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At least 19 records

Role of cardiac {sup 123}I-mIBG imaging in predicting arrhythmic events in stable chronic heart failure patients with an ICD

Background: Despite therapeutic improvement, the prognosis of chronic heart failure (CHF) remains unfavorable partly due to arrhythmia and sudden cardiac death (SCD). This prospective study evaluated myocardial {sup 123}I-meta-iodobenzylguanidine ({sup 123}I-mIBG) scintigraphy as a predictor of arrhythmic events (AE) in CHF patients. Methods: 170 CHF patients referred for implantable cardioverter-defibrillator (ICD) implantation for both primary and secondary prevention were enrolled. All patients underwent planar and SPECT imaging. Early and late heart-to-mediastinum (H/M) ratio, {sup 123}I-mIBG washout (WO), early and late summed SPECT scores were calculated The primary endpoint was an AE: sustained ventricular tachycardia, resuscitated cardiac arrest, appropriate ICD therapy or SCD. The secondary endpoint was appropriate ICD therapy. Results: During a median follow-up of 23.3 months, 69 patients experienced an AE. Early summed score (ESS) was the only independent predictor of AE [HR 1.023 (1.003-1.043)]. Focussing on only patients with an ICD for primary prevention, ESS was the only independent predictor of AE [HR 1.028 (1.007-1.050)]. {sup 123}I-mIBG-derived parameters failed to be independent predictors of appropriate ICD therapy. However there was a “bell-shaped” relation between {sup 123}I-mIBG scintigraphy-derived parameters and AE and appropriate ICD therapy, i.e., those with intermediate {sup 123}I-mIBG abnormalities tended to be at higher risk of events. Conclusion: Although SPECT {sup 123}I-mIBG scintigraphy was associated with AE in CHF patients with ICD implantation for primary and secondary prevention, no association was found between {sup 123}I-mIBG scintigraphy-derived parameters and appropriate ICD therapy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Nanosecond Gated CMOS Camera (NSGCC) ICD (Rev. 2.1)

The Ultra-Fast X-ray Imager (UXI) program is an ongoing effort at Sandia National Laboratories to create high speed, multi-frame, time-gated Read Out Integrated Circuits (ROICs), and a corresponding suite of photodetectors to image a wide variety of High Energy Density (HED) physics experiments on both Sandia’s Z-Machine and LLNL’s National Ignition Facility (NIF). Several cameras have been designed over the length of the program; one of the most recent is the Icarus, which is an improvement on past imagers (Furi and Hippogriff). A second sensor that can be connected is the Daedalus sensor. The Icarus is a 1024 × 512-pixel array with either 25 μm or 8 µm spatial resolution containing four frames of storage per pixel and has improved timing generation and distribution components while achieved 2 ns time gating. The Daedalus sensor is also a 1024 x 512-pixel array with 25 µm special resolution containing three frames of storage per pixel and has an increased set of features for a wider variety of applications from interlacing of rows in each frame to configurability of all shutters. See Section 14 for details regarding the Icarus implementation of the firmware and Section 15 for details regarding the Daedalus implementation. Due to the unique test environments UXI sensors are targeted for, full custom hardware was required to physically mount an Icarus or Daedalus sensor, manage its various functions, and read out pixel data for transfer to a host computer. Beyond experimental functionality, the hardware also needed to accommodate sensor characterization requirements. Lawrence Livermore National Laboratory’s ‘Version 4.0 Board’ was the result of these efforts. It mounts all the components required to fully utilize the Icarus and Daedalus sensors including analog to digital converters to convert pixel data and various system voltages to digital form for readout and analysis, DAC channels for remote configuration of critical bias voltages, static random-access memories to buffer pixel data, RS422 and Gigabit Ethernet communications for remote access, and an FPGA to tie these components together. This document describes the FPGA electrical interfaces in detail to allow the reader a greater understanding of the device, and to facilitate implementation of custom software to control and manage it. The Version 4.0 Board is a continuation of the Nano-second Gated CMOS hardware design that retains much of the functionality of the Version 1.0 Board while adding features including a DAC instead of digital potentiometers, as well as sensors for pressure and radiation. The Version 4.0 board is intended for applications requiring tight form-factor enclosures. It is composed of two stacking boards; one holds the FPGA and regulators to power the various components of the board while the other contains the mating connector to the sensor, image-readoff ADCs, the DAC, and other components.

