coulomb field of a Pb target and determine the radiative widths Gamma(K1(1400)-->K0+gamma)=280.8+/-23.2(stat)+/-40.4(syst) keV and Gamma(K1(1270)-->K0+gamma)=73.2+/-6.1(stat)+/-28.3(syst) keV. These first measurements appear to be lower than the quark-model predictions. We also place upper limits on the radiative widths for K(*)(1410) and K(*)(2)(1430) and find that the latter is vanishingly small in accord with SU(3) invariance in the naive quark model.

Measurement of the K(L) charge asymmetry

We present a measurement of the charge asymmetry delta(L) in the mode K(L)-->pi(+/-)e(-/+)nu based on 298 x 10(6) analyzed decays. We measure a value of delta(L) = [3322+/-58(stat)+/-47(syst)]x10(-6), in good agreement with previous measurements and 2.4 times more precise than the current best published result. The result is used to place more stringent limits on CPT and DeltaS = DeltaQ violation in the neutral kaon system.

Long-term facilitation in obstructive sleep apnea patients during NREM sleep

Repetitive hypoxia followed by persistently increased ventilatory motor output is referred to as long-term facilitation (LTF). LTF is activated during sleep after repetitive hypoxia in snorers. We hypothesized that LTF is activated in obstructive sleep apnea (OSA) patients. Eleven subjects with OSA (apnea/hypopnea index = 43.6 +/- 18.7/h) were included. Every subject had a baseline polysomnographic study on the appropriate continuous positive airway pressure (CPAP). CPAP was retitrated to eliminate apnea/hypopnea but to maintain inspiratory flow limitation (sham night). Each subject was studied on 2 separate nights. These two studies are separated by 1 mo of optimal nasal CPAP treatment for a minimum of 4-6 h/night. The device was capable of covert pressure monitoring. During night 1 (N1), study subjects used nasal CPAP at suboptimal pressure to have significant air flow limitation (>60% breaths) without apneas/hypopneas. After stable sleep was reached, we induced brief isocapnic hypoxia [inspired O(2) fraction (FI(O(2))) = 8%] (3 min) followed by 5 min of room air. This sequence was repeated 10 times. Measurements were obtained during control, hypoxia, and at 5, 20, and 40 min of recovery for ventilation, timing (n = 11), and supraglottic pressure (n = 6). Upper airway resistance (Rua) was calculated at peak inspiratory flow. During the recovery period, there was no change in minute ventilation (99 +/- 8% of control), despite decreased Rua to 58 +/- 24% of control (P < 0.05). There was a reduction in the ratio of inspiratory time to total time for a breath (duty cycle) (0.5 to 0.45, P < 0.05) but no effect on inspiratory time. During night 2 (N2), the protocol of N1 was repeated. N2 revealed no changes compared with N1 during the recovery period. In conclusion, 1) reduced Rua in the recovery period indicates LTF of upper airway dilators; 2) lack of hyperpnea in the recovery period suggests that thoracic pump muscles do not demonstrate LTF; 3) we speculate that LTF may temporarily stabilize respiration in OSA patients after repeated apneas/hypopneas; and 4) nasal CPAP did not alter the ability of OSA patients to elicit LTF at the thoracic pump muscle.

Mental health. Obstacle course

Focus groups of mental health practitioners, service users and carers, designed to test the competence of staff to deliver modern services, revealed wide discrepancies in perceptions. Staff saw the persistence of the medical model, and the risk-averse culture of trusts, as obstacles to delivering effective care. Users and carers felt generally uninvolved in care planning.

First measurement of form factors of the decay Xi(0) --> Sigma(+)e(-)nu macro(e)

We present the first measurement of the form factor ratios g(1)/f(1) (direct axial vector to vector), g(2)/f(1) (second class current), and f(2)/f(1) (weak magnetism) for the decay Xi(0)-->Sigma(+)e(-)nu macro(e) using the KTeV (E799) beam line and detector at Fermilab. From the Sigma(+) polarization measured with the decay Sigma(+)-->p pi(0) and the e(-)-nu; correlation, we measure g(1)/f(1) to be 1.32+/-(0.21)(0.17)(stat)+/-0.05(syst), assuming the SU(3)(f) (flavor) values for g(2)/f(1) and f(2)/f(1). Our results are all consistent with exact SU(3)(f) symmetry.

Branching ratio measurement of the decay K(L) --> e(+)e(-)mu(+)mu(-)

We have collected a 43 event sample of the decay K(L)-->e(+)e(-)mu(+)mu(-) with negligible backgrounds and measured its branching ratio to be (2.62+/-0.40+/-0.17)x10(-9). We see no evidence for CP violation in this decay. In addition, we set the 90% confidence upper limit on the combined branching ratios for the lepton flavor violating decays K(L)-->e(+/-)e(+/-)mu(-/+)mu(-/+) at B(K(L)-->e(+/-)e(+/-)mu(-/+)mu(-/+))< or =1.23x10(-10), assuming a uniform phase space distribution.