Science.gov

Sample records for controlled retrospective follow

  1. Sociodemographic patterning of long-term diabetes mellitus control following Japan's 3.11 triple disaster: a retrospective cohort study

    PubMed Central

    Leppold, Claire; Tsubokura, Masaharu; Ozaki, Akihiko; Nomura, Shuhei; Shimada, Yuki; Morita, Tomohiro; Tanimoto, Tetsuya; Kami, Masahiro; Kanazawa, Yukio; Oikawa, Tomoyoshi

    2016-01-01

    Objective To assess the sociodemographic patterning of changes in glycaemic control of patients with diabetes affected by the 2011 triple disaster in Japan (earthquake, tsunami and nuclear accident). Methods A retrospective cohort study was undertaken with 404 patients with diabetes at a public hospital in Minamisoma City, Fukushima Prefecture. Glycated haemoglobin (HbA1c) levels were measured in 2010, 2011 and 2012 to capture changes in glycaemic control postdisaster. Age, sex, urban/rural residency, evacuation status and medication use were also assessed. Results There was an overall deterioration in glycaemic control after the disaster, with the mean HbA1c rising from 6.77% in 2010 to 6.90% in 2012 (National Glycohemoglobin Standardization Program, NGSP). Rural residency was associated with a lower likelihood of deteriorating control (OR 0.34, 95% CI 0.13 to 0.84), compared with urban residency. Older age (OR 0.95, 95% CI 0.91 to 0.98) was also slightly protective against increased HbA1c. Evacuation and sex were not significant predictors. Conclusions Patients with diabetes who were affected by Japan's triple disaster experienced a deterioration in their glycaemic control following the disasters. The extent of this deterioration was mediated by sociodemographic factors, with rural residence and older age protective against the effects of the disaster on glycaemic control. These results may be indicative of underlying social determinants of health in rural Japan. PMID:27388360

  2. The occurrence of malignancies in patients with rheumatoid arthritis treated with cyclophosphamide: a controlled retrospective follow-up.

    PubMed Central

    Baltus, J A; Boersma, J W; Hartman, A P; Vandenbroucke, J P

    1983-01-01

    In a retrospective follow-up we compared the incidence of malignancies in patients with rheumatoid arthritis treated with cyclophosphamide with that in another group of patients with rheumatoid arthritis and also with the incidence of malignancies in the general population. Among 81 patients treated with cyclophosphamide in the past decade 15 malignancies occurred. This was 4.1 times the expected number obtained from a closely matched control group of patients with rheumatoid arthritis not treated with cytotoxic drugs (95% confidence interval 1.5 to 19.0), and 3.7 times the expected number calculated from general population rates (95% confidence interval 2.1 to 5.9). The increase in haematological and lymphoreticular malignancies was specially notable. The data also indicate that the development of malignancies after the start of cyclophosphamide therapy necessitates a certain induction time and that it is to some extent dose-dependent. PMID:6882031

  3. Radiation-induced optic neuropathy following external beam radiation therapy for nasopharyngeal carcinoma: A retrospective case-control study

    PubMed Central

    WANG, WEI; YANG, HUI; GUO, LING; SU, HONGYU; WEI, SHIHUI; ZHANG, XIULAN

    2016-01-01

    Radiation-induced optic neuropathy (RION) is a severe ocular complication in patients with nasopharyngeal carcinoma (NPC) following external beam radiation therapy. However, the systemic risk factors for this condition remain unclear. Therefore, patients with NPC who received radiotherapy between 2004 and 2007 at the Sun Yat-Sen University Cancer Center were retrospectively reviewed in this case-control study. The study included 40 RION patients and 40 patients in the control group, who were strictly matched to the RION patients by tumor histopathology, location, Union for International Cancer Control-Tumor Node Metastasis classification and radiotherapy protocol. Univariate and multivariate statistical regression analyses were performed to identify factors predictive of RION. The univariate analysis demonstrated that age (>60 years), gender (female) and chemotherapy significantly affected the risk of RION, whereas diabetes, hypertension and hepatitis B virus infection did not exert a significant effect. The results of the multivariate analysis suggested that only gender and chemotherapy were significantly associated with an increased incidence of RION. Therefore, the results of the present study suggested that female gender and chemotherapy constitute risk factors for the development of RION following radiotherapy for NPC. The ocular symptoms of high-risk patients should be carefully investigated and reported by ophthalmologists. PMID:27123298

  4. Palatal positioned implants in severely atrophic maxillae versus conventional implants to support fixed full-arch prostheses: Controlled retrospective study with 5 years of follow-up

    PubMed Central

    Candel-Marti, Eugenia; Peñarrocha-Oltra, David; Bagán, Leticia; Peñarrocha-Diago, Maria

    2015-01-01

    Background To evaluate soft tissue conditions and bone loss around palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic maxillae after a minimum follow-up of 5 years. Material and Methods A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). The following variables were assessed: age, sex, frequency of tooth brushing, smoking, type of prosthesis, type of implant, implant success, amount of buccal keratinized mucosa, buccal retraction, probing depth, plaque index, modified bleeding index, presence of mucositis or peri-implantitis and peri-implant bone loss. Statistical analysis was performed applying Chi2 Test and Student’s t-test using alpha set at 0.05. Results A total of 57 patients were included: 32 patients with 161 palatal positioned implants (test) and 25 patients with 132 well centered implants (control). No statistically significant differences were found regarding age, sex and smoking, but test group patients reported a significantly higher frequency of daily tooth brushing. Implant success rates were 96.9% for test group implants and 96.0% for control group implants. Peri-implant mucosa retraction was significantly higher in the control group than in the test group (p=0,017). No significant differences were observed either for all the other assessed clinical parameters or for peri-implant bone loss. Conclusions Despite its limitations the outcomes of the present study suggest

  5. Comparison of hearing results following the use of NiTiBOND versus Nitinol prostheses in stapes surgery: a retrospective controlled study reporting short-term postoperative results.

    PubMed

    Révész, Péter; Szanyi, István; Ráth, Gábor; Bocskai, Tímea; Lujber, László; Piski, Zalán; Karosi, Tamás; Gerlinger, Imre

    2016-05-01

    The aim of this retrospective study was to compare the 3-month postoperative hearing results following laser stapedotomy with the use of NiTiBOND versus Nitinol prostheses (31 and 39 patients, respectively). The operations were performed between September 2012 and September 2014, and between March 2006 and December 2012 regarding NiTiBOND and Nitinol, respectively. Twenty of the consecutive 31 patients were female and 11 were male for NiTiBOND, while 11 were male and 28 were female for Nitinol. The mean age was 43.8 years (range 22-61) and 46.9 years (range 28-83) for NiTiBOND and Nitinol, respectively. No significant cochlear trauma was documented postoperatively. The mean air-bone gap (ABG) for the frequencies 0.5, 1, 2 and 3 kHz at the 3-month postoperative follow-up was 7.6 dB (SD 4.7), and 9.3 dB (SD 4.1) for NiTiBOND and Nitinol, respectively. The differences between the mean pre- (p = 0.179), and postoperative (p = 0.059) ABG of the two groups were not significant. ABG closure within 10 dB was achieved in 77.4 and 59 % for NiTiBOND and Nitinol, respectively, the difference was not significant (p = 0.10). Two cases of delayed facial paralysis occurred, 1 with Nitinol and 1 with the NiTiBOND. All patients attained an ABG <20 dB following surgery. Laser stapedotomy with the application of either heat-memory piston prosthesis allowed an easy and minimally invasive approach with excellent short-term hearing results when the NiTiBOND prosthesis was applied. Laser application allowed manipulation in a bloodless environment and avoided manual crimping of the incus. PMID:26018979

  6. Autism and epilepsy: a retrospective follow-up study.

    PubMed

    Hara, Hitoshi

    2007-09-01

    So-called "idiopathic" autism, which exhibited no major complications before diagnosis is well-known as one of the risk factors for epilepsy. This retrospective follow-up study aimed to clarify the characteristics of epilepsy in the autism; onset of seizure, seizure types, EEG findings and epilepsy outcome and the differences as a group between the autism with epilepsy and those without epilepsy. One hundred thirty individuals with autistic disorder or atypical autism diagnosed in childhood were followed up over 10 years and were evaluated almost every year up to 18-35 years of age. Their medical records related to perinatal conditions, IQ, social maturity scores and several factors of epilepsy were reviewed in October 2005. Thirty-three of the follow-up group (25%) exhibited epileptic seizures. The onset of epilepsy was distributed from 8 to 26 years of age. Two types of seizure were observed; partial seizure with secondarily generalized seizure and generalized seizure. Twenty of the epileptics (61%) showed the partial seizure. Although 18% of the non-epileptic group exhibited epileptic discharges on EEG, 68% of the epileptic group revealed epileptiform EEG findings before the onset of epilepsy. No differences were observed concerning the sex ratio, autistic disorder/atypical autism and past history of febrile seizures between the epileptic and non-epileptic groups. Lower IQ, lower social maturity score and higher frequency of prescribed psychotropics were observed in the epileptic group compared to the non-epileptics. Idiopathic autism was confirmed as the high risk factor for epilepsy. Epileptiform EEG findings predict subsequent onset of epileptic seizures in adolescence. Epilepsy is one of negative factors on cognitive, adaptive and behavioral/emotional outcomes for individuals with autism. PMID:17321709

  7. Retrospective Revaluation Effects Following Serial Compound Training and Target Extinction

    ERIC Educational Resources Information Center

    Effting, Marieke; Vervliet, Bram; Kindt, Merel

    2010-01-01

    Using a conditioned suppression task, two experiments examined retrospective revaluation effects after serial compound training in a release from overshadowing design. In Experiment 1, serial X [right arrow] A+ training produced suppression to target A, which was enhanced when preceded by feature X, whereas X by itself elicited no suppression.…

  8. Adaptive control based on retrospective cost optimization

    NASA Technical Reports Server (NTRS)

    Santillo, Mario A. (Inventor); Bernstein, Dennis S. (Inventor)

    2012-01-01

    A discrete-time adaptive control law for stabilization, command following, and disturbance rejection that is effective for systems that are unstable, MIMO, and/or nonminimum phase. The adaptive control algorithm includes guidelines concerning the modeling information needed for implementation. This information includes the relative degree, the first nonzero Markov parameter, and the nonminimum-phase zeros. Except when the plant has nonminimum-phase zeros whose absolute value is less than the plant's spectral radius, the required zero information can be approximated by a sufficient number of Markov parameters. No additional information about the poles or zeros need be known. Numerical examples are presented to illustrate the algorithm's effectiveness in handling systems with errors in the required modeling data, unknown latency, sensor noise, and saturation.

  9. A retrospective study of patient outcomes and satisfaction following pinnaplasty

    PubMed Central

    Hope, Nicholas; Smith, Caroline P; Cullen, Jim R; McCluney, Neil

    2016-01-01

    Introduction Up to 5% of all children have prominent ears. Psychological distress and bullying adversely affect these children and can cause significant social exclusion. In times of austerity, cosmetic procedures such as surgical correction of prominent ears are felt to be an unnecessary cost to the health service. Materials and methods A retrospective case note review of all patients undergoing pinnaplasty was undertaken. Postoperative outcomes were compared against the Royal College of Surgeons of England standards. The Glasgow Benefit Inventory, a validated post-intervention questionnaire, was then posted out to all patients. Results A total of 72 patients were identified. Average age at procedure was 13 years. Eleven patients were above the age of 19 years. Twenty-eight patients were male and forty-four female. Sixty-two cases underwent bilateral pinnaplasty. No patients developed hematoma, and there were no readmissions within 30 days of surgery. Twenty-nine patients responded to the questionnaire (40%), of whom 27 reported a positive impact on their psychosocial well-being with a mean score of 36. Conclusion Pinnaplasty offers patients an opportunity to alleviate the psychological distress of bullying and harassment secondary to the appearance of prominent ears. PMID:27307775

  10. Academic Resilience in Retrospect: Following up a Decade Later

    ERIC Educational Resources Information Center

    Morales, Erik E.

    2008-01-01

    In a unique follow-up study, Hispanic (Dominican American) students identified as resilient 10 years ago were reinterviewed to assess their interim progress, and explore how their educational and professional achievements have evolved over time. By having the students reflect on their beliefs a decade ago and how those beliefs have evolved in…

  11. Medical care following multiple perpetrator sexual assault: a retrospective review.

    PubMed

    Morgan, Louise; Brittain, Bernadette; Welch, Jan

    2015-02-01

    This paper describes the healthcare needs of victims of multiple perpetrator sexual assault (MPSA) and single perpetrator sexual assault (SPSA) presenting to the Haven sexual assault referral centre in south-east London, and aims to identify any characteristics that might be related to attendance at follow-up appointments. We reviewed standardised casenotes of 136 MPSA victims and 139 SPSA victims attending for forensic medical examination (FME) between 1 July 2005 and 31 July 2009. MPSA victims reported a higher rate of stranger assaults, higher rates of vaginal, anal and oral rapes, more rapes at multiple anatomical sites or multiple rapes and were more likely to sustain injuries, all of which put MPSA victims at higher risk of subsequent health problems. Rates of attendance at follow-up appointments were low for all (53.5%) as were rates of completion of post-exposure prophylaxis (PEP) for HIV (33.3%). Attendance at follow-up was associated with presence of anogenital injury at the time of FME. Those over the age of 30 years were less likely to attend. PMID:24695016

  12. Risk of psychiatric disorders following pelvic inflammatory disease: a nationwide population-based retrospective cohort study.

    PubMed

    Shen, Cheng-Che; Yang, Albert C; Hung, Jeng-Hsiu; Hu, Li-Yu; Chiang, Yung-Yen; Tsai, Shih-Jen

    2016-01-01

    Pelvic inflammatory disease (PID) a common infection in women that is associated with significant morbidity and is a major cause of infertility. A clear temporal causal relationship between PID and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between PID and the subsequent development of psychiatric disorders. We identified subjects who were newly diagnosed with PID between 1 January 2000 and 31 December 2002 in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed for patients without PID. A total of 21 930 PID and 21 930 matched control patients were observed until diagnosed with psychiatric disorders, or until death, withdrawal from the NHI system, or until 31 December 2009. Adjusted hazard ratio (HR) of bipolar disorder, depressive disorder, anxiety disorder and sleep disorder in subjects with PID were significantly higher (HR: 2.671, 2.173, 2.006 and 2.251, respectively) than that of the controls during the follow-up. PID may increase the risk of subsequent newly diagnosed bipolar disorder, depressive disorder, anxiety disorder and sleep disorder, which will impair life quality. Our findings highlight that clinicians should pay particular attention to psychiatric comorbidities in PID patients. PMID:26821967

  13. Diagnosis of Depression in Adolescents Following Traumatic Fracture: A Retrospective Analysis

    PubMed Central

    Irvine, James N.; Madaan, Vishal

    2012-01-01

    Objective: To assess how frequently adolescents are clinically diagnosed with depression following hospitalization for traumatic fracture, with the assumption that a retrospective approach would yield lower rates of depression compared to those reported previously in prospective studies. We hypothesized that depression would be less common among adolescents whose injuries were primarily limited to fractures of the appendicular skeleton, vertebral column, and/or thoracic cage compared to those sustaining concomitant spinal cord and/or brain injuries and those suffering from facial/skull fractures. Method: A patient population of 1,121 adolescents, aged 12 to 19 years, who were hospitalized overnight at the University of Virginia (UVA) Health System, Charlottesville, for fractures between 2000 and 2009, was generated using the health system’s Clinical Data Repository. The number of these adolescents who received a new diagnosis of depression (per ICD-9 codes) at the UVA Health System within the first year following their injury was determined. Results: By the end of the first year, 37 of 913 adolescents (4.1%) who had at least 1 follow-up visit after their fracture were diagnosed with depression. When patients with a concomitant spinal cord injury and those with a facial/skull fracture with or without an associated brain injury were excluded, this percentage dropped to 3.2% and 1.1%, respectively. Conclusions: The results support our initial hypothesis that the percentage of adolescents diagnosed with depression following a traumatic fracture determined retrospectively would be lower than the percentages previously reported in related prospective studies. This finding adds to the growing concern that depression in youth is underdiagnosed, even among youth who have contact with health care providers. When compared to our own retrospectively determined data, the much higher rates of depression reported in several prospective studies indicate that more proactive

  14. Use of Drugs Subject to Controlled Prescriptions: a Retrospective Analysis

    PubMed Central

    Demircan, Dilek; Gülmez, Sinem Ezgi; Dönertaş, Başak; Topcu, İbrahim; Yılmaz, Hüseyin; Berkman, Kemal; Akıcı, Ahmet

    2013-01-01

    Objective: Use of drugs that may lead to abuse or dependence are subject to controlled prescriptions (CPs) in many countries, and these are closely monitored by health authorities. According to national regulations in Turkey, CPs may be red coloured (RCPs) or green coloured (GCPs). The aim of this study was to evaluate the use of such drugs in Istanbul. Study Design: Retrospective case-control study. Material and Methods: During the study period (01/01-31/12 2009), 502874 CPs were reported. Among these, 4000 CPs each month were randomly selected and evaluated. Results: The majority of GCPs were issued to women (55.6%), while the majority of RCPs were issued to men (68.4%). GCPs were most frequently prescribed by physicians working in private hospitals (33.6%) while RCPs by physicians working in university hospitals (39.7%). GCPs were mostly prescribed by psychiatrists (37.6%) while for RCPs were child and adolescent psychiatrists (35.9%). Psycholeptics (ATC code N05) were the most prescribed controlled drugs (CDs) (43.8%). Methylphenidate (53.9%) was the mostly prescribed on RCPs and alprazolam (39.6%) was on GCPs. Conclusion: We demonstrate that utilization of CDs shows demographical and institutional differences. These data could be of help to improve surveillance of CDs as well as to train prescribers and patients. PMID:25207068

  15. Unilateral proptosis in thyroid eye disease with subsequent contralateral involvement: retrospective follow-up study

    PubMed Central

    2013-01-01

    Background The purpose of this retrospective follow-up study is to evaluate the prevalence of patients with thyroid eye disease presenting with apparent unilateral proptosis and determine the occurrence of exophthalmos in contralateral non-proptotic eye over the time. Associated features with this event were evaluated. Methods A cohort of 655 consecutive patients affected by thyroid eye disease with a minimum follow-up of 10 years was reviewed. Exophthalmos was assessed by using both Hertel exophthalmometer and computed tomography (CT). The influence of age, gender, hormonal status and of different therapies such as corticosteroids, radiotherapy and surgical decompression on this disease progression was evaluated. Results A total of 89 patients (13.5%) (95% confidence interval [CI] 15%-10%) had clinical evidence of unilateral exophthalmos at the first visit. Among these, 13 patients (14%) (95% CI 22%-7%) developed subsequent contralateral exophthalmos. The increase of protrusion ranged from 2 to 7 mm (mean of 4.2). The time of onset varied from 6 months to 7 years (mean time: 29 months). Smoking status, young age and surgical decompression are significantly associated with development of contralateral proptosis (p< .05). Conclusions Asymmetric thyroid eye disease with the appearance of unilateral exophthalmos at the initial examination is a fairly frequent event, while subsequent contralateral proptosis occurs less commonly. However, physicians should be aware that young patients, particularly if smokers, undergoing orbital decompression in one eye may need further surgery on contralateral side over time. PMID:23721066

  16. Radiation Therapy Following Total Keloidectomy: A Retrospective Study over 11 Years

    PubMed Central

    Kim, Kyuhee; Kim, Jinhee

    2015-01-01

    Background Radiotherapy treatment after keloidectomy is known to be an effective method for reducing the rate of recurrence. However, to date, the appropriate total radiation dose and fractionation have not yet been confirmed. The authors performed a retrospective analysis to identify the appropriate radiation dose and fractionation in post-keloidectomy radiotherapy. Methods From May 2000 to February 2011, postoperative radiotherapy was performed on 39 lesions in 28 patients after total keloidectomy. The keloid lesions were confined to the ear lobes. Between May 2000 and May 2004, 14 keloids were treated with surgical excision, followed by a total radiation dose of 1,200 cGy in three fractions over four to five days (group 1). Between June 2004 to February 2011, 25 keloids were treated with surgical excision, followed by a total radiation dose of 1,500 cGy in three fractions over four to five days (group 2). Patients were given a survey asking them to report their experiences regarding reoperation, recurrence of symptoms, recurrence of the lesion, and satisfaction with the operation. Results Of the 28 patients who were treated, 20 underwent follow-up. Group 2 had more cases showing elevation with erythematous changes, whereas group 1 had more cases showing progressive stages of elevation than group 2. These differences were statistically significant. Moreover, a correlation was observed between the level of keloid elevation and the extent of symptoms. Conclusions We suggest 1,500 cGy of radiation in three fractions following keloidectomy for ear lobe keloids. A further randomized study is needed to assess the recurrence of keloids after radiotherapy. PMID:26430630

  17. Risk factors of infectious complications following flexible ureteroscope with a holmium laser: a retrospective study

    PubMed Central

    Fan, Song; Gong, Binbin; Hao, Zongyao; Zhang, Li; Zhou, Jun; Zhang, Yifei; Liang, Chaozhao

    2015-01-01

    Purpose: We aimed to evaluate the effectiveness of flexible ureteroscope for treating kidney stones and the risk factors for infectious complications following flexible ureteroscope (FURS) with a holmium laser. Methods: We retrospectively reviewed the data of 227 patients with kidney stones who underwent flexible ureteroscope with a holmium laser at our hospital from January 2012 to September 2014, including gender, age, comorbidity, urine analysis results, urine culture results, blood test results, stone size, operative duration, and residual stones. Patients with and without infectious complications were assigned to groups A and B, respectively. The dependent variables were postoperative infectious complications, and the risk factors for infectious complications following FURS were assessed using Chi-square tests and multivariate logistic regression analyses. Results: All the surgeries were successfully completed. The total stone-free rate was 81.9% (n = 186), and the incidence of infectious complications after FURS was 8.37% (n = 19). Fifteen patients (6.61%) developed fever postoperatively, 10 patients (4.41%) developed systemic inflammatory response syndrome (SIRS), 6 patients with fever were considered to have SIRS (2.64%), and 2 patients had sepsis (0.88%). Univariate analyses of groups A and B indicated that pyuria, stone size, operative duration, and infectious stones were risk factors for infectious complications after FURS (P < 0.05). Multivariate logistic regression analyses indicated that pyuria (P = 0.017), operative duration (P = 0.026), and infectious stones (P = 0.030) were independently related to infectious complications. Conclusion: Pyuria, operative duration, and infectious stones were risk factors for infectious complications following FURS. Hence, routine urinalysis findings should be carefully considered, particularly the finding of pyuria. PMID:26379932

  18. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

    PubMed Central

    Shervegar, Satish; Nagaraj, Prashanth; Grover, Amit; DJ, Niranthara Ganesh; Ravoof, Abdul

    2015-01-01

    Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively. Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26. Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P<0.001. Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation PMID:26550591

  19. Outcome and Predicting Factor Following Severe Traumatic Brain Injury: A Retrospective Cross-Sectional Study

    PubMed Central

    Khajavikhan, Javaher; Vasigh, Aminolah; Khani, Ali; Kokhazade, Taleb

    2016-01-01

    Introduction Severe traumatic brain injury (TBI) is a major and challenging problem in critical care medicine. Aim To assess the outcome and predicting factor following severe TBI. Materials and Methods This is a retrospective and cross-sectional study. Data were collected from two sections; one section consisting of a questionnaire answered by the patients and other section from the patient records. The instruments used included the Glasgow Outcome Scale (GOS), SF-36 and the Hospital Anxiety and Depression Scale (HAD). Results The mortality rate of the patients was 46.2%. The quality of life (QOL) of the patients in most dimension were impaired and (58%) of patients had unfavourable QOL. About (37.5%) of patients with anxiety and (27.5%) had a depression. A significant correlation was found between age, GCS arrival, length of ICU stay, mechanical ventilation, VAP & ARDS and pupil reactivity with QOL, GOS, HAD-A and HAD-D (p<0.05, p< 0.001). GCS arrival a predicate factor for QOL and GOS (p <0.001, OR: 1.75, 1.94 respectively); length of ICU stay a predicate factor for QOL and GOS (p <0.05, OR : 1.11, 1.28 respectively); mechanical ventilation a predicate factor for GOS (p <0.001, OR : 1.78); ventilation associated pneumonia (VAP) & acute respiratory distress syndrome (ARDS) and pupil reactivity a predicate factor for GOS (p <0.05, OR : 1.36; p<0.001, OR: 1.94 respectively). The GCS arrival and ICU stay a predicate factor for HAD-A (p<0.05, OR: 1.73, 1.38 respectively). Conclusion With respect to results advanced in pre hospital, medical and surgical care for the decrease in mortality rates of Head trauma (HT), the use of trauma triage tools and strict enforcement of traffic rules are necessary. PMID:27042518

  20. Follow the leader: Visual control of speed in pedestrian following

    PubMed Central

    Rio, Kevin W.; Rhea, Christopher K.; Warren, William H.

    2014-01-01

    When people walk together in groups or crowds they must coordinate their walking speed and direction with their neighbors. This paper investigates how a pedestrian visually controls speed when following a leader on a straight path (one-dimensional following). To model the behavioral dynamics of following, participants in Experiment 1 walked behind a confederate who randomly increased or decreased his walking speed. The data were used to test six models of speed control that used the leader's speed, distance, or combinations of both to regulate the follower's acceleration. To test the optical information used to control speed, participants in Experiment 2 walked behind a virtual moving pole, whose visual angle and binocular disparity were independently manipulated. The results indicate the followers match the speed of the leader, and do so using a visual control law that primarily nulls the leader's optical expansion (change in visual angle), with little influence of change in disparity. This finding has direct applications to understanding the coordination among neighbors in human crowds. PMID:24511143

  1. Retrospective analysis of 140 cases of medullary thyroid carcinoma followed-up in a single institution

    PubMed Central

    SIMÕES-PEREIRA, JOANA; BUGALHO, MARIA JOÃO; LIMBERT, EDWARD; LEITE, VALERIANO

    2016-01-01

    Familial cases of medullary thyroid carcinoma (MTC) may be diagnosed by genetic screening, while in sporadic tumors the diagnosis relies mainly on fine-needle aspiration cytology. The aim of the present study was to determine the demographic, clinical and pathological characteristics of MTC patients followed-up at the Portuguese Institute of Oncology Francisco Gentil (Lisbon, Portugal). For that purpose, a retrospective analysis of 140 MTC patients diagnosed between 1990 and 2010 was performed. The results indicated that patients with hereditary MTC (11.4%) were significantly younger than patients with sporadic MTC. Of the latter, 34.3% had no clinical suspicion of MTC prior to surgery. The sensitivity of cytology and calcitonin (CT) assay in diagnosing MTC were 51.3 and 98.7%, respectively. All familial index cases and 69.0% of sporadic cases presented with advanced stage disease at the time of diagnosis, while 73.0% of familial MTC detected by genetic/pentagastrin screening were diagnosed at the early stage of the disease. Biochemical cure (BC) was achieved in 39.7% of patients and, of these, only 6.5% relapsed. The 5 and 10-year survival rates were 79.3 and 73.6%, respectively. Age >45 years (P=0.026), advanced stage at diagnosis (P<0.001) and absence of BC (P<0.001) were predictors of a worse prognosis on univariate analysis. However, when the patients detected by genetic/pentagastrin screening were excluded from the analysis, age was no longer a prognostic factor, although disease stage remained a significant prognostic factor. On multivariate analysis, BC was the only factor with a significant impact on prognosis (P=0.031). In addition, the present study confirmed that the majority of patients were diagnosed at advanced stages, and CT determination was observed to be more sensitive than cytology to diagnose MTC. Patients at early stages were more prone to achieve BC, which was a favorable prognostic factor. To the best of our knowledge, the present study

  2. Fuel followed control rod installation at AFRRI

    SciTech Connect

    Moore, Mark; Owens, Chris; Forsbacka, Matt

    1992-07-01

    Fuel Followed Control Rods (FFCRs) were installed at the Armed Forces Radiobiology Research Institute's 1 MW TRIGA Reactor. The procedures for obtaining, shipping, and installing the FFCRs is described. As part of the FFCR installation, the transient rod drive was relocated. Core performance due to the addition of the fuel followed control rods is discussed. (author)

  3. On the role of subspace zeros in retrospective cost adaptive control of non-square plants

    NASA Astrophysics Data System (ADS)

    Dogan Sumer, E.; Bernstein, Dennis S.

    2015-02-01

    We consider adaptive control of non-square plants, that is, plants that have an unequal number of inputs and outputs. In particular, we focus on retrospective cost adaptive control (RCAC), which is a direct, discrete-time adaptive control algorithm that is applicable to stabilisation, command following, disturbance rejection, and model reference control problems. Previous studies on RCAC have focused on control of square plants. In the square case, RCAC requires knowledge of the first non-zero Markov parameter and the non-minimum-phase (NMP) transmission zeros of the plant, if any. No additional information about the plant or the exogenous signals need be known. The goal of the present paper is to consider RCAC for non-square plants. Unlike the square case, we show that the assumption that the non-square plant is minimum phase does not guarantee closed-loop stability and signal boundedness. The main purpose of this paper is to establish the existence of time-invariant input and output subspaces corresponding to the adaptive controller. In particular, we show that RCAC implicitly squares down non-square plants through pre-/post-compensation of the non-square plant with a constant matrix. We show that, for wide plants, the control input generated by RCAC lies in a time-invariant 'input subspace', which is equivalent to pre-compensating the plant with a constant matrix. On the other hand, for tall plants, we show that the controller update is driven by the output of the plant post-compensated with a constant matrix. Accordingly, in either case, signal boundedness properties of the closed-loop system are determined by the transmission zeros of the squared system, which we call the 'subspace zeros'. To deal with NMP subspace zeros, we introduce a robustness modification, which prevents RCAC from cancelling the NMP subspace zeros.

  4. Risk of Psychiatric Disorders Following Symptomatic Menopausal Transition: A Nationwide Population-Based Retrospective Cohort Study.

