text:
A core outcome set for clinical trials on non-specific low back pain: Study protocol for the development of a core domain set
Alessandro Chiarotto, Caroline B. Terwee, Richard A. Deyo, Maarten Boers, Chung Wei Christine Lin, Rachelle Buchbinder, Terry P. Corbin, Leonardo O.P. Costa, Nadine E. Foster, Margreth Grotle, Bart W. Koes, Francisco M. Kovacs, Chris G. Maher, Adam M. Pearson, Wilco C. Peul, Mark L. Schoene, Dennis C. Turk, Maurits W. van Tulder, Raymond W. Ostelo
Background: Low back pain (LBP) is one of the most disabling and costly disorders affecting modern society, and approximately 90% of patients are labelled as having non-specific LBP (NSLBP). Several interventions for patients with NSLBP have been assessed in clinical trials, but heterogeneous reporting of outcomes in these trials has hindered comparison of results and performance of meta-analyses. Moreover, there is a risk of selective outcome reporting bias. To address these issues, the development of a core outcome set (COS) that should be measured in all clinical trials for a specific health condition has been recommended. A standardized set of outcomes for LBP was proposed in 1998, however, with evolution in COS development methodology, new instruments, interventions, and understanding of measurement properties, it is appropriate to update that proposal. This protocol describes the methods used in the initial step in developing a COS for NSLBP, namely, establishing a core domain set that should be measured in all clinical trials. Methods/Design: An International Steering Committee including researchers, clinicians, and patient representatives from four continents was formed to guide the development of this COS. The approach of initiatives like Core Outcome Measures in Effectiveness Trials (COMET) and Outcome Measures in Rheumatology (OMERACT) was followed. Participants were invited to participate in a Delphi study aimed at generating a consensus-based core domain set for NSLBP. A list of potential core domains was drafted and presented to the Delphi participants who were asked to judge which domains were core. Participant suggestions about overlap, aggregation, or addition of potential core domains were addressed during the study. The patients' responses were isolated to assess whether there was substantial disagreement with the rest of the Delphi panel. A priori thresholds for consensus were established before each Delphi round. All participants' responses were analysed from a quantitative and qualitative perspective to ascertain that no substantial discrepancies between the two approaches emerged. Discussion: We present the initial step in developing a COS for NSLBP. The next step will be to determine which measurement instruments adequately cover the domains.
Core outcome set
Health interventions
Non-specific low back pain
Dive into the research topics of 'A core outcome set for clinical trials on non-specific low back pain: Study protocol for the development of a core domain set'. Together they form a unique fingerprint.
Low Back Pain Medicine & Life Sciences 100%
Delphi Technique Medicine & Life Sciences 45%
Health Care Outcome Assessment Medicine & Life Sciences 43%
Patient Advocacy Medicine & Life Sciences 43%
Rheumatology Medicine & Life Sciences 36%
Research Personnel Medicine & Life Sciences 23%
Chiarotto, A., Terwee, C. B., Deyo, R. A., Boers, M., Lin, C. W. C., Buchbinder, R., Corbin, T. P., Costa, L. O. P., Foster, N. E., Grotle, M., Koes, B. W., Kovacs, F. M., Maher, C. G., Pearson, A. M., Peul, W. C., Schoene, M. L., Turk, D. C., van Tulder, M. W., & Ostelo, R. W. (2014). A core outcome set for clinical trials on non-specific low back pain: Study protocol for the development of a core domain set. Trials, 15(1), [511]. https://doi.org/10.1186/1745-6215-15-511
A core outcome set for clinical trials on non-specific low back pain : Study protocol for the development of a core domain set. / Chiarotto, Alessandro; Terwee, Caroline B.; Deyo, Richard A.; Boers, Maarten; Lin, Chung Wei Christine; Buchbinder, Rachelle; Corbin, Terry P.; Costa, Leonardo O.P.; Foster, Nadine E.; Grotle, Margreth; Koes, Bart W.; Kovacs, Francisco M.; Maher, Chris G.; Pearson, Adam M.; Peul, Wilco C.; Schoene, Mark L.; Turk, Dennis C.; van Tulder, Maurits W.; Ostelo, Raymond W.
In: Trials, Vol. 15, No. 1, 511, 26.12.2014.
Chiarotto, A, Terwee, CB, Deyo, RA, Boers, M, Lin, CWC, Buchbinder, R, Corbin, TP, Costa, LOP, Foster, NE, Grotle, M, Koes, BW, Kovacs, FM, Maher, CG, Pearson, AM, Peul, WC, Schoene, ML, Turk, DC, van Tulder, MW & Ostelo, RW 2014, 'A core outcome set for clinical trials on non-specific low back pain: Study protocol for the development of a core domain set', Trials, vol. 15, no. 1, 511. https://doi.org/10.1186/1745-6215-15-511
Chiarotto A, Terwee CB, Deyo RA, Boers M, Lin CWC, Buchbinder R et al. A core outcome set for clinical trials on non-specific low back pain: Study protocol for the development of a core domain set. Trials. 2014 Dec 26;15(1). 511. https://doi.org/10.1186/1745-6215-15-511
Chiarotto, Alessandro ; Terwee, Caroline B. ; Deyo, Richard A. ; Boers, Maarten ; Lin, Chung Wei Christine ; Buchbinder, Rachelle ; Corbin, Terry P. ; Costa, Leonardo O.P. ; Foster, Nadine E. ; Grotle, Margreth ; Koes, Bart W. ; Kovacs, Francisco M. ; Maher, Chris G. ; Pearson, Adam M. ; Peul, Wilco C. ; Schoene, Mark L. ; Turk, Dennis C. ; van Tulder, Maurits W. ; Ostelo, Raymond W. / A core outcome set for clinical trials on non-specific low back pain : Study protocol for the development of a core domain set. In: Trials. 2014 ; Vol. 15, No. 1.
@article{39cfd7e8d2744c5a9942cd175c7a79bb,
title = "A core outcome set for clinical trials on non-specific low back pain: Study protocol for the development of a core domain set",
abstract = "Background: Low back pain (LBP) is one of the most disabling and costly disorders affecting modern society, and approximately 90% of patients are labelled as having non-specific LBP (NSLBP). Several interventions for patients with NSLBP have been assessed in clinical trials, but heterogeneous reporting of outcomes in these trials has hindered comparison of results and performance of meta-analyses. Moreover, there is a risk of selective outcome reporting bias. To address these issues, the development of a core outcome set (COS) that should be measured in all clinical trials for a specific health condition has been recommended. A standardized set of outcomes for LBP was proposed in 1998, however, with evolution in COS development methodology, new instruments, interventions, and understanding of measurement properties, it is appropriate to update that proposal. This protocol describes the methods used in the initial step in developing a COS for NSLBP, namely, establishing a core domain set that should be measured in all clinical trials. Methods/Design: An International Steering Committee including researchers, clinicians, and patient representatives from four continents was formed to guide the development of this COS. The approach of initiatives like Core Outcome Measures in Effectiveness Trials (COMET) and Outcome Measures in Rheumatology (OMERACT) was followed. Participants were invited to participate in a Delphi study aimed at generating a consensus-based core domain set for NSLBP. A list of potential core domains was drafted and presented to the Delphi participants who were asked to judge which domains were core. Participant suggestions about overlap, aggregation, or addition of potential core domains were addressed during the study. The patients' responses were isolated to assess whether there was substantial disagreement with the rest of the Delphi panel. A priori thresholds for consensus were established before each Delphi round. All participants' responses were analysed from a quantitative and qualitative perspective to ascertain that no substantial discrepancies between the two approaches emerged. Discussion: We present the initial step in developing a COS for NSLBP. The next step will be to determine which measurement instruments adequately cover the domains.",
keywords = "Clinical trials, Core outcome set, Domains, Effectiveness, Efficacy, Health interventions, Non-specific low back pain",
author = "Alessandro Chiarotto and Terwee, {Caroline B.} and Deyo, {Richard A.} and Maarten Boers and Lin, {Chung Wei Christine} and Rachelle Buchbinder and Corbin, {Terry P.} and Costa, {Leonardo O.P.} and Foster, {Nadine E.} and Margreth Grotle and Koes, {Bart W.} and Kovacs, {Francisco M.} and Maher, {Chris G.} and Pearson, {Adam M.} and Peul, {Wilco C.} and Schoene, {Mark L.} and Turk, {Dennis C.} and {van Tulder}, {Maurits W.} and Ostelo, {Raymond W.}",
note = "Funding Information: This research project was funded by the Wetenschappelijk College Fysiotherapie (WCF) of the Royal Dutch Society for Physical Therapy (KNGF). The funding body did not have any role in trial design, collection, analysis, and interpretation of data, nor in writing the manuscript and deciding to submit this manuscript for publication. The views expressed here are those of the authors and do not necessarily reflect those of their funding bodies. Publisher Copyright: {\textcopyright} Chiarotto et al.",
doi = "10.1186/1745-6215-15-511",
journal = "Trials",
T1 - A core outcome set for clinical trials on non-specific low back pain
T2 - Study protocol for the development of a core domain set
AU - Chiarotto, Alessandro
AU - Terwee, Caroline B.
AU - Deyo, Richard A.
AU - Boers, Maarten
AU - Lin, Chung Wei Christine
AU - Buchbinder, Rachelle
AU - Corbin, Terry P.
AU - Costa, Leonardo O.P.
AU - Foster, Nadine E.
AU - Grotle, Margreth
AU - Koes, Bart W.
AU - Kovacs, Francisco M.
AU - Maher, Chris G.
AU - Pearson, Adam M.
AU - Peul, Wilco C.
AU - Schoene, Mark L.
AU - Turk, Dennis C.
AU - van Tulder, Maurits W.
AU - Ostelo, Raymond W.
N1 - Funding Information: This research project was funded by the Wetenschappelijk College Fysiotherapie (WCF) of the Royal Dutch Society for Physical Therapy (KNGF). The funding body did not have any role in trial design, collection, analysis, and interpretation of data, nor in writing the manuscript and deciding to submit this manuscript for publication. The views expressed here are those of the authors and do not necessarily reflect those of their funding bodies. Publisher Copyright: © Chiarotto et al.
N2 - Background: Low back pain (LBP) is one of the most disabling and costly disorders affecting modern society, and approximately 90% of patients are labelled as having non-specific LBP (NSLBP). Several interventions for patients with NSLBP have been assessed in clinical trials, but heterogeneous reporting of outcomes in these trials has hindered comparison of results and performance of meta-analyses. Moreover, there is a risk of selective outcome reporting bias. To address these issues, the development of a core outcome set (COS) that should be measured in all clinical trials for a specific health condition has been recommended. A standardized set of outcomes for LBP was proposed in 1998, however, with evolution in COS development methodology, new instruments, interventions, and understanding of measurement properties, it is appropriate to update that proposal. This protocol describes the methods used in the initial step in developing a COS for NSLBP, namely, establishing a core domain set that should be measured in all clinical trials. Methods/Design: An International Steering Committee including researchers, clinicians, and patient representatives from four continents was formed to guide the development of this COS. The approach of initiatives like Core Outcome Measures in Effectiveness Trials (COMET) and Outcome Measures in Rheumatology (OMERACT) was followed. Participants were invited to participate in a Delphi study aimed at generating a consensus-based core domain set for NSLBP. A list of potential core domains was drafted and presented to the Delphi participants who were asked to judge which domains were core. Participant suggestions about overlap, aggregation, or addition of potential core domains were addressed during the study. The patients' responses were isolated to assess whether there was substantial disagreement with the rest of the Delphi panel. A priori thresholds for consensus were established before each Delphi round. All participants' responses were analysed from a quantitative and qualitative perspective to ascertain that no substantial discrepancies between the two approaches emerged. Discussion: We present the initial step in developing a COS for NSLBP. The next step will be to determine which measurement instruments adequately cover the domains.
AB - Background: Low back pain (LBP) is one of the most disabling and costly disorders affecting modern society, and approximately 90% of patients are labelled as having non-specific LBP (NSLBP). Several interventions for patients with NSLBP have been assessed in clinical trials, but heterogeneous reporting of outcomes in these trials has hindered comparison of results and performance of meta-analyses. Moreover, there is a risk of selective outcome reporting bias. To address these issues, the development of a core outcome set (COS) that should be measured in all clinical trials for a specific health condition has been recommended. A standardized set of outcomes for LBP was proposed in 1998, however, with evolution in COS development methodology, new instruments, interventions, and understanding of measurement properties, it is appropriate to update that proposal. This protocol describes the methods used in the initial step in developing a COS for NSLBP, namely, establishing a core domain set that should be measured in all clinical trials. Methods/Design: An International Steering Committee including researchers, clinicians, and patient representatives from four continents was formed to guide the development of this COS. The approach of initiatives like Core Outcome Measures in Effectiveness Trials (COMET) and Outcome Measures in Rheumatology (OMERACT) was followed. Participants were invited to participate in a Delphi study aimed at generating a consensus-based core domain set for NSLBP. A list of potential core domains was drafted and presented to the Delphi participants who were asked to judge which domains were core. Participant suggestions about overlap, aggregation, or addition of potential core domains were addressed during the study. The patients' responses were isolated to assess whether there was substantial disagreement with the rest of the Delphi panel. A priori thresholds for consensus were established before each Delphi round. All participants' responses were analysed from a quantitative and qualitative perspective to ascertain that no substantial discrepancies between the two approaches emerged. Discussion: We present the initial step in developing a COS for NSLBP. The next step will be to determine which measurement instruments adequately cover the domains.
KW - Clinical trials
KW - Core outcome set
KW - Domains
KW - Effectiveness
KW - Health interventions
KW - Non-specific low back pain
U2 - 10.1186/1745-6215-15-511
DO - 10.1186/1745-6215-15-511
JO - Trials
JF - Trials


