Professional integrity in clinical research

In response to public concern over abuses in human medical experimentation, the dominant approach to the ethics of clinical research during the past 30 years has been regulation, particularly via institutional review board review and approval of scientific protocols and written consent forms. However, the effectiveness of regulatory mechanisms in ensuring the ethical conduct of clinical research is limited. Little attention has been devoted to the nature and role of professional integrity of physician investigators, a conscientious framework for guiding investigators in the socially important but morally complex activity of clinical research. Professional integrity is vital in forging an ethically sound relationship between investigators and patient volunteers, a relationship that differs in important ways from the patient-physician relationship in standard clinical practice. We examine critically 2 models of the moral identity of physician investigators, the investigator as clinician and the investigator as scientist; in neither of these 2 models can the physician investigator eliminate completely the moral conflicts posed by clinical research. The professional integrity of physician investigators depends on a coherent moral identity that is proper to the enterprise of clinical research. The roles of clinician and scientist must be integrated to manage conscientiously the ethical complexity, ambiguity, and tensions between the potentially competing loyalties of science and care of volunteer patients.     

A formant bandwidth estimation procedure for vowel synthesis [43.72.Ja]

The specification of vowel formant bandwidths for speech synthesis has been inconsistent in the past, perhaps due to the difficulty of measuring formant bandwidths in natural speech and the possible perceptual insignificance of formant bandwidths on the intelligibility of synthetic speech. Here, regression equations are presented for the estimation of formant bandwidths based on measurements from natural speech which is based only on formant center frequency and independent of other formant values. Current usage, as well as comparison with another well-known estimation algorithm suggests that the new procedure should be quite acceptable for some types of speech synthesis.     

Renewable energy in competitive electricity markets

A restructured electricity system may undervalue renewable energy. We remain wary of unregulated markets, but urge the renewable energy community to begin considering how they could adapt to increasing customer choice.     

Temperature and modulation characteristics of resonant-cavitylight-emitting diodes

Resonant-cavity light-emitting diodes (RCLED) are novel, high-efficiency light-emitting diodes which employ optical microcavities. These diodes have higher intensities and higher spectral purity as compared to conventional LEDs. Analytical formulas are derived for the enhancement of the spontaneous emission along the optical axis of the cavity. The design rules for high-efficiency operation of RCLEDs are established. The temperature dependence of the emission intensity is analyzed in the range 20-80° and it is described by an exponential dependence with a characteristic temperature of 112 K. The modulation characteristics of RCLEDs exhibit 3 dB frequencies of 580 MHz. Eye diagrams at transmission rates of 622 Mb/s are wide open indicating the suitability of RCLEDs for high-speed data transmission     

Polarisation insensitive semiconductor optical amplifier withintegrated electroabsorption modulators

The authors demonstrate a 1.55 μm wavelength multiquantum well semiconductor optical amplifier, integrated with bulk layer electroabsorption modulators and passive waveguide beam expanders at the input and output ports. The device has a fibre to fibre gain of 9 dB, an extinction ratio of 15 dB per modulator, a spectral range >35 nm, and polarisation sensitivity <1 dB     

A 16-Kbit Θ-search associative memory

The design of a high-capacity Θ-search associative memory (Θ∈{<,>,⩽,⩾,=≠}) is presented. PSPICE simulation and layouts show that the proposed Θ-search associative memory chip consisting of 256 words, each 64-b long, can fit on a 13.5-mm×9.5-mm chip. It can perform maskable Θ-search operations over its contents in 110 ns     

Correlation between clinical course and quantitative analysis of the ischemia related artery in patients with unstable angina pectoris, refractory to medical treatment. Results of two randomized trials. The European Cooperative Study Group

Patients with unstable angina, refractory to intensive medical therapy, are at high risk for developing thrombotic complications, such as recurrent ischemia, myocardial infarction and coronary occlusion during coronary angioplasty. As both platelet aggregation and/or thrombus formation play an important role in this ongoing ischemic process, a monoclonal platelet GPIIb/IIIa receptor antibody (c7E3) or thrombolytic therapy (alteplase) might be able to modify the clinical course and underlying coronary lesion morphology. To evaluate whether alteplase or c7E3 could influence the incidence of complications, we randomized 36 and 60 patients, respectively to alteplase or placebo, or c7E3 or placebo. All patients exhibited dynamic ECG changes and recurrent pain attacks, despite maximal tolerated medical therapy. Patients were randomized in both studies after initial angiography had demonstrated a culprit lesion amenable for angioplasty. After study drug infusion quantitative angiography was repeated and angioplasty performed. Recurrent ischemia during study drug infusion occurred in 5, 6, 9 and 16 patients from the alteplase, placebo, c7E3 and placebo group, respectively. Major events defined as death, myocardial infarction or urgent intervention occurred in 7, 3, 1 and 7 patients, respectively. Two patients died: one in the alteplase group and one in the placebo group from the c7E3 study. The first patient due to retroperitoneal hemorrhage, the second as a result of recurrent infarction. Qualitative angiography showed resolution of clots in the c7E3 group only, while the same group of patients showed in 20% an improvement in TIMI flow grade, without deterioration in any patient from this group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary cell culture of human type II pneumonocytes: maintenance of a differentiated phenotype and transfection with recombinant adenoviruses