    PubMed

    Hu, Li-Yu; Shen, Cheng-Che; Hung, Jeng-Hsiu; Chen, Pan-Ming; Wen, Chun-Hsien; Chiang, Yung-Yen; Lu, Ti

    2016-02-01

    Menopausal transition is highly symptomatic in at least 20% of women. A higher prevalence of psychiatric symptoms, including depression, anxiety, and sleep disturbance, has been shown in women with symptomatic menopausal transition. However, a clear correlation between symptomatic menopausal transition and psychiatric disorders has not been established.We explored the association between symptomatic menopausal transition and subsequent newly diagnosed psychiatric disorders, including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders.We investigated women who were diagnosed with symptomatic menopausal transition by an obstetrician-gynecologist according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised age-matched women without symptomatic menopausal transition. The incidence rate and the hazard ratios of subsequent newly diagnosed psychiatric disorders were evaluated in both cohorts, based on the diagnoses of psychiatrists.The symptomatic menopausal transition and control cohorts each consisted of 19,028 women. The incidences of bipolar disorders (hazard ratio [HR] = 1.69, 95% confidence interval [CI] = 1.01-2.80), depressive disorders (HR = 2.17, 95% CI = 1.93-2.45), anxiety disorders (HR = 2.11, 95% CI = 1.84-2.41), and sleep disorders (HR = 2.01, 95% CI = 1.73-2.34) were higher among the symptomatic menopausal transition women than in the comparison cohort. After stratifying for follow-up duration, the incidence of newly diagnosed bipolar disorders, depressive disorders, anxiety disorders, and sleep disorders following a diagnosis of symptomatic menopausal transition remained significantly increased in the longer follow-up groups (1-5 and ≥ 5 years).Symptomatic menopausal transition might increase the risk of subsequent newly onset bipolar disorders, depressive disorders, anxiety disorders, and sleep disorders. A prospective study is necessary to confirm

  5. Atrial fibrillation and flutter following coronary artery bypass graft surgery: A retrospective study and review

    PubMed Central

    Premaratne, Ishani D; Fernando, Naomi D; Williams, Lashira; Hasaniya, Nahidh W

    2016-01-01

    Introduction and objectives Atrial fibrillation is a common arrhythmia following coronary artery bypass graft surgery. Its incidence can range from 10 to 60% of patients undergoing coronary artery bypass graft. This rhythm can result in shorter or longer intervals between beats. Methods Medical records of 143 patients from the Queen’s Medical Center, Kuakini Medical Center, Saint Francis Medical Center, and Straub Hospital and Clinic, all of which are located in Honolulu, Hawaii were reviewed. An additional 39 records of patients who did not develop these complications were also reviewed as a control group. Patients were selected according to the ICD codes for atrial fibrillation/flutter and coronary artery bypass graft. Both anomalies can lead to increased health care costs, morbidity, and mortality. In this study, possible predisposing factors to these complications were investigated. The time of onset, weight gain, elapsed time, fluid status (in/out), hematocrit, and drug regimens were compared between the two groups. Results The differences in weight gain, fluid status, and hematocrit between the groups were not significant. There were a total of 17 different drugs prescribed to the group as a whole but not every patient received the same regimen. Conclusions Atrial fibrillation and flutter were found to be more common in males, particularly between the ages of 60 and 69 years. There were no other significant findings. PMID:27123238

  6. Extraovarian peritoneal serous papillary carcinoma: a case-control retrospective comparison to papillary adenocarcinoma of the ovary.

    PubMed

    Bloss, J D; Liao, S Y; Buller, R E; Manetta, A; Berman, M L; McMeekin, S; Bloss, L P; DiSaia, P J

    1993-09-01

    Since the establishment of extraovarian peritoneal serous papillary carcinoma (EPSPC) as a clinical entity in 1959, less than 250 cases have been described and its clinicopathologic features remain obscure. The present series is a retrospective, case-controlled study comparing the response and survival to cytoreductive surgery followed by cisplatin-based multiagent chemotherapy of 33 women with confirmed EPSPC versus 33 cases with papillary serous ovarian cancer (PSOC). Each EPSPC case was matched to a PSOC control for extent and distribution of disease prior to and following cytoreductive surgery, tumor grade, patient age, and treatment. Additionally, the new Gynecologic Oncology Group criteria for the diagnosis for EPSPC are discussed. There were no significant differences in tumor response to therapy, disease-free interval, and actuarial survival between cases and controls. These data suggest that EPSPC is clinically similar to PSOC and support the need for a prospective clinical trial to compare these two entities further. PMID:8406199

  7. Turned Implants in Vertical Augmented Bone: A Retrospective Study with 13 to 21 Years Follow-Up.

    PubMed

    Simion, Massimo; Ferrantino, Luca; Idotta, Eleonora; Zarone, Fernando

    2016-01-01

    The aim of this retrospective clinical trial was to evaluate the performance of 91 turned implants placed in vertically augmented ridges in 33 patients by means of guided bone regeneration techniques after a mean follow-up of 15 years. A total of 88 implants were in function (97% survival rate), whereas 9 showed peri-implantitis (9.9%). A mean radiographic bone loss of 1.02 mm between the baseline evaluation (1 year after loading) and the final visit (13 to 21 years later) was recorded. In conclusion, turned implants placed in vertically augmented bone seem to remain stable after many years of function. PMID:27100800

  8. Nasopharyngeal Development in Patients with Cleft Lip and Palate: A Retrospective Case-Control Study

    PubMed Central

    Wermker, Kai; Jung, Susanne; Joos, Ulrich; Kleinheinz, Johannes

    2012-01-01

    Introduction. The aim of this paper was to evaluate cephalometrically the nasopharyngeal development of patients with complete unilateral cleft lip and palate. Influencing factors were evaluated and cleft to noncleft subjects were compared to each other. Material and Methods. The lateral cephalograms of 66 patients with complete cleft lip and palate were measured and compared retrospectively to the cephalograms of 123 healthy probands. Measurements were derived from a standardized analysis of 56 landmarks. Results. We observed significant differences between cleft and control group: the cleft patients showed amaxillary retroposition and a reduced maxillary length; the inclination of the maxilla was significantly more posterior and cranial; the anterior nasopharyngeal height was reduced; the nasopharyngeal growth followed a vertical tendency with reduced sagittal dimensions concerning hard and soft tissue. The velum length was reduced. In the cleft group, an accumulation of mandibular retrognathia and an anterior position of the hyoid were observed. Skeletal configuration and type of growth were predominantly vertical. Conclusions. Our data provides a fundamental radiological analysis of the nasopharyngeal development in cleft patients. It confirms the lateral cephalogram as a basic diagnostic device in the analysis of nasopharyngeal and skeletal growth in cleft patients. PMID:22523495

  9. Impact of tamsulosin exposure on late complications following cataract surgery: retrospective cohort study.

    PubMed

    González-Martín-Moro, Julio; González-López, Julio José; Gómez-Sanz, Fernando; Zarallo-Gallardo, Jesús; Cobo-Soriano, Rosario

    2014-08-01

    The purpose of this study is to measure the impact of tamsulosin intake on five postoperative cataract surgery complications (toxic anterior segment syndrome, rebound uveitis, retinal detachment, macular edema, and postoperative endophthalmitis). This retrospective cohort study was conducted at University Hospital of Henares. The study included 660-eyes of 660 patients submitted to cataract surgery at the ophthalmology unit of Hospital del Henares (Madrid) between 2 March 2009 and 28 February 2010. Extracapsular cataract extraction, combined glaucoma and cataract surgery phacovitrectomy, posterior capsule rupture and zonular damage were considered exclusion criteria. Clinical charts were reviewed during July 2012. Patients were divided in two groups (exposed and non-exposed to tamsulosin). Cumulative incidence of toxic anterior segment syndrome, rebound uveitis, retinal detachment, macular edema and postoperative endophthalmitis were compared in both groups. Rebound uveitis (relative risk [RR] 3.39; confidence interval [CI] 1.63-7.08) and macular edema (RR 4.15; CI 1.06-16.22) were more common in the tamsulosin-exposed group. Retinal detachment had a similar incidence in both groups. We observed no cases of endophthalmitis or toxic anterior segment syndrome in either of the two groups. Tamsulosin exposure in this cohort was associated with a higher risk of rebound uveitis and macular edema but the other three studied postoperative complications had a similar incidence in both groups. PMID:24158613

  10. Pseudomeningocele formation following chiari decompression: 19-year retrospective review of predisposing and prognostic factors

    PubMed Central

    Menger, R.; Connor, D.E.; Hefner, M.; Caldito, G.; Nanda, A.

    2015-01-01

    Background: Pseudomeningocele is a known operative complication of Chiari decompression with significant morbidity. Methods: A retrospective analysis of 150 consecutive patients from November 1991 to June 2011 was conducted. Symptomatic pseudomeningocele was defined clinically; to meet definition it must have required operative intervention. Variables evaluated included sex, age, use of graft, and use of operative sealant. The Chi-square, Fisher test, and the two-sample t-test were used as appropriate to determine significance. Multiple logistic regression was used to determine independent risk factors for complication. Results: A total of 67.3% of patients were female, with average age being 39.7 years. A total of 67.3% of patients had a graft placed with the most common being fascia lata. Only nine patients (6%) presented with pseudomeningocele. Factors observed to be significantly associated with pseudomeningocele development were age and use of sealant. Age and sealant use were also independent risk factors for complication. Adjusted for the significant effect of age, odds for complication among patients with sealant usage were 6.67 times those for patients without sealant. Adjusted for the significance of sealant usage, there is a 6% increase in odds for complication for every year increase in patient's age. Conclusions: A statistically significant relationship exists between age and sealant use and the risk of developing a postoperative pseudomeningocele. Emphasis and attention must be placed on meticulous closure technique. This information can aide in preoperative planning and patient selection. PMID:25984384

  11. Space tug thermal control follow-on

    NASA Technical Reports Server (NTRS)

    Ward, T. L.

    1975-01-01

    The Space Tug Thermal Control Follow-On program was conducted to further explore some of the thermal control concepts proposed for use in space tug in a breadboard test program. The objectives were to demonstrate the thermal control capabilities of a louver/battery configuration and a thermal conditioning panel/heat pipe radiator configuration. An additional objective was added to model the header pipe and radiator of the second test and correlate the analysis with the test results. These three objectives were achieved and are discussed within this report.

  12. Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study

    PubMed Central

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Bardhan, Pradip Kumar; Faruque, Abu S. G.; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

    2015-01-01

    Background In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM) children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children. Methods In this retrospective case-control study SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50) with those without severe sepsis (controls = 354). Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline. Results The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001). In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons). Conclusion and Significance We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case

  13. Risk of Nephrotic Syndrome following Enteroviral Infection in Children: A Nationwide Retrospective Cohort Study

    PubMed Central

    Lin, Jiun-Nong; Lin, Cheng-Li; Yang, Chi-Hui; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Kao, Chia-Hung

    2016-01-01

    Purpose Nephrotic syndrome is a common chronic illness encountered during childhood. Infections have been identified as a cause of nephrotic syndrome. The aim of this study was to evaluate the association between enteroviral infection and nephrotic syndrome. Methods A nationwide retrospective cohort study was conducted by analyzing data from the National Health Insurance Research Database in Taiwan. Children aged <18 years with enteroviral infection were enrolled. Non-enterovirus-infected children were randomly selected as the comparison cohort. The primary endpoint was the occurrence of nephrotic syndrome. Methods This study included 280,087 enterovirus-infected children and 280,085 non-enterovirus-infected children. The mean age of the enterovirus-infected children was 2.38 years, and 53.7% of these children were boys. The overall incidence densities of nephrotic syndrome for enterovirus- and non-enterovirus-infected children were 2.65 and 2.21 per 10,000 person-years, respectively. The enterovirus-infected cohort had a higher cumulative incidence of nephrotic syndrome than did the non-enterovirus-infected cohort (log-rank test, p = 0.01). Multivariable analyses revealed that children with enteroviral infection were significantly associated with an increased risk of nephrotic syndrome compared with those without enteroviral infection (adjusted hazard ratio, 1.20; 95% confidence interval, 1.04–1.39; p = 0.01), particularly in children infected with coxsackievirus. Subgroup analyses revealed that enterovirus-infected girls, children of blue-collar workers, and children without allergies had a higher risk of nephrotic syndrome than did children in the non-enterovirus-infected cohort. Conclusion This study revealed a significant association between enteroviral infection and nephrotic syndrome. Additional studies elucidating the role and pathogenesis of enterovirus in nephrotic syndrome are warranted. PMID:27508414

  14. A Retrospective Investigation of Thiamin and Energy Intakes Following an Outbreak of Beriberi in the Gambia

    PubMed Central

    Thurnham, David I.; Cathcart, Angela E.; Livingstone, Margaret B. E.

    2011-01-01

    In the early part of the rainy season in 1988, an outbreak of beriberi occurred in free-living adults in a relatively small area in the North Bank region of The Gambia. In 1995 we selected two compounds in a village called Chilla situated within the affected district to retrospectively examine dietary factors potentially contributing to the outbreak. There had previously been cases of beriberi in one compound (BBC) but not in the other (NBC). We measured energy and thiamin intakes for four days on six occasions during the year. We calculated energy and thiamin intakes of people living in the two compounds and foods were collected for thiamin analysis through the year. Thiamin:Energy ratios only met international recommendations in the immediate post‑harvest season when energy and thiamin intakes were highest and then fell through the year. In the rainy season when food was short and labour was heaviest, energy intakes were lower in the NBC but thiamin:energy ratios were lower in BBC. Records of rainfall in 1988 collected near the village indicated that the amount in August was twice the average. We suggest the heavy rainfall may have increased farm workload and reduced income from outside-village work activity. The lower energy intakes in the NBC may have forced adults to rest thus sparing thiamin demands and delaying onset of beriberi. In contrast, the higher energy intake of adults in the BBC may have enabled them to continue working, thus increasing demands for thiamin and inducing the earlier onset of beriberi. PMID:22254079

  15. A retrospective investigation of thiamin and energy intakes following an outbreak of beriberi in The Gambia.

    PubMed

    Thurnham, David I; Cathcart, Angela E; Livingstone, Margaret B E

    2011-01-01

    In the early part of the rainy season in 1988, an outbreak of beriberi occurred in free-living adults in a relatively small area in the North Bank region of The Gambia. In 1995 we selected two compounds in a village called Chilla situated within the affected district to retrospectively examine dietary factors potentially contributing to the outbreak. There had previously been cases of beriberi in one compound (BBC) but not in the other (NBC). We measured energy and thiamin intakes for four days on six occasions during the year. We calculated energy and thiamin intakes of people living in the two compounds and foods were collected for thiamin analysis through the year. Thiamin:Energy ratios only met international recommendations in the immediate post‑harvest season when energy and thiamin intakes were highest and then fell through the year. In the rainy season when food was short and labour was heaviest, energy intakes were lower in the NBC but thiamin:energy ratios were lower in BBC. Records of rainfall in 1988 collected near the village indicated that the amount in August was twice the average. We suggest the heavy rainfall may have increased farm workload and reduced income from outside-village work activity. The lower energy intakes in the NBC may have forced adults to rest thus sparing thiamin demands and delaying onset of beriberi. In contrast, the higher energy intake of adults in the BBC may have enabled them to continue working, thus increasing demands for thiamin and inducing the earlier onset of beriberi. PMID:22254079

  16. Recovery of postural equilibrium control following spaceflight

    NASA Technical Reports Server (NTRS)

    Paloski, W. H.; Reschke, M. F.; Black, F. O.; Doxey, D. D.; Harm, D. L.

    1992-01-01

    Decreased postural stability is observed in most astronauts immediately following spaceflight. Because ataxia may present postflight operational hazards, it is important to determine the incidence of postural instability immediately following landing and the dynamics of recovery of normal postural equilibrium control. It is postulated that postflight postural instability results from in-flight adaptive changes in central nervous system (CNS) processing of sensory information from the visual, vestibular, and proprioceptive systems. The purpose of the present investigation was to determine the magnitude and time course of postflight recovery of postural equilibrium control and, hence, readaptation of CNS processing of sensory information. Thirteen crew members from six spaceflight missions were studied pre- and postflight using a modified commercial posturography system. Postural equilibrium control was found to be seriously disrupted immediately following spaceflight in all subjects. Readaptation to the terrestrial environment began immediately upon landing, proceeded rapidly for the first 10-12 hours, and then proceeded much more slowly for the subsequent 2-4 days until preflight stability levels were reachieved. It is concluded that the overall postflight recovery of postural stability follows a predictable time course.

  17. Outcome of nephrostomy balloon dilation for vesicourethral anastomotic strictures following radical prostatectomy: A retrospective study

    PubMed Central

    Zhang, Chong-Yu; Zhu, Yu; Li, Kin; Ian, Laphong; Ho, Sonfat; Pun, Waihong; Lao, Hiofai; Carvalho, Vitalino; Liu, Ding-Yi; Shen, Zhou-Jun

    2014-01-01

    To evaluate the efficacy of nephrostomy balloon dilation (NBD) for patients who developed vesicourethral anastomotic stricture (VAS) following radical prostatectomy. NBD was performed in patients who developed VAS following radical prostatectomy. Quality of life (QoL), International Prostate Symptom Score (IPSS) and maximal urinary flow rate (Qmax) were evaluated. Four hundred and sixty-three prostate cancer patients underwent radical retropubic prostatectomy (RRP), and 86 underwent laparoscopic radical prostatectomy (LRP). Most patients (90.3%) had T2 or T3 prostate cancer and a pathological Gleason score of ≤ 7. Forty-five (8.2%) and four (4.7%) patients developed VAS due to radical or LRP, respectively. Forty (89%) patients underwent NBD, including three cases of repeat dilation. The median Qmax was 4 ml s−1 (interquartile range (IQR), 2.3-5.6) before dilation and improved to 16 ml s−1 (IQR, 15–19) and 19 ml s−1 (IQR, 18-21) at the 1- and 12-month follow-up, respectively (P < 0.01). Fifteen (37.5%) patients had urinary incontinence prior to dilation, whereas only three (7.5%) patients had incontinence 12 months following dilation (P < 0.01). The median IPSS score improved from 19 (IQR, 17–24) before dilation to 7 (IQR, 6–8) at 12 months following dilation, and the QoL score improved from 5 (IQR, 4–6) before dilation to 2 (IQR, 2–3) at 12 months following dilation (P < 0.01 in both). VAS occurs in a small but significant proportion of patients following radical prostatectomy. NBD offers an effective remedy for VAS. PMID:24369143

  18. An 11-year retrospective review of venlafaxine ingestion in children from the California Poison Control System.

    PubMed

    Doroudgar, S; Perry, P J; Lackey, G D; Veselova, N G; Chuang, H M; Albertson, T E

    2016-07-01

    Venlafaxine is commonly used in the United States for approved and non-Food and Drug Administration-approved indications in adults. It is used off-label to treat children for psychiatric diagnoses. The aim of the study was to describe venlafaxine toxicities in children and to identify the venlafaxine dose per weight that correlates with toxicities. An 11-year retrospective study of venlafaxine ingestion in children was performed using the California Poison Control System (CPCS) database. Data was extracted from phone calls received by CPCS clinicians and follow-up phone calls made to assess the patient's progress in a health-care setting. Inclusion criteria were venlafaxine ingestion cases reported to CPCS between January 2001 and December 2011, children aged 20 years and under, venlafaxine as the only ingested substance, managed in a health-care facility, and followed to a known outcome. Two hundred sixty-two cases met the study criteria. Common presentations included gastrointestinal (14.9%), altered mental status (13.7%), and tachycardia (13.4%). The majority of the cases resulted in no effect (51.5%) or minor effect (19.9%). The average estimated dose per weight was 18.3 mg/kg in all patients and 64.5 mg/kg in those experiencing moderate-to-severe adverse effects. Seizures occurred in only 4 of the 262 cases at doses ranging from 1500 to 7500 mg. Although the estimated dose per weight exceeded 10 mg/kg for the majority of the cases, only 12 cases resulted in moderate or severe outcomes. The majority of venlafaxine ingestion cases in children resulted in either no clinical effects or minor clinical effects. PMID:26351291

  19. The human controller in car following

    NASA Technical Reports Server (NTRS)

    Burnham, G. O.; Bekey, G. A.

    1975-01-01

    The man machine interface between the human driver and his automobile during car following tasks was examined. A direct connection between models of the human operator and the theory of optimal control was established for car following situations involving both linear and nonlinear car dynamics. Results obtained from several types of mathematical models are discussed. Conventional parameter identification techniques were used to obtain the parameters of these models by comparing their performance to data obtained by aerial photogrammetry. The results indicate that there are two general classes of model structures: models assumed to have preview information and models without preview.

  20. Lower Eyelid Malposition Following Orbital Fracture Surgery: A Retrospective Analysis Based on 198 Surgeries.

    PubMed

    Kesselring, Alexandra G; Promes, Paul; Strabbing, Elske M; van der Wal, Karel G H; Koudstaal, Maarten J

    2016-06-01

    The aim of this study is to analyze the development of lower eyelid malposition following reconstruction of orbital fractures, in relation to the incisions used for access. A total of 198 surgical orbital floor reconstructions were performed in 175 patients between 2001 and 2011. Preoperative and postoperative presence of lower eyelid malposition of patients was reported. The types of incision used for access were as follows: approach via laceration (4.5%), via preexisting scar (16.2%), infraorbital (40.9%), subciliar (23.7%), transconjunctival (13.1%), and transconjunctival with lateral canthotomy (1.5%). The incidence of ectropion development following surgery was 3.0% and the incidence of entropion development following surgery was 1.0%. The highest rate of ectropion (11.1%) was seen using an approach via a laceration, followed by approach via a scar (6.3%). Our conclusion is that the transconjunctival incision without a lateral canthotomy has a low complication rate, provides adequate exposure, and leaves no visible scar. PMID:27162565

  1. Symptomatic hypothalamic-pituitary dysfunction in nasopharyngeal carcinoma patients following radiation therapy: a retrospective study

    SciTech Connect

    Lam, K.S.; Ho, J.H.; Lee, A.W.; Tse, V.K.; Chan, P.K.; Wang, C.; Ma, J.T.; Yeung, R.T.

    1987-09-01

    Endocrine assessment was performed in 32 relapse-free southern Chinese patients 5-17 years following radiation therapy (RT) alone for early nasopharyngeal carcinoma (NPC). Initial screening was done using questionnaires emphasizing impaired sexual function and menstrual disturbance plus measurement of serum levels of thyroxine, free thyroxine index, thyrotropic hormone, prolactin, and additionally testosterone for males only. Those showing abnormalities were subjected to detailed pituitary function tests. Hypothalamic-pituitary dysfunction was found in 7 female patients and only 1 male patient. A delayed TSH response to thyrotropin releasing hormone suggesting a hypothalamic disorder was seen in 6 of the affected female patients, and hyperprolactinaemia in also 6. None of the patients had evidence of diabetes insipidus. Hypopituitarism became symptomatic 2-5 years after RT with a mean latent interval of 3.8 years. A practical protocol for regular endocrine assessment for NPC patients after RT has been proposed. Multiple linear regression analysis of the radiotherapeutic data from the 11 female patients indicates that the likelihood of late occurrence of symptomatic hypothalamic-pituitary dysfunction following RT is dependent on the TDF of the target dose to the nasopharyngeal region and the height of the upper margin of the opposed lateral facial fields above the diaphragma sellae (coefficient of multiple correlation = 0.9025). Except when the sphenoid sinus or the middle cranial fossa is involved, it is advisable to set the height of the upper margin of the lateral facial field at a level no higher than the diaphragma sellae. The hypothalamus and possibly the pituitary stalk as well may sustain permanent damage by doses of radiation within the conventional radiotherapeutic range for carcinomas.

  2. Thin-Section CT Characteristics and Longitudinal CT Follow-up of Chemotherapy Induced Interstitial Pneumonitis: A Retrospective Cohort Study.

    PubMed

    Lee, Han Na; Kim, Mi Young; Koo, Hyun Jung; Kim, Sung-Soo; Yoon, Dok Hyun; Lee, Jae Cheol; Song, Jin Woo

    2016-01-01

    To describe the computed tomography (CT) features of chemotherapy-induced interstitial pneumonitis (CIIP) with longitudinal follow-up.The study was approved by the local ethics committee. One hundred consecutive patients with CIIP between May 2005 and March 2015 were retrospectively enrolled. The initial CT was reviewed by 2 independent chest radiologists and categorized into 1 of 4 CT patterns in accordance with the 2013 guidelines for idiopathic interstitial pneumonia: nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), hypersensitivity pneumonitis (HP) mimicking desquamative interstitial pneumonitis, and diffuse alveolar damage (DAD). We assessed semiquantitative analysis on a 5% scale to assess the extent of parenchymal abnormalities (emphysema, reticulation, ground-glass opacity, consolidation, honeycombing cyst) and their distribution on initial (n = 100), subsequent (n = 87), and second follow-up CT (n = 48). Interval changes in extent on follow-up CT were compared using paired t test. The clinic-radiologic factors were compared between Group 1 (NSIP and OP patterns) and Group 2 (HP and DAD patterns) using χ and independent t tests.The most common pattern of CIIP on the initial CT was HP (51%), followed by NSIP (23%), OP (20%), and DAD (6%). Diffuse ground-glass opacity was the most common pulmonary abnormality. The predominant distribution was bilateral (99%) and symmetric (82%), with no craniocaudal (60%) or axial (79%) dominance. Subsequent and second follow-up CTs showed decreased extent of total pulmonary abnormalities (P < 0.001, respectively). In comparison with Group 1 CIIP, Group 2 CIIP was more likely to be caused by molecularly targeted drugs (P = 0.030), appeared earlier (P = 0.034), and underwent more complete resolution (P < 0.001). Use of a CT pattern-recognition approach to CIIP is appropriate and practical in interpreting radiological findings. PMID:26765442

  3. Neoadjuvant chemoradiation versus perioperative chemotherapy followed by surgery in resectable adenocarcinomas of the esophagogastric junction: A retrospective single center analysis

    PubMed Central

    SCHULZE, BJÖRN; BERGIS, DOMINIK; BALERMPAS, PANAGIOTIS; TROJAN, JÖRG; WOESTE, GUIDO; BECHSTEIN, WOLF OTTO; RÖDEL, CLAUS; WEISS, CHRISTIAN

    2014-01-01

    The current study presents a retrospective comparison, performed at a single academic center, of preoperative chemoradiation (CRT) and perioperative chemotherapy (CT) in addition to surgery in locally advanced but resectable adenocarcinoma of the esophagogastric junction (AEG). A total of 29 consecutive patients with locally advanced AEGs were retrospectively analyzed. Treatment consisted of preoperative CRT (mean dose, 45.0 Gy) plus two cycles of CT with cisplatin and 5-FU or perioperative CT with epirubicin, cisplatin and capecitabine (three cycles preoperatively and postoperatively). Within four to six weeks following preoperative treatment, surgical therapy was performed. Median overall survival was 21.0 months in the perioperative CT group versus 41.7 months in the CRT group [P=0.36; hazard ratio (HR), 1.50; 95% confidence interval (CI), 0.58–3.84]. Three-year survival rates were 55 and 38%, respectively, in favor of the CRT group, and progression-free survival was 20.0 months in the CT group compared with 24.1 months in the CRT group (P=0.71; HR, 1.19; 95% CI, 0.46–3.05). The total number of major surgical complications was almost equal in the two groups. Margin-free resections were achieved in all patients of the CRT group, but only 76.9% of the CT group (P=0.05). In addition, significantly higher R0 resection rates and an increased number of pathological complete remissions were demonstrated in the CRT group compared with those of the CT group. These results appear to indicate a trend for improved progression-free and overall survival for the CRT group. As postoperative morbidity and mortality rates were similar in the two groups, the results support the use of CRT for patients with advanced AEG tumors. PMID:24396483

  4. Executive control and felt concentrative engagement following intensive meditation training

    PubMed Central

    Zanesco, Anthony P.; King, Brandon G.; MacLean, Katherine A.; Saron, Clifford D.

    2013-01-01

    Various forms of mental training have been shown to improve performance on cognitively demanding tasks. Individuals trained in meditative practices, for example, show generalized improvements on a variety of tasks assessing attentional performance. A central claim of this training, derived from contemplative traditions, posits that improved attentional performance is accompanied by subjective increases in the stability and clarity of concentrative engagement with one's object of focus, as well as reductions in felt cognitive effort as expertise develops. However, despite frequent claims of mental stability following training, the phenomenological correlates of meditation-related attentional improvements have yet to be characterized. In a longitudinal study, we assessed changes in executive control (performance on a 32-min response inhibition task) and retrospective reports of task engagement (concentration, motivation, and effort) following one month of intensive, daily Vipassana meditation training. Compared to matched controls, training participants exhibited improvements in response inhibition accuracy and reductions in reaction time variability. The training group also reported increases in concentration, but not effort or motivation, during task performance. Critically, increases in concentration predicted improvements in reaction time variability, suggesting a link between the experience of concentrative engagement and ongoing fluctuations in attentional stability. By incorporating experiential measures of task performance, the present study corroborates phenomenological accounts of stable, clear attentional engagement with the object of meditative focus following extensive training. These results provide initial evidence that meditation-related changes in felt experience accompany improvements in adaptive, goal-directed behavior, and that such shifts may reflect accurate awareness of measurable changes in performance. PMID:24065902

  5. Medical Efforts and Injury Patterns of Military Hospital Patients Following the 2013 Lushan Earthquake in China: A Retrospective Study.