Comedian CJ Hunt thinks out loud.
A selection from my 2014 solo sketch show, Hunting Season. A 30 min version of the show played at Hell Yes Fest, New Orleans Fringe Festival, and The Moontower Comedy and Oddity fest.
A character I filmed way back before the 2008 election. Also a good example of my love for satire and psychopaths. The director, Jonathan Evans has gone on to make Airsex: The Movie and tons of stuff you must see.
A video from my #CharacterADay Project. Each August, I create and film one new character every day for a month. So far there are 65 characters in total. Yes, many of them are dumb. But all of them are fuel for more refined sketches.


text:
The barrel cortex is a region of the somatosensory cortex that is identifiable in some species of rodents and species of at least two other orders and contains the barrel field. The 'barrels' of the barrel field are regions within cortical layer IV that are visibly darker when stained to reveal the presence of cytochrome c oxidase and are separated from each other by lighter areas called septa. These dark-staining regions are a major target for somatosensory inputs from the thalamus, and each barrel corresponds to a region of the body. Due to this distinctive cellular structure, organisation, and functional significance, the barrel cortex is a useful tool to understand cortical processing and has played an important role in neuroscience. The majority of what is known about corticothalamic processing comes from studying the barrel cortex, and researchers have intensively studied the barrel cortex as a model of neocortical column.

The most distinctive aspect of the barrel field are the whisker barrels. These structures were first discovered by Woolsey and Van der Loos in 1970. Staining in the whisker barrels is more distinct than that in other areas of the somatosensory cortex. Recognizing that the array was similar to that of the vibrissae (whiskers) on the mystacial pad (region where whiskers grow from) of certain mammals, they hypothesized that the barrels were the "cortical correlates of the mystacial vibrissae" and that "one barrel represents one vibrissa". Whereas small non-whisker areas of barrel cortex correspond to large and sometimes overlapping areas of the body, each much larger whisker barrel corresponds to a single whisker. As a result, the whisker barrels are the focus of the majority of barrel cortex research, and 'barrel cortex' is often used to refer primarily to the whisker barrels. Consequently, much of this article focuses on rodent whisker barrel cortex.

Organisation of the barrel fields

The barrel field, like many regions of cortex, is organised into a topographic map. In the case of the barrel field, the map is somatotopic - based on the arrangement of body parts. Areas corresponding to the nose and mouth are more rostral and lateral in the map, the forelimb, hindlimb and trunk are more medial, with the forelimb rostral of the hindlimb, and the whisker barrel subfields - the posteromedial barrel subfield, which corresponds to the major facial whiskers (the mystacial vibrissae), and the anteriolateral barrel subfield, which corresponds to the smaller whiskers of the face - are caudal and lateral. Although the whiskers make up a relatively small portion of the animal, they dominate the somatotopic map.

Barrels of the major facial whiskers
The barrels that correspond to the major facial whiskers (mystacial vibrissae) are contained within the posteromedial barrel subfield (PMBSF). The barrels here are the largest and most elliptical in shape and have a striking topographical organization that is identical to that of the whiskers; they are organized into 5 rows of 4-7 large whiskers that run close to parallel with the bridge of the nose. The organisation of the mystacial vibrissae and corresponding barrels is so consistent that there is a naming convention to identify each whisker in rats and mice. Rows are designated A to E from top to bottom, and columns of whiskers within each row are numbered from back to front. The first four rows also have an additional whisker behind column 1, which is designated with a lower case letter or a Greek letter (α, β, γ, or δ). These four whiskers are also called straddlers.

Anatomy and connectivity of the barrels

The barrels of the barrel cortex were named because the densities of cells resembled barrels, that is, they are collected into cylindrical shapes that are narrowed at the top and bottom. The centre of the barrel is designated the hollow, and the spaces between the barrels are the septa (singular: septum)

Sensory information flows from whisker follicles to barrel cortex via the trigeminal nerve nuclei and the thalamus. Barrel like divisions can be seen in some, but not all parts of the trigeminal nuclei (where they are called barrelets) and the thalamus (where they are called barreloids). The trigeminal nerve carries afferent fibres from the follicles into the brainstem where they connect to neurons in four different trigeminal nerve nuclei: principal, interpolar, oral, and caudal. Projections from the trigeminal nuclei to the thalamus are split into pathways designated lemniscal, extralemniscal, and paralemniscal. In the lemniscal pathway, axons from the principal trigeminal nucleus cross over the midline and project to "barreloids" in the thalamus, specifically in the dorsomedial section of the ventroposterior medial nucleus (VPMdm). Neurons in VPMdm project mainly to barrels in layer 4 of primary somatosensory cortex (S1). In the extralemniscal pathway, neurons of the interpolar nucleus project to the ventrolateral section of the ventroposterior medial nucleus (VPMvl). Neurons in VPMvl project to septa between the barrels and to secondary somatosensory cortex (S2). The paralemniscal pathway runs from the interpolar trigeminal nucleus via posterior nucleus (POm) of the thalamus to S2 and to diffuse targets in barrel cortex especially layer 5. Each pathway also has secondary projections to other layers within barrel cortex and other regions of cortex, including motor cortex. These different pathways are thought to transmit different modalities of sensory information from the whisker.

Whisker barrel neurophysiology
The whisker barrel cortex contains different types of neurons that receive input from a range of sources that themselves receive and process an array of different types of information. As a result, neurons of the whisker barrel cortex respond to whisker-related input, but in a way that is specific to the neurons type and location. This can manifest in different ways. The simplest way is whether the cortical neuron responds only to the deflection of one whisker, or to the deflection of many whiskers. Neurons in layer 4 barrels tend to strongly or exclusively respond to one whisker, while neurons in other layers are less strongly tuned and can respond to multiple whiskers. Neurons that respond to the deflection of multiple whiskers typically have a primary whisker, to which they respond the most. The difference in response magnitude between deflection of the primary whisker and secondary whiskers can also vary between neurons. Stimulation of multiple whiskers may produce a response that is equal to the sum of the responses if each whisker was stimulated independently, or it may be different. Some neurons show greater responses when multiple neurons are stimulated in sequence, and the sequence may be direction specific.

