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PubMed1990

The crossover surface coil: an efficient in vivo NMR detector.

The crossover surface coil is constructed with two turns of copper foil using a unique transposition construction which incorporates an explicit center tap ground of the widened bottom layer. The coil reduces dielectric and inductive losses by effective shielding of electric fields and uniform distribution of magnetic fields for minimum Q losses upon loading of the coil. Flexible, copper foil construction permits easy conformation to tissues of interest, enhancing coil performance. Construction details of the crossover coil and Q data for coils of various sizes operating at a number of frequencies are given.

Equipment Design↗

PubMed1990

The slotted crossover surface coil: a detector for in vivo NMR of skin.

An elongated, narrow, slotted crossover surface coil provides surface localization capable of resolving in vivo 31P NMR spectra from skin tissues. The shallow B1 field penetration achieves localization objectives while the probe length maintains signal-to-noise requirements. Dielectric and inductive losses are minimized via the crossover design (see T. L. Nagel et al., Magn. Reson. Med. 13, xxx (1990). In vivo spectra with millimeter depth resolution were acquired in 5 min at 2 T without pulse localization sequences. Preliminary 31P NMR spectra of normal and thermally injured rat skin were completed using a 25 X 3-mm slotted probe with a 3 X 2-cm surface region of excitation. Normal rat skin tissue PCr/Pi ratios ranged from 3.8 to 4.7 for 5-, 10-, and 30-mus pulse widths, while partial- and full-thickness scald injured tissues ranged from 0 to 2.8. Evaluation of a single minor partial thickness injury 1 to 5 h postburn shows evidence of a localized hypermetabolic response associated with hyperemia. Determination of burn depth and tissue viability appears feasible using: (1) PCr/Pi ratios and (2) observation of localized hypermetabolism.

Animals↗

PubMed1989

Bronchodilation from intravenous theophylline in patients with cystic fibrosis: results of a blinded placebo-controlled crossover clinical trial.

Most patients with cystic fibrosis (CF) eventually develop chronic obstructive pulmonary disease and theoretically could benefit from theophylline therapy. The purpose of this study was to investigate the pharmacologic response to intravenous theophylline by pulmonary function tests (PFT) and the theophylline pharmacokinetics in patients with CF. A randomized, double-blind, placebo-controlled, crossover trial was conducted in 10 ambulant patients with CF (5 females, 5 males), aged 11 to 21 years. Each patient received an intravenous dose of theophylline and normal saline over 1/2 hour on consecutive days. Spirometry and whole-body plethysmography were performed at baseline, 1, 3, 5, and 7 h after the theophylline dose, and 10 blood samples were collected over 9 h on both study days. The percent change of PFT from the baseline was recorded. Analysis of variance for balanced two-period crossover design was used to evaluate the effectiveness of theophylline therapy. The serum concentration (Conc.) vs. time data were fitted using nonlinear least-squares regression analysis. The theophylline dose administered was 7.9 +/- 0.4 (mean +/- SD) mg/kg, which produced a maximal Conc. (Cmax) of 14.6 +/- 2.7 microgram/ml. The half-life (T1/2), volume of distribution (Vd), and total body clearance (TBC) were 4.9 +/- 1.9 h, 537 +/- 124 mL/kg, and 80 +/- 16 ml/h/kg, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Crossover trials, degrees of freedom, the carryover problem and its dual.

The problem of carryover in crossover trials has received a great deal of attention in the statistical literature. Carryover is just one form of period by treatment interaction; yet a parallel problem of patient by treatment interaction, which may be regarded as dual to that of carryover, has received little attention. We suggest that the phenomenon of patient by treatment interaction requires a repeated measures approach to the analysis of crossover trials. A simple solution using predefined contrasts is presented and illustrated by example.

Analysis of Variance↗

PubMedDate not supplied

An analysis of two-period crossover designs with carry-over effects.