    PubMed

    Kang, Peng; Tang, Bihan; Liu, Yuan; Liu, Xu; Liu, Zhipeng; Lv, Yipeng; Zhang, Lulu

    2015-09-01

    The aim of this paper is to investigate medical efforts and injury profiles of victims of the Lushan earthquake admitted to three military hospitals. This study retrospectively investigated the clinical records of 266 admitted patients evacuated from the Lushan earthquake area. The 2005 version of the Abbreviated Injury Scale (AIS-2005) was used to identify the severity of each injury. Patient demographic data, complaints, diagnoses, injury types, prognosis, means of transportation, and cause of injury were all reviewed individually. The statistical analysis of the study was conducted primarily using descriptive statistics. Of the 266 patients, 213 (80.1%) were admitted in the first two days. A total of 521 injury diagnoses were recorded in 266 patients. Earthquake-related injuries were primarily caused by buildings collapsing (38.4%) and victims being struck by objects (33.8%); the most frequently injured anatomic sites were the lower extremities and pelvis (34.2%) and surface area of the body (17.9%). Fracture (41.5%) was the most frequent injury, followed by soft tissue injury (27.5%), but crush syndrome was relatively low (1.2%) due to the special housing structures in the Lushan area. The most commonly used procedure was suture and dressings (33.7%), followed by open reduction and internal fixation (21.9%).The results of this study help formulate recommendations to improve future disaster relief and emergency planning in remote, isolated, and rural regions of developing countries. PMID:26334286

  6. Medical Efforts and Injury Patterns of Military Hospital Patients Following the 2013 Lushan Earthquake in China: A Retrospective Study

    PubMed Central

    Kang, Peng; Tang, Bihan; Liu, Yuan; Liu, Xu; Liu, Zhipeng; Lv, Yipeng; Zhang, Lulu

    2015-01-01

    The aim of this paper is to investigate medical efforts and injury profiles of victims of the Lushan earthquake admitted to three military hospitals. This study retrospectively investigated the clinical records of 266 admitted patients evacuated from the Lushan earthquake area. The 2005 version of the Abbreviated Injury Scale (AIS-2005) was used to identify the severity of each injury. Patient demographic data, complaints, diagnoses, injury types, prognosis, means of transportation, and cause of injury were all reviewed individually. The statistical analysis of the study was conducted primarily using descriptive statistics. Of the 266 patients, 213 (80.1%) were admitted in the first two days. A total of 521 injury diagnoses were recorded in 266 patients. Earthquake-related injuries were primarily caused by buildings collapsing (38.4%) and victims being struck by objects (33.8%); the most frequently injured anatomic sites were the lower extremities and pelvis (34.2%) and surface area of the body (17.9%). Fracture (41.5%) was the most frequent injury, followed by soft tissue injury (27.5%), but crush syndrome was relatively low (1.2%) due to the special housing structures in the Lushan area. The most commonly used procedure was suture and dressings (33.7%), followed by open reduction and internal fixation (21.9%).The results of this study help formulate recommendations to improve future disaster relief and emergency planning in remote, isolated, and rural regions of developing countries. PMID:26334286

  7. Prolonged Epidural Infusion Improves Functional Outcomes Following Knee Arthroscopy in Patients with Arthrofibrosis after Total Knee Arthroplasty: A Retrospective Evaluation.

    PubMed

    Saltzman, Bryan M; Dave, Ankur; Young, Adam; Ahuja, Mukesh; Amin, Sandeep D; Bush-Joseph, Charles A

    2016-01-01

    A total of 20 consecutive patients with knee stiffness post total knee arthroplasty (TKA) underwent arthroscopic lysis of adhesions and manipulation plus indwelling epidural were evaluated retrospectively. Epidural catheters were placed preoperatively for an intended 6 weeks of postoperative analgesia to facilitate intensive physical therapy. The mean loss of knee extension immediately before incision was 13.5 ± 9.1 degrees (range, 0-35 degrees) and flexion was 77.65 ± 19.2 degrees (range, 45-125 degrees). At the 6-week and final (mean, 0.47 years) follow-up, the loss of extension was 1.5 ± 5.1 degrees (range, -10 to +7 degrees) and 5.4 ± 4.7 degrees (range, 0-15 degrees), respectively, and flexion was 99.7 ± 12.3 degrees (range, 75-120 degrees) and 98.5 ± 16.1 degrees (range, 75-130 degrees), respectively. Of the 20 patients, 2 missed their 6-week clinic visit. Improvements in motion immediately preoperative to 6-week and final follow-up were each significant (p < 0.01). At examination 6 weeks postoperatively, 94.4% of patients met the definition for clinical motion success and 70% maintained success at final follow-up. Visual analog scale improved significantly from 5.4 to 2.0 (p < 0.01) at 6 weeks postoperative in the 12 patients with this data recorded. On the basis of this data, use of tunneled epidurals with arthroscopic lysis of adhesions for arthrofibrosis after TKA is correlated with a high likelihood of functional success postoperatively as measured by range of motion improvement. PMID:25300008

  8. Regression Rates Following the Treatment of Aggressive Posterior Retinopathy of Prematurity with Bevacizumab Versus Laser: 8-Year Retrospective Analysis.

    PubMed

    Nicoară, Simona D; Ștefănuţ, Anne C; Nascutzy, Constanta; Zaharie, Gabriela C; Toader, Laura E; Drugan, Tudor C

    2016-01-01

    BACKGROUND Retinopathy is a serious complication related to prematurity and a leading cause of childhood blindness. The aggressive posterior form of retinopathy of prematurity (APROP) has a worse anatomical and functional outcome following laser therapy, as compared with the classic form of the disease. The main outcome measures are the APROP regression rate, structural outcomes, and complications associated with intravitreal bevacizumab (IVB) versus laser photocoagulation in APROP. MATERIAL AND METHODS This is a retrospective case series that includes infants with APROP who received either IVB or laser photocoagulation and had a follow-up of at least 60 weeks (for the laser photocoagulation group) and 80 weeks (for the IVB group). In the first group, laser photocoagulation of the retina was carried out and in the second group, 1 bevacizumab injection was administered intravitreally. The following parameters were analyzed in each group: sex, gestational age, birth weight, postnatal age and postmenstrual age at treatment, APROP regression, sequelae, and complications. Statistical analysis was performed using Microsoft Excel and IBM SPSS (version 23.0). RESULTS The laser photocoagulation group consisted of 6 premature infants (12 eyes) and the IVB group consisted of 17 premature infants (34 eyes). Within the laser photocoagulation group, the evolution was favorable in 9 eyes (75%) and unfavorable in 3 eyes (25%). Within the IVB group, APROP regressed in 29 eyes (85.29%) and failed to regress in 5 eyes (14.71%). These differences are statistically significant, as proved by the McNemar test (P<0.001). CONCLUSIONS The IVB group had a statistically significant better outcome compared with the laser photocoagulation group, in APROP in our series. PMID:27062023

  9. Retrospective hospital-based analysis of age-related macular degeneration patterns in India: 5-year follow-up

    PubMed Central

    Sudhalkar, Aditya; Sethi, Vaibhav; Gogte, Priyanka; Bondalapati, Sailaja; Khodani, Mitali; Chhablani, Jay Kumar

    2015-01-01

    Purpose: To provide a detailed analysis of age-related macular degeneration (AMD) with a 5-year follow-up at a Tertiary Eye Care Center in India. Methods: In this retrospective institutional study, 408 eyes of 204 subjects (100 males) with a diagnosis of AMD with minimum 5-year follow-up were included. Data collected included demographics, details of the ocular exam, special investigations performed, treatment offered, complications, and systemic diseases, if any. Results: The median age was 74.24 ± 8.23 years. Median follow-up was 5.77 years. The visual acuity (VA) at baseline and last visit was 0.74 ± 0.12 (Snellen's equivalent 20/100) and 0.54 ± 0.12 logarithm of the minimum angle of resolution (Snellen's equivalent 20/50; P = 0.032) in patients with choroidal neovascular membrane (CNVM). The most common complaint was decreased vision (94.5%). AMD (any stage) was found to be bilateral in 93% of patients at baseline and 197 patients (96.56%) at 5 years. Seventeen eyes had active CNVM (12 of these were occult) at presentation. At baseline, 43 eyes had a disciform scar. Three hundred twenty-one eyes had dry AMD at baseline (geographic atrophy - 12 [3.7%] eyes). Five-year conversion rate into wet AMD and geographic atrophy was 2.87% and 3.12%. Median number of anti-vascular endothelial growth factor injections administered per patient was 2.8 ± 1.2. CNVM bilaterality was low (7.5%). Conclusion: Patients with AMD in India presented later in the course of the disease. Bilateral advanced AMD and geographic atrophy were uncommon. Five-year conversion rate into wet AMD and geographic atrophy was 2.87% and 3.12%. PMID:26862094

  10. Regression Rates Following the Treatment of Aggressive Posterior Retinopathy of Prematurity with Bevacizumab Versus Laser: 8-Year Retrospective Analysis

    PubMed Central

    Nicoară, Simona D.; Ştefănuţ, Anne C.; Nascutzy, Constanta; Zaharie, Gabriela C.; Toader, Laura E.; Drugan, Tudor C.

    2016-01-01

    Background Retinopathy is a serious complication related to prematurity and a leading cause of childhood blindness. The aggressive posterior form of retinopathy of prematurity (APROP) has a worse anatomical and functional outcome following laser therapy, as compared with the classic form of the disease. The main outcome measures are the APROP regression rate, structural outcomes, and complications associated with intravitreal bevacizumab (IVB) versus laser photocoagulation in APROP. Material/Methods This is a retrospective case series that includes infants with APROP who received either IVB or laser photocoagulation and had a follow-up of at least 60 weeks (for the laser photocoagulation group) and 80 weeks (for the IVB group). In the first group, laser photocoagulation of the retina was carried out and in the second group, 1 bevacizumab injection was administered intravitreally. The following parameters were analyzed in each group: sex, gestational age, birth weight, postnatal age and postmenstrual age at treatment, APROP regression, sequelae, and complications. Statistical analysis was performed using Microsoft Excel and IBM SPSS (version 23.0). Results The laser photocoagulation group consisted of 6 premature infants (12 eyes) and the IVB group consisted of 17 premature infants (34 eyes). Within the laser photocoagulation group, the evolution was favorable in 9 eyes (75%) and unfavorable in 3 eyes (25%). Within the IVB group, APROP regressed in 29 eyes (85.29%) and failed to regress in 5 eyes (14.71%). These differences are statistically significant, as proved by the McNemar test (P<0.001). Conclusions The IVB group had a statistically significant better outcome compared with the laser photocoagulation group, in APROP in our series. PMID:27062023

  11. Sarcopenia as a prognostic factor in hepatolithiasis-associated intrahepatic cholangiocarcinoma patients following hepatectomy: a retrospective study

    PubMed Central

    Zhou, Gongting; Bao, Haili; Zeng, Qiqiang; Hu, Weijian; Zhang, Qiyu

    2015-01-01

    Background: Sarcopenia is closely associated with poor performance status and high mortality in cancer patients. The present study is to determine the correlation between sarcopenia and prognosis of hepatectomy for hepatolithiasis-associated intrahepatic cholangiocarcinoma (IHHCC). Methods: Sixty-seven eligible IHHCC patients who underwent hepatectomy, between January 2000 and August 2014 were retrospectively evaluated. Sarcopenia was determined from skeletal muscle index (SMI), assessed by skeletal muscle mass on axial computed tomography images. Factors contributing to overall survival (OS) and recurrence-free survival (RFS) were analyzed by univariate and multivariate analyses. Results: Sarcopenia occurred in 33 (49.3%) out of 67 patients. Median OS of the enrolled patients was 12 months. Sarcopenic patients had a shorter OS compared with non-sarcopenic patients (P < 0.001). On univariate analyses, sarcopenia was significantly associated with overall survival (OS) and recurrence-free survival (RFS; both P < 0.05). On multivariate analysis, sarcopenic patients suffered poor overall survival (P < 0.001) and recurrence-free survival (P = 0.011) compared with non-sarcopenic patients. Conclusions: Preoperative sarcopenia is an independent biomarker of poor prognosis in IHHCC patients following hepatectomy. The identification of sarcopenia may enhance a clinical consideration on decision making for IHHCC patients before surgery. PMID:26770426

  12. A Control Chart Based on Cluster-Regression Adjustment for Retrospective Monitoring of Individual Characteristics

    PubMed Central

    Ong, Hong Choon; Alih, Ekele

    2015-01-01

    The tendency for experimental and industrial variables to include a certain proportion of outliers has become a rule rather than an exception. These clusters of outliers, if left undetected, have the capability to distort the mean and the covariance matrix of the Hotelling’s T2 multivariate control charts constructed to monitor individual quality characteristics. The effect of this distortion is that the control chart constructed from it becomes unreliable as it exhibits masking and swamping, a phenomenon in which an out-of-control process is erroneously declared as an in-control process or an in-control process is erroneously declared as out-of-control process. To handle these problems, this article proposes a control chart that is based on cluster-regression adjustment for retrospective monitoring of individual quality characteristics in a multivariate setting. The performance of the proposed method is investigated through Monte Carlo simulation experiments and historical datasets. Results obtained indicate that the proposed method is an improvement over the state-of-art methods in terms of outlier detection as well as keeping masking and swamping rate under control. PMID:25923739

  13. Preliminary Retrospective Analysis of Daily Tomotherapy Output Constancy Checks Using Statistical Process Control

    PubMed Central

    Menghi, Enrico; Marcocci, Francesco; Bianchini, David

    2016-01-01

    The purpose of this study was to retrospectively evaluate the results from a Helical TomoTherapy Hi-Art treatment system relating to quality controls based on daily static and dynamic output checks using statistical process control methods. Individual value X-charts, exponentially weighted moving average charts, and process capability and acceptability indices were used to monitor the treatment system performance. Daily output values measured from January 2014 to January 2015 were considered. The results obtained showed that, although the process was in control, there was an out-of-control situation in the principal maintenance intervention for the treatment system. In particular, process capability indices showed a decreasing percentage of points in control which was, however, acceptable according to AAPM TG148 guidelines. Our findings underline the importance of restricting the acceptable range of daily output checks and suggest a future line of investigation for a detailed process control of daily output checks for the Helical TomoTherapy Hi-Art treatment system. PMID:26848962

  14. The importance of radiological controls of anastomoses after upper gastrointestinal tract surgery - a retrospective cohort study

    PubMed Central

    2010-01-01

    Introduction This study was designed to analyze whether routine radiological controls of anastomoses in the upper gastrointestinal tract an early detection of anastomotic leaks. Patients and Methods 135 patients who underwent upper gastrointestinal tract surgery were retrospectively analyzed. Patients in the first group (n = 55) underwent routine radiological control of the anastomoses. In the second group (n = 80) the radiological control was only performed in case of clinical symptoms or signs of anastomotic leaks. Results The incidence of anastomotic leaks in the patients seen by us was 5.2%, equivalent to 7 of 135 patients In Group 1 leaks were seen in 4 of 55 patients (7,2%) in group 2 leaks were seen in 3 of 80 (3,8%). The radiological control of the anastomoses with contrast swallow showed the leakage in two cases. Twice the results were false negative. The sensitivity of computed tomography was 100%. Discussion Routine radiological control of anastomoses with contrast swallow only has low sensitivity. This procedure should not be performed routinely any more. The radiological control should be used in cases with signs of anastomotic leakage or with postoperatively impaired gastrointestinal passage. PMID:21070633

  15. Preliminary Retrospective Analysis of Daily Tomotherapy Output Constancy Checks Using Statistical Process Control.

    PubMed

    Mezzenga, Emilio; D'Errico, Vincenzo; Sarnelli, Anna; Strigari, Lidia; Menghi, Enrico; Marcocci, Francesco; Bianchini, David; Benassi, Marcello

    2016-01-01

    The purpose of this study was to retrospectively evaluate the results from a Helical TomoTherapy Hi-Art treatment system relating to quality controls based on daily static and dynamic output checks using statistical process control methods. Individual value X-charts, exponentially weighted moving average charts, and process capability and acceptability indices were used to monitor the treatment system performance. Daily output values measured from January 2014 to January 2015 were considered. The results obtained showed that, although the process was in control, there was an out-of-control situation in the principal maintenance intervention for the treatment system. In particular, process capability indices showed a decreasing percentage of points in control which was, however, acceptable according to AAPM TG148 guidelines. Our findings underline the importance of restricting the acceptable range of daily output checks and suggest a future line of investigation for a detailed process control of daily output checks for the Helical TomoTherapy Hi-Art treatment system. PMID:26848962

  16. Effects of Miniscalpel-Needle Release on Chronic Neck Pain: A Retrospective Analysis with 12-Month Follow-Up

    PubMed Central

    Li, Shuming; Shen, Tong; Liang, Yongshan; Zhang, Ying; Bai, Bo

    2015-01-01

    Objective Chronic neck pain is a highly prevalent condition, and is often treated with non-steroidal anti-inflammatory drugs. Limited clinical studies with short-term follow-up have shown promising efficacy of acupuncture as well as miniscalpel-needle (MSN) release. In this retrospective study, we examined whether MSN release could produce long-lasting relief in patients with chronic neck pain. Methods We retrieved the medical records of all patients receiving weekly MSN release treatment for chronic neck pain at this institution during a period from May 2012 to December 2013. Only cases with the following information at prior to, and 1, 6, and 12 months after the treatment, were included in the analysis: neck disability index (NDI), numerical pain rating scale (NPRS), and active cervical range of motion (CROM). The primary analysis of interest is comparison of the 12-month measures with the baseline. Patients who took analgesic drugs or massage within 2 weeks prior to assessment were excluded from the analysis. For MSN release, tender points were identified manually by an experienced physician, and did not necessarily follow the traditional acupuncture system. MSN was inserted vertically (parallel to the spine) until breaking through resistance and patient reporting of distention, soreness or heaviness. The depth of the needling ranged from 10 to 50 mm. The release was carried out by moving the MSN up and down 3–5 times without rotation. Results A total of 559 cases (patients receiving weekly MSN release treatment for chronic neck pain) were screened. The number of cases with complete information (NDI, NPRS, and CROM at baseline, 1, 6 and 12 months after last treatment) was 180. After excluding the cases with analgesic treatment or massage within 2 weeks of assessment (n = 53), a total of 127 cases were included in data analysis. The number of MSN release session was 7 (range: 4–11). At 12 months after the treatment, both NPRS and NDI were significantly lower

  17. Towards more reliable automated multi-dose dispensing: retrospective follow-up study on medication dose errors and product defects.

    PubMed

    Palttala, Iida; Heinämäki, Jyrki; Honkanen, Outi; Suominen, Risto; Antikainen, Osmo; Hirvonen, Jouni; Yliruusi, Jouko

    2013-03-01

    To date, little is known on applicability of different types of pharmaceutical dosage forms in an automated high-speed multi-dose dispensing process. The purpose of the present study was to identify and further investigate various process-induced and/or product-related limitations associated with multi-dose dispensing process. The rates of product defects and dose dispensing errors in automated multi-dose dispensing were retrospectively investigated during a 6-months follow-up period. The study was based on the analysis of process data of totally nine automated high-speed multi-dose dispensing systems. Special attention was paid to the dependence of multi-dose dispensing errors/product defects and pharmaceutical tablet properties (such as shape, dimensions, weight, scored lines, coatings, etc.) to profile the most suitable forms of tablets for automated dose dispensing systems. The relationship between the risk of errors in dose dispensing and tablet characteristics were visualized by creating a principal component analysis (PCA) model for the outcome of dispensed tablets. The two most common process-induced failures identified in the multi-dose dispensing are predisposal of tablet defects and unexpected product transitions in the medication cassette (dose dispensing error). The tablet defects are product-dependent failures, while the tablet transitions are dependent on automated multi-dose dispensing systems used. The occurrence of tablet defects is approximately twice as common as tablet transitions. Optimal tablet preparation for the high-speed multi-dose dispensing would be a round-shaped, relatively small/middle-sized, film-coated tablet without any scored line. Commercial tablet products can be profiled and classified based on their suitability to a high-speed multi-dose dispensing process. PMID:22458299

  18. Reduction in Hospital-Wide Clinical Laboratory Specimen Identification Errors following Process Interventions: A 10-Year Retrospective Observational Study

    PubMed Central

    Ning, Hsiao-Chen; Lin, Chia-Ni; Chiu, Daniel Tsun-Yee; Chang, Yung-Ta; Wen, Chiao-Ni; Peng, Shu-Yu; Chu, Tsung-Lan; Yu, Hsin-Ming; Wu, Tsu-Lan

    2016-01-01

    Background Accurate patient identification and specimen labeling at the time of collection are crucial steps in the prevention of medical errors, thereby improving patient safety. Methods All patient specimen identification errors that occurred in the outpatient department (OPD), emergency department (ED), and inpatient department (IPD) of a 3,800-bed academic medical center in Taiwan were documented and analyzed retrospectively from 2005 to 2014. To reduce such errors, the following series of strategies were implemented: a restrictive specimen acceptance policy for the ED and IPD in 2006; a computer-assisted barcode positive patient identification system for the ED and IPD in 2007 and 2010, and automated sample labeling combined with electronic identification systems introduced to the OPD in 2009. Results Of the 2000345 specimens collected in 2005, 1023 (0.0511%) were identified as having patient identification errors, compared with 58 errors (0.0015%) among 3761238 specimens collected in 2014, after serial interventions; this represents a 97% relative reduction. The total number (rate) of institutional identification errors contributed from the ED, IPD, and OPD over a 10-year period were 423 (0.1058%), 556 (0.0587%), and 44 (0.0067%) errors before the interventions, and 3 (0.0007%), 52 (0.0045%) and 3 (0.0001%) after interventions, representing relative 99%, 92% and 98% reductions, respectively. Conclusions Accurate patient identification is a challenge of patient safety in different health settings. The data collected in our study indicate that a restrictive specimen acceptance policy, computer-generated positive identification systems, and interdisciplinary cooperation can significantly reduce patient identification errors. PMID:27494020

  19. Clinical outcome of 215 transmucosal implants with a conical connection: a retrospective study after 5-year follow-up.

    PubMed

    Lopez, M A; Andreasi Bassi, M; Confalone, L; Gaudio, R M; Lombardo, L; Lauritano, D

    2016-01-01

    The purpose of this retrospective clinical study was to evaluate the survival rate (i.e. SVR – fixtures still in place at the end of the observation period) and success rate (i.e. SCR - bone resorption around implant neck) of an implant system characterized by cylindrical and tapered implants, both types of implant being equipped with a conical connection with an internal octagon (COC), both implant types having a 1.8 mm smooth neck, positioned above the bone crest level. A total of 65 subjects received 215 COCs between January 1996 and October 2011. All COCs were placed and restored by three experienced dental surgeons. The mean follow-up was 84±44 months. The patients involved in the study were both male (30) and female (35), of whom 30 were smokers (less than 20 cigarettes/day) and none was diabetic. The implants differed in terms of diameter and length, and were inserted both in the mandible (97) and in the maxilla (118). Sixty-seven implants were single tooth rehabilitations, and 148 prosthetic bridges. Fourteen had guided bone regeneration (GBR), and 10 were placed in post-extractive sites. Forty of the implants were provided with passing-screw abutments and 175 with full-screw abutments. The data were analyzed using descriptive statistics. None of the implants failed before prosthetic restoration, resulting in an SVR=100% after loading. The radiographic and clinical data revealed well-maintained, hard and soft tissue around the COCs, with an SCR=92.6%. Cox regression analyses did not detect any variables with statistical impact on the clinical outcome. In conclusion, Shiner XT implants are reliable tools for oral rehabilitation. PMID:27469549

  20. A 7-year follow-up retrospective, international, multicenter study of insulin pump therapy in children and adolescents with type 1 diabetes.

    PubMed

    Mameli, Chiara; Scaramuzza, Andrea E; Ho, Josephine; Cardona-Hernandez, Roque; Suarez-Ortega, Larisa; Zuccotti, Gian Vincenzo

    2014-04-01

    We evaluated the long-term glycemic control in children with type 1 diabetes, using continuous subcutaneous insulin infusion (CSII) for at least 5 years in three diabetes centers from three different countries: Canada, Italy and Spain. This was an observational retrospective multicenter cohort study. Subjects were included if they were followed at one of the participating centers, had type 1 diabetes, age 5-20 years at time of data collection and used CSII for more than 5 years. Data collected included gender, age, disease duration, age at CSII initiation, body mass index (BMI), hemoglobin A1c (HbA1c), insulin requirement and serious adverse events (SAE) at baseline and every 12 months during follow-up. One hundred fifteen patients were included in the study (55% males), aged 5-20 years (mean: 13.5 ± 3.8 years), with mean diabetes duration of 6.3 ± 3.4 years, using CSII for mean of 6.9 ± 1.2 years (range 5-12 years.). HbA1c significantly improved after 1 year of CSII treatment and during follow-up (p = 0.02). When HbA1c was compared between countries, a difference was observed, with slightly lower values in Italy than in Canada and Spain (p = 0.04). When evaluated by gender, HbA1c was similar at baseline, but significantly improved only in males during all follow-up (p = 0.004). No significant differences were observed for BMI, insulin requirement or SAE. Insulin pump therapy is safe and effective in the pediatric population, although in this study, the major benefit in HbA1c was seen in males. The use of advanced pump features was associated with greater improvement in HbA1c. PMID:23681558

  1. DEVELOPMENTAL NEUROTOXICITY TESTING GUIDELINES: A QUALIFICATIVE RETROSPECTIVE ANALYSIS OF POSITIVE CONTROL DATA.

    EPA Science Inventory

    The USEPA Developmental Neurotoxicity (DNT) Study Test Guideline calls for both functional and neuropathological assessments in offspring during and following maternal exposure. This guideline also requires data from positive control (PC) agents. Submission of these data permit e...

  2. Maintenance of Certification Part IV Quality-Improvement Project for Hypertension Control: A Preliminary Retrospective Analysis

    PubMed Central

    Kolasinski, Vallerie A; Price, David W

    2015-01-01

    Context: A Maintenance of Certification Part IV project was created on the basis of an existing, multifaceted hypertension improvement program. Objective: To evaluate the impact of the Maintenance of Certification project, the effects of the improvement options on blood pressure control in hypertensive patients, and the participants’ perception of the workload related to participation in the project. Design: Nonexperimental retrospective analysis. Setting: Kaiser Permanente hospitals and medical office buildings in Northern California. Intervention: Participants used one or more options from a defined menu of strategies to attempt to increase the percentage of hypertensive patients on their patient panels who had controlled blood pressure. Main Outcome Measure: Proportion of hypertensive patients with blood pressure ≤ 139/89 mm Hg. Results: Fifty-two American Board of Family Medicine and 19 American Board of Internal Medicine certified physicians completed projects. Mean panel blood pressure control improved from 79.49% (standard deviation [SD] = 11.32) to 84.64% (SD = 7.80). The choice of improvement option was not associated with the level of improvement or with the participants’ perception of the workload related to completing the project. Conclusion: Project participants improved the care of their patients without an increased perceived burden to their practice. We found no association between the choice of improvement option and either the level of improvement or the perception of workload. PMID:25785642

  3. Survival analysis in second-line and third-line chemotherapy with irinotecan followed by topotecan or topotecan followed by irinotecan for extensive-stage small-cell lung cancer patients: a single-center retrospective study

    PubMed Central

    Aktas, Gokmen; Kus, Tulay; Kalender, Mehmet Emin; Sevinc, Alper; Camci, Celaletdin; Kul, Seval

    2016-01-01

    Purpose The number of patients who make it to receive third-line chemotherapy is increasing owing to the improvements in adverse-event management of chemotherapy for small-cell lung cancer (SCLC). Sequencing of optimal treatment for SCLC is still a challenge for oncologists. In this paper, we aim to present a different approach to the treatment of SCLC. Methods Between January 2008 and July 2014, all patients diagnosed with extensive-stage SCLC and treated with third-line chemotherapy at Gaziantep University Oncology Hospital were analyzed retrospectively. Disease control rates and progression-free survival (PFS) for first-, second-, and third-line chemotherapy, and overall survival (OS) were recorded. Survival analysis was calculated by using Kaplan–Meier method. Results A total of 255 SCLC patients were screened, and 25 of those patients who received third-line chemotherapy were included in this study. Median age was 57±10.131 years (range: 39–74 years). Disease control rates at first-, second-, and third-line chemotherapy were 92%, 68%, and 44%, respectively. Fourteen patients received irinotecan followed by topotecan, and eleven patients received topotecan followed by irinotecan. Second-line median PFS was statistically better in patients treated with irinotecan at second-line compared with those treated with topotecan (21 vs 12 weeks, P=0.018). Comparison of third-line median PFS of the two groups was not statistically significant (14 vs 12 weeks, P=0.986). Median OS was not statistically significant in patients who received irinotecan followed by topotecan vs those who received topotecan followed by irinotecan (18 vs 14 months, P=0.112). Conclusion Sequential monotherapy with topotecan and irinotecan provides a considerable contribution to OS, and second-line irinotecan showed a better PFS, despite a similar OS, compared with topotecan. PMID:27099522

  4. Prediction of the location and size of the stomach using patient characteristics for retrospective radiation dose estimation following radiotherapy

    NASA Astrophysics Data System (ADS)

    Lamart, Stephanie; Imran, Rebecca; Simon, Steven L.; Doi, Kazutaka; Morton, Lindsay M.; Curtis, Rochelle E.; Lee, Choonik; Drozdovitch, Vladimir; Maass-Moreno, Roberto; Chen, Clara C.; Whatley, Millie; Miller, Donald L.; Pacak, Karel; Lee, Choonsik

    2013-12-01

    Following cancer radiotherapy, reconstruction of doses to organs, other than the target organ, is of interest for retrospective health risk studies. Reliable estimation of doses to organs that may be partially within or fully outside the treatment field requires reliable knowledge of the location and size of the organs, e.g., the stomach, which is at risk from abdominal irradiation. The stomach location and size are known to be highly variable between individuals, but have been little studied. Moreover, for treatments conducted years ago, medical images of patients are usually not available in medical records to locate the stomach. In light of the poor information available to locate the stomach in historical dose reconstructions, the purpose of this work was to investigate the variability of stomach location and size among adult male patients and to develop prediction models for the stomach location and size using predictor variables generally available in medical records of radiotherapy patients treated in the past. To collect data on stomach size and position, we segmented the contours of the stomach and of the skeleton on contemporary computed tomography (CT) images for 30 male patients in supine position. The location and size of the stomach was found to depend on body mass index (BMI), ponderal index (PI), and age. For example, the anteroposterior dimension of the stomach was found to increase with increasing BMI (≈0.25 cm kg-1 m2) whereas its craniocaudal dimension decreased with increasing PI (≈-3.3 cm kg-1 m3) and its transverse dimension increased with increasing PI (≈2.5 cm kg-1 m3). Using the prediction models, we generated three-dimensional computational stomach models from a deformable hybrid phantom for three patients of different BMI. Based on a typical radiotherapy treatment, we simulated radiotherapy treatments on the predicted stomach models and on the CT images of the corresponding patients. Those dose calculations demonstrated good

  5. Tobacco Control in India; A Myth or Reality- Five Year Retrospective Analysis Using WHO MPOWER for Tobacco Control

    PubMed Central

    Gupta, Ritu; Basavaraj, Patthi; Singla, Ashish; Vashishtha, Vaibhav; Pandita, Venisha; Kumar, Jishnu Krishna; Prasad, Monika