As well as combinations of which whiskers have been stimulated, neurons may also respond to specific types of whisker stimulation. The simplest response, seen in neurons within the layer IV barrel cortex, directly code for whisker displacement. That is to say, that the neuron within a given barrel will fire when the whisker that barrel represents is moved at a rate that is roughly proportional to the angular displacement of the neuron. These neurons also show directional sensitivity; certain neurons will only fire when the whisker is moved in a specific direction. Deflection-based firing neurons can sustain their response throughout the deflection of the whisker. Other neurons respond to the initial deflection, but then quickly return to their previous level of activity. Much of this activity is also modulated by the behaviour of the animal - rats and mice actively move their whiskers to explore their environment, and the response of a neuron to a particular stimulus can vary depending on what the animal is doing.

Experience-dependent plasticity

Because the barrel cortex has a well-organised structure that relates clearly to the whisker pad, it has been used extensively as a tool to study sensory processing and development, and the phenomenon of experience-dependent plasticity - changes in the activity, connectivity, and structure of neural circuits in response to experience. Neurons in the barrel cortex exhibit the property of synaptic plasticity that allows them to alter the vibrissae to which they respond depending on the rodent's history of tactile experience. Experience-dependent plasticity is commonly studied in the barrel cortex by partially depriving it of sensory input, either by lesioning elements of the afferent pathway (e.g. the trigeminal nerve) or by ablating, plucking, or trimming some of the facial whiskers. The anatomical structure of the barrels is only affected by lesioning elements of the pathway, but innocuous forms of deprivation can induce rapid changes in the cortical map into adulthood, without any corresponding changes in the barrel structures. Because of their different effects, it seems these two paradigms work by different mechanisms.

Some forms of plasticity in the barrel cortex display a critical period. Plucking whiskers in neonatal rats causes a long-lasting expansion of the representation of the spared whisker in layer 4. However, layer 4 plasticity rapidly diminishes if sensory deprivation begins after day 4 of life (P4) whereas representations in layer 2/3 remain highly plastic into adulthood.

Two cortical processes run alongside each other when barrel cortex is deprived of sensory input from some whiskers to produce representational plasticity. In deprived cortex, neuronal responses to spared whiskers are enhanced and responses to deprived whiskers are weakened. These two processes have different time courses, with the weakening of deprived response preceding the strengthening of spared response, implying that they have different underlying mechanisms. These two effects combine to produce an expansion of the cortical representation of spared whiskers into the representation of adjacent deprived whiskers.

It is likely that several different mechanisms are involved in producing experience-dependent
plasticity in a whisker deprivation protocol (adapted from Feldman and Brecht, 2005 ):

Almost immediately, loss of input to a deprived barrel column leads to a loss of inhibitory firing in that column. This unmasks horizontal excitatory connections from adjacent spared columns. This does not explain longer-lasting plastic changes as the unmasking would disappear immediately if the deprived input was reinstated (for example by allowing the whisker to regrow).
LTP- and LTD-like processes also seem to be involved. This can be inferred by using transgenic mice where there are changes in the expression of enzymes related to LTP and LTD e.g. calmodulin-dependent protein kinase II (CaMKII) or cyclic-AMP response element binding protein (CREB). In these mice, plasticity is compromised Spike timing rather than frequency may be an important factor. Associative LTP has been demonstrated at layer 4 to layer 2/3 synapses when the layer 4 neuron fires 0-15 ms before the layer 2/3 neuron, and LTD is observed when this timing order is reversed. Such mechanisms could act rapidly to produce plastic changes within hours or days.
Sensory deprivation has been demonstrated to cause changes in synaptic dynamics such as EPSP amplitude and frequency. The net effect of these changes is to increase the proportion of synaptic input which layer 2/3 neurons in deprived barrels receive from spared barrels. These observations suggest that other, more specific, mechanisms besides LTP/LTD are at play in experience-dependent plasticity.
It seems intuitively likely that structural changes at the level of axons, dendrite branches, and dendrite spines underlie some of the long-term plastic changes in the cortex. Changes in axon structure have been reported in plasticity following lesions   and more recently by studies using whisker trimming. Dendritic branching is important during prenatal and neonatal development, is involved in  plasticity induced by lesions, but is not involved in experience-dependent plasticity. In vivo two-photon microscopy reveals that dendritic spines in mouse barrel cortex are highly dynamic and subject to continuous turnover, and may be associated with formation or deletion of synapses. It is likely that spine turnover is necessary but not sufficient to produce experience-dependent plasticity, and other mechanisms such as axonal remodelling are also needed to explain features such as savings from prior experience.

Plasticity and remodelling of barrel cortex has also been studied in the context of traumatic brain injury, where environmental enrichment of stimuli has been shown to induce plasticity/recovery  and patterns of temporal coding have been altered via plasticity and recovery mechanisms.

Notes

References

External links

Research groups working on barrel cortex:
Ahissar Lab, Israel
Barrel cortex group, Cardiff
Barth Lab, Pittsburgh, USA
Bruno Lab, New York, USA
Tactile Perception & Learning Lab (Diamond Lab), Triestes, Italy
Feldman Lab, Berkeley, USA
Finnerty Lab, MRC Centre for Neurodegeneration Research, London
Sensory Systems & Neural Engineering Group (Hartmann Lab), Chicago, USA
Helmchen Lab, Zürich, Switzerland
Hires Lab, Los Angeles, USA
Kleinfeld Lab, San Diego, USA
Maravall Lab, Sussex, UK
Moore Lab, Providence, USA
Oberländer Lab, Bonn, Germany
O'Connor Lab, Baltimore, USA
Lab of Sensory Processing (Petersen Lab), Lausanne, Switzerland
Schwarz Lab, Tübingen, Germany
Barrel Group (Staiger Lab), Göttingen, Germany
Stanley Lab, Atlanta, USA
Svoboda Lab, Ashburn, USA

Books on barrel cortex
 Barrel Cortex book

Memory
Animal nervous system
Neuroplasticity

redpajama_set_name: RedPajamaWikipedia


text:
Aritri Sarkar
November 16, 2019 1:53 pm GMT+0530
Joshua Jackson and boyfriend Jodie Turner-Smith are Married? The couple made Red carpet debut flashing their Rings!
Pacey Witter's star actor Joshua Jackson and the British model Jodie Turner-Smith tied knots to each other.
The two on Thursday night were spotted as a real-life couple stepping on the red carpet. The couple took a big step in their personal life. All the fans have been making a buzz and everyone is congratulating them.
In the premiere of Jodie's latest movie 'Queen and Slim' as part of AFI Fest, the two were seen walking together holding hands. The Fest took place in Los Angeles. Jodie was witnessed to wear a diamond ring on the ring finger of her left hand.
The Canadian actor was wearing a three-piece black color suit. He was also wearing a gold ring on his ring finger. The model looked stunning in a Gucci lilac gown (purple shade).
It is been reported that the couple got a marriage license back in August at Beverly Hills. The idea of getting married was already going on in their minds, so the news is no shock for the fans.
In November 2018, the two got linked together and were rumored to be dating each other. Joshua Jackson and Jodie Turner were seen having lunch together for the first time in November 2018.
Both Jodie and Jackson have been keeping their love life very private. It's very rare when they are seen to speak about their relationship. Though, earlier this year, Jodie shared a picture of him sleeping.
She confirmed they both are in a romantic relationship since this summer but never spoke much about it. She showcases her love publically sometimes. Like she shared Joshua's picture when he was felicitated at the Environmental Media Gala Association's 2019 gala.
Jackson once revealed in a 2014's interview that he is been raised by the parents who got divorced. So, it is difficult for him to take up marriage at an early age and promise to commit to a single person forever.
But, after meeting Jodie, it seems that his heart has finally changed. We wish both of them a very happy married life.
Alex Rodriguez took two decades to win the heart of her 'dream date' Jennifer Lopez since 1998; Alex reacts to an old footage admitting the fact!!
Prince Andrew finally talks about his friendship with sexual offender Jeffery Epstein for the first time in BBC interview! Reveals he regrets being Epstein's friend!

redpajama_set_name: RedPajamaCommonCrawl


getting here with a full-size truck. If you're traveling to East Brunswick, do yourself a favor and try Comfort Suites East Brunswick. You could use an iron at Comfort Suites East Brunswick, so you can iron your socks, and ice cubes are always in perfect stock since there's an ice making machine.
You can heat up breakfast at Comfort Suites East Brunswick with microwaves in the rooms, and naturally there are hair dryers available, so your hair won't remain dripping wet.
These are some other hotels near Comfort Suites East Brunswick, East Brunswick.
These outdoors activities are available near Comfort Suites East Brunswick.