42 ENGINEERING↗

Power Production, Inter- and Intra-Array Wake Losses from the U.S. East Coast Offshore Wind Energy Lease Areas

There is an urgent need to develop accurate predictions of power production, wake losses and array–array interactions from multi-GW offshore wind farms in order to enable developments that maximize power benefits, minimize levelized cost of energy and reduce investment uncertainty. New, climatologically representative simulations with the Weather Research and Forecasting (WRF) model are presented and analyzed to address these research needs with a specific focus on offshore wind energy lease areas along the U.S. east coast. These, uniquely detailed, simulations are designed to quantify important sources of wake-loss projection uncertainty. They sample across different wind turbine deployment scenarios and thus span the range of plausible installed capacity densities (ICDs) and also include two wind farm parameterizations (WFPs; Fitch and explicit wake parameterization (EWP)) and consider the precise WRF model release used. System-wide mean capacity factors for ICDs of 3.5 to 6.0 MWkm−2 range from 39 to 45% based on output from Fitch and 50 to 55% from EWP. Wake losses are 27–37% (Fitch) and 11–19% (EWP). The discrepancy in CF and wake losses from the two WFPs derives from two linked effects. First, EWP generates a weaker ‘deep array effect’ within the largest wind farm cluster (area of 3675 km2), though both parameterizations indicate substantial within-array wake losses. If 15 MW wind turbines are deployed at an ICD of 6 MWkm−2 the most heavily waked wind turbines generate an average of only 32–35% of the power of those that experience the freestream (undisturbed) flow. Nevertheless, there is no evidence for saturation of the resource. The wind power density (electrical power generation per unit of surface area) increases with ICD and lies between 2 and 3 Wm−2. Second, EWP also systematically generates smaller whole wind farm wakes. Sampling across all offshore wind energy lease areas and the range of ICD considered, the whole wind farm wake extent for a velocity deficit of 5% is 1.18 to 1.38 times larger in simulations with Fitch. Over three-quarters of the variability in normalized wake extents is attributable to variations in freestream wind speeds, turbulent kinetic energy and boundary layer depth. These dependencies on meteorological parameters allow for the development of computationally efficient emulators of wake extents from Fitch and EWP.

17 WIND ENERGY↗

Density functional study of the variants of inter-Coulombic decay resonances in the photoionization of Cl@C 60

Inter-Coulombic decay (ICD) resonances in the photoionization of Cl@C 60 endofullerene molecule are calculated using a perturbative density functional theory (DFT) method. This is the first ICD study of an open shell atom in a fullerene cage. Here, three classes of resonances are probed: (i) Cl inner vacancies decaying through C 60 outer continua, (ii) C 60 inner vacancies decaying through Cl outer continua, and (iii) inner vacancies of either system decaying through the continua of Cl-C 60 hybrid levels, the hybrid Auger-ICD resonances. Comparisons with Ar@C 60 results reveal that the properties of hybrid Auger-ICD resonances are affected by the extent of level hybridization.

74 ATOMIC AND MOLECULAR PHYSICS↗

Tracing intermolecular Coulombic decay of carbon-dioxide dimers and oxygen dimers after valence photoionization

In this study, we have conducted an experimental study on the photo double ionization (PDI) of carbon-dioxide dimers at photon energies of 37 and 55 eV and oxygen dimers at photon energies of 38, 41.5, and 46 eV, while focusing on the dissociation dynamics upon single-photon absorption. The investigation was performed by applying the cold-target recoil-ion momentum spectroscopy method in order to collect and record the three-dimensional momenta of the ionic fragments and emitted electrons from the dissociating dimer in coincidence. The kinetic-energy release upon fragmentation and the electron angular distributions in the laboratory and body-fixed frames, as well as the relative electron-electron emission angle, show unambiguous experimental evidence of intermolecular Coulombic decay (ICD) in carbon-dioxide dimers upon photoionization below and above the double-ionization threshold of CO 2 monomers. The PDI of oxygen dimers is less conclusive and shows contributions from ICD and knock-off ionization mechanisms. As for atomic dimers, the present results reveal that ICD in CO 2 dimers after valence PDI can also serve as a source for low-energy electrons, known to be very relevant in biological systems, cells, and tissues.