    2015-01-01

    Introduction Tobacco use is a major public health challenge in India and government of India has taken various initiatives for tobacco control in the country. India was among the first few countries to ratify WHO the Framework Convention on Tobacco Control (WHO FCTC) in 2004 and to make it easy, WHO introduced the MPOWER measures. Objective This study aimed to quantify the implementation of MPOWER tobacco control policies in India. Materials and Methods In this retrospective analysis information was collected from the WHO report on the Global Tobacco Epidemic Program, India for the year 2009, 2011 and 2013 using MPOWER and this analysis was based on the checklist which was designed previously by Iranian and international tobacco control specialists in their study on tobacco control and its cut-offs were set according to the scoring of key sections of the MPOWER 2011 report. Results In this study India was ranked by scores and these scores were obtained from each indicator for each activity. The highest scores were achieved in 2013 and there are marked increase in scores in health warning on cigarette packages but as far as the cessation programmes and taxation is concerned, there is decline in the progress. Conclusion MPOWER programmes are accepted in the India but there is considerable room for improvement as we are still far from the ideal situation. PMID:26674509

  6. Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey

    PubMed Central

    2011-01-01

    Background In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre. Objectives To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk Methods We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland. Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees. Results Retrospective survey A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. Case-control survey 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury. Conclusions Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index. PMID:21294862

  7. Safety and Efficacy of Ferric Carboxymaltose in Anemic Pregnant Women: A Retrospective Case Control Study

    PubMed Central

    Pels, Anouk; Ganzevoort, Wessel

    2015-01-01

    Background. Anemia during pregnancy is commonly caused by iron deficiency and can have severe consequences for both the mother and the developing fetus. The aim of this retrospective study was to assess the safety and efficacy of intravenous ferric carboxymaltose (FCM) in pregnant women. Methods. All women treated with FCM for anemia during pregnancy between 2010 and 2012 at our institution were included. A matched control group was selected, including women who either were nonanemic or had anemia but were not considered for intravenous iron. Main outcome measures were maternal safety and pregnancy outcomes. Results. The study included 128 patients (FCM: 64; control: 64). Median FCM dose was 1000 mg and median gestational age at the time of first treatment was 34 weeks and 6 days. Median Hb increased from 8.4 g/dL (interquartile range 7.7; 8.9 g/dL) at the first FCM administration to 10.7 g/dL (9.8; 11.5 g/dL; n = 46 with available Hb at delivery) at the time of delivery, achieving levels similar to those in the control group (10.8 g/dL [9.8; 11.8 g/dL; n = 48]). No treatment-related adverse events were reported and no statistically significant differences in pregnancy outcomes were observed between groups. Conclusions. Within the limitations of this case control study, FCM was a safe and efficient treatment of anemia during pregnancy. PMID:26688686

  8. Safety and Efficacy of Ferric Carboxymaltose in Anemic Pregnant Women: A Retrospective Case Control Study.

    PubMed

    Pels, Anouk; Ganzevoort, Wessel

    2015-01-01

    Background. Anemia during pregnancy is commonly caused by iron deficiency and can have severe consequences for both the mother and the developing fetus. The aim of this retrospective study was to assess the safety and efficacy of intravenous ferric carboxymaltose (FCM) in pregnant women. Methods. All women treated with FCM for anemia during pregnancy between 2010 and 2012 at our institution were included. A matched control group was selected, including women who either were nonanemic or had anemia but were not considered for intravenous iron. Main outcome measures were maternal safety and pregnancy outcomes. Results. The study included 128 patients (FCM: 64; control: 64). Median FCM dose was 1000 mg and median gestational age at the time of first treatment was 34 weeks and 6 days. Median Hb increased from 8.4 g/dL (interquartile range 7.7; 8.9 g/dL) at the first FCM administration to 10.7 g/dL (9.8; 11.5 g/dL; n = 46 with available Hb at delivery) at the time of delivery, achieving levels similar to those in the control group (10.8 g/dL [9.8; 11.8 g/dL; n = 48]). No treatment-related adverse events were reported and no statistically significant differences in pregnancy outcomes were observed between groups. Conclusions. Within the limitations of this case control study, FCM was a safe and efficient treatment of anemia during pregnancy. PMID:26688686

  9. Nursing consultations and control of diabetes in general practice: a retrospective observational study

    PubMed Central

    Murrells, Trevor; Ball, Jane; Maben, Jill; Ashworth, Mark; Griffiths, Peter

    2015-01-01

    Background Diabetes affects around 3.6 million people in the UK. Previous research found that general practices employing more nurses delivered better diabetes care, but did not include data on individual patient characteristics or consultations received. Aim To examine whether the proportion of consultations with patients with diabetes provided by nurses in GP practices is associated with control of diabetes measured by levels of glycated haemoglobin (HbA1c). Design and setting A retrospective observational study using consultation records from 319 649 patients with diabetes from 471 UK general practices from 2002 to 2011. Method Hierarchical multilevel models to examine associations between proportion of consultations undertaken by nurses and attaining HbA1c targets over time, controlling for case-mix and practice level factors. Results The proportion of consultations with nurses has increased by 20% since 2002 but patients with diabetes made fewer consultations per year in 2011 compared with 2002 (11.6 versus 16.0). Glycaemic control has improved and was more uniformly achieved in 2011 than 2002. Practices in which nurses provide a higher proportion of consultations perform no differently to those where nurse input is lower (lowest versus highest nurse contact tertile odds ratio [OR] [confidence interval {95% CI}]: HbA1c ≤53 mmol/mol (7%) 2002, 1.04 [95% CI = 0.87 to 1.25] and 2011, 0.95 [95% CI = 0.87 to 1.03]; HbA1c ≤86 mmol/mol (10%) 2002, 0.97 [95% CI = 0.73 to 1.29] and 2011, 0.95 [95% CI = 0.86 to 1.04]). Conclusion Practices that primarily use GPs to deliver diabetes care could release significant resources with no adverse effect by switching their services towards nurse-led care. PMID:26412840

  10. Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study

    PubMed Central

    Buhary, Badurudeen Mahmood; Almohareb, Ohoud; Aljohani, Naji; Alzahrani, Saad H.; Elkaissi, Samer; Sherbeeni, Suphia; Almaghamsi, Abdulrahman; Almalki, Mussa

    2016-01-01

    Context: Diabetes in pregnancy (DIP) is either pregestational or gestational. Aims: To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients. Settings and Design: In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included. Subjects and Methods: The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6.5% (48 mmol/mol) and those with glycated hemoglobin (HbA1c) above 6.5%. The two groups were compared for differences in maternal and fetal outcomes. Statistical Analysis Used: Independent Student's t-test and analysis of variance were performed for comparison of continuous variables and Chi-square test for frequencies. Odds ratio and 95% confidence intervals were calculated using logistic regression. Results: Patients with higher HbA1c were older (P = 0.0077), had significantly higher blood pressure, proteinuria (P < 0.0001), and were multiparous (P = 0.0269). They had significantly shorter gestational periods (P = 0.0002), more preterm labor (P < 0.0001), more perineal tears (P = 0.0406), more miscarriages (P < 0.0001), and more operative deliveries (P < 0.0001). Their babies were significantly of greater weight, had more Neonatal Intensive Care Unit (NICU) admissions, hypoglycemia, and macrosomia. Conclusions: Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission). Especially at risk are those with preexisting diabetes, who would benefit from earlier diabetes consultation and tighter glycemic control before conception. PMID:27366714

  11. Hyperglycaemic index as a tool to assess glucose control: a retrospective study

    PubMed Central

    Vogelzang, Mathijs; van der Horst, Iwan CC; Nijsten, Maarten WN

    2004-01-01

    Introduction Critically ill patients may benefit from strict glucose control. An objective measure of hyperglycaemia for assessing glucose control in acutely ill patients should reflect the magnitude and duration of hyperglycaemia, should be independent of the number of measurements, and should not be falsely lowered by hypoglycaemic values. The time average of glucose values above the normal range meets these requirements. Methods A retrospective, single-centre study was performed at a 12-bed surgical intensive care unit. From 1990 through 2001 all patients over 15 years, staying at least 4 days, were included. Admission type, sex, age, Acute Physiology and Chronic Health Evaluation II score and outcome were recorded. The hyperglycaemic index (HGI) was defined as the area under the curve above the upper limit of normal (glucose level 6.0 mmol/l) divided by the total length of stay. HGI, admission glucose, mean morning glucose, mean glucose and maximal glucose were calculated for each patient. The relations between these measures and 30-day mortality were determined. Results In 1779 patients with a median stay in the intensive care unit of 10 days, the 30-day mortality was 17%. A total of 65,528 glucose values were analyzed. Median HGI was 0.9 mmol/l (interquartile range 0.3–2.1 mmol/l) in survivors versus 1.8 mmol/l (interquartile range 0.7–3.4 mmol/l) in nonsurvivors (P < 0.001). The area under the receiver operator characteristic curve was 0.64 for HGI, as compared with 0.61 and 0.62 for mean morning glucose and mean glucose. HGI was the only significant glucose measure in binary logistic regression. Conclusion HGI exhibited a better relation with outcome than other glucose indices. HGI is a useful measure of glucose control in critically ill patients. PMID:15153239

  12. A qualitative retrospective analysis of positive control data in developmental neurotoxicity studies.

    PubMed

    Crofton, K M; Makris, S L; Sette, W F; Mendez, E; Raffaele, K C

    2004-01-01

    Testing for neurodevelopmental effects commonly involves both functional and neuropathological assessments in offspring during and following maternal exposure. The use of positive controls in neurotoxicity screening has been advocated by numerous expert groups. Evaluation of positive control data allows evaluation of laboratory proficiency in detecting changes in the structure and function of the developing nervous system and comparison of the sensitivity of assessments in different studies and laboratories. This project surveyed approaches taken in contract and industrial laboratories in generating and providing these data. Positive control data submitted in support of 34 developmental neurotoxicity (DNT) studies from 16 different laboratories were summarized by test method for information on the following: age relevance of test subjects, the presence of a dose-response relationship, gender, group size, statistics, report quality, quality assurance, and the year the study was conducted. Endpoints included the following: developmental landmarks, clinical observations (CO), motor activity, startle response, learning and memory, qualitative neuropathology, and quantitative brain morphometry (linear measurements of selected brain regions). Results ranged from no positive control data for three laboratories, to one laboratory that submitted 17 separate positive control reports. The qualitative range was similarly broad, from excellent to poor. Various problems were identified, including the following: inappropriate report structure (e.g., copies of poster presentations), lack of individual data, inadequate methodological details, submission of very old data (>10 years) or data from completely different laboratories, use of inappropriate positive control chemicals or doses that were without effect, lack of statistical analysis, use of only one sex, and use of incompatibly aged animals. Analyses revealed that there were only 3 out of 16 laboratories that had submitted

  13. Objective and subjective outcome in 42 patients after treatment of sialolithiasis by transoral incision of Warthon's duct: a retrospective middle-term follow-up study.

    PubMed

    Juul, Marie Louise; Wagner, Niels

    2014-11-01

    In this retrospective follow-up study, we present the middle-term results of transoral removal of submandibular calculi by incision in the floor of the mouth together with a patient satisfaction survey. These results will be compared with those of international studies. This is an individual retrospective cohort follow-up study. Forty-two patients had salivary calculi removed by incision in the mouth in the period from August 2009 to July 2012 at the Ear-nose-throat department of the North Zealand Hospital, Hillerød, Denmark. A retrospective study was carried out, focusing on the effects of the surgery and on patient satisfaction. The patients completed a questionnaire and underwent an objective physical exam. We found a high success rate (93 %), high patient satisfaction (94 %) and a high number of patients with no symptoms (92 %). In 94 % of the patients the gland was preserved, and there were no infections. One patient (3 %) suffered from damage to the lingual nerve, and 6 % (n = 2) claimed to suffer from continuous tingling of the tongue. Based on the present study and previous studies on transoral removal of calculi by incision in the floor of the mouth, we find this procedure effective, brief and safe for removal of large, immobile calculi from the hilum of the submandibular gland to the papilla. PMID:24493562

  14. Global path following control for underactuated stratospheric airship

    NASA Astrophysics Data System (ADS)

    Zheng, Zewei; Wu, Zhe

    2013-10-01

    This paper develops a nonlinear path following control method that drives an underactuated stratospheric airship onto a predefined planar path with a given speed profile. The dynamic model of the airship used for controller design is first introduced with kinematics and dynamics equations. In order to render good pilot behavior for the control action, a guidance controller by referring to the guidance-based path following principle is derived. Then the controller is extended to cope with the airship attitude and velocity by resorting to the backstepping and Lyapunov-based techniques. The designed control system finally possesses a cascaded structure which consists of guidance loop, attitude control loop and velocity control loop. Stability analysis shows that the controlled closed-loop system is globally asymptotically stable, and the sway velocity which cannot be directly controlled is bounded. Simulation results for the airship following typical paths are illustrated to verify effectiveness of the proposed approach.

  15. A retrospective pilot study of the use of a new algorithm to improve quality control in bronchodilator studies.

    PubMed

    Earle, Charlotte L; Jefferies, Rhys

    2015-01-01

    Reversibility testing is used to identify a positive or negative response to bronchodilators. Results from a reversibility test can not only support a diagnosis of asthma but can alter a patient's treatment plan, so its clinical importance should not be understated. With multiple guidelines published classifying a 'positive response' it becomes unclear on how to categorise certain individuals. This study looks into the discrepancies between the guidelines, and introduces a new algorithm to help clinicians. This retrospective pilot study was completed across four hospitals in South Wales. Data were collected from a total of 117 patients referred for a reversibility study during November 2013 and April 2014. An algorithm was created to improve flow-volume loop (FVL) quality control when assessing airways bronchodilation in symptomatic patients. Each patient result was placed through four major reversibility guidelines [British Thoracic Society (BTS), National Institute for Clinical Excellence (NICE), Association for Respiratory Technology Physiologists (ARTP) and Global Lung Initiative (GLI)] and the new algorithm. When comparing published guidelines, 75% of patients would receive the same bronchodilator response decision, positive or negative, irrespective of the guideline followed. Variability between the numbers of positive responders in each guideline varied by up to 58%, with NICE found to give the least number of positive responses (7%), and BTS giving the greatest (65%). Using the new algorithm, over one third (38%) of patients required a repeat FVL, as baseline and/or post-bronchodilator FVLs did not meet the quality control specification. Further investigation is needed to establish the clinical impact of the new algorithm, and its approach to using the whole of the FVL in bronchodilator analysis; however, quality control during reversibility testing needs to be improved to ensure that bronchodilator responses are correctly identified. PMID:26557258

  16. Retrospective analysis of quality improvement when using liposome bupivacaine for postoperative pain control

    PubMed Central

    King, Nicole M; Quiko, Albin S; Slotto, James G; Connolly, Nicholas C; Hackworth, Robert J; Heil, Justin W

    2016-01-01

    Background/objective Liposome bupivacaine, a prolonged-release bupivacaine formulation, recently became available at the Naval Medical Center San Diego (NMCSD); before availability, postsurgical pain for large thoracic/abdominal procedures was primarily managed with opioids with/without continuous thoracic epidural (CTE) anesthesia. This retrospective chart review was part of a clinical quality initiative to determine whether postsurgical outcomes improved after liposome bupivacaine became available. Methods Data from patients who underwent laparotomy, sternotomy, or thoracotomy at NMCSD from May 2013 to May 2014 (after liposome bupivacaine treatment became available) were compared with data from patients who underwent these same procedures from December 2011 to May 2012 (before liposome bupivacaine treatment became available). Collected data included demographics, postoperative pain control methods, opioid consumption, perioperative pain scores, and lengths of intensive care unit and overall hospital stays. Results Data from 182 patients were collected: 88 pre-liposome bupivacaine (laparotomy, n=52; sternotomy, n=26; and thoracotomy, n=10) and 94 post-liposome bupivacaine (laparotomy, n=49; sternotomy, n=31; and thoracotomy, n=14) records. Mean hospital stay was 7.0 vs 5.8 days (P=0.009) in the pre- and post-liposome bupivacaine groups, respectively, and mean highest reported postoperative pain score was 7.1 vs 6.2 (P=0.007), respectively. No other significant between-group differences were observed for the overall population. In the laparotomy subgroup, there was a reduction in the proportion of patients who received CTE anesthesia post-liposome bupivacaine (22% [11/49] vs 35% [18/52] pre-liposome bupivacaine). Conclusion Surgeons and anesthesiologists have changed the way they manage postoperative pain since the time point that liposome bupivacaine was introduced at NMCSD. Our findings suggest that utilization of liposome bupivacaine may be a useful alternative

  17. A retrospective review of 911 calls to a regional poison control center

    PubMed Central

    Bosak, Adam; Brooks, Daniel E.; Welch, Sharyn; Padilla-Jones, Angie; Gerkin, Richard D.

    2015-01-01

    Background: There is little data as to what extent national Emergency Medical Services (EMS; 911) utilize poison control centers (PCCs). A review of data from our PCC was done to better understand this relationship and to identify potential improvements in patient care and health care savings. Methods: Retrospective chart review of a single PCC to identify calls originating from 911 sources over a 4-year study period (1/1/08–12/31/11). Recorded variables included the origin of call to the PCC, intent of exposure, symptoms, management site, hospital admission, and death. Odds ratios (OR) were developed using multiple logistic regressions to identify risk factors for EMS dispatch, management site, and the need for hospital admission. Results: A total of 7556 charts were identified; 4382 (58%) met inclusion criteria. Most calls (63.3%) involved accidental exposures and 31% were self-harm or misuse. A total of 2517 (57.4%) patients had symptoms and 2044 (50.8%) were transported to an Emergency Department (ED). Over 38% of calls (n = 1696) were handled primarily by the PCC and did not result in EMS dispatch; only 6.5% of cases (n = 287) with initial PCC involvement resulted in crew dispatch. There were 955 (21.8%) cases that resulted in admission, and five deaths. The OR for being transported to an ED was 45.4 (95% confidence interval [CI]: 30.2–68.4) when the crew was dispatched by the PCC. Hospital admission was predicted by intent for self-harm (OR 5.0; 95% CI: 4.1–6.2) and the presence of symptoms (OR 2.43; 95% CI: 1.9–3.0). The ORs for several other predictive variables are also reported. Conclusions: When 911 providers contact a PCC about poisoning-related emergencies, a history of intentional exposure and the presence of symptoms each predicted EMS dispatch by the PCC, patient transport to an ED, and hospital admission. Early involvement of a PCC may prevent the need for EMS activation or patient transfer to a health care facility. PMID:26985414

  18. Sphincter of Oddi Dysfunction and the Formation of Adult Choledochal Cyst Following Cholecystectomy: A Retrospective Cohort Study.

    PubMed

    Xia, Hong-Tian; Wang, Jing; Yang, Tao; Liang, Bin; Zeng, Jian-Ping; Dong, Jia-Hong

    2015-11-01

    To determine the causes underlying the formation of adult choledochal cyst.Anomalous pancreaticobiliary junction is the most widely accepted theory regarding the etiology of choledochal cyst. However, choledochal cysts have been found in patients in the absence of this anomaly. Because the number of adult patients with choledochal cyst is increasing, it is important to address this controversy.Bile amylase levels in the cysts of 27 patients (8 males and 19 females) who had undergone cholecystectomy were retrospectively evaluated.The average age of the 27 patients was 45.8 ± 10.1 years and the majority (85.2%) were diagnosed with Todani type I cysts. None of the patients had dilatation of the common bile duct prior to surgery. There were 6 (22.2%) patients with anomalous pancreaticobiliary junction. However, amylase levels did not significantly differ between patients with and without this anomaly (P = 0.251). According to bile amylase levels, pancreatobiliary reflux was present in 21 (77.8%) patients. The mean amylase level significantly differed in patients with pancreatobiliary reflux (23,462 ± 11,510 IU/L) and those without (235 ± 103 IU/L) (P < 0.001). In patients with pancreatobiliary reflux, only 4 patients had anomalous pancreaticobiliary junction. That is, the majority of patients (17/21, 81%) having pancreatobiliary reflux did not have an anomalous junction of the pancreatic and biliary ducts.Since the only explanation for pancreatobiliary reflux in patients with a normal pancreaticobiliary junction is sphincter of Oddi dysfunction, we proposed that the formation of adult choledochal cyst is mainly due to sphincter of Oddi dysfunction. PMID:26632721

  19. Vehicle following controller design for autonomous intelligent vehicles

    NASA Technical Reports Server (NTRS)

    Chien, C. C.; Lai, M. C.; Mayr, R.

    1994-01-01

    A new vehicle following controller is proposed for autonomous intelligent vehicles. The proposed vehicle following controller not only provides smooth transient maneuvers for unavoidable nonzero initial conditions but also guarantees the asymptotic platoon stability without the availability of feedforward information. Furthermore, the achieved asymptotic platoon stability is shown to be robust to sensor delays and an upper bound for the allowable sensor delays is also provided in this paper.

  20. Predicting worsening asthma control following the common cold

    PubMed Central

    Walter, Michael J.; Castro, Mario; Kunselman, Susan J.; Chinchilli, Vernon M; Reno, Melissa; Ramkumar, Thiruvamoor P.; Avila, Pedro C.; Boushey, Homer A.; Ameredes, Bill T.; Bleecker, Eugene R.; Calhoun, William J.; Cherniack, Reuben M.; Craig, Timothy J.; Denlinger, Loren C.; Israel, Elliot; Fahy, John V.; Jarjour, Nizar N.; Kraft, Monica; Lazarus, Stephen C.; Lemanske, Robert F.; Martin, Richard J.; Peters, Stephen P.; Ramsdell, Joe W.; Sorkness, Christine A.; Rand Sutherland, E.; Szefler, Stanley J.; Wasserman, Stephen I.; Wechsler, Michael E.

    2008-01-01

    The asthmatic response to the common cold is highly variable and early characteristics that predict worsening of asthma control following a cold have not been identified. In this prospective multi-center cohort study of 413 adult subjects with asthma, we used the mini-Asthma Control Questionnaire (mini-ACQ) to quantify changes in asthma control and the Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) to measure cold severity. Univariate and multivariable models examined demographic, physiologic, serologic, and cold-related characteristics for their relationship to changes in asthma control following a cold. We observed a clinically significant worsening of asthma control following a cold (increase in mini-ACQ of 0.69 ± 0.93). Univariate analysis demonstrated season, center location, cold length, and cold severity measurements all associated with a change in asthma control. Multivariable analysis of the covariates available within the first 2 days of cold onset revealed the day 2 and the cumulative sum of the day 1 and 2 WURSS-21 scores were significant predictors for the subsequent changes in asthma control. In asthmatic subjects the cold severity measured within the first 2 days can be used to predict subsequent changes in asthma control. This information may help clinicians prevent deterioration in asthma control following a cold. PMID:18768579

  1. Evaluation of postoperative pain scores following ultrasound guided transversus abdominis plane block versus local infiltration following day surgery laparoscopic cholecystectomy-retrospective study

    PubMed Central

    Kadam, Vasanth Rao; Howell, Stuart; Kadam, V.

    2016-01-01

    Background and Aims: Postoperative pain for day surgery laparoscopic cholecystectomy has traditionally been managed with the surgeon infiltrating the wound with local anesthetic (LA). However, transversus abdominis plane (TAP) block has recently been used, although its superiority over LA remains uncertain. The primary aim was to compare LA and TAP block pain scores and analgesia used. The secondary aim was to assess satisfaction score and cost. Material and Methods: This retrospective study was commenced after ethics committee approval and ANZ clinical trial registry (ACTRN: 12612000737831). The data were collected from the theatre database and medical records of patients presenting for day case laparoscopic cholecystectomy. The sample included patients who received either bilateral port site LA infiltration with 20 ml of 0.25% Bupivacaine or bilateral TAP block with 20 ml of 0.5% ropivacaine and fentanyl postoperative pain protocol. The patients with incomplete medical records were excluded as were those admitted to an inpatient ward. Demographics and clinical characteristics were obtained from the hospital record along with pain score and postsurgery analgesia use. Postoperative pain satisfaction scores were collected by telephonic interview 30-180 days postsurgery. Results: Of 51 patients analyzed, 19 were in TAP group 29 in LA group. There were no significant differences between the LA and TAP groups with respect to postoperative pain scores (P = 0.31) or patient satisfaction scores (1 and 2+) (P = 0.36). However, fentanyl consumption in the recovery room was significantly lower in TAP group (P = 0.0079.). The consumables cost were >3 times higher in the TAP when compared to LA group. Conclusion: The performance of the TAP block with respect to pain management was comparable to LA. However, LA remains more cost effective. PMID:27006547

  2. [Hair Analysis for the Retrospective and Prospective Consume-Monitoring: Substance Abuse, Abstinence- and Compliance Control].

    PubMed

    Binz, Tina M; Baumgartner, Markus R

    2016-01-01

    The possibilities and applications of modern hair analytics have rapidly developed in recent years. The compounds that can be detected in hair comprise, next to a multitude of drugs, also medications, alcohol markers, and endogenous compound like the stress hormone cortisol. Hair analysis is suitable for both forensic and clinical applications because it enables a retrospective overview of the consumption behavior during an extended time interval. PMID:26732713

  3. Simplified Load-Following Control for a Fuel Cell System

    NASA Technical Reports Server (NTRS)

    Vasquez, Arturo

    2010-01-01

    A simplified load-following control scheme has been proposed for a fuel cell power system. The scheme could be used to control devices that are important parts of a fuel cell system but are sometimes characterized as parasitic because they consume some of the power generated by the fuel cells.

  4. Blood and bombs: the demand and use of blood following the London Bombings of 7 July 2005--a retrospective review.

    PubMed

    Glasgow, S M; Allard, S; Doughty, H; Spreadborough, P; Watkins, E

    2012-08-01

    Mass casualty events (MCE) present health systems with a sudden demand on key services. The overall objective of this study was to describe the experience of the National Blood Service (NBS) following the largest UK MCE in recent times. Data was collated from the NBS database and directly from the hospitals involved. All data was collected immediately following the event and included: all blood components requested, issued and transfused in relation to the bombings, blood stock levels at the time and the injury profiles of the casualties transfused. The total NBS order from hospitals for the event was 1455 units of blood components. All requests were fulfilled, this included: 978 units of red cells (RC), 36 doses of platelets, 141 units of fresh frozen plasma (FFP) and 300 doses of cryoprecipitate. The amount of blood ordered was three times that initially used and the total number of RC transfused in treating all victims from admission to discharge was approximately 440 units. The greatest use of blood components was for those casualties who had sustained traumatic amputations amongst their injury profile. Published data with which to compare these results is lacking, although the RC use was similar to the initial mean individual usage described in previous military and civilian bombings. The overall implication for any blood service remains, there is now likely to be a far greater demand for plasma, platelets and cryoprecipitate in any future incidents involving victims suffering major haemorrhage. PMID:22809430

  5. Severe Ocular Inflammation Following Ranibizumab or Aflibercept Injections for Age-Related Macular Degeneration: A Retrospective Claims Database Analysis

    PubMed Central

    Souied, Eric H.; Dugel, Pravin U.; Ferreira, Alberto; Hashmonay, Ron; Lu, Jingsong; Kelly, Simon P.

    2016-01-01

    ABSTRACT Purpose: Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents including ranibizumab and aflibercept are used to treat patients with ocular disorders such as neovascular age-related macular degeneration (nAMD); however, the injections are associated with rare instances of severe ocular inflammation. This study compared severe ocular inflammation rates in patients treated with ranibizumab versus aflibercept. Methods: United States physician-level claims data covering an 18-month period for each therapy were analyzed. The primary analysis compared severe ocular inflammation event rates per 1000 injections. Sensitivity and subgroup analyses evaluated the impact of factors including intraocular surgery, intravitreal antibiotic administration, and previous intravitreal injections. Results: The analysis included 432,794 injection claims (ranibizumab n = 253,647, aflibercept n = 179,147); significantly, more unique severe ocular inflammation events occurred in patients receiving aflibercept than ranibizumab (1.06/1000 injections, 95% confidence interval [CI], 0.91–1.21, vs. 0.64/1000 injections, 95% CI 0.54–0.74; p < 0.0001). Comparable results were observed for analyses of patients who had undergone glaucoma or cataract surgeries, had antibiotic-associated endophthalmitis, had non-antibiotic-associated endophthalmitis, and were non-treatment-naive. In contrast, no significant differences in severe ocular inflammation claims were recorded in treatment-naive patients who had no record of anti-VEGF treatment in the 6 months preceding the index claim. No significant change occurred in the rate of severe ocular inflammation claims over time following ranibizumab treatment. Conclusions: Severe ocular inflammation was more frequent following intravitreal injection with aflibercept than with ranibizumab during routine clinical use in patients with nAMD. This highlights the importance of real-world, post-approval, observational monitoring

  6. Lifestyle-related diseases following the evacuation after the Fukushima Daiichi nuclear power plant accident: a retrospective study of Kawauchi Village with long-term follow-up

    PubMed Central

    Ebner, Daniel K; Ohsawa, Megumi; Igari, Keiko; Harada, Kouji H; Koizumi, Akio

    2016-01-01

    Objectives Kawauchi Village lies 20 km west of the Fukushima Daiichi nuclear power plant. On 16 March 2011, evacuation was ordered due to the threat of radiological exposure, and was lifted in April 2012. In this study, we aimed to evaluate the predisaster and postdisaster health status of the Kawauchi Villagers, measured by routine yearly physical examinations. Methods We analysed the annual health examination data of residents of Kawauchi Village from 2008 to 2013, as available from the Japanese National Health Insurance system. Data from 2011 were not available due to the disaster. Since the health data included the same participants repeatedly from year to year, the sample was non-independent and generalised estimated equation modelling was used. A predisaster time period (2008–2010) was categorised for comparison with postdisaster 2012 and 2013. The outcome examined was the prevalence of metabolic disease, and was adjusted for confounding factors. Results Data for 20.6%–25.9% of the total residents were available in this period. In 2013, the prevalence of metabolic syndrome (from 17.0% to 25.2%, p<0.001), diabetes (from 11.3% to 17.0%, p<0.001), dyslipidaemia (from 43.2% to 56.7%, p<0.0001), hyperuricaemia (from 5.2% to 8.4%, p=0.006) and chronic kidney disease (from 16.1% to 26.7%, p<0.001) was found to be elevated significantly compared to predisaster years, while that of obesity or hypertension did not change. Conclusions The present follow-up study for Kawauchi Village revealed an increase in lifestyle-related disease following the March 2011 disaster and subsequent evacuation, and this trend still continues 2 years later. PMID:27401362

  7. A retrospective comparison of techniques to prevent secondary cataract formation following posterior chamber intraocular lens implantation in infants and children.

    PubMed Central

    Koch, D D; Kohnen, T

    1997-01-01

    PURPOSE: To determine the effect of various methods of managing the posterior capsule and anterior vitreous on the rate of posterior capsular opacification in children implanted with posterior chamber intraocular lenses (PC IOL). METHODS: We reviewed the charts of 20 eyes of 15 children (1.5-12 years) who underwent primary cataract surgery with PC IOL in the last 5 years. The posterior capsule and anterior vitreous were managed in a variety of ways: in 5 eyes the posterior capsule was left intact, and 15 eyes underwent posterior continuous curvilinear capsulorhexis (PCCC)-nine cases without and 6 with anterior vitrectomy. In 8 eyes posterior optic capture was performed, 3 with and 5 without vitrectomy. The follow-up ranged from 1 to 4.5 years (mean: 2 years). RESULTS: Visually significant secondary cataract developed in all 5 eyes with intact posterior capsules and in the 4 eyes that underwent PCCC without vitrectomy and without posterior optic capture (i.e., the optic was left in the capsular bag). The optical axis remained clear in all 6 eyes that underwent PC IOL implantation with vitrectomy (with or without posterior optic capture). Initially, all optic capture cases without vitrectomy also remained clear, but after 6 months 4 out of 5 developed opacification. CONCLUSIONS: In this series posterior capsulorhexis with anterior vitrectomy was the only effective method of preventing or delaying secondary cataract formation in infants and children. Images FIGURE 2 FIGURE 4 A FIGURE 4 B FIGURE 4 C PMID:9440179

  8. Retrospective cohort study between selective and standard C3-7 laminoplasty. Minimum 2-year follow-up study

    PubMed Central

    Asazuma, Takashi; Masuoka, Kazunori; Yasuoka, Hiroki; Motosuneya, Takao; Sakai, Tsubasa; Nemoto, Koichi

    2007-01-01

    A total of 64 patients with cervical spondylotic myelopathy (CSM) were assessed in this study. Forty-two patients underwent selective expansive open-door laminoplasty (ELAP). Twenty-two patients who underwent conventional C3-7 ELAP served as controls. There were no significant differences in recovery rate of JOA scores, C2–C7 angle or cervical range of motion between two groups. Incidence of axial symptoms and segmental motor paralysis in selective ELAP was significantly lower than those in the C3-7 ELAP. Size of anterior compression mass, postoperative spinal cord positions and decompression conditions were evaluated using preoperative or postoperative MRI in 50 of 64 patients. There was a positive correlation between number of expanded laminae and maximum anterior spaces of spinal cord. Incomplete decompression was developed in three of 37 patients in selective ELAP and in two of 13 patients in C3-7ELAP. Mean size of anterior compression mass at incomplete decompression levels was significantly greater than that at complete decompression levels. Since, there was less posterior movement of the spinal cord in selective ELAP than that in C3-7ELAP, minute concerns about size of anterior compression mass is necessary to decide the number of expanded laminae. Overall, selective ELAP was less invasive and useful in reducing axial symptoms and segmental motor paralysis. This new surgical strategy was effective in improving the surgical outcomes of CSM, and short-term results were satisfactory. PMID:17726618

  9. Incident atrial fibrillation in the emergency department in Ontario: a population-based retrospective cohort study of follow-up care

    PubMed Central

    Yu, Bing; Ivers, Noah; Rochon, Paula; Lee, Douglas S.; Schull, Michael J.; Austin, Peter C.

    2015-01-01

    Background Continuity of care has been shown to be poor following in-hospital discharge, and there are substantially fewer resources to facilitate follow-up care arrangements after discharge from an emergency department. Our objective was to assess the frequency, timeliness and predictors for obtaining follow-up care following discharge from an emergency department in Ontario with a new diagnosis of atrial fibrillation. Methods We conducted a retrospective cohort study involving all patients discharged from the 157 nonpediatric emergency departments in Ontario, who received a new diagnosis of atrial fibrillation between 2007 and 2012. We determined the frequency of follow-up care with a family physician, cardiologist or internist within 7 (timely) and 30 days of the emergency department visit, and assessed the association of emergency and family physician characteristics, including primary care model type, with obtaining timely follow-up care. Results Among 14 907 patients discharged from Ontario emergency departments with a new, primary diagnosis of atrial fibrillation, half (n = 7473) had timely follow-up care. At 30 days, 2678 patients (18.0%) still had not obtained follow-up care. Among emergency and family physician factors, lack of a family physician had the largest independent association with acquiring timely follow-up care (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.50–0.69). Using patients with a family physician belonging to a primarily fee-for-service remuneration model as the comparison group, patients with a family physician belonging to a capitation-based Family Health Network, as part of a Family Health Team, were less likely to receive timely follow-up care (OR 0.73, 95% CI 0.62–0.86), as were those whose family physician belonged to the same model type that was not part of a Family Health Team (OR 0.77, 95% CI 0.60–0.97). Interpretation Only half of the patients who were discharged from an emergency department in Ontario with a new

  10. Incidence and Predictors of Tuberculosis among HIV Positive Children at University of Gondar Referral Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study

    PubMed Central

    Ayalaw, Sualiha Gebeyaw; Alene, Kefyalew Addis

    2015-01-01

    Background. The aim of this study was to determine the incidence of tuberculosis and its predictors among HIV positive children. Methods. A six-year retrospective follow-up study was conducted among HIV infected children aged less than 15 years. Life table was used to estimate the cumulative probability of tuberculosis free survival. Cox proportional hazards model was used to identify predictors of tuberculosis. Results. A total of 271 HIV positive children were followed for six years and produced 1100.50 person-years of observation. During the follow-up period 52 new TB cases occurred. The overall incidence density of TB was 4.9 per 100 PY. Inappropriate vaccination [AHR: 8.03 (95% CI; 4.61–13.97)], ambulatory functional status [AHR: 1.99 (95% CI; 1.04–3.81)], and having baseline anemia [AHR: 2.23 (95% CI; 1.19–4.15)] were important predictors of time to TB occurrence. Conclusion. TB incidence rate was high. Early diagnosis and treatment of anemia and strengthening immunization program would reduce the risk of TB occurrence.

  11. Implant success rates in full-arch rehabilitations supported by upright and tilted implants: a retrospective investigation with up to five years of follow-up

    PubMed Central

    2015-01-01

    Purpose The aim of this retrospective study was to investigate the cumulative success rate, the implant survival rate, and the occurrence of biological complications in implants supporting full-arch immediately loaded rehabilitations supported by upright and tilted implants. Methods The clinical records and periapical radiographs of patients who attended follow-up visits were collected, and information was recorded regarding marginal bone loss resorption, the occurrence of peri-implant infectious diseases, and the implant survival rate. Implants were classified as successful or not successful according to two distinct classifications for implant success. Results A total of 53 maxillary and mandibular restorations including 212 implants were analysed, of which 56 implants were studied over the full five-year follow-up period. After five years, the cumulative success rate was 76.04% according to the Misch classification and 56.34% according to the Albrektsson classification. The cumulative implant survival rate was 100%, although one implant was found to be affected by peri-implantitis at the second follow-up visit. Conclusions The cumulative success rate of the implants dropped over time, corresponding to the progression of marginal bone resorption. The prevalence of peri-implantitis was very low, and the implant survival rate was not found to be related to the cumulative success rate. PMID:26734491

  12. Follow-the-Leader Control for the PIPS Prototype Hardware

    NASA Technical Reports Server (NTRS)

    Williams, Robert L. II; Lippitt, Thimas

    1996-01-01

    This report describes the payload inspection and processing system (PIPS), an automated system programmed off-line for inspection of space shuttle payloads after integration and prior to launch. PIPS features a hyper-redundant 18-degree of freedom (DOF) serpentine truss manipulator capable of snake like motions to avoid obstacles. During the summer of 1995, the author worked on the same project, developing a follow-the-leader (FTL) algorithm in graphical simulation which ensures whole arm collision avoidance by forcing ensuing links to follow the same tip trajectory. The summer 1996 work was to control the prototype PIPS hardware in follow-the-leader mode. The project was successful in providing FTL control in hardware. The STS-82 payload mockup was used in the laboratory to demonstrate serpentine motions to avoid obstacles in a realistic environment.

  13. Boron neutron capture therapy (BNCT) for liver metastasis in an experimental model: dose–response at five-week follow-up based on retrospective dose assessment in individual rats

    SciTech Connect

    Emiliano C. C. Pozzi; Veronica A. Trivilin; Lucas L. Colombo; Andrea Monti Hughes; Silvia I. Thorp; Jorge E. Cardoso; Marcel A. Garabalino; Ana J. Molinari; Elisa M. Heber; Paula Curotto; Marcelo Miller; Maria E. Itoiz; Romina F. Aromando; David W. Nigg; Amanda E. Schwint

    2013-11-01

    Boron neutron capture therapy (BNCT) was proposed for untreatable colorectal liver metastases. Employing an experimental model of liver metastases in rats, we recently demonstrated that BNCT mediated by boronophenylalanine (BPA-BNCT) at 13 Gy prescribed to tumor is therapeutically useful at 3-week follow-up. The aim of the present study was to evaluate dose–response at 5-week follow-up, based on retrospective dose assessment in individual rats. BDIX rats were inoculated with syngeneic colon cancer cells DHD/K12/TRb. Tumor-bearing animals were divided into three groups: BPA-BNCT (n = 19), Beam only (n = 8) and Sham (n = 7) (matched manipulation, no treatment). For each rat, neutron flux was measured in situ and boron content was measured in a pre-irradiation blood sample for retrospective individual dose assessment. For statistical analysis (ANOVA), individual data for the BPA-BNCT group were pooled according to absorbed tumor dose, BPA-BNCT I: 4.5–8.9 Gy and BPA-BNCT II: 9.2–16 Gy. At 5 weeks post-irradiation, the tumor surface area post-treatment/pre-treatment ratio was 12.2 +/- 6.6 for Sham, 7.8 +/- 4.1 for Beam only, 4.4 +/- 5.6 for BPA-BNCT I and 0.45 +/- 0.20 for BPA-BNCT II; tumor nodule weight was 750 +/- 480 mg for Sham, 960 +/- 620 mg for Beam only, 380 +/- 720 mg for BPA-BNCT I and 7.3 +/- 5.9 mg for BPA-BNCT II. The BPA-BNCT II group exhibited statistically significant tumor control with no contributory liver toxicity. Potential threshold doses for tumor response and significant tumor control were established at 6.1 and 9.2 Gy, respectively.

  14. Digital flight control design using implicit model following.

    NASA Technical Reports Server (NTRS)

    Stengel, R. F.

    1973-01-01

    A design procedure for determining the control gains of a discrete-time ('digital') control system is presented. The method is separable into four distinct steps: (1) the definition of closed-loop response criteria, (2) the choice of a discrete-time model which provides the desired response, (3) the determination of control gains which implicitly force the actual system to follow the desired response, and (4) the reduction of the measurement state by the introduction of an 'observer' (a form of integral-differential compensation). It is shown that a single desired response does not completely define the 'ideal' system. The response criterion generally leaves some parameters of the model unspecified, allowing two courses for improving the model: (1) definition of additional response criteria, or (2) redefinition of the discrete-time model for improved implicit model-following with the actual closed-loop system.

  15. Risk factors for late recurrent candidaemia. A retrospective matched case-control study.

    PubMed

    Muñoz, P; Vena, A; Valerio, M; Álvarez-Uría, A; Guinea, J; Escribano, P; Bouza, E

    2016-03-01

    Incidence, risk factors and clinical significance of late recurrent (LR) candidaemia (>1 month between episodes) remains unclear. The 1219 episodes of candidaemia detected from January 1985 to December 2014 were reviewed. We selected all cases with more than one episode separated by at least 30 days after clinical resolution in the interim (cases) and compared each of them with two controls (patients with single episodes of candidaemia). Clinical strains were genotyped to differentiate relapses from re-infection. Eighteen patients (1.48%) had 36 episodes of LR candidaemia (median 4 months). Independent risk factors for recurrence in the multivariate analysis were: underlying gastrointestinal disease (OR 67.16; 95% CI 5.23-861.71; p 0.001) and fungaemia due to Candida parapsilosis (OR 9.10; 95% 1.33-62.00; p 0.02). All episodes of LR candidaemia diagnosed during the first 3 months were due to an intravascular source of infection, whereas in those occurring after 3 months the main source of the disease was the abdomen, followed by endocarditis, and urinary tract. Molecular typing showed that 42.9% of LR candidaemias were relapses and 57.1% were re-infections. Neither time of recurrence nor clinical origin could predict type of recurrence. LR candidaemia is a relatively rare event that is more frequent in patients who have an initial episode of candidaemia due to C. parapsilosis or an underlying gastrointestinal disease. Episodes of LR candidaemia that occur within the first 3 months should prompt an attempt to exclude an intravascular source of infection, whereas those occurring later point to an intra-abdominal origin. PMID:26548507

  16. A QUALITATIVE RETROSPECTIVE ANALYSIS OF POSITIVE CONTROL DATA IN DEVELOPMENTAL NEUROTOXICITY STUDIES.

    EPA Science Inventory

    A manuscript reviews positive control data submitted by registrants in support of Developmental Neurotoxicity (DNT) guideline studies. Adequate positive control data are needed to evaluate laboratory proficiency in detecting changes in the structure and function of the developin...

  17. Radiologic Findings and Risk Factors of Adjacent Segment Degeneration after Anterior Cervical Discectomy and Fusion : A Retrospective Matched Cohort Study with 3-Year Follow-Up Using MRI

    PubMed Central

    So, Wan-Soo; Ku, Min-Geun; Kim, Sang-Hyeon; Kim, Dong-Won; Lee, Byung-Hun

    2016-01-01

    Objective The purpose of this study was to figure out the radiologic findings and risk factors related to adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) using 3-year follow-up radiography, computed tomography (CT), and magnetic resonance image (MRI). Methods A retrospective matched comparative study was performed for 64 patients who underwent single-level ACDF with a cage and plate. Radiologic parameters, including upper segment range of motion (USROM), lower segment range of motion (LSROM), upper segment disc height (UDH), and lower segment disc height (LDH), clinical outcomes assessed with neck and arm visual analogue scale (VAS), and risk factors were analyzed. Results Patients were categorized into the ASD (32 patients) and non-ASD (32 patients) group. The decrease of UDH was significantly greater in the ASD group at each follow-up visit. At 36 months postoperatively, the difference for USROM value from the preoperative one significantly increased in the ASD group than non-ASD group. Preoperative other segment degeneration was significantly associated with the increased incidence of ASD at 36 months. However, pain intensity for the neck and arm was not significantly different between groups at any post-operative follow-up visit. Conclusion The main factor affecting ASD is preoperative other segment degeneration out of the adjacent segment. In addition, patients over the age of 50 are at higher risk of developing ASD. Although there was definite radiologic degeneration in the ASD group, no significant difference was observed between the ASD and non-ASD groups in terms of the incidence of symptomatic disease. PMID:26962418

  18. Retrospective analysis of linear accelerator output constancy checks using process control techniques.

    PubMed

    Sanghangthum, Taweap; Suriyapee, Sivalee; Srisatit, Somyot; Pawlicki, Todd

    2013-01-01

    Shewhart control charts have previously been suggested as a process control tool for use in routine linear accelerator (linac) output verifications. However, a comprehensive approach to process control has not been investigated for linac output verifications. The purpose of this work is to investigate a comprehensive process control approach to linac output constancy quality assurance (QA). The RBA-3 dose constancy check was used to verify outputs of photon beams and electron beams delivered by a Varian Clinac 21EX linac. The data were collected during 2009 to 2010. Shewhart-type control charts, exponentially weighted moving average (EWMA) charts, and capability indices were applied to these processes. The Shewhart-type individuals chart (X-chart) was used and the number of data points used to calculate the control limits was varied. The parameters tested for the EWMA charts (smoothing parameter (λ) and the control limit width (L)) were λ = 0.05, L = 2.492; λ = 0.10, L = 2.703; and λ = 0.20, L = 2.860, as well as the number of points used to estimate the initial process mean and variation. Lastly, the number of in-control data points used to determine process capability (C(p)) and acceptability (C(pk)) were investigated, comparing the first in-control run to the longest in-control run of the process data. C(p) and C(pk) values greater than 1.0 were considered acceptable. The 95% confidence intervals were reported. The X-charts detected systematic errors (e.g., device setup errors). In-control run lengths on the X-charts varied from 5 to 30 output measurements (about one to seven months). EWMA charts showed in-control runs ranging from 9 to 33 output measurements (about two to eight months). The C(p) and C(pk) ratios are higher than 1.0 for all energies, except 12 and 20 MeV. However, 10 MV and 6, 9, and 16 MeV were in question when considering the 95% confidence limits. The X-chart should be calculated using 8-12 data points. For EWMA chart, using 4 data points

  19. Future of 34 meniscectomies after bucket-handle meniscus tear: a retrospective study with a follow-up over 22 years.

    PubMed

    Vautrin, Matthias; Schwartz, Claude

    2016-05-01

    After a bucket-handle meniscus tear, a partial meniscectomy by arthroscopy is recommended, when a meniscal suture is impossible. Short-term results of meniscectomy after bucket-handle meniscus tear, without cartilage or ligament additional injury, are mostly excellent: pain and blocking disappear, return to sports activities is possible. The aim of this retrospective study is to follow a partial meniscectomy evolution with a long follow-up between March 1990 and April 1994, and a senior surgeon operated 34 meniscectomies for bucket-handle meniscus tear by 34 patients (29 male and 5 female) with a mean age of 31.7 years (16-52 years) at time of surgery. The bucket-handle meniscus tear had a traumatic etiology on a knee with no cartilage lesion. The functional results were assessed by IKDC subjective score (International Knee Documentation Committee) and ARPEGE score (Association pour la Recherche et la Promotion de l'Etude du Genou). These scores were obtained by phone call questionnaire in March 2014 with a mean follow-up of 22.7 years (20-24 years). In this study, patients were reviewed and got a clinical examination to determine the Lequesne score, a radiological knee assessment according to Ahlbäck classification and a weight-bearing teleradiography. With an IKDC mean score of 85.8 after surgery, we observed that 29 patients go back to sports activities with the same level as before injury. The level of sports activity, with a regular practice after a mean follow-up of 22.7 years, was the same as immediately after surgery or just the level under for 85.3 % of patients. With ARPEGE score, 48.5 % of patients had a global excellent result and 38.2 % had a global good result after a long follow-up. With a mean Lequesne score of 2.38, osteoarthritis of knee is still clinical minimal after meniscectomy at long term. The score was worse after external meniscectomy (EM) than after an internal meniscectomy (IM). 57.7 % of patients have osteoarthritis on X

  20. An overview of retrospective case-control studies investigating the relationship between prone sleeping position and SIDS.

    PubMed

    Beal, S M; Finch, C F

    1991-12-01

    A critical overview of 19 case-control studies that have investigated the relationship between prone sleeping position and sudden infant death syndrome (SIDS) is presented. Issues relating to the non-comparability of the studies are described in terms of: (i) case definition; (ii) selection of controls; (iii) quality of the sleeping position data; (iv) recall bias; and (v) adjustment for confounding factors. All studies showed a positive association (2 out of the 19 studies were not significant) between prone sleeping position and SIDS. Meta-analysis techniques applied to six of these studies, based on 'usual' sleeping position in cases and population representative controls, has confirmed an overall higher risk of SIDS in infants who usually sleep prone. The most common odds ratio for an association between prone sleeping position and SIDS was 2.72 (95% confidence interval 2.27-3.26). The extent to which the methodological problems of retrospective case-control studies interfere with our interpretations of this association are discussed. PMID:1836736

  1. Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years

    PubMed Central

    Vianelli, Nicola; Palandri, Francesca; Polverelli, Nicola; Stasi, Roberto; Joelsson, Joel; Johansson, Eva; Ruggeri, Marco; Zaja, Francesco; Cantoni, Silvia; Catucci, Angelo Emanuele; Candoni, Anna; Morra, Enrica; Björkholm, Magnus; Baccarani, Michele; Rodeghiero, Francesco

    2013-01-01

    The treatment of choice in steroid-resistant immune thrombocytopenia is still controversial due to the recent advent of new drugs (anti-CD20 antibodies and thrombopoietin mimetics) that have encouraged a generalized tendency to delay splenectomy. Consequently, it is extremely importance to define the efficacy and safety of splenectomy in the long term. We retrospectively analyzed the data of 233 patients affected by immune thrombocytopenia who underwent splenectomy between 1959 and 2001 in 6 European hematologic institutions and who have now a minimum follow up of ten years from surgery. Of the 233 patients, 180 (77%) achieved a complete response and 26 (11%) a response. Sixty-eight of 206 (33%) responsive patients relapsed, mostly (75%) within four years from first response. In 92 patients (39.5%), further treatment was required after splenectomy that was effective in 76 cases (83%). In 138 patients (59%), response was maintained free of any treatment at last contact. No significant association between baseline characteristics and likelihood of stable response was found. Overall, 73 (31%) and 58 (25%) patients experienced at least one infectious or hemorrhagic complication, which was fatal in 2 and 3 patients, respectively. A stable response to splenectomy was associated with a lower rate of infections (P=0.004) and hemorrhages (P<0.0001). Thrombosis developed in 18 patients (8%) and was fatal in 4. Splenectomy achieved a long-term stable response in approximately 60% of cases. Complications mainly affected non-responding patients and were fatal in a minority. PMID:23144195

  2. High Incidence of Tuberculosis in the Absence of Isoniazid and Cotrimoxazole Preventive Therapy in Children Living with HIV in Northern Ethiopia: A Retrospective Follow-Up Study

    PubMed Central

    Alemu, Yihun Mulugeta; Andargie, Gashaw; Gebeye, Ejigu

    2016-01-01

    Objective To identify the incidence of and predictors for tuberculosis in children living with HIV in Northern Ethiopia. Design Observational, retrospective follow-up study. Methods A total of 645 HIV-infected children were observed between September 2009 and September 2014. Cox regression analysis was used to identify predictors for developing TB. Results The incidence rate of tuberculosis was 4.2 per 100 child-years. Incidence of tuberculosis was higher for subjects who were not on cotrimoxazole preventive therapy, were not on isoniazid preventive therapy, had delayed motor development, had a CD4 cell count below the threshold, had hemoglobin level less than 10 mg/dl and were assessed as World Health Organization (WHO) clinical stage III or IV. Conclusion Incidence of TB in children living with HIV was high. This study reaffirmed that isoniazid preventive therapy is one of the best strategy to reduce incidence of TB in children living with HIV. All children living with HIV should be screened for TB but for children with delayed motor development, advanced WHO clinical stage, anemia or immune suppression, intensified screening is highly recommended. PMID:27070435

  3. Retrospective study and review of ocular radiation side effects following external-beam Cobalt-60 radiation therapy in 37 dogs and 12 cats

    PubMed Central

    Pinard, Chantale L.; Mutsaers, Anthony J.; Mayer, Monique N.; Woods, J. Paul

    2012-01-01

    This retrospective study evaluated the ocular side effects of cancer-bearing dogs and cats treated with external–beam Cobalt-60 (Co-60) radiation in which one or both orbit(s) were included in the radiation field. A total of 37 dogs and 12 cats presented to the Ontario Veterinary College during the 10-year study period (1999–2009) were evaluated. The radiation protocols ranged from a maximum of 60 Gray (Gy) in 24 fractions for curative intent to a minimum of 8 Gy in 1 fraction for palliative treatment. The main ocular side effect reported in both dogs and cats was conjunctivitis (79% and 55%, respectively). Other common ocular side effects included eyelid lesions in dogs (44%), ulcerative keratitis in cats (36%), and keratoconjunctivitis sicca in both dogs and cats (44% and 27%, respectively). The high incidence of ocular side effects in both patient populations indicates a need for regular ophthalmic examinations as a component of routine follow-up for radiation therapy involving the orbit. Radiation damage to ocular tissues is also reviewed. PMID:23729828

  4. Following control for a UUV using temporary path generation guidance

    NASA Astrophysics Data System (ADS)

    Yan, Zheping; Chi, Dongnan; Zhou, Jiajia; Zhao, Yufei

    2012-06-01

    A path following control algorithm for an unmanned underwater vehicle (UUV) using temporary path generation guidance was proposed in this paper. Owing to different initial states of the vehicle, such as position and orientation, the path following control in the horizontal plane may yield a poor performance. To deal with the negative effect induced by initial states, a temporary path generation was presented based on the relationship between the original reference path and the vehicle's initial states. With different relative positions between the vehicle and reference path, including out of straight lines, as well as inside and outside a circle, the related temporary paths guiding the vehicle to the reference path were able to be generated in real time. The vehicle was guided to steer along the temporary path until it reached the tangent point at the reference path, where the controller was designed using the input-output feedback linearization method. Simulation results demonstrated that the proposed algorithm is effective under the three different situations mentioned above.

  5. Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery

    PubMed Central

    Alevizopoulos, Aristeidis; Zosimas, Dimitrios; Piha, Lamprini; Hanna, Milad; Charitopoulos, Konstantinos

    2016-01-01

    Introduction The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm. Objectives We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free. Materials and methods 192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed. Results Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm). Conclusion Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute. PMID:26989370

  6. Outcomes for patients with anaplastic astrocytoma treated with chemoradiation, radiation therapy alone or radiation therapy followed by chemotherapy: a retrospective review within the era of temozolomide.

    PubMed

    Shonka, Nicole A; Theeler, Brett; Cahill, Daniel; Yung, Alfred; Smith, Lynette; Lei, Xiudong; Gilbert, Mark R

    2013-06-01

    Treatment for anaplastic astrocytoma (AA) is controversial. To assess three primary treatment approaches, patients from a single institution were retrospectively evaluated. To represent modern treatment selection, patients diagnosed with AA from December 2003 to December 2009 were selected. Those with insufficient data, incomplete pathology, and transformation or reclassification to glioblastoma in fewer than 6 months were excluded. A total of 163 patients were included in the final analyses. Median follow-up time was 4.2 years (range 0.5-7.8 years). Median age and Karnofsky performance status at diagnosis were 39.2 years and 90, respectively. 23.6 % of patients underwent biopsy, and 72.2 % underwent resection. Approximately 31 % received concurrent chemoradiation (CRT), 26.1 % had radiation therapy alone (RT), 38.2 % had radiation therapy followed by chemotherapy (RT-C), and 3 % were treated only with chemotherapy. Temozolomide was used almost exclusively during CRT (94.2 %) and adjuvantly. A median of 9.5 cycles of adjuvant chemotherapy was given. The combination of radiation and chemotherapy, either concurrent or sequential trended toward a higher rate of radiation necrosis. Median progression free survival (PFS) favored RT (not reached) over CRT (1.5 years) and RT-C (3.6 years) adjusted for pairwise comparison (p = 0.033, p = 0.050). Median overall survival (OS) was 5.7 years, and did not differ significantly by treatment group. OS for patients with AA did not vary by initial treatment selection. Although the longer PFS in those receiving RT versus CRT may be confounded by pseudoprogression, the equivalent OS among groups supports RT. PMID:23526410

  7. Combined chemoradiotherapy with local microwave hyperthermia for treatment of T3N0 laryngeal carcinoma: a retrospective study with long-term follow-up.

    PubMed

    Kouloulias, V; Triantopoulou, S; Vrouvas, J; Gennatas, K; Ouzounoglou, N; Kouvaris, J; Karaiskos, P; Aggelakis, P; Antypas, C; Zygogianni, A; Papavasiliou, K; Platoni, K; Kelekis, N

    2014-06-01

    The purpose of our study was to test the efficacy and toxicity of hyperthermia in conjunction with chemoradiotherapy for T3N0 laryngeal cancer. From 1997-2006, 25 patients diagnosed with T3N0 laryngeal carcinoma who denied laryngectomy were selected for this retrospective study. Patients received a total dose of 70 Gy (2 Gy per fraction, 5 days per week) in combination with 6 weekly sessions of hyperthermia, in addition to weekly cisplatin chemotherapy. The hyperthermia device was operated as a 433 MHz microwave heating with water loaded and water-cooled waveguides. The temperature was monitored subcutaneously in the skin under the aperture of the waveguide. The median follow-up was 60 months, while 23 of 25 patients (92%) presented complete response to treatment. The two patients that did not respond to thermoradiotherapy underwent total laryngectomy, and during follow-up were alive and free of disease. According to EORTC/RTOG criteria, toxicity was mild: three patients (12%) presented grade III, eight (32%) presented grade II and 14 (56%) presented grade I acute skin toxicity. Grade III laryngeal late toxicity (vocal cord malfunction due to severe oedema) was noted in two patients (8%) at 6-8 months post-thermo-chemoradiotherapy. Tmin was correlated (Spearman rho, p < 0.05) with response to treatment as well as with acute skin toxicity and laryngeal function. When a patient with T3N0 laryngeal carcinoma denies laryngectomy, an alternative treatment is combined thermo-chemoradiotherapy which seems to be effective and generally tolerable with radiation-induced skin toxicity and/or late side effects. A larger patient cohort is needed to confirm these results. PMID:24882925

  8. A retrospective review of outcome and survival following surgery and adjuvant xenogeneic DNA vaccination in 32 dogs with oral malignant melanoma

    PubMed Central

    TREGGIARI, Elisabetta; GRANT, Jessica Pauline; NORTH, Susan Margaret

    2016-01-01

    A xenogeneic DNA vaccination has been licensed for use in dogs with locally controlled stage II and III oral malignant melanoma (OMM). At present, there are limited outcome data for dogs with OMM treated with surgery and immunotherapy. The aim of this study is to retrospectively review the outcome and survival of 32 dogs affected by OMM that were treated with a combination of surgery and the xenogeneic DNA vaccination (with the addition of radiotherapy in some cases) and to determine the influence of surgical margins and delay in receiving vaccination. The overall median survival time (MST) was 335 days (95% CI: 301–540 days), and the overall median progression-free survival (PFS) was 160 days (mean 182 days, 95% CI: 132–232 days). Stage, completeness of surgical margins and delay in administration of the vaccine did not appear to statistically influence survival or PFS, although these results may reflect the low statistical power of the study due to small numbers. Further studies are required to assess whether the addition of any adjuvant treatment to surgery, including immunotherapy, is able to significantly prolong survival in cases of canine oral melanoma. PMID:26781703

  9. Reliability of an expert rating procedure for retrospective assessment of occupational exposures in community-based case-control studies.

    PubMed

    Siemiatycki, J; Fritschi, L; Nadon, L; Gérin, M

    1997-03-01

    The most daunting problem in community-based studies of occupational cancer is retrospective exposure assessment. To avoid the error involved in using job title as the exposure variable or self-report of exposure, our team developed an approach based on expert judgment applied to job descriptions obtained by interviewers. A population-based case-control study of cancer and occupation was carried out in Montreal between 1979 and 1986, and over 4,000 job histories were assessed by our team of experts. The job histories of these subjects were evaluated, by consensus, by a team of chemist/hygienists for evidence of exposure to a list of 294 workplace chemicals. In order to evaluate the reliability of this exposure assessment procedure, four years after the rating was completed, we selected 50 job histories at random and had two members of the expert team carry out the same type of coding, blind to the original ratings for these jobs. For 25 job histories, comprising 94 distinct jobs, the pair worked as a consensus panel; for the other 25, comprising 92 distinct jobs, they worked independently. Statistical comparisons were made between the new ratings and the old. Among those rated by consensus, the marginal distribution of exposure prevalence was almost identical between old and new. The weighted kappa for agreement was 0.80. Among items for which both ratings agreed that there had been exposure, there was good agreement on the frequency, concentration, and route of contact. When the two raters worked independently, the levels of agreement between them and between each of them and the original rating was good (kappas around 0.70), though not as high as when they worked together. It is concluded that high levels of reliability are attainable for retrospective exposure assessment by experts. PMID:9055950

  10. Two one-stage posterior approaches for treating thoracic and lumbar spinal tuberculosis: A retrospective case-control study

    PubMed Central

    XU, ZHENGQUAN; WANG, XIYANG; SHEN, XIONGJIE; WU, PING; PANG, XIAOYANG; LUO, CHENGKE; ZENG, HAO

    2015-01-01

    The aim of this retrospective study was to analyze the results of two surgical treatments for thoracic and lumbar spinal tuberculosis. A total of 73 patients with monosegmental thoracic or lumbar spinal tuberculosis were enrolled from January 2006 to April 2011. The patients were divided into two groups. Patients in group A (n=34) underwent one-stage posterior debridement, limited decompression, bone grafting and internal fixation combined with lamina reconstruction, while those in group B (n=39) underwent one-stage posterior debridement, decompression, bone grafting and posterior instrumentation. Clinical and radiographic results were analyzed and compared between the groups. Patients were followed for a mean 31.3 months (range, 21–42 months). Fusion occurred at 4–12 months (mean, 7.7 months). Surgical complications affected one and five patients in groups A and B, respectively. There was extraction of internal fixation in two group B patients. Postoperatively, there was significant Cobb angle correction in the two groups. By the last follow-up, the Cobb angle and correction loss in group A were significantly better than that in group B; the group A Oswestry Disability Index and Frankel grade were better than that in group B. In conclusion, one-stage posterior limited decompression, bone grafting and internal fixation combined with lamina reconstruction enables rapid management of monosegmental thoracic and lumbar spinal tuberculosis with fewer complications and minimal invasion. PMID:26136972

  11. A Retrospective Study of Equine Infectious Anemia Based on the Canadian Control Program

    PubMed Central

    Paquette, Benoit

    1985-01-01

    Equine infectious anemia in Canada was reviewed for the period January 1976 to December 1981. The human and ecological factors prevailing in Canada are deemed instrumental with respect to the evolution of the disease. The natural spread of the disease on a large scale has not been influenced by the Federal program. Reactors with signs of the disease are important for it's propagation. The author underlines the necessity of cooperation with private practising veterinarians to control it. PMID:17422597

  12. Recovery of postural equilibrium control following space flight

    NASA Technical Reports Server (NTRS)

    Paloski, William H.; Reschke, Millard F.; Black, F. Owen; Dow, R. S.

    1999-01-01

    DSO 605 represents the first large study of balance control following spaceflight. Data collected during DSO 605 confirm the theory that postural ataxia following short duration spaceflight is of vestibular origin. We used the computerized dynamic posturography technique developed by Nashner et al. to study the role of the vestibular system in balance control in astronauts during quiet stance before and after spaceflight. Our results demonstrate unequivocally that balance control is disrupted in all astronauts immediately after return from space. The most severely affected returning crew members performed in the same way as vestibular deficient patients exposed to this test battery. We conclude that otolith mediated spatial reference provided by the terrestrial gravitational force vector is not used by the astronauts balance control systems immediately after spaceflight. Because the postflight ataxia appears to be mediated primarily by CNS adaptation to the altered vestibular inputs caused by loss of gravitational stimulation, we believe that intermittent periods of exposure to artificial gravity may provide an effective in-flight countermeasure. Specifically, we propose that in-flight centrifugation will allow crew members to retain their terrestrial sensory-motor adapted states while simultaneously developing microgravity adapted states. The dual-adapted astronaut should be able to make the transition from microgravity to unit gravity with minimal sensory-motor effects. We have begun a ground based program aimed at developing short arm centrifuge prescriptions designed to optimize adaptation to altered gravitational environments. Results from these experiments are expected to lead directly to in-flight evaluation of the proposed centrifuge countermeasure. Because our computerized dynamic posturography system was able to (1) quantify the postflight postural ataxia reported by crew members and observed by flight surgeons and scientists, (2) track the recovery of

  13. Risk factors at medical school for subsequent professional misconduct: multicentre retrospective case-control study

    PubMed Central

    James, David

    2010-01-01

    Objective To determine whether there are risk factors in a doctor’s time at medical school that are associated with subsequent professional misconduct. Design Matched case-control study. Setting Records from medical schools and the General Medical Council (GMC). Participants 59 doctors who had graduated from any one of eight medical schools in the United Kingdom in 1958-97 and had a proved finding of serious professional misconduct in GMC proceedings in 1999-2004 (cases); 236 controls (four for each case) were selected by systematic sampling from matching graduation cohorts. Case-control status was revealed by the GMC after completion of data entry. Main outcome measure Odds ratios for being a “case,” with multivariable conditional logistic regression of potential risk factors including pre-admission characteristics and progress during the course. These data were obtained from anonymised copies of the students’ progress files held by their original medical schools. Results Univariate conditional logistic regression analysis found that cases were more likely to be men, to be of lower estimated social class, and to have had academic difficulties during their medical course, especially in the early years. Multivariable analysis showed that male sex (odds ratio 9.80, 95% confidence interval 2.43 to 39.44, P=0.001), lower social class (4.28, 1.52 to 12.09, P=0.006), and failure of early or preclinical examinations (5.47, 2.17 to 13.79, P<0.001) were independently associated with being a case. Conclusions This small study suggests that male sex, a lower socioeconomic background, and early academic difficulties at medical school could be risk factors for subsequent professional misconduct. The findings are preliminary and should be interpreted with caution. Most doctors with risk factors will not come before the GMC’s disciplinary panels. PMID:20423965

  14. Glycemic Control Outcomes by Gender in the Pay-for-Performance System: A Retrospective Database Analysis in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Yuan, Shao-Ping; Huang, Chien-Ning; Liao, Hung-Chang; Lin, Yu-Tzu; Wang, Ya-huei

    2014-01-01

    Background. The purpose of this study was to investigate how the degree of glycemic control in patients with type 2 diabetes associated with lifestyle interventions as well as sociodemographic factors and further examine the differences by gender. Methods. This was a retrospective study using data collected from a diabetes quality improvement plan that began in 2002 in a medical center in Taiwan. Statistic analysis was used to determine the associations of sociodemographic data, lifestyle intervention, and treatment regimens with changes in HbA1c levels (between the initial visit and the latest follow-up measured level), and the differences were then sorted by the sex of the patients. Results. Our results showed that HbA1c averaged 7.50% for males and 7.80% for females at the initial visit, compared to levels averaging 7.50% for males and 7.70% for females at the most recent follow-up visit. There was no significant change (P = 0.541) in HbA1c in males, but there was a 0.10% (P = 0.384) reduction in females. The duration of the diabetes and medication regimen was associated with the decrease seen in the females. Conclusions. The results of these analyses provide important insights for policy makers to formulate healthcare policies related to chronic diseases or illnesses. PMID:25202328

  15. Early psychopathological signs in bulimia nervosa. A retrospective comparison of the period of puberty in bulimic and control girls.

    PubMed

    Corcos, M; Flament, M F; Giraud, M J; Paterniti, S; Ledoux, S; Atger, F; Jeammet, P

    2000-06-01

    While bulimia nervosa (BN) typically begins in girls during late adolescence, puberty and associated developmental changes have been linked to negative body image and onset of a variety of psychological problems. This study aimed to identify early psychopathological signs, which could have marked the period of puberty in subjects whom later developed BN. In a case control study, we compared 49 girls with BN according to DSM-IV, aged between 18 and 20 years, to 49 girls of the same age, who were free of any past or current psychiatric diagnosis. Psychiatrists or clinical psychologists, using a semi-structured clinical interview including retrospective assessment of the emotional and behavioural changes that had occurred in puberty evaluated both groups. Before the onset of a clinical eating disorder, the subjects with BN presented significantly more often than controls weight related concerns, attitudes of withdrawal and social isolation, and negative changes in their body image and self-image, as well as in their relationships with siblings and peers. The results suggest that early psychological distress precedes the onset of an eating disorder in many cases, and that prevention efforts should be directed towards peripubertal psychopathology. PMID:10926061

  16. A Multicenter Retrospective Analysis of Survival Outcome Following Postoperative Chemoradiotherapy in Non-Small-Cell Lung Cancer Patients With N2 Nodal Disease

    SciTech Connect

    Zou Bingwen; Xu Yong; Li Tao; Li Wenhui; Tang Bangxian; Zhou Lin; Li Lu; Liu Yongmei; Zhu Jiang; Huang Meijuan; Wang Jin; Ren Li; Gong Youlin; Che Guowei; Liu Lunxu; Hou Mei; Lu You

    2010-06-01

    Purpose: To retrospectively evaluate the role of postoperative chemoradiotherapy (POCRT) in patients with completely resected non-small-cell lung cancer (NSCLC) with N2 lymph node involvement. Methods and Materials: This study included 183 patients from four centers in southwest China who underwent radical section of Stage III-N2 NSCLC without any preoperative therapy. One hundred and four were treated with POCRT and 79 with postoperative chemotherapy (POCT) alone. The median radiation dose to clinical target volume (CTV) was 50 Gy (varying between 48 and 54 Gy), whereas the cycles of platinum-based chemotherapy ranged from two to six with a median of four. Results: The median duration of follow-up was 72 months. The 5-year overall survival rate (OS) was 30.5% in the POCRT group, and 14.4% in the POCT group (p = 0.007). The 5-year disease-free survival rate (DFS) was 22.2% in POCRT group and 9.3% in POCT group (p = 0.003). In a multivariate analysis, N1 nodal involvement (N1+/N2+) was associated with significantly worse OS (HR = 1.454, 95% CI, 1.012-2.087, p = 0.043) and DFS (HR = 1.685, 95% CI, 1.196-2.372, p = 0.003). Absence of radiotherapy and treatment with fewer than three cycles of chemotherapy both were poor prognostic factors for both OS and DFS. Conclusions: As compared with chemotherapy alone, adjuvant treatment with both radiotherapy and chemotherapy improves survival in patients with completely resected Stage III-N2 nodal disease in NSCLC. Future study of treatment modality with radiotherapy and chemotherapy is warranted, especially focusing on both N1 and N2 nodal status.

  17. Immunological and Clinical Responses following the Use of Antiretroviral Therapy among Elderly HIV-Infected Individuals Attending Care and Treatment Clinic in Northwestern Tanzania: A Retrospective Cohort Study

    PubMed Central

    Mpondo, Bonaventura C. T.; Gunda, Daniel W.; Kilonzo, Semvua B.; Mgina, Erick

    2016-01-01

    Background. Limited information exists on adults ≥50 years receiving HIV care in sub-Saharan Africa despite their increasing number. We aimed at studying immunologic and clinical responses to ART in this population. Methods. Data of patients who initiated HAART between 30th of June 2004 and 1st of May 2008 at Sekou Toure Care and Treatment Clinic were retrospectively analyzed. Date of ART initiation was used as a baseline and 48 months as a follow-up date. Immune recovery was defined as a CD4 count of ≥350 cells/mm3 at 48 months and late presentation as presentation with WHO stage 3 or 4 at clinic enrollment. Proportions of patients reaching this endpoint were compared between the two groups. Results. A total of 728 patients were included in our study; of these 73 (10.0%) were aged 50 years and above. Late presentation was more common in elderly patients than young patients (65.7% versus 56.1%, P = 0.12). Proportion of patients with CD4 count ≥350 (immune recovery) was higher in younger patients than in elderly patients, although this was not statistically significant (54.5% versus 44.9%, P = 0.2). Median absolute increase in CD4 at 48 months was higher in younger patients than in elderly patients (+241.5 cells/mm3 versus +146 cells/mm3, P = 0.007). Conclusion. Elderly HIV patients have higher rates of late presentation, with lower immune recovery. Strategies to increase HIV testing in this group are required for early diagnosis and treatment to improve outcomes. PMID:27042375

  18. Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study

    PubMed Central

    Almashrafi, Ahmed; Alsabti, Hilal; Mukaddirov, Mirdavron; Balan, Baskaran

    2016-01-01

    Objectives Two objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive model for prolonged LOS in the cardiac intensive care unit (CICU) based on preoperative factors available at admission and to compare it against two existing cardiac stratification systems. Design Observational retrospective study. Settings A tertiary hospital in Oman. Participants All adult patients who underwent cardiac surgery at a major referral hospital in Oman between 2009 and 2013. Results 30.5% of the patients had prolonged LOS (≥11 days) after surgery, while 17% experienced prolonged ICU LOS (≥5 days). Factors that were identified to prolong CICU LOS were non-elective surgery, current congestive heart failure (CHF), renal failure, combined coronary artery bypass graft (CABG) and valve surgery, and other non-isolated valve or CABG surgery. Patients were divided into three groups based on their scores. The probabilities of prolonged CICU LOS were 11%, 26% and 28% for group 1, 2 and 3, respectively. The predictive model had an area under the curve of 0.75. Factors associated with prolonged overall postoperative LOS included the body mass index, the type of surgery, cardiopulmonary bypass machine use, packed red blood cells use, non-elective surgery and number of complications. The latter was the most important determinant of postoperative LOS. Conclusions Patient management can be tailored for individual patient based on their treatments and personal attributes to optimise resource allocation. Moreover, a simple predictive score system to enable identification of patients at risk of prolonged CICU stay can be developed using data that are routinely collected by most hospitals. PMID:27279475

  19. Impact of hospitalizations for bronchiolitis in preterm infants on long-term health care costs in Italy: a retrospective case-control study

    PubMed Central

    Roggeri, Daniela Paola; Roggeri, Alessandro; Rossi, Elisa; Cataudella, Salvatore; Martini, Nello

    2016-01-01

    Purpose Bronchiolitis is an acute inflammatory injury of the bronchioles, and is the most frequent cause of hospitalization for lower respiratory tract infections in preterm infants. This was a retrospective, observational, case-control study conducted in Italy, based on administrative database analysis. The aim of this study was to evaluate differences in health care costs of preterm infants with and without early hospitalization for bronchiolitis. Patients and methods Preterm infants born in the period between January 1, 2009 and December 31, 2010 and hospitalized for bronchiolitis in the first year of life were selected from the ARNO Observatory database and observed for the first 4 years of life. These preterm infants were compared (paired 1–3) with preterm infants who were not hospitalized for bronchiolitis in the first year of life and with similar characteristics. Only direct health care costs reimbursed by the Italian National Health Service were considered for this study (drugs, hospitalizations, and diagnostic/therapeutic procedures). Results Of 40,823 newborns in the accrual period, 863 were preterm with no evidence of prophylaxis, and 22 preterm infants were hospitalized for bronchiolitis (cases) and paired with 62 controls. Overall, cases had 74% higher average cost per infant in the first 4 years of life than controls (18,624€ versus 10,189€, respectively). The major cost drivers were hospitalizations, accounting for >90% in both the populations. The increase in total yearly health care cost between cases and controls remained substantial even in the fourth year of life for all cost items. A relevant increase in hospitalizations and drug consumption linked to respiratory tract diseases was noted in infants hospitalized for bronchiolitis during the entire follow-up period. Conclusion Preterm infants hospitalized for bronchiolitis in the first year of life were associated with increased resource consumption and costs throughout the entire period

  20. Prison tobacco control policies and deaths from smoking in United States prisons: population based retrospective analysis

    PubMed Central

    Carson, E Ann; Krueger, Patrick M; Mueller, Shane R; Steiner, John F; Sabol, William J

    2014-01-01

    Objective To determine the mortality attributable to smoking and years of potential life lost from smoking among people in prison and whether bans on smoking in prison are associated with reductions in smoking related deaths. Design Analysis of cross sectional survey data with the smoking attributable mortality, morbidity, and economic costs system; population based time series analysis. Setting All state prisons in the United States. Main outcome measures Prevalence of smoking from cross sectional survey of inmates in state correctional facilities. Data on state prison tobacco policies from web based searches of state policies and legislation. Deaths and causes of death in US state prisons from the deaths in custody reporting program of the Bureau of Justice Statistics for 2001-11. Smoking attributable mortality and years of potential life lost was assessed from the smoking attributable mortality, morbidity, and economic costs system of the Centers for Disease Control and Prevention. Multivariate Poisson models quantified the association between bans and smoking related cancer, cardiovascular and pulmonary deaths. Results The most common causes of deaths related to smoking among people in prison were lung cancer, ischemic heart disease, other heart disease, cerebrovascular disease, and chronic airways obstruction. The age adjusted smoking attributable mortality and years of potential life lost rates were 360 and 5149 per 100 000, respectively; these figures are higher than rates in the general US population (248 and 3501, respectively). The number of states with any smoking ban increased from 25 in 2001 to 48 by 2011. In prisons the mortality rate from smoking related causes was lower during years with a ban than during years without a ban (110.4/100 000 v 128.9/100 000). Prisons that implemented smoking bans had a 9% reduction (adjusted incidence rate ratio 0.91, 95% confidence interval 0.88 to 0.95) in smoking related deaths. Bans in place for longer than

  1. Survivors, not invaders, control forest development following simulated hurricane.

    PubMed

    Plotkin, Audrey Barker; Foster, David; Carlson, Joel; Magill, Alison

    2013-02-01

    Wind disturbance profoundly shapes temperate forests but few studies have evaluated patterns and mechanisms of long-term forest dynamics following major windthrows. In 1990, we initiated a large hurricane simulation experiment in a 0.8-ha manipulation (pulldown) and 0.6-ha control area of a maturing Quercus rubra--Acer rubrum forest in New England. We toppled 276 trees in the pulldown, using a winch and cable, in the northwesterly direction of natural treefall from major hurricanes. Eighty percent of canopy trees and two-thirds of all trees > or = 5 cm dbh (diameter at breast height) suffered direct and indirect damage. We used 20 years of measurements to evaluate the trajectory and mechanisms of forest response after intense disturbance. Based on the patch size and disturbance magnitude, we expected pioneer tree and understory species to drive succession. The first decade of analyses emphasized tree seedling establishment and sprouting by damaged trees as the dominant mechanisms of forest recovery in this extensive damaged area. However, despite 80% canopy damage and 8000-m2 patch size, surviving overstory and advance regeneration controlled longer-term forest development. Residual oaks make up 42% of stand basal area after 20 years. The new cohort of trees, dominated by black birch advance regeneration, contributes 30% of stand basal area. There were shifts in understory vegetation composition and cover, but few species were gained or lost after 20 years. Stand productivity rebounded quickly (litterfall recovered to pre-disturbance levels in six years), but we predict that basal area in the pulldown will lag behind the control (which gained 6 m2/ha over 20 years) for decades to come. This controlled experiment showed that although the scale and intensity of damage were great, abundant advance regeneration, understory vegetation, and damaged trees remained, allowing the forest to resist changes in ecosystem processes and invasion by new species. PMID:23691660

  2. Infectious diseases following natural disasters: prevention and control measures.

    PubMed

    Kouadio, Isidore K; Aljunid, Syed; Kamigaki, Taro; Hammad, Karen; Oshitani, Hitoshi

    2012-01-01

    Natural disasters may lead to infectious disease outbreaks when they result in substantial population displacement and exacerbate synergic risk factors (change in the environment, in human conditions and in the vulnerability to existing pathogens) for disease transmission. We reviewed risk factors and potential infectious diseases resulting from prolonged secondary effects of major natural disasters that occurred from 2000 to 2011. Natural disasters including floods, tsunamis, earthquakes, tropical cyclones (e.g., hurricanes and typhoons) and tornadoes have been secondarily described with the following infectious diseases including diarrheal diseases, acute respiratory infections, malaria, leptospirosis, measles, dengue fever, viral hepatitis, typhoid fever, meningitis, as well as tetanus and cutaneous mucormycosis. Risk assessment is essential in post-disaster situations and the rapid implementation of control measures through re-establishment and improvement of primary healthcare delivery should be given high priority, especially in the absence of pre-disaster surveillance data. PMID:22149618

  3. Changes in vegetation and grazing capacity following honey mesquite control

    USGS Publications Warehouse

    McDaniel, Kirk C.; Brock, John H.; Haas, Robert H.

    1982-01-01

    Honey mesquite kill and suppression, vegetation response, and changes in grazing use and capacity were evaluated following brush control in north-central Texas. Tree grubbing was most effective for eliminating honey mesquite, but because of soil and plant damage the treatment did not increase grazing capacity or improve range condition compared to nontreated rangeland. Aerial application of 2,4,5-T + picloram was more effective in klllmg and defoliating honey mesquite than 2,4,5-T alone, but both treatments significantly increased forage production. The 2,4,5-T + picloram and 2,4,5-T sprays provided a 7 to 16% increase in grazing capacity over a 4-year period on light and heavy honey mesquite infested pastures, respectively.

  4. Retrospective optimization of time-dependent fermentation control strategies using time-independent historical data.

    PubMed

    Coleman, Matthew C; Block, David E

    2006-10-20

    We have previously shown the usefulness of historical data for fermentation process optimization. The methodology developed includes identification of important process inputs, training of an artificial neural network (ANN) process model, and ultimately use of the ANN model with a genetic algorithm to find the optimal values of each critical process input. However, this approach ignores the time-dependent nature of the system, and therefore, does not fully utilize the available information within a database. In this work, we propose a method for incorporating time-dependent optimization into our previously developed three-step optimization routine. This is achieved by an additional step that uses a fermentation model (consisting of coupled ordinary differential equations (ODE)) to interpret important time-course features of the collected data through adjustments in model parameters. Important process variables not explicitly included in the model were then identified for each model parameter using automatic relevance determination (ARD) with Gaussian process (GP) models. The developed GP models were then combined with the fermentation model to form a hybrid neural network model that predicted the time-course activity of the cell and protein concentrations of novel fermentation conditions. A hybrid-genetic algorithm was then used in conjunction with the hybrid model to suggest optimal time-dependent control strategies. The presented method was implemented upon an E. coli fermentation database generated in our laboratory. Optimization of two different criteria (final protein yield and a simplified economic criteria) was attempted. While the overall protein yield was not increased using this methodology, we were successful in increasing a simplified economic criterion by 15% compared to what had been previously observed. These process conditions included using 35% less arabinose (the inducer) and 33% less typtone in the media and reducing the time required to reach

  5. Factors associated with loss to follow-up among women in Option B+ PMTCT programme in northeast Ethiopia: a retrospective cohort study

    PubMed Central

    Mitiku, Israel; Arefayne, Mastewal; Mesfin, Yonatal; Gizaw, Muluken

    2016-01-01

    Introduction Ethiopia has recently adopted lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women (Option B+ strategy), regardless of CD4 count or clinical stage. However, the exact timing and predictors of loss to follow-up (LFU) are unknown. Thus, we examined the levels and determinants of LFU under Option B+ among pregnant and breastfeeding women initiated on lifelong ART for prevention of mother-to-child transmission (PMTCT) in Ethiopia. Methods We conducted a retrospective cohort study among 346 pregnant and breastfeeding women who started ART at 14 public health facilities in northeast Ethiopia from March 2013 to April 2015. We defined LFU as 90 days since the last clinic visit among those not known to have died or transferred out. We used Kaplan-Meier and Cox proportional hazards regression to estimate cumulative LFU and identify the predictors of LFU, respectively. Results Of the 346 women included, 88.4% were pregnant and the median follow-up was 13.7 months. Overall, 57 (16.5%) women were LFU. The cumulative proportions of LFU at 6, 12 and 24 months were 11.9, 15.7 and 22.6%, respectively. The risk of LFU was higher in younger women (adjusted hazard ratio (aHR) 18 to 24 years/30 to 40 years: 2.3; 95% confidence interval (CI): 1.2 to 4.5), in those attending hospitals compared to those attending health centres (aHR: 1.8; 95% CI: 1.1 to 3.2), in patients starting ART on the same day of diagnosis (aHR: 1.85; 95% CI: 1.1 to 3.2) and missing CD4 cell counts at ART initiation (aHR: 2.3; 95% CI: 1.2 to 4.4). Conclusions The level of LFU we found in this study is comparable with previous findings from other resource-limited settings. However, high early LFU shortly after ART initiation is still a major problem. LFU was high among younger women, those initiating ART on the day of HIV diagnosis, those missing baseline CD4 count and those attending hospitals. Thus, targeted HIV care and treatment programmes for these patients

  6. A retrospective analysis of the postoperative use of loteprednol etabonate gel 0.5% following laser-assisted in situ keratomileusis or photorefractive keratectomy surgery

    PubMed Central

    Salinger, Clifford L; Gordon, Michael; Jackson, Mitchell A; Perl, Theodore; Donnenfeld, Eric

    2015-01-01

    Background While loteprednol etabonate ophthalmic gel 0.5% (LE gel) is approved for treatment of postoperative ocular inflammation and pain, there have been no reported studies in patients undergoing laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). Methods This was a retrospective chart review conducted at five refractive surgical centers in the USA. Data were collected from primary LASIK or PRK surgery cases in which LE gel was used postoperatively as the clinician’s routine standard of care and in which patients were followed-up for up to 6 months. Data extracted from charts included patient demographics, surgical details, LE gel dosing regimen, pre- and postsurgical refractive characteristics, intraocular pressure (IOP) measurements, and visual acuity. Primary outcomes included postoperative IOP elevations, adverse events, and early discontinuations. Results Data were collected on 189 LASIK eyes (96 patients) and 209 PRK eyes (108 patients). Mean (standard deviation [SD]) years of age at surgery was 36.0 (11.7) and 33.9 (11.3) in LASIK and PRK patients. LE gel was prescribed most often four times daily during the first postoperative week, regardless of procedure; the most common treatment duration was 7–14 days in LASIK and ≥30 days in PRK patients. No unusual corneal findings or healing abnormalities were reported. Mean postoperative uncorrected distance visual acuity was 20/24 in LASIK and 20/30 in PRK eyes. Mild/trace corneal haze was reported in 20% of PRK patients; two PRK patients with moderate/severe corneal haze were switched to another corticosteroid. Mean postoperative IOP did not increase over time in either LASIK or PRK eyes (P≥0.331); clinically significant elevations from baseline in IOP (≥10 mmHg) were noted in only three eyes of two PRK patients. Conclusion LE gel appears to have a high level of safety and tolerability when used for the management of postoperative pain and inflammation following LASIK

  7. Whole Lung Lavage Treatment of Chinese Patients with Autoimmune Pulmonary Alveolar Proteinosis: A Retrospective Long-term Follow-up Study

    PubMed Central

    Zhao, Yu-Yue; Huang, Hui; Liu, Yong-Zhe; Song, Xin-Yu; Li, Shan; Xu, Zuo-Jun

    2015-01-01

    Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disease, the most common type of which is autoimmune PAP. The gold standard therapy for PAP is whole lung lavage (WLL). Few studies have reported the optimal technique with which to evaluate the response to WLL. In this study, we aimed to identify parameters with which to assess the need for repeat WLL during a long-term 8-year follow-up. Methods: We conducted a retrospective analysis of 120 patients with autoimmune PAP with 80 of whom underwent WLL. Physiologic, serologic, and radiologic features of the patients were analyzed during an 8-year follow-up after the first WLL treatment. Results: Of the 40 patients without any intervention, 39 patients either achieved remission or remained stable and only one died of pulmonary infection. Of the 56 patients who underwent WLL for 1 time, 55 remained free from a second WLL and 1 patient died of cancer. Twenty-four required additional treatments after their first WLL. The baseline PaO2 (P = 0.000), PA-aO2 (P = 0.000), shunt fraction rate (P = 0.001), percent of predicted normal diffusing capacity of the lung for carbon monoxide (DLCO%Pred) (P = 0.016), 6-min walk test (P = 0.013), carcinoembryonic antigen (CEA) (P = 0.007), and neuron-specific enolase (NSE) (P = 0.003) showed significant differences among the three groups. The need for a second WLL was significantly associated with PaO2 (P = 0.000), CEA (P = 0.050), the 6-minute walk test (P = 0.026), and DLCO%Pred (P = 0.041). The DLCO%Pred on admission with a cut-off value of 42.1% (P = 0.001) may help to distinguish whether patients with PAP require a second WLL. Conclusions: WLL is the optimal treatment method for PAP and provides remarkable improvements for affected patients. The DLCO%Pred on admission with a cut-off value of 42.1% may distinguish whether patients with PAP require a second WLL. PMID:26481735

  8. Retrospective Comparison of Chemoradiotherapy Followed by Adjuvant Chemotherapy, With or Without Prior Gliadel Implantation (Carmustine) After Initial Surgery in Patients With Newly Diagnosed High-Grade Gliomas

    SciTech Connect

    Noeel, Georges; Schott, Roland; Froelich, Sebastien; Gaub, Marie-Pierre; Boyer, Patrick; Fischer-Lokou, David; Dufour, Patrick; Kehrli, Pierre; Maitrot, Daniel

    2012-02-01

    Purpose: Retrospective study of patients treated for high-grade glioma, with or without biodegradable carmustine wafers and according to the Stupp protocol. Methods and Materials: Between May 2007 and June 2008, 65 patients underwent surgery for high-grade glioma, 28 had implantation of Gliadel and 37 patients did not. Patients received radiotherapy with concomitant temozolomide followed by 5 consecutive days of temozolomide every month for 6 months. Results: Overall median follow-up was 17.1 months; the median relapse-free survival (RFS) was 14 months with a RFS of 54% at 12 months, and 38% at 24 months. For patient with and without Gliadel, median and 1-year RFS were 12.9 months and 52% vs. 14 months and 42%, respectively (p = 0.89). According to pathology, Gliadel did not influence RFS of patients with Grade III or glioblastoma. However, for all patients, in multivariate analysis, non-methylated methylguanine methyltransferase (MGMT) was the only unfavorable prognostic factor of RFS (p = 0.017; HR 2.8; CI [1.2-7]). Median overall survival (OS) was 20.8 months; the OS rate at 12 months was 78.5%, and at 24 months 35.4%. For patients treated with and without Gliadel, median and 1-year OS were 20.6 months and 78.6% vs. 20.8 months and 78.4%, respectively. According to pathology, Gliadel did not influence OS of patients with Grade III or glioblastoma. For all patients, in multivariate analysis, unfavorable prognosticators for OS were non-methylated MGMT (p = 0.001; HR: 6.5; CI [2-20]) and irradiation dose <60 Gy (p = 0.02; HR: 6.3; CI [2-20]). With carmustine wafers, before irradiation, median gross tumor volume plus edema was 84 mL (27-229), whereas it was 68 mL (10-362) without carmustine (p = nonsignificant). Four cases of Grade 3 thrombopenia occurred, all in the carmustine wafer group. Conclusion: In patients with high-grade gliomas, adding Gliadel before performing a Stupp protocol did not improve survival.