text:
Health, Safety & Personal Injury Law Blog
July 10, 2021 • Compensation for Injuries,Hiring a West Virginia Lawyer
Punitive Damages Vs. Compensatory Damages: What's the Difference Under West Virginia Law?
If you have been wrongfully injured in West Virginia, understanding the difference between punitive damages and compensatory damages can help make sure you recover full and fair compensation. Punitive damages are not available in every case, but when they are, they can add substantial value to your claim. What are Punitive Damages? Under West Virginia…
May 6, 2021 • Compensation for Injuries,Hiring a West Virginia Lawyer
How Much is Your Personal Injury Claim Worth?
How to Determine the Value of Your Car Accident or Personal Injury Case If you have been injured in an accident because of another's negligence, you may be wondering what a fair settlement would be. The answer to that question is largely determined by what "damages" the other party's negligence caused you. Money damages is…
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What Types of Cases Do Personal Injury Lawyers Handle?
Each year, over 24 million Americans go to the emergency room because of injuries caused by accidents, many of which are caused by negligence, dangerous drugs, or defective products. Personal injury law provides accident and injury victims the opportunity for compensation in many of these cases. Below is a summary of the majority of these…
February 15, 2021 • Attorney Tips,Compensation for Injuries,Hiring a West Virginia Lawyer,Representing Yourself Without a Lawyer
If you or a loved one has been injured in an accident or hurt by someone else's negligence, it's usually helpful to at least speak with an experienced West Virginia personal injury lawyer about your rights and options. If your accident or injury case meets certain criteria, finding an attorney who wants to take your…


text:
International Journal of Arts and Technology
Prof. Athanasios Vasilakos
IJART addresses arts and new technologies, highlighting computational art. With evolution of intelligent devices, sensors and ambient intelligent/ubiquitous systems, projects are exploring the design of intelligent artistic artefacts. Ambient intelligence supports the vision that technology becomes invisible, embedded in our natural surroundings, present whenever needed, attuned to all senses, adaptive to users/context and autonomously acting, bringing art to ordinary people, offering artists creative tools to extend the grammar of the traditional arts. Information environments will be the major drivers of culture.
New media arts, science and technology
Interactive/visual theatre, neurobiological base of acting, digital/wearable cinema
Augmented performance in dance
Artificial intelligence-based art practice, web art and postmodernism
Using analysis of artworks in conjunction with AmI to produce novel objects
Using AmI to promote the creativity of a human user
Autonomic sensor networks and wearable computers in the performing arts
Computer vision and optical tracking for music and dance performance
Cognitive intelligence and natural intelligence for the arts
Collaborative distributed environments
Evolutionary art systems that create drawings/images/animations/sculptures/poetry/text
Evolutionary music systems that create musical pieces/sounds/instruments/voices
Choreographing media for interactive virtual environments
New media actors, new media aesthetics
Social and ethical issues in the arts and technology
The objectives of IJART are to address new works, research and performances in the multi-disciplinary emerging area of new technologies and the arts - and to provide a common platform under which this artwork can be published and disseminated. IJART provides a high-quality platform for this purpose.
IJART provides a vehicle to help professionals, academics, researchers ,artists, museum curators, and graduate students working in the field of arts and technology, to disseminate information and to learn from each other's work.
IJART publishes original research papers, review papers, artworks, performances, conference reports, book reviews, notes, commentaries, and news. Special Issues devoted to important topics in the arts and new technologies will occasionally be published.
IJART is indexed in:
Compendex [formerly Ei] (Elsevier)
Emerging Sources Citation Index (Clarivate Analytics)
IJART is listed in:
Vasilakos, Athanasios, Lulea University of Technology, Sweden
(th.vasilakos gmail.com)
Wan, Jiafu, South China University of Technology, China
Xia, Zhihua, Nanjing University of Information Science and Technology, China
Brooks, Tony, Aalborg University, Denmark
Chen, Min, Seoul National University, South Korea
Cheok, Adrian David, National University of Singapore, Singapore
Draisin, Maya, International Academy of Digital Arts & Sciences (IADAS), USA
El-Nasr, Magy Seif, Simon Fraser University, Canada
Fisher, Scott S., University of Southern California, Los Angeles, USA
Fishwick, Paul, University of Florida, USA
Grau, Oliver, Danube University, Austria
Gross, Tom, University of Bamberg, Germany
Hu, Jun, Eindhoven University of Technology, Netherlands
Inakage, Masa, Keio University, Japan
Ishii, Hiroshi, MIT Media Laboratory, USA
Kato, Hirokazu, Nara Institute of Science and Technology, Japan
Lee, Newton, Institute for Education, Research, and Scholarships, USA
Maes, Patti, MIT Media Laboratory, USA
Marranca, Bonnie, PAJ Publications, USA
Natkin, Stéphane, Conservatoire National des Arts et Métiers, France
Pan, Zhigeng, Zhejiang University, China
Pentland, Alex (Sandy), MIT Media Laboratory, USA
Rokem, Freddie, Tel Aviv University, Israel
Salem, Ben, Kwansei Gakuin University, Japan
Sarfraz, Muhammad, Kuwait University, Kuwait
Selker, Ted, MIT Media Laboratory, USA
Shu, Lei, Guangdong University of Petrochemical Technology, China
Vercoe, Barry, MIT Media Laboratory, USA
Wilson, Stephen, San Francisco State University, USA
Xiong, Neal Naixue, Colorado Technical University, USA