74 ATOMIC AND MOLECULAR PHYSICS↗

MR Imaging of Patients with Cardiac Implantable Electronic Devices (CIEDs): Implementing a Program and Optimizing CMR

Purpose of review: How to implement a program for MRI in patients with conditional and non-conditional (“legacy”) CIED. How to optimize safety and image quality in CMR? What the radiologists need to know: device programming, pre- and post-MRI CIED parameters. Recent findings: New Center for Medicare and Medicaid Services (CMS) guidelines have opened MRI to many patients with nonconditional devices. Newer pulse sequences for cardiac MRI (CMR) in device patients, including modified cine, late gadolinium enhancement and T1 mapping sequences, have resulted in improved image quality in device patients. We present several cases of CMR in device patients, including imaging of leadless pacemakers subcutaneous ICDs. Imaging pitfalls/artifacts in CMR interpretation are also presented. Summary: An organized institutional workflow with an established protocol involving proper patient screening, device programming, scan monitoring, and pre- and post-ICD interrogation minimizes risk in patients with conditional and non-conditional CIEDs. Although rare, significant changes in lead performance, power-on/reset, inappropriate pacing or ICD discharges and battery voltage depletion should be documented. High-quality scans with accurate scar characterization in CIED patients require the use of wideband sequences. CMS has recently acknowledged MRI as a reasonable test necessary for the diagnosis and treatment of beneficiaries with implanted CIEDs, improving the financial prospects and encouraging future developments.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Efficient Intermolecular Energy Exchange and Soft-ionization of Water at Nanoplatelet Interfaces

X-ray, energetic photon and electron irradiation can ionize and electronically excite target atoms and molecules. These excitations undergo complicated relaxation and energy transfer processes that ultimately determine the manifold of system responses to the deposited excess energy. In weakly bound gas- and solution-phase samples, intermolecular Coulomb decay (ICD) and electron-transfer mediated decay (ETMD) can occur with neighboring atoms or molecules leading to efficient transfer of the excess energy to the surroundings. In ionic solids such as metal-oxides, intra- and inter-atomic Auger decay produces localized final states that lead to lattice damage and typically removal of cations from the substrate. The relative importance of Auger stimulated damage (ASD) versus ICD and ETMD in micro-solvated nanoparticle interfaces is not known. Though ASD is generally expected, essentially no lattice damage and very efficient ICD and ETMD resulting from ionization and electronic excitation of micro-solvated boehmite (AlOOH) nanoplatelets has been observed. Efficient energy transfer and soft ionization of interfacial molecules is likely a general phenomenon at gas-oxyhydroxide nanoparticle interfaces where the density of states of the ionized chemisorbed species significantly overlap the core hole states of the solid.

Jones, Brant M.↗

A systematic review of validated suicide outcome classification in observational studies