The crossover design is a type of longitudinal study with subjects receiving different treatments in different time periods. When carry-over effects are absent, the usual crossover design is structured so that all the information about treatment effects is contained in the within-subject contrasts; standard analyses are based on these within-subject contrasts and ignore any between-subject information. With carry-over effects present these standard analyses can be very inefficient, especially for suboptimal designs. We describe alternative approaches based on methods for the analysis of longitudinal data.

Longitudinal Studies↗

PubMed1993

A conditional analysis for two-treatment multiple-period crossover designs with binomial or poisson outcomes and subjects who drop out.

We propose a conditional analysis for outcome data on numbers of recurrent symptoms arising in a two-treatment, multiple-period crossover trial. Conditioning on subject-specific totals removes any dependence on mean subject-specific symptom rates and permits the use of standard software to perform regression analysis to examine treatment, period, carryover and interaction effects. The addition of offsets to the regression equations allows the incorporation of data from subjects who do not complete all periods in the trial. We apply the proposed method to data from a crossover trial and discuss its advantages and disadvantages.

Adult↗

PubMed1994

Crossover designs for clinical trials.

I discuss three-period crossover designs for an efficient comparison of two test treatments with special application to clinical trials which often have many practical limitations. In this paper I specify a subset of three-period crossover designs so that the investigators are not left with the problematic two-period two-sequence design, should the trials be terminated after the second period. I show that there is a dramatic reduction in variability for estimating the direct and residual treatment effects in three-period designs compared to two-period designs. I also show that the universally optimal design with ABB and BAA sequences is unsuitable when a complex form of residual effects is suspected, such as the second-order residual effects or treatment by period interactions. The design with ABB, BAA, AAB, and BBA sequences is relatively robust to these uncertain model assumptions. I also discuss missing data problems and conclude that, even with a large proportion of missing values, the three-period design is far more efficient than the two-period design.

Analysis of Variance↗

PubMedDate not supplied

Fieller's confidence intervals for the ratio of two means in the assessment of average bioequivalence from crossover data.

The two-period crossover design is the most commonly used study design for bioequivalence of one test formulation to be assessed in comparison to one reference formulation. Consequently, in this paper, all derivation is based on this particular design. It is assumed that for the underlying statistical model the usual assumptions of normality and additivity are satisfied on the original scale of measurement and that it is wanted to base the assessment of average bioavailability on the ratio of the unknown population means for the test and reference formulation. The purpose of this paper is to illustrate that it is reasonable to assume a uniform covariance structure for the two-period crossover design, because the demand of equal variability in bioavailabilities, in addition to equal average bioavailabilities, for the reference and test formulation makes the assumption of uniform covariance structure very realistic, and also because the properties of a decision rule based upon a Fieller's confidence interval under a uniform covariance structure are competitive with those of the corresponding rule based on a general covariance structure.

Bayes Theorem↗

PubMed2001

Within-subject exposure dependency in case-crossover studies.

In the case-crossover design, only cases are sampled and the hazard ratio is estimated from within-subject comparisons of exposures at the event time and in M control periods prior to the event. We consider the effect of within-subject dependence of exposures in successive time periods. We show that estimates obtained from the conditional logistic model are biased. This bias disappears if the distribution of exposures in the M+1 successive time intervals is exchangeable. In contrast, the Mantel-Haenszel estimator for the odds ratio is approximately unbiased provided that exposures are stationary. Suitable methods of analysis of case-crossover designs using maximum likelihood may be derived from cohort rather than case-control models.

Bias↗

PubMed2002

Qualitative analysis of the all-cause black-white mortality crossover.

To date, despite decades of investigations and the relative abundance of mortality data, our understanding of the phenomenon of 'mortality crossover' remains inadequate. We propose a methodology for transforming mortality data from the 'age-domain' to the 'time-domain'. We then introduce a model of selection partially offset by mobility, to simulate the dynamics of vulnerability in a population cohort that is heterogeneous in health and death. Using our model of vulnerability simulating the dynamics of mortality in the time-domain, we compare the mortality experience of the Black and White populations of the United States, identify the significance of selection and mobility as potential factors producing the crossover phenomenon, and make diagnostic use of them.