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Most popular articles (Since August 12, 2015)
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Role of social media during the COVID-19 pandemic: Beneficial, destructive, or reconstructive?
Heena Sahni, Hunny Sharma
April-June 2020, 6(2):70-75
DOI:10.4103/IJAM.IJAM_50_20
The world is facing the extensive spread of severe acute respiratory syndrome-coronavirus 2. This epidemic puts intensive pressure on healthcare, economic, and social structures. Commitment to implementing effective approaches for public health will take bold interventions by public health professionals and strong leadership by the nation's governing bodies. During this crisis, lack of awareness, knowledge, and preparedness would put people and health care staff at risk. The dilemma is how to pass the knowledge of current disease statistics and its prevention to the general population at a rate equivalent to or better than the spreading epidemic. At the same time, a huge amount of health-threatening misinformation is spreading at a faster rate than the disease itself. The major proportion of this false rumor is disseminated in the web-2 era through social media. Thus, delivering fast, accurate and reliable information addressing critical problems of infection control is, therefore, of key importance. This review outlines both the positive and negative impact of social media during coronavirus epidemic on health-care professionals and on the general population. However, if used wisely and prudently, social media serves as a powerful tool for changing people's behavior and to promote the well-being of individual and public health. The following core competencies are addressed in this article: Medical knowledge, Interpersonal and communication skills, Practice-based learning.
305,903 2,462 -
Parampreet Kaur, Jill Stoltzfus, Vikas Yellapu
DOI:10.4103/IJAM.IJAM_7_18
Descriptive statistics are used to summarize data in an organized manner by describing the relationship between variables in a sample or population. Calculating descriptive statistics represents a vital first step when conducting research and should always occur before making inferential statistical comparisons. Descriptive statistics include types of variables (nominal, ordinal, interval, and ratio) as well as measures of frequency, central tendency, dispersion/variation, and position. Since descriptive statistics condense data into a simpler summary, they enable health-care decision-makers to assess specific populations in a more manageable form. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.
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Type I, II, and III statistical errors: A brief overview
Parampreet Kaur, Jill Stoltzfus
Jul-Dec 2017, 3(2):268-270
As a key component of scientific research, hypothesis testing incorporates a null hypothesis (H0) of no difference in a larger population and an alternative hypothesis (H1or HA) that becomes true when the null hypothesis is shown to be false. Two potential types of statistical error are Type I error (α, or level of significance), when one falsely rejects a null hypothesis that is true, and Type II error (β), when one fails to reject a null hypothesis that is false. To reduce Type I error, one should decrease the pre-determined level of statistical significance. To decrease Type II error, one should increase the sample size in order to detect an effect size of interest with adequate statistical power. Reducing Type I error tends to increase Type II error, and vice versa. Type III error, although rare, occurs when one correctly rejects the null hypothesis of no difference, but does so for the wrong reason. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.
Tattoo-associated complications and related topics: A comprehensive review
Jameson M Petrochko, Andrew C Krakowski, Colin Donnelly, John B Wilson, Jennifer Bruno Irick, Stanislaw P Stawicki
As tattoos become more common, it is likely that practitioners will encounter adverse tattoo reactions with increasing frequency. While some tattoo-related complications (TRCs) may be nonspecific and challenging to diagnose, others present overtly and can be identified quickly by a well-informed practitioner. TRCs occur at both of these extremes, highlighting the need for better awareness and knowledge sharing regarding this heterogeneous group of morbidities. This review is a result of a compilation of the best available clinical evidence across various groupings of TRCs. The authors' intent was to provide the reader with a comprehensive overview of the topic while creating a rich repository of referenced knowledge for future investigations. From the standpoint of frontline health-care providers, effective recognition and management of TRCs require an open-mind, high degree of clinical suspicion, and nonjudgmental approach to a mainstream phenomenon that is still considered by many to be a taboo. The following core competencies are addressed in this article: Medical knowledge, Patient care, and Systems-based practice.
IMAGES IN ACADEMIC MEDICINE
Classic brown recluse spider bite
Mark William Fegley, Rodrigo Duarte-Chavez, Lauren E Stone, Sudip Nanda
July-December 2016, 2(2):256-259
A 58-year-old female presented with leg paresthesia and rash. On presentation, the rash was most consistent with cellulitis and cephalexin was started. The next day vesicles appeared which were presumed to be shingles and acyclovir was started. They evolved into a fully necrotic lesion on day 4 and had the classic presentation of a brown recluse spider bite. Bite marks were missed at presentation. Brown recluse spider bites are commonly misdiagnosed 80% of the time. Brown recluse venom contains a variety of toxins which can lead to skin necrosis (37% of patients) that occurs via an unknown mechanism dependent on host neutrophils. Skin changes progress over 12–36 h and necrosis develops within several days. Treatment recommendations call for exclusion of other diagnoses and conservative management with local wound care, tetanus prophylaxis, and debridement. Other forms of treatment should be avoided. Our patient was treated with a skin graft with good results. The following core competencies are addressed in this article: Patient care and medical knowledge.
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Scrutinizing the evidence linking hypokalemia and ileus: A commentary on fact and dogma
William Matthew Brigode, Christian Jones, Daniel E Vazquez, David C Evans
July-December 2015, 1(1):21-26
Low serum potassium has been linked to classic signs and symptoms including mental status changes, muscular dysfunction and paralysis, and cardiac arrhythmias. Frequently, it has been listed as a cause for paralytic ileus, and correcting electrolyte anomalies is one of the first steps in treatment of a patient with nonfunctioning bowels. However, our review of the literature does not support a clear causative link. Older studies cite potassium as one of the many factors to optimize to regain bowl function, while newer studies do not support hypokalemia as a cause of ileus. Current treatment of ileus supports focusing on reversal of the effect of opiates on the gut, while electrolyte therapeutic goals are directed to prevent complications outside of the gastrointestinal (GI) tract. We review the cellular physiology and clinical data to elucidate the nature of the link between low potassium values and its impact on GI motility. Patients: Patients with hypokalemia and ileus. Intervention: Potassium repletion. Comparison: Patients with normal potassium values. Outcomes: Resolution of ileus. Population, intervention, comparator, and outcomes questions: Does low serum potassium cause intestinal ileus, and will correction of this deficit correct the intestinal paralysis?. The following core competencies are addressed in this article: Practice-based learning and improvement of medical knowledge. This article addresses the evidence linking hypokalemia and ileus to improve medical knowledge and enable physicians to put this evidence into practice.
Finger nail changes: A red flag for connective tissue disease
Mark W Fegley, Rodrigo Duarte-Chavez, Whitney Fegley, Lauren E Stone, Amitoj Singh, Sudip Nanda
January-June 2017, 3(1):197-201
We report a 68-year-old female who presented to the cardiology clinic with ventricular tachycardia and specific finger nail abnormalities including proximal capillary loops and proximal and periungual erythema. The patient had multiple underlying connective tissue disorders and pulmonary fibrosis. Finger nail changes are highly specific and are an indication for all healthcare providers that connective tissue diseases (CTDs) are likely underlying. We review the clinical signs and symptoms, review diagnostic criteria, and further testing to evaluate for CTDs. The following core competencies are addressed in this article: Patient care, Medical knowledge.
The shortage of psychiatrists and other mental health providers: Causes, current state, and potential solutions
Tracy Butryn, Leah Bryant, Christine Marchionni, Farhad Sholevar
January-June 2017, 3(1):5-9
IMAGES IN ACADEMIC MEDICINE: REPUBLICATION
Diagnosis of Achilles tendon rupture with ultrasound in the emergency department setting
Jeff Peck, Karen E Gustafson, David P Bahner
May 2017, 3(3):205-207
The authors describe a case of a middle-aged male with ruptured Achilles tendon sustained while jumping. Bedside ultrasound was instrumental in making the diagnosis. The following core competencies are addressed in this article: Medical knowledge, Patient care. Reprinted with permission from: Peck J, Gustafson KE, Bahner DP. Bedside sonography primer: diagnosis of Achilles tendon rupture with ultrasound in the emergency department. OPUS 12 Scientist 2011;5(2):17-18.
Neurosurgery in India: Success and challenges
Ankit Raj, Amit Agrawal
Maggot debridement therapy: A practical review
Ashley Jordan, Neeraj Khiyani, Steven R Bowers, John J Lukaszczyk, Stanislaw P Stawicki
Maggot debridement therapy (MDT) has a long and well-documented history. Once a popular wound care treatment, especially prior to the discovery of antibiotics, modern dressings or debridement techniques, MDT fell out of favor after the 1940s. With the increasing prevalence of chronic medical conditions and associated complex and difficult-to-treat wounds, new approaches have become necessary to address emerging issues such as antibiotic resistance, bacterial biofilm persistence and the high cost of advanced wound therapies. The constant search for a dressing and/or medical device that will control pain, remove bacteria/biofilm, and selectively debride necrotic wound material, all while promoting the growth of healthy new tissue, remains elusive. On review of the current literature, MDT comes very close to addressing all of the previously mentioned factors, while at the same time remaining cost-effective. Complications of MDT are rare and side effects are minimal. If patients and providers can look past the obvious anxiety associated with the management and presence of larvae, they will quickly see the benefits of this underutilized modality for healing multiple types of wounds. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.
SPECIAL ARTICLE
Retained surgical items: Building on cumulative experience
Brett Styskel, Brian Wernick, Ronnie N Mubang, Steven M Falowski, Thomas J Papadimos, Stanislaw P Stawicki
January-June 2016, 2(1):5-21
Retained surgical items (RSIs) are much dreaded, preventable complications associated with surgical and other invasive procedures. Despite much effort going into eliminating these "never events" and the associated heavy burden for patients, providers, and institutions, RSIs continue to occur. This manuscript reviews fundamental concepts related to RSI, including risk factors, prevention strategies, technology-assisted detection, team strategies, and pertinent safety education. In addition, we performed a secondary review of a database of all published case reports and series of RSI between 1909 and 2015, focusing on clinical presentation, symptomatology, morbidity, diagnostic workup, pathology findings, and temporal characteristics. Despite a vast body of knowledge regarding RSIs, more needs to be done to help further reduce and prevent these occurrences. The following core competencies are addressed in this article: Patient care, Medical knowledge, Practice based learning and improvement, Systems based practice, Professionalism, and Interpersonal skills and communication
Effectiveness of music therapy on academic performance of nursing students
Arumugam Indira, Phanishree V Pydimarry, Kantha Katari, Rajeswari Hemanathan, Ranabir Pal, Amrita Ghosh, Prashant Bhandarkar, Priti Patil, Amit Agrawal
September-December 2018, 4(3):278-283
Background: It has been shown that music has effect on intellectual functions, behavioral aspects, and emotional aspects of students. The present study explores the role of music on these aspects of nursing students. The purpose of this study is to observe the effect of music listening on academic performance. Materials and Methods: Data were collected using a questionnaire. Sociodemographic data, study habits, home-related aspects, teacher-related aspects, and academic performance rating scale was used to analyze the academic performance of the students. Instrumental flute and violin music called Raag Shivaranjani and Raag Mohana were administered to the experimental group using a comfortable head set; it took 10 min for each sample. Music therapy was withheld from the control group. Posttest was conducted on 30th day in both intervention and control group with the same tool to assess the effectiveness of music therapy. Results: Of the 191 participants, intervention arm in the music therapy group (91 nursing students) and in the control group (100 nursing students), the positive findings obtained were that listening to music during studying had positive effects on the concentration of students and improved the academic performance. In the posttest academic performance rating to assess the effectiveness of music therapy, "estimate the percentage of written Nursing Foundation (care plan and case study) work completed (regardless of accuracy) relative to classmates" and "estimate the accuracy completed written nursing foundation (care plan and case study) work (i.e., percent correct of work done)" there were statistically significant changes in academic performances on exposure to music therapy. Conclusions: The current study suggests that a sub-group of students can get benefitted when the music is used as an intervention to improve academic performance. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Interpersonal and communication skills.
Workplace violence in the emergency department in India and the United States
Nicolas Grundmann, Yonatan Yohannes, Mark Silverberg, Jayaraj Mymbilly Balakrishnan, S Vimal Krishnan, Bonnie Arquilla
Background: Internationally, emergency medicine (EM) physicians are vulnerable to both physical and verbal violence. Few studies have examined or compared perceptions and the impacts of workplace violence in India and the United States (US). Objectives: To assess the perceived incidence of workplace violence and its implications on sleep, missed days of work, fear in the workplace, and overall job satisfaction. Materials and Methods: This was an anonymous, prospective, cross-sectional electronic survey of EM residents and physicians. A cohort of physicians in the US was matched to a cohort of physicians in India. Results: Overall, 286 physicians were eligible to participate, 177 responded (98 people from the US and 79 from Indian, for a 62% total response rate). In the US 100% of respondents witnessed verbal violence, whereas only 23% of verbal abuse cases were reported. In India, 89% of respondents witnessed verbal abuse, 46% of cases were reported. Respondents in the US both witnessed and experienced significantly more verbal and physical abuse (P < 0.001). Despite the differences in perceived rates of violence, there were no significant differences between country cohorts regarding the consequences of these incidents. This includes self-reported sleep, missed days of work, and fear of going to the workplace. US respondents were less satisfied with their jobs due to workplace violence as compared to their Indian colleagues (P = 0.041). Conclusion: ED workplace violence is common internationally, underreported, and results in poor job satisfaction, workplace fear, and loss of sleep. The following core competencies are addressed in this article: Patient care, Professionalism, Systems-based practice.
Shikha Jain, Katayoun S Madani, Mamta Swaroop
The women in medicine summit: An evolution of empowerment in Chicago, Illinois, October 9 and 10, 2020: Event highlights, scientific abstracts, and dancing with markers
Katayoun Madani, Tricia Pendergrast, Vidya Sundareshan, Shikha Jain
October-December 2020, 6(4):337-398
Understanding the calculation of the kappa statistic: A measure of inter-observer reliability
Sidharth S Mishra, Nitika
It is common practice to assess the consistency of diagnostic ratings in terms of "agreement beyond chance." The kappa coefficient is a popular index of agreement for binary and categorical ratings. This article focuses on the unweighted kappa statistic calculation by providing a stepwise approach that is supplemented with an example. The aim is that health care personnel may better understand the purpose of the kappa statistic and how to calculate it. The following core competencies are addressed in this article: Medical knowledge.
LEADERSHIP IN ACADEMIC MEDICINE
Focus on emotional intelligence in medical education: From problem awareness to system-based solutions
Reina Uchino, Franz Yanagawa, Bob Weigand, James P Orlando, Thomas J Tachovsky, Kathleen A Dave, Stanislaw P Stawicki
July-December 2015, 1(1):9-20
Objective: To review emotional intelligence (EI) literature in the context of how its application can help mediate various stressors among medical students, physicians-in-training, and faculty. Also, discussed are potential barriers to why EI-based programs face challenges to full implementation in medical education. Literature Search: MEDLINE, PsychINFO, EMBASE, Google Scholar, and Web of Science were searched for English language articles using various combinations of the following terms: EI, medical students, medical education, graduate medical education, trainees (including intern, resident, and residency), practitioners, and physicians. Electronic publications and printed books referenced by primary sources were also included. Results: Although there is increasing evidence for EI implementation being favorably associated with physician wellness, decreasing burnout, building better physician-patient relationships, and even better patient outcomes, there has so far not been a large scale movement to integrate EI into medical school curricula. The main barriers to wider implementation of EI are general lack of awareness, insufficient time and resources, and paucity of qualified faculty. Conclusions: Despite a number of associated potential benefits, EI has been facing various implementation hurdles in the medical education setting. Increasing awareness of EI and its benefits could help medical schools and residency programs around the globe to more actively engage in the implementation of EI training into medical school and residency curricula. We expect that such interventions would have several desirable outcomes, including improved overall physician wellness, enhanced patient experience, and perhaps even improved patient outcomes. The following core competencies are addressed in this article: Practice-based Learning and Improvement, Patient care, Professionalism, Interpersonal and communication skills, Systems-based practice.
Bland–Altman plot: A brief overview
Parampreet Kaur, Jill C Stoltzfus
In healthcare research, it is common to compare two methods of measurement to determine the overall degree of agreement. The Bland–Altman (BA) plot is an alternative to traditional correlational analyses. The BA plot portrays the agreement graphically by creating statistical limits of agreement using the mean and standard deviation of the differences between two measurements. The difference (Test #1 − Test #2) is constructed on the vertical axis while the mean ([Test #1 + Test #2]/2) is depicted on the horizontal axis. Within this plot, one can detect bias between the mean differences, as well as estimate an agreement interval. If the data points are normally distributed, 95% of differences will lie between the limits, but smaller sample sizes may be unreliable for estimating larger population parameters. Although nonparametric methods can estimate limits of agreement with nonnormally distributed data, they may be less reliable than logarithmically transforming the data before creating the plot. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.
Gitelman syndrome: A case report of hypokalemic seizures in an adolescent male
Kristine Cornejo, Pritiben Patel, Swomya Bal, Pamela L Valenza
Gitelman syndrome (GS) is an autosomal recessive tubular disorder with an incidence of 1 in 40,000. It is characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, with secondary hyperreninemia, which can easily be managed with a potassium (K+) sparing diuretic if correctly recognized, and with an understanding of the pathophysiology. A 17-year-old male patient presented to the emergency department after an episode of tonic-clonic seizure activity and subsequent loss of consciousness. Diagnosis of GS was made following persistent hypokalemia despite adequate repletion and further laboratory analysis. The patient was placed on a K+-sparing diuretic and had no further seizure activity. This case illustrates the importance of proper clinical and diagnostic evaluation of electrolyte abnormalities in all patients, especially in younger patients in whom early diagnosis can be crucial in preventing future complications. The following core competencies are addressed in this article: Medical knowledge, Patient care.
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REVIEW ARTICLES: REPUBLICATION
Gastrointestinal fistulae
Stanislaw P Stawicki, Benjamin M Braslow
May 2017, 3(3):77-81
Key points: (a) Gastrointestinal fistulae (GIF) continue to be associated with high morbidity and mortality; (b) Approximately 85% to 90% of GIF result from surgical procedures; (c) Spontaneous GIF (10% to 15%) most commonly result from inflammatory bowel disease, malignancy, and infection (i.e., diverticulitis); (d) Fistula classification and natural behavior are discussed; followed by (e) Discussion of diagnostic and treatment principles, as well as special issues encountered in GIF management. The following core competencies are addressed in this article: Medical knowledge and patient care. Republished with permission from: Stawicki SP, Braslow BM. Gastrointestinal fistulae. OPUS 12 Scientist 2008;2(1):13-16.
Missed traumatic injuries: A synopsis
Stanislaw P Stawicki, David E Lindsey
The ultimate goal in trauma resuscitation is to promptly identify and treat all injuries. Despite clinical and technological advances in the diagnosis and treatment of trauma patients, missed injuries continue to significantly affect modern trauma services. Delayed diagnosis and missed injuries have the potential to exacerbate the severity of the initial insult, and may result in permanent disability or even mortality. Moreover, missed injuries add significantly to the length of hospitalization and overall costs of trauma patient care. This article will discuss the common themes associated with missed injuries, and will highlight steps that practitioners can take to minimize delays in diagnosis and to reduce the number of missed injuries. This article begins with basic definitions, followed by a discussion of literature pertaining to, and factors associated with, missed injuries. We will then focus on specific mechanisms and injury patterns, as well as the corresponding injury-specific diagnostic and treatment pitfalls that have to be considered in order to avoid missed injuries. The following core competencies are addressed in this article: Interpersonal and communication skills, Medical knowledge, Patient care, Practice-based learning and improvement, Systems-based practice. Republished with permission from: Stawicki SP, Lindsey DE. Trauma Corner – Missed traumatic injuries: A synopsis. OPUS 12 Scientist 2009;3(2):35-43.
Neuromonitoring protocol for spinal cord stimulator cases with case descriptions
Steven Falowski, Andres Dianna
Spinal cord stimulation (SCS) relies on the ability to create an overlap of paresthesia on the painful regions. Electrode implantation has historically been performed with awake intraoperative testing to allow the patient to report on the device-induced paresthesia. More recently, the use of neuromonitoring has come into favor and can be used for SCS placement, while the patient remains fully anesthetized throughout the surgery. This is a critical evaluation of the neuromonitoring technique and protocol with an in-depth description of neuromonitoring for SCS placement using electro-myography (EMG) responses in both cervical and thoracic electrode placement. There is an explanation for the interpretation of the EMG responses, as well as case reports of two patients. Neuromonitoring is used to determine myotomal coverage, as a marker that corresponds with dermatomal coverage. This article demonstrates some of the critical steps for both the surgeon and neuromonitoring group to implement this technique, as well as the clinical results of paresthesia coverage in patients. This protocol can be utilized in implementing neuromonitoring into a practice for those implanting SCS systems. The following core competencies are addressed in this article: Medical knowledge, patient care, practice-based learning and improvement, system-based practice, interpersonal and communication skills. This article addresses the gap in knowledge base to implement an approach to improve patient care and outcome.
Delayed intra-abdominal complications of ventriculoperitoneal shunts
Mihir Shah, Bhuwan Giri, Tony R Capizzani, Matthew L Moorman
May-August 2018, 4(2):153-159
Acute perioperative abdominal complications of ventriculoperitoneal shunt placement are generally well understood and managed by general surgeons. Delayed complications occur at nontrivial rates and can masquerade as a variety of typical diagnoses such as adhesive bowel obstruction. In some rare cases, the presentation is quite unusual with the shunt protruding from the anus or urethral meatus. Preexisting neurologic conditions often make the history and examination less reliable. Diagnostic and treatment delay can have devastating effects. The variability of these delayed presentations and problems does not allow for evaluation protocols, and the care of these patients must be individualized. General surgery principles continue to apply and, combined with a high index of suspicion, will lead the surgeon to the appropriate diagnosis and treatment options. The barrier is a failure to consider the shunt as the source of the problem when its placement was not recent. A review of the literature and presentation of an unusual case highlight several of the common delayed presentations, diagnoses, and management options. The following core competencies are addressed in this article: Patient Care, Medical Knowledge, System-based Practice.
Bilateral facial palsy and neurosarcoidosis – An approach to a difficult diagnosis
Mark W Fegley, Lauren E Stone, Rodrigo Duarte-Chavez, Amitoj Singh, Santo Longo, Sudip Nanda
We present a 71-year-old Caucasian female who presented with right upper quadrant abdominal pain and flank pain. As an inpatient, she subsequently developed bilateral facial palsy. After extensive workup, she was diagnosed with neurosarcoidosis. We present an algorithmic approach to diagnosing facial palsy and specific consideration when bilateral. Bilateral facial palsy accounts for <2% of all facial palsies. Unlike unilateral facial palsy, bilateral facial palsy is often associated with significant underlying disease. This systematic approach was helpful in providing the diagnosis of neurosarcoidosis and review of the disease helped confirm the diagnosis and direct further workup. The following core competencies are addressed in this article: Patient care, Medical knowledge.


