Class of 2007 Abstract / Objectives: To create a nomogram that can accurately predict dosing intervals for aminoglycoside dosing in neonates based on one concentration measurement. Methods: Pooled pharmacokinetic data from previous studies were used (n=341) to create a nomogram that would accurately predict dosing intervals for aminoglycosides. The population value for volume of distribution (0.45 L/kg) was used to formulate a nomogram to select a dosing interval for neonates that would achieve a trough concentration of < 0.5 mg/L one hour prior to the next scheduled dose. The fixed dose of 4 mg/kg was used to simulate concentration elimination profiles all neonates in the study group. The data from the study group elimination profile was then compared against the nomogram and evaluated for the number of correct dosing intervals the nomogram predicted from hour 6 to 22 at 1 hour intervals. The trough concentration cutoff was < 0.5 mg/L with neonates not achieving this concentration prior to the next dose to be deemed dosed incorrectly. The nomogram was considered to have failed at any time point where the nomogram indicated an interval that would not have achieved the desired trough concentration of < 0.5 mg/L or if the interval chosen by the nomogram was longer then necessary. Results: The simulated data from the test group showed that from 15 to 21 hours post infusion 81.0 to 92.1% of neonates had the correct interval predicted by the nomogram. Greater accuracy was achieved the longer time that elapsed before a concentration is drawn, with the greatest accuracy (92.1%) at 21 hours post infusion. However, this was close to the next dose recommending a concentration draw time at 18 hours post infusion to maximize the combination of accuracy and time remaining before the next scheduled dose. This gives the lab time to report the concentration before the next dose is scheduled and achieves an accuracy rate of 87.6%. Conclusions: The use of this nomogram is a valid tool to predict dosing intervals for aminoglycosides in neonates and can aid in saving hospital resources by needing only one concentration measurement to determine dosing interval.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21014号 / 医博第4360号 / 新制||医||1028(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 木原 正博, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

BACKGROUND: The human eye is an incredible organ, capable of focusing and detecting light that passes through its specialized structures. These organs are responsible for the sensation of vision and are crucial to the ability to function and operate during daily life. Loss of the sense of vision can result in serious deficits that greatly reduce the quality of a person’s life. One of the most prevalent causes of vision impairment in the world is refractive error. Although this is a common and relatively simple problem to fix with modern technology, ophthalmologists are continuously searching for new methods of treating people’s eyes to correct refractive errors and improve vision. There are several popular methods for correcting refractive errors, including traditional glasses, contact lenses, and laser vision correction. Laser vision correction is the most modern method for improving visual acuity deficits caused by refractive errors. The two most favored techniques for laser vision correction are laser assisted in site keratomileusis (LASIK) and photorefractive keratectomy (PRK). The performance of these procedures requires a laser treatment input to be calculated based on the patient’s refractive error. These laser treatment inputs are often determined using a nomogram. Nomograms are mathematical functions utilizing a graphical display to calculate a given value based on a set of parameters. Nomograms are crucial for safe and effective LASIK and PRK procedures and there is much interest in enhancing these algorithms to improve the refractive and visual acuity outcomes. OBJECTIVES: The objective of the study was to determine if a newer, more complex laser vision correction nomogram could generate laser treatment inputs better than another more traditional nomogram in terms of refractive and visual acuity outcomes. METHODS: The study included 109 eyes belonging to 59 patients. Fifty-one eyes belonging to 28 patients were operated on using the Wellington nomogram and 58 eyes belonging to 31 patients were operated on using the Internet-based refractive analysis (IBRA) nomogram. Visual acuity and refractive outcomes were recorded at a six-week follow-up evaluation. Data were analyzed using statistical tests to determine significant values. RESULTS: No statistically significant difference was found between the recorded visual acuity and refractive outcomes of eyes operated on using the Wellington and IBRA nomograms. CONCLUSIONS: The two nomograms were found to perform at equal efficacy and to reach the established standards for safety. Although no significant difference was found between the two nomogram outcomes it is possible that there were variables limiting the external validity of the statistical analysis. With extra time, additional cases, and better sample matching the study could be expanded and developed to provide a more reliable and more representative dataset to elucidate conclusions with greater impact. / 2022-06-07T00:00:00Z