Adolescent↗

PubMed2002

A survey of unequal crossover systems and their mathematical properties.

We present a model of gene duplication by means of unequal crossover (UCO) where the probability of any given pairing between homologous sequences scales as a penalty factor pz < or = 1, with z the number of mismatches due to asymmetric sequence alignment. From this general representation, we derive several limiting case models of UCO, some of which have been treated elsewhere in the literature. One limiting case is random unequal crossover (RUCO), obtained by setting p = 1 (corresponding to equiprobable pairings at each site). Another limiting case scenario (the 'Krueger-Vogel' model) proposes an optimal 'endpoint' alignment which strongly penalizes both overhang and deviations from endpoint matching positions. For both of these scenarios, we make use of the symmetry properties of the transition operator (together with the more general UCO properties of copy number conservation and equal parent-offspring mean copy number) to derive the stationary distribution of gene copy number generated by UCO. For RUCO, the stationary distribution of genotypes is shown to be a negative binomial, or alternatively, a convolution of geometric distributions on 'haplotype' frequencies. A different type of model derived from the general representation only allows recombination without overhang (internal UCO or IntUCO). This process has the special property of converging to a single copy length or a distribution on a pair of copy lengths in the absence of any other evolutionary forces. For UCO systems in general, we also show that selection can readily act on gene copy number in all of the UCO systems we investigate due to the perfect heritability (h 2 = 1) imposed by conservation of copy number. Finally, some preliminary work is presented which suggests that the more general models based on misalignment probabilities seem to also converge to stationary distributions, which are most likely functions of parameter value p.

Animals↗

PubMed1990

Comparison of trimetazidine with nifedipine in effort angina: a double-blind, crossover study.

Trimetazidine has been shown to have an antianginal effect, increasing exercise capability without producing any significant change of heart rate or systolic blood pressure. The aim of this study was to compare trimetazidine efficiency to that of another classical antianginal drug. A double-blind crossover trimetazidine versus nifedipine trial was carried out in 39 male patients, mean age 58 years, with effort angina for 5 years on average, and a mean number of weekly attacks of 2.4. Thirteen patients had previous myocardial infarction. Nineteen patients received nifedipine (40 mg per day) then trimetazidine (60 mg per day), and 20 patients received the drugs in the opposite order. Each therapeutic period of 6 weeks was preceded by 1 week of washout with placebo. Drug efficacy was assessed by a bicycle exercise tolerance test, performed at the beginning and at the end of each therapeutic period, and by clinical symptoms observed with placebo or with treatment. The statistical analysis was performed according to a crossover design, with repeated measurements. The decrease of the number of weekly attacks was not significantly different with trimetazidine and nifedipine. Results on the exercise test showed no significant differences for maximum workload, the duration of exercise, ST-segment depression at peak exercise, and the time to 1-mm ST-segment depression. Heart rate and systolic blood pressure were not significantly different at rest and at peak exercise. However, the change in the rate-pressure product at the same workload differed significantly between the drugs: It decreased with nifedipine and remained unchanged with trimetazidine, indicating the difference to be in the mode of action of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1984

Crossover comparison of moxonidine and clonidine in mild to moderate hypertension.

The antihypertensive effect of moxonidine X HCl X H2O (MOX) was compared with that of clonidine X HCl (CLON) in a randomized double-blind crossover study in 20 hypertensive outpatients (BP range 154-178/96-108 mmHg). After 2 weeks without antihypertensive medication, either MOX 0.2 mg daily or CLON 0.2 mg daily was given and the dose was titrated until the diastolic blood pressure fell below 90 mmHg. The first treatment period was continued for 2 weeks and, after crossover without a wash-out period, it was followed by the second treatment for a further 2 weeks. Within the first 4 days of administration 0.2-0.4 mg of either agent caused a significant decrease in BP (p less than 0.001) from a mean of 166/100 mmHg to 149/86 mmHg after CLON (approx. -10/-14%), and 163/99 mmHg to 146/84 mmHg after MOX (approx. -10/-15%). No significant difference in the fall in BP or pulse rate was detected between the two drugs. In the mean daily dose of 0.3 mg both drugs showed the same antihypertensive activity, but on CLON a higher incidence of side effects (p = 0.003) was noted, and after discontinuation of therapy a more rapid rise in BP (systolic BP p less than 0.01, diastolic BP p less than 0.02) was found. 17 patients on CLON complained of side effects, especially tiredness and dry mouth, whilst only 6 patients on MOX were affected (p = 0.003).