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Aument, Hickernell Announce Major Flood Control Grant for Mount Joy Borough
HARRISBURG – Rep. Dave Hickernell (R-Lancaster/Dauphin) and Sen. Ryan Aument (R-Lancaster) announced that today, the Commonwealth Financing Authority (CFA) met and approved a $176,022 grant to allow Mount Joy Borough to proceed with its stormwater basin rehabilitation project to alleviate flooding within the borough.
"Mount Joy has experienced major flooding events due to the limited capacity of their stormwater basin," Hickernell said. "The basin has flooded twice in a seven-year period, causing significant damage, particularly on private property and a railroad right-of-way. I am pleased the CFA saw the importance of this project in the application and provided a significant portion needed to get this flood project done."
"The stormwater basin was built in 1994 and was supposed to have the capacity to handle a 100-year storm event," Aument said. "However, recent studies have determined that the basin can only handle 60% of the water from a 100-year storm event, leading to heavy flooding during Tropical Storm Lee in 2011 and a flash flood event on Aug. 31, 2018."
Mount Joy Borough Manager Sam Sulkosky said the basin upgrade is desperately needed as residents are anxious about another flood, and the damage caused by previous floods has been very costly in property loss, damage and cleanup.
Sulkosky detailed the scope of work the CFA grant will enable to be accomplished.
"The Borough of Mount Joy is pleased to receive the Pennsylvania Department of Community and Economic Development's Flood Mitigation Program Grant, which will enable the borough to complete the Mount Joy Borough Stormwater Detention Basin Improvement Project," Sulkosky said.
Sulkosky detailed the improvements the $207,085 project would accomplish:
•	Reconstruct the swale/pipe in the northwest corner of the basin.
•	Excavate the basin bottom by 2 feet and regrade at a 0.50% slope to maintain appropriate dewatering time.
•	Raise the basin berm to an elevation of 385.00 and the spillway to an elevation of 384.50.
These three improvements will increase the capacity of the basin by 159,000 cubic feet to a total holding capacity of 325,907 cubic feet. In addition, the project will update the outlet structure in the southwest corner to have a 4" orifice with an invert of 376.12 and a 6" orifice with an invert of 380.00 to decrease the peak discharge of the basin. After the project is completed, the basin will accommodate the 100-year storm event and mitigate the existing flood risk.
Senator Ryan Aument
Pennsylvania Senate
Media Contact: Ryan Boop
Senatoraument.com