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24844号 / 社医博第133号 / 新制||社医||13(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 近藤, 尚己, 教授 川上, 浩司, 教授 平井, 豊博 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Pumping is the most efficient transportation and placing method for concrete. Despite the immense progress in the field of concrete technology in the last years, so far there are still neither official regulations nor verified theoretical foundations to be used for the assessment and accurate prediction pumping behaviour of ordinary and high performance concretes. This thesis aims at purposefully investigating pumping of modern concretes and bridging the existing knowledge gap. The main achievement of the present research is the development and verification of a sitecompliant and scientifically based methodology for characterisation and prediction of fresh concrete pumping behaviour. The research focus is set on the importance of the forming lubricating layer (LL) during pumping. Within an extended experimental program, the properties of the LL are captured and quantified. They determine the reduction of friction at the pipe wallconcrete interface and thereby govern the concrete flow. It is proven that the composition and the rheological properties of the forming LL exert an enormous impact on pumping since most of the induced shear stress by pumping pressure is concentrated in this layer. In a further step, the flow pattern of concrete is analytically and numerically determined. The concrete exhibits various principal flow types which are already defined at low flow rates: plug flow in case of strainhardening cementbased composite (SHCC), partial concrete bulk shear in ordinary concretes and pronounced bulk shear for selfcompacting concrete (SCC). The results from the fullscale pumping campaign are confronted with the existing pressure performance nomogram on the determination of pumping parameters. The nomogram’s prediction capacity is extended and verified for highly flowable concretes by replacing the slump and flow table results with the viscosity parameter of the LL. Furthermore, the challenges during pumping of concrete, inter alia, priming of the pipeline, blockage formation and final cleaning, are exemplified, and recommendations for the practitioners are provided. Finally, the transfer of the developed scientifically based and ready to use methodology on site is strongly advocated as a part of the future in situ rheology monitoring concept towards envisaged full automation of concrete production and casting processes. / Das Pumpen stellt die effektivste Methode für das Fördern und Einbringen von Frischbeton auf der Baustelle dar. Trotz der in den letzten Jahren erreichten deutlichen Fortschritte auf betontechnologischem Gebiet existieren für die Beurteilung der Pumpbarkeit von Beton bisher weder offiziell gültige Vorschriften noch abgesicherte theoretische Grundlagen, die eine zielsichere Vorhersage des Pumpverhaltens von Normal- als auch Hochleistungsbetonen ermöglichen. Die vorliegende Arbeit schließt entsprechende Wissenslücken und befasst sich gezielt mit dem Pumpen moderner Betone. Grundlegenden Erkenntnisgewinn stellt die Entwicklung einer wissenschaftlich fundierten, baustellengerechten Prüfmethodik zur Charakterisierung und Vorhersage des Pumpverhaltens von Frischbeton dar. Der Untersuchungsfokus richtet sich auf die Wirkung der sich beim Pumpvorgang ausbildenden Gleitschicht. Ein umfangreiches Untersuchungsprogramm gestattet die Erfassung und Quantifizierung der Eigenschaften dieser Schicht. Sie bestimmen infolge deutlicher Reduzierung der Reibung an der Grenzfläche zwischen Rohrwandung und Beton die Betonströmung entscheidend. Bewiesen wird, dass Betonzusammensetzung und rheologische Eigenschaften der Gleitschicht maßgebende Auswirkungen auf den Pumpvorgang haben, da sich die pumpdruckinduzierte Scherspannung in dieser Schicht konzentriert. Weiterhin erfolgt sowohl eine analytische als auch numerische Charakterisierung der Betonströmung im Rohr. Nachgewiesen wird, dass sich beim Pumpvorgang betonspezifisch unterschiedliche Strömungsarten einstellen, die bereits bei niedrigen Durchflussmengen definiert sind: Pfropfenströmung in hochduktilen Betonen, partielle Scherung des Kernbetons in Normalbetonen und signifikante Scherung in selbstverdichtenden Betonen. Aus großtechnisch durchgeführten Pumpversuchen gewonnene Ergebnisse werden dem derzeit vorhandenen, verbesserungsbedürftigen Betondruck-Leistungs-Nomogramm zur Einstellung von Parametern an der Betonpumpe gegenübergestellt. Die Vorhersagekapazität des Nomogramms kann durch den Ersatz der Ausbreit- bzw. Setzfließmaßangaben mit Viskositätsangaben der Gleitschicht erweitert und verifiziert werden. Des Weiteren werden baustellenbezogene Herausforderungen im Gesamtprozess des Betonpumpvorgangs, u. a. Vorbereitung der Rohrleitung vor dem Pumpen, Auftreten von Stopfern und Endreinigung exemplarisch dargestellt sowie Empfehlungen für die Praktiker erarbeitet. Schließlich wird der Transfer der in dieser Arbeit entwickelten wissenschaftlich basierten und anwendungsbereiten Methodik als Teil des zukünftigen Konzeptes für die in-situ Rheologie-Überwachung hinsichtlich einer angestrebten vollständigen Automatisierung von Fertigungs- und Einbringprozessen von Beton mit Nachdruck empfohlen.