Adult↗

PubMed1987

Molecular characterization of meiotic recombination within the major histocompatibility complex of the mouse: mapping of crossover sites within the I region.

The molecular analysis of crossing-over within the mouse major histocompatibility complex provides a useful approach for the study of the structural characteristics of meiotic recombination. In this study five intra-I-region recombinants, each derived from Ik/Ib heterozygotes, were characterized for restriction-fragment length polymorphisms (RFLPs) characteristic of the I region of the two parental strains. Southern blot analysis of intra-I recombinant strains A.TBR2, A.TBR3, A.TBR5, A.TBR13, and A.TBR17 using six I-region DNA probes revealed that the point of crossing-over in all five recombinants occurred within a 6.2-kb KpnI-EcoRI segment located within the E beta gene. The segments of DNA containing the crossover point from each of the recombinant chromosomes were cloned by screening partial genomic libraries constructed in lambda gt7 bacteriophage. Construction of partial restriction maps of the cloned segments from the parental and recombinant chromosomes permitted the boundaries of the area containing the crossover site to be narrowed to a 4.0-kb segment located almost entirely within an intron of the E beta gene. The recognition that the points of crossing-over in all five recombinants studied are clustered in a relatively small area of the I region provides further evidence for a hot spot of recombination associated with the E beta gene.

Animals↗

PubMed1992

Idarubicin metabolism and pharmacokinetics after intravenous and oral administration in cancer patients: a crossover study.

The pharmacokinetics and metabolism of 4-demethoxydaunorubicin (idarubicin, IDA) were studied in 21 patients with advanced cancer after i.v. (12 mg/m2) and oral (30-35 mg/m2) treatment according to a balanced crossover design. Patients were divided into four groups: subjects who showed normal liver and kidney function (group N), those who presented with normal kidney function and liver metastases (group L), those with kidney dysfunction (creatinine clearance, less than or equal to 60 l/h; group R), and those with both liver and kidney dysfunction (group LR). Five patients showed variations in liver or kidney function after the first treatment and were considered to be nonevaluable for the crossover study but evaluable for the liver/kidney function study; some of them appeared in different groups for the i.v. as opposed to p.o. treatments. After i.v. administration, IDA plasma levels followed a triphasic decay pattern. The main metabolite observed in all patients was the 13C-reduced compound (IDAol), which attained plasma levels 2-12 times higher than those of the parent compound. IDA pharmacokinetics was not dependent on the presence of liver metastases but was related to the integrity of kidney function. Analysis of variance indicated a significant correlation between IDA plasma clearance and creatinine clearance; it was also found that IDA plasma clearance was lower in patients whose creatinine clearance was less than 60 ml/min [group N, 122.8 +/- 44.0 l/h; group L, 104.4 +/- 27.7 l/h (P = 0.58) vs group R, 83.4 +/- 18.3 l/h (P = 0.037)]. The IDAol terminal half-life and mean residence time (MRT) were significantly increased in patients with impaired kidney function [MRT: group N, 63.6 +/- 10.8 h; group L, 69.9 +/- 10.2 h (P = 0.27) vs group R, 83.2 +/- 10.9 h (P = 0.025) and t1/2 gamma: group N, 41.3 +/- 10.1 h; group L, 47.0 +/- 7.4 h (P = 0.31) vs group R, 55.8 +/- 8.2 h (P = 0.025)]. After oral treatment, drug absorption occurred during in the first 2-4 h after IDA administration; a biphasic decay pattern was observed thereafter. The main metabolite observed in all patients was again IDAol. The AUC of IDAol was greater after oral administration than after i.v. treatment in proportion to the AUC of IDA (i.v.: AUC-IDAol/AUC-IDA, 2.4-18.9; p.o.: AUC-IDAol/AUC-IDA, 4.1-21.4). Following oral dosing, a substantial amount of 4-demethoxydaunomycinone (AG1) was found in 11/21 patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗

PubMed1985

Intravenous digital subtraction angiography in patients with femoral arteriovenous fistulas and ilio-iliac crossover graft.

Fourteen patients with femoral arteriovenous (AV) fistulas and ilio-iliac crossover bypass grafts after postthrombotic occlusion of an iliac vein were studied by intravenous digital subtraction angiography (IV DSA). Digital radiography's utility may be evaluated in the demonstration of the vascular status of AV fistulas and venous return through the reopened iliac vein or ilio-iliac graft. Digital subtraction imaging is a suitable modality to plan operations, such as closure of temporary AV fistula. In follow-up studies of these cases, patency of the crossover bypass can be assessed by noninvasive DSA of the ascending veins.

Adolescent↗

PubMedDate not supplied

The acute effect of phenylpropanolamine and brompheniramine on blood pressure in controlled hypertension: a randomized double-blind crossover trial.

STUDY OBJECTIVE: To determine the acute effect of phenylpropanolamine, 75 mg, and brompheniramine, 12 mg, in combination (PPA/B) on blood pressure in patients with controlled hypertension, using ambulatory blood pressure monitoring (ABPM). DESIGN: Randomized double-blind crossover trial. SETTING: Outpatient clinic at one medical center. PARTICIPANTS: 13 healthy volunteers aged 36 to 64 years, receiving medication for hypertension. INTERVENTIONS: Following 24-hour baseline ABPM, participants were randomized to receive either placebo or PPA/B every 12 hours for three doses, while ABPM continued. After a 24-hour washout period, all participants received the crossover regimen. MEASUREMENTS AND MAIN RESULTS: No clinically important or statistically significant difference was noted for mean systolic and diastolic blood pressures during the baseline (125/75), PPA/B (127/72), and placebo (126/73) phases of the study. Within the first four hours of treatment, the mean change in systolic blood pressure from baseline between PPA/B and placebo phases was 1.7 mm Hg (95% CI -5.3 to 8.7), and mean change in diastolic blood pressure was 0.9 mm Hg (95% CI -1.6 to 3.5), excluding a first-dose pressor effect. CONCLUSION: When used as recommended, PPA/B, a commonly used over-the-counter cold medication, has no significant acute effect on blood pressure in patients with controlled hypertension.

Blood Pressure↗

PubMed2006

Short-term effects of psychiatric symptoms and interpersonal stressors on criminal violence--a case-crossover study.

BACKGROUND: The aim of the study was to analyse the triggering or acute risk effect of psychiatric symptoms and interpersonal stressors on criminal violence. METHOD: One hundred and thirty three violent offenders were recruited from a forensic psychiatric evaluation (FPE) unit and a national prison evaluation unit in Sweden during 2002-2003, and were interviewed about trigger exposures. A case-crossover design was used eliminating long-term within individual confounding. RESULTS: Suicidal ideation or parasuicide within 24 h before the violent event conferred a ninefold risk increase. In contrast, violent ideation did not trigger criminal violence. Hallucinations yielded a fourfold risk increase, whereas paranoid thoughts were associated with a small and statistically non-significant risk increase. Acute conflicts with others and being denied psychiatric care within 24 h before violence also increased the risk of acting violently. CONCLUSIONS: Some tested psychiatric symptoms and stressors triggered criminal violence, whereas others did not. The case-crossover design may be particularly useful for the study of triggers of violence.

Adolescent↗