Abstract Background Suicidal outcomes, including ideation, attempt, and completed suicide, are an important drug safety issue, though few epidemiological studies address the accuracy of suicidal outcome ascertainment. Our primary objective was to evaluate validated methods for suicidal outcome classification in electronic health care database studies. Methods We performed a systematic review of PubMed and EMBASE to identify studies that validated methods for suicidal outcome classification published 1 January 1990 to 15 March 2016. Abstracts and full texts were screened by two reviewers using prespecified criteria. Sensitivity, specificity, and predictive value for suicidal outcomes were extracted by two reviewers. Methods followed PRISMA-P guidelines, PROSPERO Protocol: 2016: CRD42016042794. Results We identified 2202 citations, of which 34 validated the accuracy of measuring suicidal outcomes using International Classification of Diseases (ICD) codes or algorithms, chart review or vital records. ICD E-codes (E950-9) for suicide attempt had 2–19% sensitivity, and 83–100% positive predictive value (PPV). ICD algorithms that included events with ‘uncertain’ intent had 4–70% PPV. The three best-performing algorithms had 74–92% PPV, with improved sensitivity compared with E-codes. Read code algorithms had 14–68% sensitivity and 0–56% PPV. Studies estimated 19–80% sensitivity for chart review, and 41–97% sensitivity and 100% PPV for vital records. Conclusions Pharmacoepidemiological studies measuring suicidal outcomes often use methodologies with poor sensitivity or predictive value or both, which may result in underestimation of associations between drugs and suicidal behaviour. Studies should validate outcomes or use a previously validated algorithm with high PPV and acceptable sensitivity in an appropriate population and data source.

Swain, Richard S.↗

Automatic information extraction from childhood cancer pathology reports

The International Classification of Childhood Cancer (ICCC) facilitates the effective classification of a heterogeneous group of cancers in the important pediatric population. However, there has been no development of machine learning models for the ICCC classification. We developed deep learning-based information extraction models from cancer pathology reports based on the ICD-O-3 coding standard. In this article, we describe extending the models to perform ICCC classification. We developed 2 models, ICD-O-3 classification and ICCC recoding (Model 1) and direct ICCC classification (Model 2), and 4 scenarios subject to the training sample size. We evaluated these models with a corpus consisting of 29206 reports with age at diagnosis between 0 and 19 from 6 state cancer registries. Our findings suggest that the direct ICCC classification (Model 2) is substantially better than reusing the ICD-O-3 classification model (Model 1). Applying the uncertainty quantification mechanism to assess the confidence of the algorithm in assigning a code demonstrated that the model achieved a micro-F1 score of 0.987 while abstaining (not sufficiently confident to assign a code) on only 14.8% of ambiguous pathology reports. Our experimental results suggest that the machine learning-based automatic information extraction from childhood cancer pathology reports in the ICCC is a reliable means of supplementing human annotators at state cancer registries by reading and abstracting the majority of the childhood cancer pathology reports accurately and reliably.

60 APPLIED LIFE SCIENCES↗

PIM-induced phosphorylation of Notch3 promotes breast cancer tumorigenicity in a CSL-independent fashion

Dysregulation of the developmentally important Notch signaling pathway is implicated in several types of cancer, including breast cancer. However, the specific roles and regulation of the four different Notch receptors have remained elusive. We have previously reported that the oncogenic PIM kinases phosphorylate Notch1 and Notch3. Phosphorylation of Notch1 within the second nuclear localization sequence of its intracellular domain (ICD) enhances its transcriptional activity and tumorigenicity. In this study, we analyzed Notch3 phosphorylation and its functional impact. Unexpectedly, we observed that the PIM target sites are not conserved between Notch1 and Notch3. Notch3 ICD (N3ICD) is phosphorylated within a domain, which is essential for formation of a transcriptionally active complex with the DNA-binding protein CSL. Through molecular modeling, X-ray crystallography, and isothermal titration calorimetry, we demonstrate that phosphorylation of N3ICD sterically hinders its interaction with CSL and thereby inhibits its CSL-dependent transcriptional activity. Surprisingly however, phosphorylated N3ICD still maintains tumorigenic potential in breast cancer cells under estrogenic conditions, which support PIM expression. Taken together, our data indicate that PIM kinases modulate the signaling output of different Notch paralogs by targeting distinct protein domains and thereby promote breast cancer tumorigenesis via both CSL-dependent and CSL-independent mechanisms.