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C'est La Vie: An Afternoon in France
October 27, 2016 /1 Comment/in Charity News, Press Releases, Uncategorized /by LifeInNaples
A bullet pierces the front door of the Gaillet home in France, then a menacing voice shouts, "You must leave your home within 24 hours ." This dramatic event is part of the beginning of the cruel and destructive takeover of France by the Nazis. The Catholic Gaillet family of six children not only left their home, but they endured four years of hunger, hardship, and near death while evading the brutal Germans. Their father, who had fought the Germans during WWI, was terrified that his family would be subjected to German atrocities.
This story of four harrowing years when the six siblings were separated from their parents, could seem like a plot of a novel. Hélène Gaillet de Neergard, who was only four at the beginning of their odyssey, wrote a memoir of her childhood. Her father had presented his children a lengthy account of these war years. The result is I Was a Child Bride, an exceptional memoir, which has resulted in extensive recognition.
In fact, on February 21st at the Naples Hilton, the Temple Shalom Sisterhood is presenting an event, featuring Hélène Gaillet de Neergard, "C'est La Vie—An Afternoon in France." Hélène will speak about her childhood spent trying to evade the Nazis and reminisce about her colorful adult life.
The highpoint of her professional life was that of a freelance photographer in New York as well as Paris, where she advertised her 1975 one-woman show ina poster revealing her nude self-portrait. Five hundred posters were stolen, creating extensive publicity and notoriety. This self-portrait is in the Museum of Modern Art, MOMA, and Musee Pompidou
Hélène captured the rhythms of nighttime New York with photographs of jazz great Miles Davis, Lena Horne, Artie Shaw, and Cab Calloway. For ten years Helene lived a life among New York's rich and famous, and has captured their personas with her keen eye. She photographed many notable people such as Governor Carey, David Frost and Mohammad Ali. Helene counted Jacqueline Kennedy and Aristotle Onassis among her friends. And Helene's name is found in such biographies as Ari: The Life and Times of Aristotle Onassis by Evans, A Woman Named Jackie, by C. David Heymann, and The Last Tycoons: The Secret History of Lazard Freres by William Cohan.
Hélène is a world class water sailor, which led to her writing career with the book The Boat Book: A Guide and Reference Book for All Boaters. It has been invaluable to fellow sailors. In 2014 her book I Was a War Child was published. This unique memoir has been well received, especially with book groups. It has also led to Helene's participation in the Holocaust Museum and Education Center, the Jewish Book and the Women's Cultural Alliance,
Hèlène is a fascinating and popular speaker. She will recount memories of her colorful, exciting life on Tuesday, February 21, 2017, at 11 AM. C'est La Vie—An Afternoon in France is a benefit for the Temple Shalom's youth projects. The luncheon features French cuisine. Harpist Laura Lou Roth will perform French favorites, and an informal fashion show called "A Stroll Down the Champs Elyse s" will be presented by Evelyn & Arthur. The cost is $75 ticket, $150 patron, and $300 for sponsors. For information call 239-455-2423 or send an email to Templesisterhoodevents@gmail.com. The community is invited to meet an extraordinary woman, who has led a remarkable life.
Host: Temple Shalom Sisterhood Venue: Naples Hilton
Contact: Arlene Yedid arleney2001@embarqmail.com
https://lifeinnaples.net/magazinewp/wp-content/uploads/2016/10/Final-attempt-at-french-flag-1.jpeg 104 166 LifeInNaples https://lifeinnaples.net/magazinewp/wp-content/uploads/2019/05/LIN-LOGO-2019340by78.jpg LifeInNaples2016-10-27 20:05:412016-10-28 05:54:40C'est La Vie: An Afternoon in France
muriel Colmars says:
Hélène sure IS a fascinating Speaker and I am thrilled she is offering this new lecture in February. I will spread the word, this event is a must!
The evolution of communication Life's a Beach! And now there's a book!


Parking spaces in front of the theater are very limited! Limited free street parking on Raleigh St. and Stuart St.
Recommended: Free parking garage NORTH of the theater building.
Learn More / How To Fest!
Want a chance to see every film? Thinking about seeing more than 3 films + our Opening Film? We have a pass for you! Our VIP Pass includes tickets to our Opening Night Film & Reception, and all 7 of our film features and blocks. That's a total of 12 festival films & shorts, and a savings of $40! We'll also give all our VIP Pass holders a shout out on our Facebook!
Interested in our Saturday and Sunday film line-up? This pass gives you all access to our 4 Feature Films, 2 Showcases, and our Sunday night Closing Film. That's a savings of $20 - more than enough to treat yourself to the Alamo's bottomless popcorn!
This will get you into our Friday film, Lipstick Under My Burkha, and our Opening Night Reception where we will serve light appetizers and kick off our film festival! Drinks will be available for purchase through BarFly and their bar staff. Reception hours are 6:00-7:20pm. Film is first come-first serve seating, and begins promptly at 7:30pm.
Our Saturday and Sunday films will be shown throughout the weekend. Each film is $12. Seating is general admission, so we recommend that you arrive early to grab a good seat!
Our Saturday CU Denver Showcase ticket will include a Q&A Session. Our Sunday Student & Local Film Showcase will include an Industry Expert Talkback, where our film makers and our audience will have the opportunity to engage with experts on film production, research, and submissions to large film festivals!
Our Closing Film, Men on the Dragon, celebrates the end of this year's film festival, and the start of the Colorado Dragon Boat spring season! Our non-profit organization Dragon 5280 also organizes the largest Dragon Boat Festival in Colorado and the US. Curious about what it takes to join a team? Want to learn how to paddle? Or are you just excited for the snow to melt so you can get on a boat? This is a great movie to see! Join us after the film at BarFly (next to the theater) to toast to the end of our film season.
All tickets and passes sold afterwards will include a ticket to just the opening night film at 7:30pm.