Studies of the regulation of surfactant lipoprotein metabolism and secretion and surfactant protein gene expression have been hampered by the lack of a cell culture system in which the phenotypic properties of type II cells are maintained. We have developed a primary culture system that facilitates the maintenance of a number of morphologic and biochemical properties of type II pneumonocytes for up to 2 wk. Cells were isolated by collagenase digestion of midgestation human fetal lung tissue that had been maintained in organ culture in the presence of dibutyryl cyclic AMP (Bt2cAMP) for 5 days. The isolated cells were enriched for epithelial components by treatment with DEAE-dextran, plated on an extracellular matrix (ECM) derived from Madin-Darby canine kidney (MDCK) cells, and incubated at an air/liquid interface in a minimal amount of culture medium containing Bt2cAMP. The cell cultures were comprised of islands of round epithelial-like cells containing numerous dense osmiophilic granules, surrounded by sparse spindle-shaped cells with the appearance of fibroblasts. Ultrastructural examination revealed that the osmiophilic granules had the appearance of lamellar bodies, the distinguishing feature of type II pneumonocytes. Additionally, the cultures maintained elevated levels of SP-A gene expression for up to 2 wk. The expression of mRNAs encoding SP-A, SP-B, and SP-C were regulated in the cultured cells by glucocorticoids and cyclic AMP in a manner similar to that observed in fetal lung tissue in organ culture. The differentiated phenotype was most apparent when the cells were cultured at an air/liquid interface. In order to utilize the cultured type II cells for study of the effects of overexpression of various proteins and for promoter analysis, it is of essence to transfect DNA constructs into these cells with high efficiency. Unfortunately, we found the cells to be refractory to efficient transfer of DNA using conventional methods (i.e., lipofection, electroporation, or calcium phosphate-mediated transfection). However, replication-defective recombinant human adenoviruses were found to provide a highly efficient means of introducing DNA into the type II pneumonocytes. Furthermore, we observed in type II cell-enriched cultures infected with recombinant adenoviruses containing the lacZ gene under control of a cytomegalovirus promoter, that beta-galactosidase was expressed uniformly in the islands of type II cells and surrounding fibroblasts. By contrast, in cultures infected with recombinant adenoviruses containing the human growth hormone (hGH) gene under control of the SP-A gene promoter and 5'-flanking region, hGH was expressed only in the type II cells. Thus, this culture system provides an excellent means for identifying genomic elements that mediate type II cell-specific gene expression.     

Adaptive detection of DS/CDMA signals in fading channels

This paper examines the behavior of the minimum mean-squared error (MMSE) receiver in frequency-nonselective-fading channels. It is noted that the MMSE receiver will often lose phase lock on the desired signal when the desired signal dips into a deep fade. A modification to the MMSE receiver is presented which is demonstrated to function quite nicely in flat-fading channels. Analytical results for the modified MMSE receiver are presented and found to agree very well with simulation results. These analytical results are then compared to the theoretical performance of the conventional (i.e., correlator) receiver in terms of both bit-error rate (BER) and capacity. As expected, the modified MMSE receiver was found to offer a substantial improvement in both BER and capacity. Finally, a simple empirically derived formula is given which will give a good approximation to the BER of the modified MMSE receiver in a Rayleigh-fading environment. This formula can also be used to determine the number of users a given system can support. It is noted that as E_b/N₀ grows, it is quite feasible to approach 100% channel utilization with the MMSE receiver, whereas a conventional receiver is typically limited to a utilization of 10%-20%     

Psychopharmacotherapy for addictive and comorbid disorders: current studies

Proper diagnosis of comorbid disorders is crucial in treatment planning for the dually diagnosed. Since psychoactive substance use can obfuscate the diagnosis, special care must be taken to exclude organically based syndromes. Adequate periods of abstinence should first be achieved and subsequently the patient re-examined for residual symptoms compatible with a nonaddictive, nonsubstance-induced psychiatric disorder. The integration of concurrent treatment of both the mental and the addictive disorders appears to be the best approach for treatment of comorbid psychiatric and addictive disorders. An abstinence-based model that typically utilizes a 12-step group therapy is often employed for the addictive illnesses. Other forms of psychosocial therapies such as case managers are being used as well. Presently, physicians' prescribing practices for comorbid addicted patients are based on traditional approaches to use of medications in psychiatric patients, and their attitudes towards addictive disorders may play a significant role in determining the overall success of treatment.