60 APPLIED LIFE SCIENCES↗

Electron scattering with ethane adsorbed on rare gas multilayers: Hole transfer, coulomb decay, and ion dissociation

Positive ion desorption following electron impact dissociative ionization of ethane adsorbed on Ar, Kr, and Xe multilayers has been studied as a function of incident electron energy from threshold to 100 eV. Based on the dependence of ion yields on the identity of the rare gas, it is likely that the majority of ethane molecules undergo indirect ionization following hole transfer from the ionized underlying rare gas. Further, this has also been corroborated by density of states calculations showing the energetic alignment of the outer valence states of ethane and the condensed rare gas ionization energies. Due to the near-resonant nature of charge transfer for single-hole states, the ethane molecular ion is excited to different final ionic states on different rare gases, which leads to differences in ion desorption yields and branching ratios. The quantitative yields increase with increasing ionization energy gap between the rare gas and ethane, in the order Ar > Kr >Xe. The large increase in yields from 25 eV onwards for all rare gases is likely due to the formation and decay of two-hole states on neighboring rare gas and ethane molecules due to interatomic and intermolecular Coulomb decay (ICD) and not electron transfer mediated decay (ETMD). The ICD and ETMD pathways become accessible when the incoming electron has sufficient energy to excite the inner valence ns level of the rare gas to a Rydberg state or ionize it. The experimental findings are supported by calculations of thresholds, density of states for the final configurations of these processes, and coupling strengths for hole transfer between ethane and rare gases. The fragment ion branching ratios vary with energy from threshold to about 35 eV, showing the fragmentation pattern changes with the mode of hole transfer and availability of excess energy. Sigma C–C bonds are more likely to break than C–H bonds in the mid-20 eV range, and this effect is most pronounced for Xe, followed by Kr, and then Ar.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Tracing inter-Coulombic decay of molecular dimers

We have conducted an experimental study on the photo double ionization (PDI) of carbon dioxide dimers and oxygen dimers, while focusing on the dissociation dynamics upon single photon absorption. The results in terms of the kinetic energy and angular distributions of the charged particles show unambiguous experimental evidence of intermolecular Coulombic decay (ICD) in carbon dioxide dimers. In the oxygen dimer, the results show that ICD is accompanied by knock-off ionization mechanisms.

74 ATOMIC AND MOLECULAR PHYSICS↗

Retrofitting Word Embeddings with the UMLS Metathesaurus for Clinical Information Extraction

Deep learning has surged in popularity and proven to be effective for various artificial intelligence applications including information extraction from cancer pathology reports. Since word representation is a core unit that enables deep learning algorithms to understand words and be able to perform NLP, this representation must include as much information as possible to help these algorithms achieve high classification performance. Therefore, in this work in addition to the distributional information of words in large sized corpora, we use UMLS vocabulary resources to enrich the vector space representation of words with the semantic relations between words. These resources provide many terminologies pertaining to cancer. The refined word embeddings are used with a convolutional neural (CNN) model to extract four data elements from cancer pathology reports; ICD-O-3 tumor topography codes, tumor laterality, behavior, and histological grade. We observed that using UMLS vocabulary resources to enrich word embeddings of CNN models consistently outperformed CNN models without pre-training word embeddings and even with pre-trained word embeddings on a domain specific corpus across all four tasks. The results show marginal improvement on the laterality task, but a significant improvement on the other tasks, especially for the macro-f score. Specifically, the improvements are 3%, 13%, and 15% for tumor site, histological grade, and behavior tasks, respectively. This approach is encouraging to enrich word embeddings with more clinical data resources to be used for information abstraction tasks from clinical pathology reports.

Alawad, Mohammed↗

Misclassification of causes of death among a small all-autopsied group of former nuclear workers: Death certificates vs. autopsy reports

The U.S. Transuranium and Uranium Registries performs autopsies on each of its deceased Registrants as a part of its mission to follow up occupationally-exposed individuals. This provides a unique opportunity to explore death certificate misclassification errors, and the factors that influence them, among this small population of former nuclear workers. Underlying causes of death from death certificates and autopsy reports were coded using the 10 th revision of the International Classification of Diseases (ICD-10). These codes were then used to quantify misclassification rates among 268 individuals for whom both full autopsy reports and death certificates with legible underlying causes of death were available. When underlying causes of death were compared between death certificates and autopsy reports, death certificates correctly identified the underlying cause of death’s ICD-10 disease chapter in 74.6% of cases. The remaining 25.4% of misclassified cases resulted in over-classification rates that ranged from 1.2% for external causes of mortality to 12.2% for circulatory disease, and under-classification rates that ranged from 7.7% for external causes of mortality to 47.4% for respiratory disease. Neoplasms had generally lower misclassification rates with 4.3% over-classification and 13.3% under-classification. A logistic regression revealed that the odds of a match were 2.8 times higher when clinical history was mentioned on the autopsy report than when it was not. Similarly, the odds of a match were 3.4 times higher when death certificates were completed using autopsy findings than when autopsy findings were not used. This analysis excluded cases where it could not be determined if autopsy findings were used to complete death certificates. The findings of this study are useful to investigate the impact of death certificate misclassification errors on radiation risk estimates and, therefore, improve the reliability of epidemiological studies.

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTAN↗

Comparison of Endovascular and Open Carotid Artery Treatment in Germany: A Retrospective Analysis from 2010 to 2015

Introduction: We analyzed trends in carotid artery stenting (CAS) and carotid endarterectomy (CEA) in hospitalized cases in Germany in the years 2010–2015. Methods: Data from national statistics (DRG statistics) published by the Federal Statistical Office in Germany describing the number of hospitalized patients treated with CEA and CAS were used. In addition, numbers of patients hospitalized with the principal diagnosis stroke associated with precerebral lesions (ICD code I63), transitory cerebral ischemic attacks (G45) and precerebral carotid artery stenosis (I65) treated by CEA and CAS were analyzed for the year 2015. Results: Total number of CEA decreased by 4.0% from 24.067 (2010) to 23.104 (2015) and CAS increased by 5.1% from 5.703 to 5.992. In 2015, 79.4% of all procedures coded concerning the internal carotid artery were CEA and 21.6% CAS. From 27.798 cases hospitalized with the principal diagnosis stroke associated with precerebral lesions, CEA was performed in 3.921 (14.1%) and in 2.132 (7.7%) CAS was documented, with CAS making up one-third of all treatments within the stroke group. In 28.273 cases hospitalized with a TIA, CEA was specified in 853 (3.0%) and CAS in 255 (0.9%) cases. In 27.553 cases with an occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction, 17.036 (61.8%) had a CEA and 3.156 (11.5%) a CAS procedure. Conclusion: CEA is still the primary treatment of extracranial artery stenosis. The impact of CAS becomes mainly apparent in cases presenting with acute strokes.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Outcomes of hypercalcemia of malignancy in patients with solid cancer: a national inpatient analysis

Hypercalcemia of malignancy (HCM) is present in one-third of cancer patients and is associated with a significant mortality risk of 50% within 1 month of diagnosis. We aimed to study the impact and outcomes of HCM in hospitalized patients with solid cancer. We analyzed data captured in the National Inpatient Sample database of the Agency of Healthcare Research and Quality. The study included all hospitalizations in adult solid cancer patients between January 2012 and September 2015 with hypercalcemia. All encounters associated with HCM were identified using the ICD-9 code (275.42) for hypercalcemia. Encounters with other known causes of hypercalcemia were excluded. The co-primary outcomes were incidence of HCM and inpatient mortality. During the study period, 7,501,209 hospitalizations met our inclusion criteria. Approximately 1.7% (n = 126,875) of these hospitalizations were related to HCM. This corresponds to approximately 1 in 59 solid malignancy associated hospitalizations. The mean age of patients with HCM was 65.7 years; 49% were females; 69% were Caucasians; 73% had metastatic disease and 22% received a palliative care consult. When compared to those without HCM, those hospitalized with HCM had a significantly longer mean hospital length of stay (7.3 days vs. 5.6 days, p < 0.001), higher inpatient mortality (12.3% vs. 5.5%, adjusted OR 1.76 (95% CI 1.69–1.84), p < 0·0001), and a greater likelihood of discharge to other facilities (27.4% vs. 16.2%, p < 0.0001). Although HCM accounts for < 2% of all hospitalizations in patients with solid cancer, those with HCM display higher mortality than those without HCM.

62 RADIOLOGY AND NUCLEAR MEDICINE↗