Title: Refine the prediction process for the software Combatfit Aim: Find more accurate method to predict for the need of software Combatfit. Compare software prediction with field measurements and suitable alternative for predicting. The methods used: The thesis is empiric - teoretic research and it is consist of two parts. 1) Teoretic part - analytic work 2) Empiric part - metodologic study Results: The nomogram was chosen as a suitable way of prediction. The research was realized at 3 km, 8 km and 10 km on track in the field. The measured times were used to compare the predicted time by software Combatfit with time prediction according to the nomogram. It was found that the nomogram predictions outperforms software Combatfit. Furthermore it was determined tightness of the relationship between predicted and measured time in either process. The tightness of the relationship with the nomogram was very high up to absolute. The tightness of the relationship with the software Comatfit was moderate. This statement applies to test files that was used. It is not entirely clear whether this would achieve the same conclusions for other performance groups. Key words: Software Combatfit, prediction of performance, movement, external conditions, nomograme.

Background. Clinicians are divided on dosing recommendations when a dose is delayed or missed. For a neuropsychiatric agent like valproic acid (VPA), rational dosing recommendations are of particular importance. VPA is subject to therapeutic monitoring using total concentrations. Due to non-linear binding of VPA to plasma proteins, current dose titration schemes for VPA are empirical. The objectives of this research were to 1- study the effect of missed/delayed doses on steady state concentrations of VPA and 2-design a nomogram that can be used for dose titration based on total VPA concentrations. Methods. 1- A simulation study was conducted to test for different poor compliance scenarios. The effect of missed doses was quantified and used to derive dosing recommendations. 2- A clinical study was carried out in healthy volunteers. Nine volunteers were administered 500, 750 and 1000 mg VPA in a dose escalation study. A nomogram was developed using in vitro plasma protein binding data in all volunteers and tested using dose escalation data. Several delayed/missed doses scenarios were tested in order to validate the simulation model. 3- A revised simulation model was developed using combined information from plasma protein binding and pharmacokinetic analysis of clinical study data. Results and Discussion. Simulation study: Dosing recommendations in the case of a missed or delayed dose are both formulation and dose dependent. Results from the clinical study validated the simulation model and the revised simulation model properly incorporated intra and inter individual variabilities. VPA nomogram: A one-site saturable binding model provided an adequate description of the binding of VPA to albumin. A dosing nomogram for VPA was constructed. To avoid the risk of achieving toxic concentrations, the dose should not be increased by more than 2 fold at a time. The nomogram should be used in conjunction with patient history and clinical response. Conclusions. This research provides dosing recommendations to the clinicians to counsel patients taking preparations of VPA in the event of a missed dose. The use and validation of VPA nomogram will foster the rational use of VPA for the treatment of epilepsy and its role in other neuropsychiatric disorders.

This diploma thesis deals with the analysis and description of high power laboratory CVVOZE. In the text we can find a description of the individual elements high power laboratory stating their parameters and their analysis from the perspective of impedance. The practical concern of this work is the creation of program for calculating the adjustment burdens and creating utilities helpful for operation and interpretation of laboratory function laity and technical employees.

No description available.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24281号 / 医博第4897号 / 新制||医||1061(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 森田 智視, 教授 妹尾 浩, 教授 波多野 悦朗 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM