White coat effect detected using self-monitoring of blood pressure at home: comparison with ambulatory blood pressure

The objective of the study was to investigate whether home blood pressure (HBP) is a reliable alternative to ambulatory blood pressure (ABP) for the detection of the white coat effect (WCE). Hypertensive patients were randomized to measure HBP for 2 weeks or ABP for 24 h. The alternative measurement was then performed. Clinic blood pressure (CBP) was measured in the beginning and end of the study. Subjects with a difference of > or = 20 mm Hg systolic or > or = 10 mm Hg diastolic BP between CBP and awake ABP or CBP and HBP, were classified as clinic reactors. A total of 189 patients completed the study (79 on stable antihypertensive treatment). There was no difference in the magnitude of WCE assessed using the ABP or the HBP method (mean discrepancy, systolic BP: -1.5 +/- 11.7 mm Hg, 95% CI -3.2, 0.2; diastolic BP: 0.9 +/- 7.0, 95% CI -0.1, 1.9). A strong association existed between WCE calculated using the HBP or the ABP method (r = 0.64/0.59 systolic/diastolic, P < .001). The proportion of patients classified as clinic reactors was identical using the HBP or the ABP method (25.9%). Agreement between methods in the classification of clinic reactors was found in 147 patients (78%). The sensitivity and specificity of the HBP method to classify correctly clinic reactors (ABP method used as the standard) were 57% and 85%, respectively, whereas its positive and negative predictive value were 57% and 85%. These results indicate that HBP is not appropriate as an alternative to ABP diagnostic testing in the detection of WCE. Nevertheless, HBP appears useful as a screening test for the detection of this phenomenon.     

Teledermatology and in-person examinations: a comparison of patient and physician perceptions and diagnostic agreement

PURPOSE: The aim of this study was to assess the outcome of reoperation following photorefractive keratectomy related to different techniques. MATERIAL AND METHODS: 265 retreated eyes were divided into 5 groups; low to moderate myopia, high myopia, enlargement, abrasion, and non-compliance. The low to moderate group was further subdivided into 5 categories based on the surgical approach of the reoperation. Outcomes were compared at 12 months after reoperation. RESULTS: There was no statistically significant difference in the median refraction prior to initial PRK, before reoperation, and after reoperation between the 5 categories 66%, of all reoperated patients achieved an uncorrected visual acuity of 0.5 or better after 12 months. 72% had a postoperative refraction between +/- 1 diopter. The other 4 groups were not statistically analyzed due to the wide variety of patients included and non-compliance. CONCLUSION: In low to moderate myopes, approximately 97% achieve uncorrected visual acuity of 0.5 or better following PRK, including one reoperation.     

Involving suppliers in product development in the United States andJapan: evidence for set-based concurrent engineering

Concurrent engineering (CE) involves a widely recognized revolution in the social organization of product development and a corresponding revolution in the underlying paradigm of design. We distinguish between two paradigms-point-based design and set-based design-and argue that effective, truly concurrent design requires shifting to a paradigm where design team members reason and communicate about sets of designs which we call “set-based concurrent engineering”. A survey of 92 Japanese and 119 US automotive parts suppliers who design their own products sought to quantify the pervasiveness and correlates of “set-based approaches”. The survey evidence indicates that set-based design communication is more prevalent among Japanese than among US parts suppliers, and is correlated with certain product development characteristics including years of experience with early involvement of suppliers in design, the degree of product-process design overlap, the degree to which subsystems are interdependent, and the use of quality function deployment (QFD)     

In vivo efficacy of antimicrobial-coated fabric from prosthetic heart valve sewing rings

Escherichia coli tRNA(Val) with pyrimidine substitutions for the universally conserved 3'-terminal adenine can be readily aminoacylated. It cannot, however, transfer valine into polypeptides. Conversely, despite being a poor substrate for valyl-tRNA synthetase, tRNA(Val) with a 3'-terminal guanine is active in in vitro polypeptide synthesis. To better understand the function of the 3'-CCA sequence of tRNA in protein synthesis, the effects of systematically varying all three bases on formation of the Val-tRNA(Val):EF-Tu:GTP ternary complex were investigated. Substitutions at C74 and C75 have no significant effect, but replacing A76 with pyrimidines decreases the affinity of valyl-tRNA(Val) for EF-Tu:GTP, thus explaining the inability of these tRNA(Val) variants to function in polypeptide synthesis. Valyl-tRNA(Val) terminating in 3'-guanine is readily recognized by EF-TU:GTP. Dissociation constants of the EF-Tu:GTP ternary complexes with valine tRNAs having nucleotide substitutions at the 3' end increase in the order adenine < guanine < uracil; EF-Tu has very little affinity for tRNA terminating in 3' cytosine. Similar observations were made in studies of the interaction of 3' end mutants of E. coli tRNA(Ala) and tRNA(Phe) with EF-Tu:GTP. These results indicate that EF-Tu:GTP preferentially recognizes purines and discriminates against pyrimidines, especially cytosine, at the 3' end of aminoacyl-tRNAs.     

Compound heterozygous deletion of the PROP-1 gene in children with combined pituitary hormone deficiency

Mutations in the prophet of Pit-1 gene (PROP1) have been shown to be responsible for combined pituitary hormone deficiency (CPHD) with deficiencies of growth hormone (GH), Prolactin (Prl), thyroid-stimulating hormone (TSH) and gonadotropins. We previously reported that homozygosity for a 2bp deletion in exon 2 (296delGA) accounted for CPHD in three patients from two Russian families. Here we report a second mutational hot spot in exon 2. This 2bp 149delGA deletion results in a frame shift that leads to the same serine to stop codon change at codon 109 (S109X). The predicted proteins are each truncated at residue 108 but diverge from the wild type sequence at different points in the homeodomain. Compound heterozygosity for the two mutations (149delGA/296delGA) was detected in 5 of 14 CPHD children from 4 families (36%). This provides the first evidence of heterozygosity for two common deletions as a cause of CPHD in Russian children.     

Nucleic acid concentration in the brains of inbred rats of different strains

The changes of nucleic acids content in the formation of conditioned skin-defence reflex was studied on inbred rats of various strains. In WGA rats the reflex was formed on the average aight stimulations. An increased RNA content was discovered by cytophotometric determination of the nucleic acids content in the neurons and perineural glia of the cerebral cortex in August rats only. It is assumed that an increased RNA synthesis in the animals of this strain can serve as the basis for their better training.     

A framework for intelligent test data generation

Test data generation using traditional software testing methods generally requires considerable manual effort and generates only a limited number of test cases before the amount of time expanded becomes unacceptably large. A rule-based framework that will automatically generate test data to achieve maximal branch coverage is presented. The design and discovery of rules used to generate meaningful test cases are also described. The rule-based approach allows this framework to be extended to include additional testing requirements and test case generation knowledge.This work was supported in part by George C. Marshall Space Flight Center, NASA/MSFC, AL 35812 (NASA-NCC8-14).