text:
Evaluation of a Prototype Real-Time PCR Assay for Carcinogenic Human Papillomavirus (HPV) Detection and Simultaneous HPV Genotype 16 (HPV16) and HPV18 Genotyping
Philip E. Castle, Mark Sadorra, Tiffany Lau, Carrie Aldrich, Francisco A. R. Garcia, Janet Kornegay
Philip E. Castle
1Division of Cancer Epidemiology, National Cancer Institute, NIH, DHHS, Bethesda, Maryland
For correspondence: castlep@mail.nih.gov
Mark Sadorra
2Roche Molecular Systems, Alameda, California
Tiffany Lau
Carrie Aldrich
Francisco A. R. Garcia
3University of Arizona Health Sciences Center, Tucson, Arizona
Janet Kornegay
DOI: 10.1128/JCM.00725-09
Results from a prototype real-time PCR assay that separately detected human papillomavirus genotype 16 (HPV16), HPV18, and 12 other carcinogenic HPV genotypes in aggregate (cobas 4800 HPV test) and results from a PCR assay that detects 37 HPV genotypes individually (Linear Array) were compared using a convenience sample of cervical specimens (n = 531). The percentage of total agreement between the two assays was 94.7% (95% confidence interval, 92.5 to 96.5%). The Linear Array test was more likely than cobas 4800 HPV test to test positive for the 12 other carcinogenic HPV genotypes among women without evidence of cervical disease (P = 0.004).
Persistent cervical infections by approximately 15 carcinogenic human papillomavirus (HPV) genotypes cause cervical cancer and its immediate precursor lesions (17, 22, 27). DNA testing for carcinogenic HPV has proven itself to be more sensitive, albeit slightly less specific, for the detection of cervical intraepithelial neoplasia lesion grade 2 (CIN2) and more severe lesions (CIN2+) (1, 10, 11, 15, 18, 19). Carcinogenic HPV DNA testing of cervical samples has been introduced as an adjunct to cervical cytology into primary cervical cancer screening in the United States (20, 26), and the International Agency for Research on Cancer has endorsed its use as a stand-alone option in primary cervical cancer screening (14).
The introduction of carcinogenic HPV DNA testing with cervical cytology as a primary screening modality creates a clinical dilemma—the management of carcinogenic HPV DNA-positive, cytology-negative women (4), who remain at a low but significant risk of CIN2+. One solution for identifying women at risk for CIN2+ in this subgroup is the separate detection of HPV genotype 16 (HPV16) and HPV18, the most carcinogenic HPV genotypes, referring HPV16- or HPV18-positive women immediately to colposcopy and following up with HPV16- and HPV18-negative women after a year (13, 26). While the first generation of clinical HPV tests pooled all carcinogenic HPV genotypes and did not include separate HPV genotyping, at least for HPV16 and HPV18, most of the next generation of clinical tests will offer at least HPV16 and HPV18 genotyping. The utility of full HPV genotyping is less certain (2), as it has been shown that repeatedly testing positive for any carcinogenic HPV is a good proxy for HPV genotype-specific persistence, especially in women aged 30 years and older (7).
One of the next-generation tests, the cobas 4800 HPV test, detects a pool of 12 carcinogenic HPV genotypes in aggregate, with concurrent, separate detection of HPV16 and HPV18. We conducted the first evaluation of the cobas 4800 HPV test and compared the results to previously reported results (8) generated by a now well-validated Linear Array HPV genotyping test (5, 6, 9, 12) and to cervical diagnoses.
We acquired a convenience sample of 552 anonymized residual PreservCyt (PC; Hologic) specimens, after cytologic interpretation and the histologic diagnosis had been rendered, with human subject research approvals as previously described (3, 8). Women with abnormal cytology, including carcinogenic HPV-positive atypical squamous cells of undetermined significance, underwent colposcopy. Women were assigned a worst histologic diagnosis based on the review of the biopsy specimen and loop electrosurgical excision procedure tissue sample and a pathology review as previously described (3, 8). Five sets of 2-ml aliquots were produced from the residual specimens, balanced for the aliquot order, and were stored at −20°C until used; some sets were missing aliquots because of insufficient specimen volume. Of the 552 PC specimens, nine (1.6%) were excluded because women either had unsatisfactory histology or had disease unrelated to cervical neoplasia (e.g., endometrial carcinoma).
In 2006, one set of aliquots was tested for 37 HPV genotypes (genotypes 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51 to 56, 58, 59, 61, 62, 64, 66 to 73, 81, 82 subtype [IS39], 82 subtype [W13b], 83, 84, and 89) by using the commercially available Linear Array HPV genotyping test (Roche Molecular Systems) as previously described (5, 8, 12). For Linear Array testing, 285 μl of PC was processed, and the extracted DNA was eluted into 140 μl, of which 50 μl was used in the PCR amplification reaction (0.51% of the 20-ml PC specimen).
In 2009, a second set of aliquots was tested for HPV by the cobas 4800 HPV test (Roche Molecular Systems), masked to the results from Linear Array testing. The cobas 4800 system features fully automated sample preparation combined with real-time PCR technology, plus software that integrates the two components. The cobas 4800 HPV test was designed for the amplification and detection of a broad spectrum of high-risk HPV genotypes, along with the coamplification of the human cellular gene β-globin. Briefly, 94 PC aliquots plus a positive and negative control were processed concurrently. HPV and cellular DNA were released by lysing PC aliquots under denaturing conditions at elevated temperatures in the presence of proteinase K, chaotropic agents, and detergents. Isolation and purification of the released nucleic acid occurred on magnetic beads, followed by elution with a low-salt reagent. PCR amplification and detection occurred in a single tube, where probes with four different reporter dyes track the different targets in the multiplex reaction. Reporter dye 1 tracked the high-risk HPV pool with 12 high-risk HPV targets (HPV31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68); dyes 2 and 3 tracked HPV16 and -18, respectively; and dye 4 targeted β-globin to provide a control for cell adequacy, extraction, and amplification. Probe cleavage during the amplification process generated an increase in fluorescence, resulting in a sigmoid growth curve in the ideal case. A proprietary algorithm that models the expected curve was employed to generate a cycle threshold (CT) for determining the presence of HPV or β-globin target. These results were generated with a prototype system where a validated clinical cutoff was not available and thus a conservative cutoff of 45 was used to determine positivity. For the cobas 4800 HPV test, 400 μl of PC was processed, and the extracted DNA was eluted into 150 μl, of which 25 μl was used in the real-time PCR amplification reaction (0.33% of the 20-ml PC specimen).
HPV16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68 were classified as carcinogenic HPV genotypes. HPV testing results from Linear Array and cobas 4800 HPV tests were also categorized hierarchically according to cancer risk (HPV risk category) as follows: HPV16 > HPV18 > carcinogenic HPV types other than HPV16 and HPV18 > negative for carcinogenic HPV.
Seven (1.3%) of the 543 eligible specimens did not have an aliquot for Linear Array testing: three were judged invalid because of the absence of a β-globin signal, and four aliquots were missing. Of the 536 specimens with Linear Array results, two (0.4%) did not have an aliquot for testing by the cobas 4800 HPV test, and three (0.6%) were negative for β-globin by the cobas 4800 HPV test and were excluded from this analysis. This analysis was restricted to women with satisfactory Linear Array and cobas 4800 HPV test results and a final diagnosis which was categorized as normal (which included women with no biopsy specimens taken based on a colposcopic impression of normality) or histologic diagnoses of CIN1, CIN2, or CIN3, or more severe (CIN3+) (n = 531). The hierarchical HPV results for Linear Array and cobas 4800 HPV tests were compared using contingency tables. Kappa value, percentage of total agreement, and percentage of positive agreement were calculated. Differences in HPV categorization and percentage of positive agreement were tested for statistical significance (P < 0.05) using an exact symmetry or McNemar's χ2 test, respectively.
The comparison of the results of the Linear Array and cobas 4800 HPV tests, according to the cancer risk categories, is shown in Table 1. The percentage of total agreement was 94.7% (95% confidence interval [95% CI], 92.5 to 96.5%), and the kappa value was 0.92 (95% CI, 0.89 to 0.95). There was a significant difference in the categorization of the pooled 12 carcinogenic HPV genotype results (P = 0.003), primarily due to the tendency for the Linear Array test to test positive and the cobas 4800 HPV test to test negative for carcinogenic HPV genotypes other than HPV16 and HPV18. When the results of the tests for all 14 carcinogenic HPV genotypes were pooled, there was 95.5% (95% CI, 93.3 to 97.1%) total agreement and a kappa value of 0.91 (95% CI, 0.87 to 0.94) between the two tests. The Linear Array test was more likely to test positive for any of the 14 carcinogenic HPV genotypes (P = 0.002) than was the cobas 4800 HPV test.
In Table 2, we compared the HPV tests for the detection of HPV16, HPV18, any carcinogenic HPV genotypes other than HPV16 and HPV18, or any carcinogenic HPV genotypes for all women and stratified the results based on the final-diagnosis category. The agreement between the two HPV tests was in general very good to excellent, with ≥90% total agreement, ≥78% positive agreement, and kappa values of 0.81 or greater.
There were no statistically significant differences in the detection of HPV16 or HPV18 overall or by diagnostic category. There were no statistically significant differences in the detection of the pool of carcinogenic HPV genotypes other than HPV16 and HPV18, except that the Linear Array test was more likely than the cobas 4800 HPV test to test positive for carcinogenic HPV genotypes other than HPV16 and HPV18 among women who were without evident cervical histopathology (P = 0.004). Consequently, the Linear Array test was more likely than the cobas 4800 HPV test to test positive for any carcinogenic HPV genotype among women who were without evident disease (P < 0.001) and also for all women (P = 0.002).
We could not assess the exact number of carcinogenic HPV genotypes present, because the cobas 4800 HPV test detects the non-HPV16/18 carcinogenic HPV genotypes as a pool. However, we combined the three results for the cobas 4800 HPV test for the minimum number of HPV genotypes present (1, 2, or 3) (e.g., if positive for HPV16 and for the pool of 12 carcinogenic HPV genotypes, a "2" was assigned), and we did the same for the Linear Array test results. Among women who tested carcinogenic HPV positive by the cobas 4800 HPV test, 18.5% had at least two carcinogenic HPV genotypes, compared to 16.7% of those who tested carcinogenic HPV positive by the Linear Array test. There was no difference in the minimum numbers of carcinogenic HPV genotypes detected by the two assays among women who tested positive for carcinogenic HPV by both assays (P = 0.8).
In summary, we found very good agreement between the well-validated Linear Array HPV genotyping assay (5, 6, 8, 12, 23, 25) and the new prototype clinical assay, the cobas 4800 HPV test, which offers partial HPV genotyping for HPV16 and HPV18. We noted one discrepancy, that more women without evident cervical histopathology tested positive by the Linear Array test and negative by the cobas 4800 HPV test for carcinogenic HPV excluding HPV16 and HPV18. Prospective data for this convenience sample were not available to assess the subsequent risk of CIN2+ for Linear Array-positive/cobas 4800 HPV test-negative women without evident cervical histopathology. Notably, only 3 of the 14 (21%) women without evident cervical histopathology who were Linear Array-positive/cobas 4800 HPV test-negative for carcinogenic HPV excluding HPV16 and HPV18 were positive for E6/E7 mRNA (3).
More generally, sufficiently powered, formal evaluations against rigorously defined endpoints of CIN3+ with receiver-operator curve analyses are needed to establish the optimal cut point for clinical performance by the cobas 4800 HPV test (16, 24), as has been done for other HPV assays (21). And the reproducibility and reliability of the cobas 4800 HPV test should be established before it can be widely used for cervical cancer screening (16, 24).
Comparison of Linear Array (LA) and cobas 4800 HPV test (c4800) results, categorized hierarchically according to cancer riska
Comparison of the Linear Array and cobas 4800 HPV tests for the detection of HPV16, HPV18, carcinogenic HPV genotypes other than HPV16 and HPV18, and all carcinogenic HPV genotypes, for all women, stratified based on final diagnosesa
This work was supported in part by the intramural research program of the NIH/NCI.
Received 9 April 2009.
Returned for modification 12 June 2009.
Accepted 4 August 2009.
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Journal of Clinical Microbiology Sep 2009, 47 (10) 3344-3347; DOI: 10.1128/JCM.00725-09
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Papillomaviridae
Papillomavirus Infections
polymerase chain reaction


Quick footage of live rehearsals for the Big Day Out festival. A fan driving by, DrLurch, was able to record a few minutes of video footage. Also there's a brief exchange between Lars and some fans. He was kind enough to stop and sign some autographs.
Audio is about what you'd expect considering the rehearsal footage is shot from outside the stadium.