  9. Postoperative pain relief following hysterectomy: A randomized controlled trial

    PubMed Central

    Raghvendra, K. P.; Thapa, Deepak; Mitra, Sukanya; Ahuja, Vanita; Gombar, Satinder; Huria, Anju

    2016-01-01

    Background: Women experience moderate to severe postoperative pain following total abdominal hysterectomy (TAH). The transversus abdominis plane (TAP) block is a new modality for providing postoperative pain relief in these patients. Materials and Methods: The present study was a single center, prospective randomized trial. After the Institutional Ethics Committee approval and informed consent, patients were randomized to either epidural group: Epidural block placement + general anesthesia (GA) or TAP group: Single shot TAP block + GA. Patients in both the groups received standard general anesthetic technique and intravenous tramadol patient-controlled analgesia in the postoperative period. Patients were monitored for tramadol consumption, visual analog scale (VAS) both at rest and on coughing, hemodynamics, and side effects at 0, 2, 4, 6, 8, 12, and 24 h postoperatively. Results: The total consumption of tramadol in 24 h was greater in TAP group as compared to epidural group (68.8 [25.5] vs. 5.3 [11.6] mg, P < 0.001). The VAS scores at rest and on coughing were higher in TAP group as compared to the epidural group at 6, 8, 12, and 24 h postoperatively (P < 0.05). None of the patients in either group had any adverse effects. Conclusion: Epidural analgesia provided greater tramadol-sparing effect with superior analgesia postoperatively as compared to TAP block in patients up to 24 h following TAH. PMID:27499592

  10. Comparison of Clinical Outcomes of Surgery Followed by Local Brain Radiotherapy and Surgery Followed by Whole Brain Radiotherapy in Patients With Single Brain Metastasis: Single-Center Retrospective Analysis

    SciTech Connect

    Hashimoto, Kenji; Narita, Yoshitaka; Miyakita, Yasuji; Ohno, Makoto; Sumi, Minako; Mayahara, Hiroshi; Kayama, Takamasa; Shibui, Soichiro

    2011-11-15

    Purpose: Data comparing the clinical outcomes of local brain radiotherapy (LBRT) and whole brain RT (WBRT) in patients with a single brain metastasis after tumor removal are limited. Patients and Methods: A retrospective analysis was performed to compare the patterns of treatment failure, cause of death, progression-free survival, median survival time, and Karnofsky performance status for long-term survivors among patients who underwent surgery followed by either LBRT or WBRT between 1990 and 2008 at the National Cancer Center Hospital. Results: A total of 130 consecutive patients were identified. The median progression-free survival period among the patients who received postoperative LBRT (n = 64) and WBRT (n = 66) was 9.7 and 11.5 months, respectively (p = .75). The local recurrence rates (LBRT, 9.4% vs. WBRT, 12.1%) and intracranial new metastasis rate (LBRT, 42.2% vs. WBRT, 33.3%) were similar in each arm. The incidence of leptomeningeal metastasis was also equivalent (LBRT, 9.4% vs. WBRT, 10.6%). The median survival time for the LBRT and WBRT patients was 13.9 and 16.7 months, respectively (p = .88). A neurologic cause of death was noted in 35.6% of the patients in the LBRT group and 36.7% of the WBRT group (p = .99). The Karnofsky performance status at 2 years was comparable between the two groups. Conclusions: The clinical outcomes of LBRT and WBRT were similar. A prospective evaluation is warranted.

  11. Causal Inference in Retrospective Studies.

    ERIC Educational Resources Information Center

    Holland, Paul W.; Rubin, Donald B.

    1988-01-01

    The problem of drawing causal inferences from retrospective case-controlled studies is considered. A model for causal inference in prospective studies is applied to retrospective studies. Limitations of case-controlled studies are formulated concerning relevant parameters that can be estimated in such studies. A coffee-drinking/myocardial…

  12. Surgery for Patients With Spontaneous Deep Supratentorial Intracerebral Hemorrhage: A Retrospective Case-Control Study Using Propensity Score Matching.

    PubMed

    Zheng, Jun; Li, Hao; Zhao, He-Xiang; Guo, Rui; Lin, Sen; Dong, Wei; Ma, Lu; Fang, Yuan; Tian, Meng; Liu, Ming; You, Chao

    2016-03-01

    Spontaneous intracerebral hemorrhage (sICH) is one of the most dangerous cerebrovascular diseases, especially when in deep brain. The treatment of spontaneous deep supratentorial intracerebral hemorrhage is still controversial. We conducted a retrospective case-control study using propensity score matching to compare the efficacy of surgery and conservative treatment for patients with deep surpatentorial hemorrhage. We observed the outcomes of consecutive patients with spontaneous deep supratentorial hemorrhage retrospectively from December 2008 to July 2013. Clinical outcomes of surgery and conservative treatments were compared in patients with deep sICH using propensity score matching method. The primary outcome was neurological function status at 6 months post ictus. The second outcomes included mortality at 30 days and 6 months, and the incidence of complications. Subgroup analyses of 6-month outcome were conducted. Sixty-three (22.66%) of the 278 patients who received surgery had a favorable neurological function status at 6 months, whereas in the conservative group, 66 of 278 (23.74%) had the same result (P = 0.763). The 30-day mortality in the surgical group was 19.06%, whereas 30.58% in the conservative group (P = 0.002). There was significant difference in the mortality at 6 months after ictus as well (23.38% vs 36.33%, P = 0.001). The subgroup analyses showed significantly better outcomes for the surgical group when hematoma was >40 mL (13.33% vs 0%, P = 0.005) or complicated with intraventricular hemorrhage (16.67% vs 7.27%, P = 0.034). For complications, the risk of pulmonary infection, gastrointestinal hemorrhage, urinary infection, pulmonary embolus, and need for tracheostomy/long term ventilation in the surgical group was higher than the conservative group (31.29% vs 15.47%, P < 0.001; 6.83% vs 3.96%, P = 0.133; 2.88% vs 1.80%, P = 0.400; 1.80% vs 1.08%, P = 0.476; 32.73% vs 23.38%, P = 0.014). Surgery could

  13. Diminished Baroreflex Control of Forearm Vascular Resistance Following Training

    NASA Technical Reports Server (NTRS)

    Mack, G. W.; Thompson, C. A.; Doerr, D. F.; Nadel, E. R.; Convertino, V. A.

    1991-01-01

    The stimulus-response characteristics of cardiopulmonary baroreflex control of forearm vascular resistance (FVR units in mm Hg x min x I00 ml/ml) were studied in 14 volunteers before and after 10 wk of endurance training. We assessed the relationship betaleen reflex stimulus (changes in central venous pressure, CVP) and response (FVR) during unloading of cardiopulmonary baroreceptors with lower body negative pressure (LBNP, 0 to - 2O mm Hg). Changes in CVP during LBNP were estimated from pressure changes in a large peripheral vein in the dependent arm of the subject in the right lateral decubitus position. Maximal oxygen uptake (VO(sub 2max)) and total blood volume increased with endurance training from 37.8 +/- 1.4 ml/min x kg and 63.6 +/- 2.1 ml/kg to 45.3 +/- 1.4 ml/ min x kg and 69.3 +/- 2.8 ml/kg respectively (P less than 0.05). Reflex forearm vasoconstriction occurred in response to a reduction in estimated CVP, and the absolute change in FVR per unit of CVP was reduced from -5.96 +/- 0.79 to -4.06 +/- 0.52 units x mm/ Hg (P less than 0.05) following exercise training but was unchanged from -6.10 to 0.57 to -6.22 +/- 0.94 units x mm/ Hg for the time control group (N = 7). Resting values for FVR were similar before and after exercise training; however, resting estimated CVP was elevated from 9.5 +/- 0.5 mm x Hg before training to 11.3 +/- 0.6 mm x Hg after training. The reduction in sensitivity of the cardiopulmonary baroreflex control of FVR was linearly related to the increase in blood volume (r = 0.65, P less than 0.05). suggesting that diminished cardiopulmonary baroreflex control of FVR in physically fit individuals is related, in part, to a training-induced blood volume expansion.

  14. Occupational outcomes following mild traumatic brain injury in Canadian military personnel deployed in support of the mission in Afghanistan: a retrospective cohort study

    PubMed Central

    Garber, Bryan G; Rusu, Corneliu; Zamorski, Mark A; Boulos, David

    2016-01-01

    Objective Deployment-related mild traumatic brain injury (MTBI) occurs in a significant number of military personnel but its long-term impacts are unclear. This study explores the impact of deployment-related MTBI on continued fitness-for-duty, with the ultimate intent of identifying potential targets for intervention to attenuate its effects. Participants Consisted of 16 193 Canadian Armed Forces (CAF) personnel who deployed in support of the mission in Afghanistan and completed an enhanced postdeployment screening (EPDS) questionnaire over the period January 2009–July 2012. Primary outcome The primary outcome was development of permanent medical unfitness defined as a ‘career-limiting medical condition’ (CL-MC). The secondary outcome was the diagnostic categories recorded for each individual at the time a CL-MC was established. Design This study used a retrospective cohort design. Linked administrative and health data provided the primary outcome and the diagnoses responsible for it. Survival analysis was used to estimate the risk of a CL-MC and Cox regression provided adjusted HRs (aHRs) for the association between a CL-MC and MTBI, accounting for key covariates and confounders. Diagnostic categories associated with CL-MCs were identified. Results Over a median follow-up period of 3.42 years, 6.57% of the study population developed a CL-MC. MTBI was independently associated with CL-MCs (aHR=1.65, 95% CI 1.35 to 2.03). Mental disorders and musculoskeletal conditions were the primary diagnoses associated with CL-MCs (identified as the primary diagnosis in 55.4% and 25.9%, respectively), and a neurological condition was only documented in 5.8% of those with MTBI who developed a CL-MC Conclusions Deployment-related MTBI was associated with adverse occupational outcome but mental disorders and musculoskeletal conditions primarily drove subsequent medical unfitness. These findings support a diagnostic and treatment approach focusing on these comorbidities as

  15. Affinity for risky behaviors following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study

    PubMed Central

    2011-01-01

    Background Many studies of adults with acute and chronic solvent exposure have shown adverse effects on cognition, behavior and mood. No prior study has investigated the long-term impact of prenatal and early childhood exposure to the solvent tetrachloroethylene (PCE) on the affinity for risky behaviors, defined as smoking, drinking or drug use as a teen or adult. Objectives This retrospective cohort study examined whether early life exposure to PCE-contaminated drinking water influenced the occurrence of cigarette smoking, alcohol consumption, and drug use among adults from Cape Cod, Massachusetts. Methods Eight hundred and thirty-one subjects with prenatal and early childhood PCE exposure and 547 unexposed subjects were studied. Participants completed questionnaires to gather information on risky behaviors as a teenager and young adult, demographic characteristics, other sources of solvent exposure, and residences from birth through 1990. PCE exposure was estimated using the U.S. EPA's water distribution system modeling software (EPANET) that was modified to incorporate a leaching and transport model to estimate PCE exposures from pipe linings. Results Individuals who were highly exposed to PCE-contaminated drinking water during gestation and early childhood experienced 50-60% increases in the risk of using two or more major illicit drugs as a teenager or as an adult (Relative Risk (RR) for teen use = 1.6, 95% CI: 1.2-2.2; and RR for adult use = 1.5, 95% CI: 1.2-1.9). Specific drugs for which increased risks were observed included crack/cocaine, psychedelics/hallucinogens, club/designer drugs, Ritalin without a prescription, and heroin (RRs:1.4-2.1). Thirty to 60% increases in the risk of certain smoking and drinking behaviors were also seen among highly exposed subjects. Conclusions The results of this study suggest that risky behaviors, particularly drug use, are more frequent among adults with high PCE exposure levels during gestation and early childhood

  16. Diminished baroreflex control of forearm vascular resistance following training.

    PubMed

    Mack, G W; Thompson, C A; Doerr, D F; Nadel, E R; Convertino, V A

    1991-12-01

    The stimulus-response characteristics of cardiopulmonary baroreflex control of forearm vascular resistance (FVR units in mm Hg.min.100 ml.ml-1) were studied in 14 volunteers before and after 10 wk of endurance training. We assessed the relationship between reflex stimulus (changes in central venous pressure, CVP) and response (FVR) during unloading of cardiopulmonary baroreceptors with lower body negative pressure (LBNP, 0 to -20 mm Hg). Changes in CVP during LBNP were estimated from pressure changes in a large peripheral vein in the dependent arm of the subject in the right lateral decubitus position. Maximal oxygen uptake (VO2max) and total blood volume increased with endurance training from 37.8 +/- 1.4 ml.min-1.kg-1 and 63.6 +/- 2.1 ml.kg-1 to 45.3 +/- 1.4 ml.min-1.kg-1 and 69.3 +/- 2.8 ml.kg-1, respectively (P less than 0.05). Reflex forearm vasoconstriction occurred in response to a reduction in estimated CVP, and the absolute change in FVR per unit of CVP was reduced from -5.96 +/- 0.79 to -4.06 +/- 0.52 units.mm Hg-1 (P less than 0.05) following exercise training but was unchanged from -6.10 to 0.57 to -6.22 +/- 0.94 units.mm Hg-1 for the time control group (N = 7). Resting values for FVR were similar before and after exercise training; however, resting estimated CVP was elevated from 9.5 +/- 0.5 mm Hg before training to 11.3 +/- 0.6 mm Hg after training.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1798379

  17. Following and intercepting scribbles: interactions between eye and hand control

    PubMed Central

    Mrotek, Leigh Ann

    2013-01-01

    The smooth pursuit eye movement system appears to be importantly engaged during the planning and execution of interceptive hand movements. The present study sought to probe the interaction between eye and hand control systems by examining their responses during an interception task that included target speed perturbations. On 2/3 of trials the target increased or decreased speed at various times, ranging from about 300 ms before to 150 ms after the onset of a finger movement directed to intercept the target and was triggered by a GO signal. Additionally the same 2D sum-of-sines target trajectories were followed with the eyes without interception. The smooth pursuit system responded more quickly if the target speed perturbation occurred earlier during the reaction time (i.e., near the time of the GO signal). Similarly, the finger movement began more quickly if target speed was increased earlier during the reaction time. For early perturbation conditions, the initial direction of the finger movement matched the predicted target intercept using the new target speed. For perturbations occurring after finger movement onset initial direction of finger movement did not match target interception such that, the finger path began to curve toward the perturbed target after about 150–200 ms. The results support the idea of an active process of visual target path extrapolation simultaneously used to guide both the eye and hand. PMID:23552996

  18. Serum Anion Gap Predicts All-Cause Mortality in Patients with Advanced Chronic Kidney Disease: A Retrospective Analysis of a Randomized Controlled Study

    PubMed Central

    Lee, Sung Woo; Kim, Sejoong; Na, Ki Young; Cha, Ran-hui; Kang, Shin Wook; Park, Cheol Whee; Cha, Dae Ryong; Kim, Sung Gyun; Yoon, Sun Ae; Han, Sang Youb; Park, Jung Hwan; Chang, Jae Hyun; Lim, Chun Soo; Kim, Yon Su

    2016-01-01

    Background and Objectives Cardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified. Methods A retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15–60 mL/min/1.73m2. Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality. Results Of 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0–5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6%). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95% CI 0.520–0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95% CI 1.143–7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG. Conclusions A-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed. Trial Registration Clinicaltrials.gov NCT 00860431 PMID:27249416

  19. A Controlled and Retrospective Study of 144 Chronic Low Back Pain Patients to Evaluate the Effectiveness of an Intensive Functional Restoration Program in France

    PubMed Central

    Caby, Isabelle; Olivier, Nicolas; Janik, Frédérick; Vanvelcenaher, Jacques; Pelayo, Patrick

    2016-01-01

    Study Design: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. Objective: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients with chronic low back pain (LBP), during 6 and 12 months follow up. Summary of background data: Chronic low back pain disease has a multifactor nature, involving physical, psychological professional and social factors. A functional restoration program (FRP) has been included in a multidisciplinary training program which provides an efficient therapeutic solution. However, the effectiveness of an FRP has not been yet established. Methods: 144 subjects (71 males, 73 females) with chronic low back pain were included in a functional restoration program. The FRP includes physiotherapy and occupational therapy interventions together with psychological counselling. Patients participated as in- or outpatients 6 h per day, 5 days a week over 5 weeks. Pain intensity, trunk flexibility, trunk strength, lifting ability, quality of life and return to work were recorded before, immediately after, and at 6 months and 12 months after the treatment period. Results: All outcome measures were significantly higher just after the FRP (144 patients) and at 6 and 12 months (from available data in 31 subjects) compared to pre-treatment values. This FRP for chronic low back pain maintained its benefits whatever the patient’s activities. Conclusions: The effects reflected on all outcome measures, both on short and long term follow-up. The multidisciplinary FRP for chronic low back pain patients durably stopped the de-conditioning syndrome and involved new life-style habits for the patient, daily pain management and a return to work. PMID:27417611

  20. Improved asthma control in patients with severe, persistent allergic asthma after 12 months of nightly temperature-controlled laminar airflow: an observational study with retrospective comparisons

    PubMed Central

    Schauer, Uwe; Bergmann, Karl-Christian; Gerstlauer, Michael; Lehmann, Sylvia; Gappa, Monika; Brenneken, Amelie; Schulz, Christian; Ahrens, Peter; Schreiber, Jens; Wittmann, Michael; Hamelmann, Eckard

    2015-01-01

    Introduction Continuous or episodic allergen exposure is a major risk factor of frequent symptoms and exacerbations for patients with allergic asthma. It has been shown that temperature-controlled laminar airflow (TLA) significantly reduced allergen exposure and airway inflammation and improved quality of life of patients with poorly controlled allergic asthma. Objective The objective was to evaluate the effects of nighttime TLA when used during real-life conditions for 12 consecutive months in addition to the patients’ regular medication. Methods This multicenter, pre- and postretrospective observational study included patients with inadequately controlled moderate-to-severe allergic asthma who received add-on treatment with TLA for 12 consecutive months. Data on medication use, asthma control, asthma symptoms, lung function, use of hospital resources, and exacerbations were collected after 4 and 12 months and compared with corresponding data collected retrospectively from medical records during the year prior to inclusion in the study. Results Data from 30 patients (mean age 28; range 8–70) completing 4 months and 27 patients completing 12 months of TLA use are presented. The mean number of exacerbations was reduced from 3.6 to 1.3 (p<0.0001), and the ratio of asthma-related emergency room visits or hospitalizations diminished from 72.4 to 23.3% (p=0.001) or from 44.8 to 20.0% (p<0.05), respectively, after 12 months of TLA use. The Asthma Control Test index increased from 14.1 to 18.5 (p<0.0001). After 4 months of TLA use, clear improvements can be shown for most variables in line with the data collected after 12 months. Conclusions The addition of TLA to the patients’ regular medication significantly reduced exacerbations, asthma symptoms, and the utilization of hospital resources. The data support that TLA may be an important new non-pharmacological approach in the management of poorly controlled allergic asthma. PMID:26557252

  1. Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study.

    PubMed

    Itoh, Arata; Saisho, Yoshifumi; Miyakoshi, Kei; Fukutake, Marie; Kasuga, Yoshifumi; Ochiai, Daigo; Matsumoto, Tadashi; Tanaka, Mamoru; Itoh, Hiroshi

    2016-01-31

    Though recommended for pregnant women at risk of preterm birth to improve perinatal outcomes, antenatal corticosteroid (ACS) treatment can cause maternal hyperglycemia, especially in cases of glucose intolerance. A standardized protocol for preventing hyperglycemia during ACS treatment remains to be established. We herein retrospectively investigated the time-dependent changes in insulin dose required for maternal glycemic control during ACS treatment in gestational diabetes (GDM). Twelve singleton pregnant women with GDM who received 12 mg of betamethasone intramuscularly twice 24 hours apart were included in this analysis. Of those, eight also received ritodrine hydrochloride for preterm labor. The blood glucose levels were maintained at 70-120 mg/dL with continuous intravenous infusion of insulin and nothing by mouth for 48 hours after the first betamethasone administration. After the first dose of betamethasone, the insulin dosage needed for glycemic control gradually increased and reached a maximum (6.6 ± 5.8 units/hr) at 10 hours, then, decreased to 4.1 ± 1.5 units/hr at 24 hours. Similar changes in the insulin requirement were found after the second betamethasone dose (the maximum insulin dosage: 5.5 ± 1.6 units/hr at 9 hours following the second administration). Women treated with ritodrine hydrochloride needed more insulin, than those without ritodrine hydrochloride treatment (130.8 ± 15.0 vs. 76.8 ± 15.2 units/day, respectively, p < 0.05). Our data indicated that the requirement for insulin is highest 9-10 hours after each dose of betamethasone. When GDM is treated with ACS, levels of blood glucose should be carefully monitored, especially in patients treated with ritodrine hydrochloride. PMID:26510662

  2. Servo control booster system for minimizing following error

    DOEpatents

    Wise, William L.

    1985-01-01

    A closed-loop feedback-controlled servo system is disclosed which reduces command-to-response error to the system's position feedback resolution least increment, .DELTA.S.sub.R, on a continuous real-time basis for all operating speeds. The servo system employs a second position feedback control loop on a by exception basis, when the command-to-response error .gtoreq..DELTA.S.sub.R, to produce precise position correction signals. When the command-to-response error is less than .DELTA.S.sub.R, control automatically reverts to conventional control means as the second position feedback control loop is disconnected, becoming transparent to conventional servo control means. By operating the second unique position feedback control loop used herein at the appropriate clocking rate, command-to-response error may be reduced to the position feedback resolution least increment. The present system may be utilized in combination with a tachometer loop for increased stability.

  3. Retrospective study of irinotecan/cisplatin followed by etoposide/cisplatin or the reverse sequence in extensive-stage small cell lung cancer

    PubMed Central

    Xiao, Xiaoguang; Wang, Shujing; Xia, Shu; Zou, Man; Li, Yang; Wei, Yao; Mei, Qi; Chen, Yuan

    2015-01-01

    Background Much research has confirmed the favorable effect of irinotecan/cisplatin (IP) and etoposide/cisplatin (EP) on extensive-stage small cell lung cancer (E-SCLC). This study investigated two sequential orders of IP and EP in the treatment of E-SCLC. We also compared the efficacy and safety of IP and EP in first-line chemotherapy in E-SCLC. Methods Ninety-three untreated patients with E-SCLC were randomly allocated to two groups. Group A received IP as first-line therapy until progression and then changed to EP; group B received EP as first-line therapy until tumor progression followed by IP. The primary endpoints were overall survival and time to second tumor progression. The secondary endpoints were first progression-free survival (PFS), ie, time from randomization to first occurrence of tumor progression after first-line treatment with IP or EP, tumor response, and safety of the different sequential treatment orders of IP and EP. Results Median overall survival was 15.4 months in group A (IP followed by EP) versus 15.7 months in group B (EP followed by IP; P=0.483). The median time to second tumor progression was 9.5 months in group A versus 9.9 months in group B (P=0.361). As first-line and second-line therapy, IP achieved a 95.9% and 60% disease control rate, respectively, and EP achieved 95.6% and 59% disease control rate. The median first PFS was not significantly different between group A and group B (6.5 months and 6.3 months, respectively; P=0.256). Grade 3/4 diarrhea appeared to be significantly more frequent with IP than with EP. The probability of anemia and thrombocytopenia was not significantly different between the two groups. However, significantly more patients who received the IP regimen as second-line treatment developed grade 3/4 neutropenia than those who received the IP regimen as first-line therapy. Conclusion There were no statistically significant differences in between the two sequences of IP and EP in the treatment of E

  4. Servo control booster system for minimizing following error

    DOEpatents

    Wise, W.L.

    1979-07-26

    A closed-loop feedback-controlled servo system is disclosed which reduces command-to-response error to the system's position feedback resolution least increment, ..delta..S/sub R/, on a continuous real-time basis, for all operational times of consequence and for all operating speeds. The servo system employs a second position feedback control loop on a by exception basis, when the command-to-response error greater than or equal to ..delta..S/sub R/, to produce precise position correction signals. When the command-to-response error is less than ..delta..S/sub R/, control automatically reverts to conventional control means as the second position feedback control loop is disconnected, becoming transparent to conventional servo control means. By operating the second unique position feedback control loop used herein at the appropriate clocking rate, command-to-response error may be reduced to the position feedback resolution least increment. The present system may be utilized in combination with a tachometer loop for increased stability.

  5. Daptomycin antibiotic lock therapy for hemodialysis patients with Gram-positive bloodstream infections following use of tunneled, cuffed hemodialysis catheters: retrospective single center analysis.

    PubMed

    Yen, Hung-Wen; Yang, Wu-Chang; Tarng, Der-Cherng; Yang, Chih-Yu; Chuang, Chiao-Lin; Huang, Ling-Ju; Lin, Pei-Yu; Wang, Chih-Chun; Li, Szu-Yuan

    2016-04-01

    Catheter-related blood stream infection (CRBSI) is a major complication in hemodialysis patients. We assessed the efficacy of systemic daptomycin (DPT) plus DPT antibiotic lock therapy (DPT-ALT) for catheter salvage in patients with Gram-positive CRBSIs. This is a retrospective study of hemodialysis patients with tunneled and cuffed hemodialysis catheters. All patients were from a single institution in Taipei and received systemic DPT plus DPT-ALT for the treatment of Gram-positive CRBSI. Successful resolution of CRBSI was implemented. Resolution of fever within 48 hours, negative result of repeated blood cultures after resolution of fever, no clinical evidence of CRBSI relapse and no need for catheter removal were measured. Fifteen hemodialysis patients received DPT-ALT for CRBSI, nine with coagulase-negative Staphylococcus (CONS), two with methicillin-resistant Staphylococcus aureus (MRSA), three with methicillin-sensitive Staphylococcus aureus (MSSA) and one with polymicrobial infections. Systemic DPT plus DPT-ALT cured 11 patients (73.3%). Treatment failed in all three MRSA cases (two with MRSA and one with MRSA + Enterococcus faecalis). Retrospective design and small sample size were the limitations of this study. Systemic DPT plus DPT-ALT appears to be a promising treatment for CRBSI from CONS and MSSA, but not for MRSA CRBSI. Systemic DPT plus DPT-ALT should be considered for patients with CRBSIs caused by certain species. PMID:26549513

  6. Retrospective studies.

    PubMed

    Silveira, Patrícia Pelufo; Manfro, Gisele Gus

    2015-01-01

    Large retrospective, epidemiological studies accumulated in the late 1980s, providing increasing evidence to the deeply rooted thought that perinatal events could persistently affect the individual's functioning and health/disease patterns throughout the lifetime. Evidences of such associations can be found in the literature since the beginning of the twentieth century, but studies from Barker, Hales, and colleagues serve as an important hallmark. They proposed the "thrifty phenotype" hypothesis, stating that poor nutrition in fetal and early infant life is detrimental to the development and function of the individuals' organism, predisposing them to the later development of adult chronic diseases. At first used to explain the increased risk for type 2 diabetes in low birth weight individuals, the hypothesis was soon adapted to other systems, becoming one of the core assumptions of the Developmental Origins of Adult Health and Disease (DOHaD) model. The central nervous system is also vulnerable to the effects of environmental variation during fetal or neonatal life. Many researchers have explored the effects of perinatal programming on the human neurodevelopment, and some aspects of the brain structure and/or functioning (such as cognitive function, physiological reactivity to stress, and the risk for behavioral disorders or psychopathology) were shown to be modifiable by the exposure to certain adverse events early in life such as neonatal infections, exposure to gestational psychosocial stress, nutrition during gestation, exposure to drugs, or tobacco smoking during pregnancy. Until recently, most studies focused on birth weight as a strong surrogate of the intrauterine environment, investigating the effects of low birth weight (as a marker of suboptimal fetal environment) on a variety of neurodevelopmental outcomes. Despite the fact that literature reviews on this topic are as old as 1940, the more recent retrospective studies are summarized in this chapter

  7. Is nonstructural bone graft useful in surgical treatment of lumbar spinal tuberculosis?: A retrospective case-control study.

    PubMed

    Liu, Jia-Ming; Chen, Xuan-Yin; Zhou, Yang; Long, Xin-Hua; Chen, Wen-Zhao; Liu, Zhi-Li; Huang, Shan-Hu; Yao, Hao-Qun

    2016-08-01

    Surgical intervention is an important option for treating spinal tuberculosis. Previous studies have reported different surgical procedures and bone grafts for it. To our knowledge, few studies demonstrated the clinical results of using nonstructural autogenous bone graft in surgical treatment of spinal tuberculosis.The purpose of this study is to compare the clinical outcomes of surgical management lumbar spinal tuberculosis by one-stage posterior debridement with nonstructural autogenous bone grafting and instrumentation versus anterior debridement, strut bone grafting combined with posterior instrumentation.A total of 58 consecutive patients who underwent surgical treatment due to lumbar spinal tuberculosis from January 2011 to December 2013 were included. A total of 22 patients underwent one-stage posterior debridement, nonstructural autogenous bone grafting, and instrumentation (group A), and 36 patients received anterior debridement, strut bone grafting combined with posterior instrumentation (group B). The operative duration, total blood loss, perioperative transfusion, length of hospital stay, hospitalization cost, and complications were recorded. The bony fusion of the graft was assessed by computed tomography scans. American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate the neurological function of patients in the 2 groups.All the patients were followed up, with a mean follow-up duration of 21.6 ± 5.7 months in group A and 22.3 ± 6.2 months in group B (P = 0.47). The average operative duration was 257.5 ± 91.1 minutes in group A and 335.7 ± 91.0 minutes in group B (P = 0.002). The mean total blood loss was 769.6 ± 150.9 mL in group A and 1048.6 ± 556.9 mL in group B (P = 0.007). Also, significant differences were found between the 2 groups in perioperative transfusion volumes, length of hospital stay, and hospitalization cost (P < 0.05), which were less in group A compared with

  8. Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy

    PubMed Central

    Al-Omair, Ameen; Masucci, Laura; Masson-Cote, Laurence; Campbell, Mikki; Atenafu, Eshetu G.; Parent, Amy; Letourneau, Daniel; Yu, Eugene; Rampersaud, Raja; Massicotte, Eric; Lewis, Stephen; Yee, Albert; Thibault, Isabelle; Fehlings, Michael G.; Sahgal, Arjun

    2013-01-01

    Background Spine stereotactic body radiotherapy (SBRT) is increasingly being applied to the postoperative spine metastases patient. Our aim was to identify clinical and dosimetric predictors of local control (LC) and survival. Methods Eighty patients treated between October 2008 and February 2012 with postoperative SBRT were identified from our prospective database and retrospectively reviewed. Results The median follow-up was 8.3 months. Thirty-five patients (44%) were treated with 18–26 Gy in 1 or 2 fractions, and 45 patients (56%) with 18–40 Gy in 3–5 fractions. Twenty-one local failures (26%) were observed, and the 1-year LC and overall survival (OS) rates were 84% and 64%, respectively. The most common site of failure was within the epidural space (15/21, 71%). Multivariate proportional hazards analysis identified systemic therapy post-SBRT as the only significant predictor of OS (P = .02) and treatment with 18–26 Gy/1 or 2 fractions (P = .02) and a postoperative epidural disease grade of 0 or 1 (0, no epidural disease; 1, epidural disease that compresses dura only, P = .003) as significant predictors of LC. Subset analysis for only those patients (n = 48/80) with high-grade preoperative epidural disease (cord deformed) indicated significantly greater LC rates when surgically downgraded to 0/1 vs 2 (P = .0009). Conclusions Postoperative SBRT with high total doses ranging from 18 to 26 Gy delivered in 1–2 fractions predicted superior LC, as did postoperative epidural grade. PMID:24057886

  9. Chernobyl retrospective.

    PubMed

    Bonte, F J

    1988-01-01

    On April 28, 1986 heavy radioactive fallout from an unknown source was reported from Sweden. Later, it was discovered that two days earlier, a nuclear power reactor at Chernobyl, in the Soviet Union, had exploded releasing an enormous cloud of effluent containing 40 million Ci of 131I, 3 million Ci of 137Cs, and 50 million Ci of xenon radioisotopes. This far exceeded the 15 Ci of 131I escape in the notorious Three Mile Island accident. Chernobyl reactor IV, of an antiquated design, was a graphite-moderated reactor which suffered a steam explosion when the operating staff attempted an experiment involving preservation of safety functions during a planned shutdown. Following the explosion, a fire started in the graphite core which required ten days to control. Thirty-one persons died, two in the initial explosion and 29 of various combinations of thermal and radiation burns, and gamma irradiation. Existing emergency plans were invoked involving treatment on the scene and evacuation of seriously injured patients to a special hospital in Moscow, as well as to nearby Kiev. Later, 135,000 residents of the immediate neighborhood were surveyed and evacuated after fallout radiation levels began to rise. Fallout patterns around Europe and the northern hemisphere were closely tracked. Consequences of the accident in human and monetary terms will require years of evaluation. Although the United States has no power reactors of the Chernobyl type, the country does have a radiation disaster management plan, often rehearsed at the state level. As a consequence of Chernobyl certain international agreements dealing with radiation disaster information and management have been forged. PMID:3278382

  10. Development of a Model Following Control Law for Inflight Simulation and Flight Controls Research

    NASA Technical Reports Server (NTRS)

    Takahashi, Mark; Fletcher, Jay; Aiken, Edwin W. (Technical Monitor)

    1994-01-01

    The U.S. Army and NASA are currently developing the Rotorcraft Aircrew Systems Concepts Airborne Laboratory (RASCAL) at the Ames Research Center. RASCAL, shown in Figure 1, is a UH-60, which is being modified in a phased development program to have a research fly-by-wire flight control system, and an advanced navigation research platform. An important part of the flight controls and handling qualities research on RASCAL will be an FCS design for the aircraft to achieve high bandwidth control responses and disturbance rejection characteristics. Initially, body states will be used as feedbacks, but research into the use of rotor states will also be considered in later stages to maximize agility and maneuverability. In addition to supporting flight controls research, this FCS design will serve as the inflight simulation control law to support basic handling qualities, guidance, and displays research. Research in high bandwidth controls laws is motivated by the desire to improve the handling qualities in aggressive maneuvering and in severely degraded weather conditions. Naturally, these advantages will also improve the quality of the model following, thereby improving the inflight simulation capabilities of the research vehicle. High bandwidth in the control laws provides tighter tracking allowing for higher response bandwidths which can meet handling qualities requirements for aggressive maneuvering. System sensitivity is also reduced preventing variations in the response from the vehicle due to changing flight conditions. In addition, improved gust rejection will result from this reduced sensitivity. The gust rejection coupled with a highly stable system will make more precise maneuvering and pointing possible in severely degraded weather conditions. The difficulty in achieving higher bandwidths from the control laws in the feedback and in the responses arises from the complexity of the models that are needed to produce a satisfactory design. In this case, high

  11. Controlled management of public relations following a public health incident.

    PubMed

    Holdsworth, G M; Breathnach, A; Asboe, D; Free, D; Cranston, R; Peters, B S; de Ruiter, A

    1999-09-01

    This paper describes the management of public relations following an outbreak of multidrug resistant TB at a London hospital. Eight patients were involved, all of the secondary cases occurred in HIV seropositive patients, and three cases died. The paper describes how the the Incident Committee undertook to recall contacts of the cases for screening, inform the general practitioners of all of the contacts about their patients' exposure, warn other organizations and professionals interested or involved in the management of HIV in the London area as to the nature of the incident, and establish a helpline, before informing a wider audience through the EPINET, Communicable Disease Report and national press. PMID:10528951

  12. A speed feedback control strategy for car-following model

    NASA Astrophysics Data System (ADS)

    Zhu, Wen-Xing; Zhang, Li-Dong

    2014-11-01

    A speed feedback control mechanism was introduced into the system to improve the dynamical performance of the traffic flow. The modern control theory was used to analyze the stability of the system. It is found that the stability region varies with the feedback coefficient proportionally. In addition, the unit step responses in time domain and phase-frequency curves in frequency domain were given with different feedback coefficients in step response diagram and Bode diagram respectively. The overshoot and phase margins are inversely proportional to the speed feedback coefficients in an underdamped condition. The simulations were conducted to verify the validity of the improvement. The conclusion can be drawn that the analytical result and the simulation result are in good agreement with each other.

  13. Lower limb control and mobility following exercise training

    PubMed Central

    2012-01-01

    The objective of the present study was to evaluate the effects of 8-week balance or weight training on ankle joint stiffness and limb stability for older adults, furthermore, on outcomes of slips while walking. Eighteen older adults volunteered for the study and randomly were assigned to the three groups, such as, weight, balance, or control group. While walking on a walking track, three-dimensional posture data were sampled and ankle joint stiffness and limb stability were computed to evaluate the effects of training. 2 (pre and post) × 3 (weight, balance, and control) × 2 (dominant and non-dominant legs) mixed factor repeated ANOVA was performed. The results indicated that only balance training group showed an improvement in joint stiffness and both the training groups showed improvements in limb stability. Also, fall frequency results suggested that joint stiffness and limb stability had an effect on the likelihood of slip-induced falls. In conclusion, training can facilitate improvements in joint and limb control mechanism for older adults contributing to an improvement in the likelihood of slip-induced falls. PMID:22335998

  14. Mastectomy following preoperative chemotherapy. Strict operative criteria control operative morbidity.

    PubMed

    Broadwater, J R; Edwards, M J; Kuglen, C; Hortobagyi, G N; Ames, F C; Balch, C M

    1991-02-01

    The surgical morbidity associated with aggressive preoperative chemotherapy in 106 patients with advanced primary breast cancer who had chemotherapy followed by mastectomy was examined. These patients were compared with a group of 91 consecutive patients who had mastectomy without preoperative chemotherapy. Strict operative criteria were used to determine the timing of mastectomy following chemotherapy. Wound infection rates were no different in the preoperative chemotherapy group compared to the mastectomy-alone groups (7% versus 4%; p = 0.62). The incidence of wound necrosis was similar (11% versus 6%; p = 0.29). Seroma formation was decreased significantly in the preoperative chemotherapy group compared to the mastectomy-alone group (15% versus 28%; p = 0.04). Intensive preoperative chemotherapy did not delay the reinstitution of postoperative treatment (30% versus 20%; p = 0.27). However, when delay in instituting postoperative chemotherapy was more than 30 days, there was a significant decrease in overall survival rate (p = 0.04). This study provides evidence that intensive preoperative chemotherapy and mastectomy can be performed without increased morbidity. Furthermore it is important to institute systemic chemotherapy within 30 days of mastectomy to achieve maximum survival. PMID:1992938

  15. Osseointegrated implants in vertical ridge augmentation with a nonresorbable membrane: a retrospective study of 75 implants with 1 to 6 years of follow-up.

    PubMed

    Fontana, Filippo; Grossi, Giovanni Battista; Fimanò, Maurizio; Maiorana, Carlo

    2015-01-01

    The aim of this study was to retrospectively evaluate 75 implants inserted in vertically augmented bone at the time of or prior to implant placement after 1 to 6 years of prosthetic loading. The study included 21 patients (29 surgical sites). The vertical procedure was performed combining a titanium-reinforced expanded polytetrafluoroethylene membrane with autograft (7 sites), allograft (5 sites), or auto-xenograft (17 sites). Healing was uneventful in 24 surgical sites. Three sites showed premature exposure, and two sites presented an abscess. Two implants were lost, for a cumulative survival rate of 93.6%. Mean bone remodeling at 1, 2, 3, 4, 5, and 6 years was 0.34, 0.72, 1.04, 0.84, 0.56, and 0.61 mm, respectively. The implant success rate was higher with a simultaneous approach (82.5%) compared with a staged approach (66.8%). Implants surrounded by keratinized mucosa revealed a higher success rate (82.1%) than those without it (58.4%). PMID:25734704

  16. Predictive mechanisms in the control of contour following

    PubMed Central

    Tramper, Julian J.; Flanders, Martha

    2013-01-01

    In haptic exploration, when running a fingertip along a surface, the control system may attempt to anticipate upcoming changes in curvature in order to maintain a consistent level of contact force. Such predictive mechanisms are well known in the visual system, but have yet to be studied in the somatosensory system. Thus the present experiment was designed to reveal human capabilities for different types of haptic prediction. A robot arm with a large 3D workspace was attached to the index fingertip and was programmed to produce virtual surfaces with curvatures that varied within and across trials. With eyes closed, subjects moved the fingertip around elliptical hoops with flattened regions or Limaçon shapes, where the curvature varied continuously. Subjects anticipated the corner of the flattened region rather poorly, but for the Limaçon shapes they varied finger speed with upcoming curvature according to the two-thirds power law. Furthermore, although the Limaçon shapes were randomly presented in various 3D orientations, modulation of contact force also indicated good anticipation of upcoming changes in curvature. The results demonstrate that it is difficult to haptically anticipate the spatial location of an abrupt change in curvature, but smooth changes in curvature may be facilitated by anticipatory predictions. PMID:23649968

  17. Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia

    PubMed Central

    Rodriguez-Morales, Alfonso J.; Gil-Restrepo, Andrés F.; Ramírez-Jaramillo, Valeria; Montoya-Arias, Cindy P.; Acevedo-Mendoza, Wilmer F.; Bedoya-Arias, Juan E.; Chica-Quintero, Laura A.; Murillo-García, David R.; García-Robledo, Juan E.; Castrillón-Spitia, Juan D.; Londoño, Jose J.; Bedoya-Rendón, Hector D.; Cárdenas-Pérez, Javier de Jesús; Cardona-Ospina, Jaime A.; Lagos-Grisales, Guillermo J.

    2016-01-01

    Objective: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. Methods: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. Results: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). Conclusions: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre). PMID:27081477

  18. Use of Renal Replacement Therapy May Influence Graft Outcomes following Liver Transplantation for Acute Liver Failure: A Propensity-Score Matched Population-Based Retrospective Cohort Study

    PubMed Central

    Knight, Stephen R.; Oniscu, Gabriel C.; Devey, Luke; Simpson, Kenneth J.; Wigmore, Stephen J.; Harrison, Ewen M.

    2016-01-01

    Introduction Acute kidney injury is associated with a poor prognosis in acute liver failure but little is known of outcomes in patients undergoing transplantation for acute liver failure who require renal replacement therapy. Methods A retrospective analysis of the United Kingdom Transplant Registry was performed (1 January 2001–31 December 2011) with patient and graft survival determined using Kaplan-Meier methods. Cox proportional hazards models were used together with propensity-score based full matching on renal replacement therapy use. Results Three-year patient and graft survival for patients receiving renal replacement therapy were 77.7% and 72.6% compared with 85.1% and 79.4% for those not requiring renal replacement therapy (P<0.001 and P = 0.009 respectively, n = 725). In a Cox proportional hazards model, renal replacement therapy was a predictor of both patient death (hazard ratio (HR) 1.59, 95% CI 1.01–2.50, P = 0.044) but not graft loss (HR 1.39, 95% CI 0.92–2.10, P = 0.114). In groups fully matched on baseline covariates, those not receiving renal replacement therapy with a serum creatinine greater than 175μmol/L had a significantly worse risk of graft failure than those receiving renal replacement therapy. Conclusion In patients being transplanted for acute liver failure, use of renal replacement therapy is a strong predictor of patient death and graft loss. Those not receiving renal replacement therapy with an elevated serum creatinine may be at greater risk of early graft failure than those receiving renal replacement therapy. A low threshold for instituting renal replacement therapy may therefore be beneficial. PMID:26930637

  19. Incidence of invasive aspergillosis following remission–induction chemotherapy for acute leukemia: a retrospective cohort study in a single Canadian tertiary care centre

    PubMed Central

    Barkati, Sapha; Dufresne, Simon F.; Bélanger, Sylvie; Vadnais, Barbara; Bergeron, Julie; Labbé, Annie Claude

    2014-01-01

    Background The decision to use universal primary antimould prophylaxis to prevent invasive aspergillosis in patients with acute leukemia depends on the incidence of infection at individual centres. We determined our institution’s incidence of invasive aspergillosis among patients who received remission–induction chemotherapy for acute leukemia to evaluate the potential benefits of primary antimould prophylaxis. Methods We conducted this retrospective cohort study at a Canadian tertiary care centre. From the central pharmacy registries, we retrieved records for all adult patients for whom remission–induction chemotherapy for acute leukemia was prescribed between 2008 and 2010. We retrieved clinical, microbiologic, pathologic and radiologic data from the patients’ medical charts. The primary outcome was a diagnosis of probable or proven invasive aspergillosis up to 180 days after resolution of aplasia. Results We retrieved records for 123 patients with acute leukemia. Twenty-two of these patients did not receive the prescribed chemotherapy and were excluded from the analysis. Of the 101 patients included, 77 (76.2%) had acute myeloid leukemia. Overall, 136 courses of chemotherapy were administered, with more than 1 course administered to 26 (25.7%) of the 101 patients. In 9 of the patients (8.9%; 95% confidence interval 4.2%–16.2%), invasive aspergillosis was diagnosed (3 proven and 6 probable cases) a median of 19 (range 11–34) days after initiation of chemotherapy. In 7 (78%) of these 9 patients, invasive aspergillosis occurred during the first course of chemotherapy. Three patients died within the first year after diagnosis of invasive aspergillosis. Interpretation We found a high incidence (8.9%) of invasive aspergillosis at our centre. This finding triggered the introduction of targeted antimould prophylaxis for patients with acute leukemia who were undergoing remission–induction chemotherapy. PMID:25077134

  20. Predictors of delayed recovery following pediatric sports-related concussion: a case-control study.

    PubMed

    Miller, Joseph H; Gill, Clarence; Kuhn, Elizabeth N; Rocque, Brandon G; Menendez, Joshua Y; O'Neill, Jilian A; Agee, Bonita S; Brown, Steven T; Crowther, Marshall; Davis, R Drew; Ferguson, Drew; Johnston, James M

    2016-04-01

    OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score < 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for

  1. Parallel analysis of finite element model controlled trial and retrospective case control study on percutaneous internal fixation for vertical sacral fractures

    PubMed Central

    2013-01-01

    Background Although percutaneous posterior-ring tension-band metallic plate and percutaneous iliosacral screws are used to fix unstable posterior pelvic ring fractures, the biomechanical stability and compatibility of both internal fixation techniques for the treatment of Denis I, II and III type vertical sacral fractures remain unclear. Methods Using CT and MR images of the second generation of Chinese Digitized Human “male No. 23”, two groups of finite element models were developed for Denis I, II and III type vertical sacral fractures with ipsilateral superior and inferior pubic ramus fractures treated with either a percutaneous metallic plate or a percutaneous screw. Accordingly, two groups of clinical cases that were fixed using the above-mentioned two internal fixation techniques were retrospectively evaluated to compare postoperative effect and function. Parallel analysis was performed with a finite element model controlled trial and a case control study. Results The difference of the postoperative Majeed standards and outcome rates between two case groups was no statistically significant (P > 0.05). Accordingly, the high values of the maximum displacements/stresses of the plate-fixation model group approximated those of the screw-fixation model group. However, further simulation of Denis I, II and III type fractures in each group of models found that the biomechanics of the plate-fixation models became increasingly stable and compatible, whereas the biomechanics of the screw-fixation models maintained tiny fluctuations. When treating Denis III fractures, the biomechanical effects of the pelvic ring of the plate-fixation model were better than the screw-fixation model. Conclusions Percutaneous plate and screw fixations are both appropriate for the treatment of Denis I and II type vertical sacral fractures; whereas percutaneous plate fixation appears be superior to percutaneous screw fixation for Denis III type vertical sacral fracture. Biomechanical

  2. Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review

    PubMed Central

    Tanweer, Omar; Kalhorn, Stephen P.; Snell, Jamaal T.; Lieber, Bryan A.; Agarwal, Nitin; Huang, Paul P.; Sutin, Kenneth M.

    2015-01-01

    Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases. PMID:27065093

  3. Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review.

    PubMed

    Tanweer, Omar; Kalhorn, Stephen P; Snell, Jamaal T; Wilson, Taylor A; Lieber, Bryan A; Agarwal, Nitin; Huang, Paul P; Sutin, Kenneth M

    2015-12-01

    Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases. PMID:27065093

  4. Long-term follow-up after ileocaecal continent cutaneous urinary diversion (Mainz I pouch): A retrospective study of a monocentric experience

    PubMed Central

    Khalil, Fahd; Fellahi, Saad; Ouslim, Hicham; Mhanna, Tarik; El Houmaidi, Amine; Aynaou, Mohammed; Boteng, Paapa Dua; Barki, Ali; Nouini, Yassine

    2015-01-01

    Objective To assess the long-term follow-up after ileocaecal continent cutaneous reservoir (ICCR) and to review the late complications. Patients and methods In all, 756 patients underwent an ICCR in our department, with long-term follow-up data available in 50 patients. The inclusion criterion was ICCR regardless of the indication and the exclusion criteria were orthotopic neobladder or other continent urinary diversions not performed with the ileocaecum. Patients were followed to record primary outcomes and late complications. Complications were stratified according to the Clavien–Dindo classification. Results The mean patient age was 44 years and pelvic malignancies were the first indication for urinary diversion. The mean (range) follow-up was 19 (9–36) years. A stoma stenosis was the most frequent outlet-related complication requiring re-intervention, followed by ischaemic outlet degeneration, and stoma incontinence. Six renal units (RUs) developed obstruction at the anastomotic site and were managed by open surgery. Three RUs had to be removed due to deterioration. A dederivation was necessary in three patients (6%). Conclusion The ICCR is a safe and established technique when an orthotopic pouch is impossible. The long-term follow-up shows acceptable complication rates and satisfactory continence conditions. However, large population studies are necessary to confirm this observation. PMID:26609442

  5. Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective case-control study

    PubMed Central

    Huang, Chen; Shen, Jia-Cheng; Zhang, Jing; Jiang, Tao; Wu, Wei-Dong; Cao, Jun; Huang, Ke-Jian; Qiu, Zheng-Jun

    2015-01-01

    AIM: To assess the diverse immediate and long-term clinical outcomes, a retrospective comparison between laparoscopic and conventional operation was performed. METHODS: A total number of 916 clinical cases, from January 2006 to December 2013 in our hospital, were analyzed which covered 492 patients underwent the laparoscopy in radical resection (LRR) and 424 cases in open radical resection (ORR). A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complications as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation. RESULTS: There were no statistically significance differences between gender, age, height, weight, body mass index (BMI), tumor loci, tumor node metastasis stages, cell differentiation degree or American Society of Anesthesiologists scores of the patients (P > 0.05). In contrast to the ORR group, the LRR group experienced less operating time (P < 0.001), a lower blood loss (P < 0.001), and had a 2.44% probability of conversion to open surgery. Postoperative bowel function recovered more quickly, analgesic usage and the average hospital stay (P < 0.001) were reduced after LRR. Lymph node dissection during LRR appeared to be slightly more than in ORR (P = 0.338). There were no obvious differences in the lengths and margins (P = 0.182). And the occurrence rate in the two groups was similar (P = 0.081). Overall survival rate of ORR and LRR for 1, 3 and 5 years were 94.0% and 93.6% (P = 0.534), 78.1% and 80.9% (P = 0.284) and 75.2% and 77.0% (P = 0.416), respectively. CONCLUSION: Laparoscopy as a radical operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation. PMID:26730165

  6. Prehospital digital photography and automated image transmission in an emergency medical service – an ancillary retrospective analysis of a prospective controlled trial

    PubMed Central

    2013-01-01

    Background Still picture transmission was performed using a telemedicine system in an Emergency Medical Service (EMS) during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of the transmitted pictures and the possible influences of this application on prehospital time requirements were investigated. Methods A digital camera was used with a telemedicine system enabling encrypted audio and data transmission between an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480 pixels). On occasion, this compression was deactivated (3648 x 2736 pixels). Two independent investigators assessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator had final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol sheets and dispatch centre reports. Results Overall 314 pictures (mean 2.77 ± 2.42 pictures/mission) were transmitted during 113 missions (group 1). Pictures were not taken for 151 missions (group 2). Regarding picture quality, the content of 240 (76.4%) pictures was clearly identifiable; 45 (14.3%) pictures were considered “limited quality” and 29 (9.2%) pictures were deemed “not useful” due to not/hardly identifiable content. For pictures with file compression (n = 84 missions) and without (n = 17 missions), the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003). Medical reports (n = 98, 32.8%), medication lists (n = 49, 16.4%) and 12-lead ECGs (n = 28, 9.4%) were most frequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age – 72.5 vs. 56.5 years, p = 0.001; frequency of acute coronary syndrome – 24/113 vs. 15/151, p = 0.014. The NACA scores and gender distribution were comparable. Median on-scene times were longer with picture transmission (26 vs. 22

  7. Association of disease activity with acute exacerbation of interstitial lung disease during tocilizumab treatment in patients with rheumatoid arthritis: a retrospective, case-control study.

    PubMed

    Akiyama, Mitsuhiro; Kaneko, Yuko; Yamaoka, Kunihiro; Kondo, Harumi; Takeuchi, Tsutomu

    2016-06-01

    The objective of the study was to identify risk factors for acute exacerbation of interstitial lung disease (ILD) during tocilizumab treatment in patients with rheumatoid arthritis (RA). This is a retrospective, case-control study. We reviewed 395 consecutive RA patients who received tocilizumab. First, we divided the patients according to the presence (RA-ILD) or absence of ILD (non-ILD) assessed by chest X-ray or high-resolution computed tomography, and compared them for characteristics relevant to RA-ILD. Subsequently, focusing on the patients with RA-ILD, we assessed their baseline characteristics and clinical courses comparing patients with acute exacerbation to those without. Comparing 78 with ILD and 317 without ILD, the following were identified as factors related to RA-ILD on multivariate analysis: age 60 years or older (OR 4.5, 95 % CI 2.2-9.4, P < 0.0001), smoking habit (OR 2.9, 95 % CI 1.5-5.5, P = 0.002), and high rheumatoid factor levels (OR 2.8, 95 % CI 1.4-5.5, P = 0.002). Of 78 RA-ILD patients, six developed acute exacerbation during tocilizumab treatment. The median duration between the initiation of tocilizumab treatment and the acute exacerbation occurrence was 48 weeks. While baseline characteristics did not differ between acute exacerbation and non-acute exacerbation groups, patients experiencing acute exacerbation had significantly higher Clinical Disease Activity Index (CDAI) at 24 weeks (20.8 vs. 6.2, P = 0.019). Univariate analysis showed that CDAI > 10 at 24 weeks was a risk factor for acute exacerbation (OR 4.7, 95 % CI 2.1-10.4, P = 0.02). Uncontrolled arthritis activity during tocilizumab treatment may be associated with acute exacerbation of RA-ILD, suggesting post-treatment monitoring of disease activity is important not only with respect to RA itself but also for RA-ILD. PMID:27072347

  8. Controlled continuous systemic heparinization increases success rate of artery-only anastomosis replantation in single distal digit amputation: A retrospective cohort study.

    PubMed

    Lee, Jun Yong; Kim, Hak Soo; Heo, Sang Taek; Kwon, Ho; Jung, Sung-No

    2016-06-01

    Replantation is a prime indication for distal digital amputation, as it helps restore hand aesthetics and functions; however, venous anastomosis is often not feasible. Previous studies used systemic anticoagulation in distal digital artery only anastomosis replantation surgery to improve replantation success rate, however, which yielded limited level of clinical evidence. This study aimed to compare controlled continuous heparinization (CCH) and intermittent bolus heparinization (IBH) for surgical outcome and clinical variables after single distal digital artery only anastomosis replantation surgery.A single-institution, retrospective cohort study was performed. Out of 324 patients who underwent digital replantation surgery, we focused the study for the Zone I and II single distal digital amputation patients excluding confounding factors. Sixty-one patients were included in this study and underwent artery-only anastomosis replantation surgery with postoperative CCH (34 patients) or IBH (27 patients) protocols. The CCH group targeted activated partial thromboplastin time (aPTT) at 51 to 70 seconds, monitoring aPTT levels every eight hours and administering 100 mg of aspirin per day. The IBH group received 300 mg of aspirin per day and underwent IBH (12,500 U). Both groups received intravenous prostaglandin E1 drips (10 μg). To verify the factors affecting the success rate of the heparin protocol, patient factors, clinical factors, and operative factors were extracted from the medical records. Statistical analysis with inverse probability of treatment weights propensity score methods compared treatment outcomes and clinical variables.The CCH group's replantation success rate was higher (91.17% vs 59.25%), and the transfusion rate was increased (P = 0.032). However, the significant decrease in hemoglobin levels (>15%) did not differ between the groups (P = 0.108). Multivariable logistic regression analysis with potent univariate variables (P < .10

  9. Occurrence of mental illness following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study

    PubMed Central

    2012-01-01

    Background While many studies of adults with solvent exposure have shown increased risks of anxiety and depressive disorders, there is little information on the impact of prenatal and early childhood exposure on the subsequent risk of mental illness. This retrospective cohort study examined whether early life exposure to tetrachloroethylene (PCE)-contaminated drinking water influenced the occurrence of depression, bipolar disorder, post-traumatic stress disorder, and schizophrenia among adults from Cape Cod, Massachusetts. Methods A total of 1,512 subjects born between 1969 and 1983 were studied, including 831 subjects with both prenatal and early childhood PCE exposure and 547 unexposed subjects. Participants completed questionnaires to gather information on mental illnesses, demographic and medical characteristics, other sources of solvent exposure, and residences from birth through 1990. PCE exposure originating from the vinyl-liner of water distribution pipes was assessed using water distribution system modeling software that incorporated a leaching and transport algorithm. Results No meaningful increases in risk ratios (RR) for depression were observed among subjects with prenatal and early childhood exposure (RR: 1.1, 95% CI: 0.9-1.4). However, subjects with prenatal and early childhood exposure had a 1.8-fold increased risk of bipolar disorder (N = 36 exposed cases, 95% CI: 0.9-1.4), a 1.5-fold increased risk post-traumatic stress disorder (N = 47 exposed cases, 95% CI: 0.9-2.5), and a 2.1-fold increased risk of schizophrenia (N = 3 exposed cases, 95% CI: 0.2-20.0). Further increases in the risk ratio were observed for bipolar disorder (N = 18 exposed cases, RR; 2.7, 95% CI: 1.3-5.6) and post-traumatic stress disorder (N = 18 exposed cases, RR: 1.7, 95% CI: 0.9-3.2) among subjects with the highest exposure levels. Conclusions The results of this study provide evidence against an impact of early life exposure to PCE on the risk of depression. In contrast, the

  10. Learning to control actions: transfer effects following a procedural cognitive control computerized training.

    PubMed

    Shahar, Nitzan; Meiran, Nachshon

    2015-01-01

    Few studies have addressed action control training. In the current study, participants were trained over 19 days in an adaptive training task that demanded constant switching, maintenance and updating of novel action rules. Participants completed an executive functions battery before and after training that estimated processing speed, working memory updating, set-shifting, response inhibition and fluid intelligence. Participants in the training group showed greater improvement than a no-contact control group in processing speed, indicated by reduced reaction times in speeded classification tasks. No other systematic group differences were found across the different pre-post measurements. Ex-Gaussian fitting of the reaction-time distribution revealed that the reaction time reduction observed among trained participants was restricted to the right tail of the distribution, previously shown to be related to working memory. Furthermore, training effects were only found in classification tasks that required participants to maintain novel stimulus-response rules in mind, supporting the notion that the training improved working memory abilities. Training benefits were maintained in a 10-month follow-up, indicating relatively long-lasting effects. The authors conclude that training improved action-related working memory abilities. PMID:25799443

  11. The 'swallow tail' appearance of the healthy nigrosome - a new accurate test of Parkinson's disease: a case-control and retrospective cross-sectional MRI study at 3T.

    PubMed

    Schwarz, Stefan T; Afzal, Mohammed; Morgan, Paul S; Bajaj, Nin; Gowland, Penny A; Auer, Dorothee P

    2014-01-01

    There is no well-established in vivo marker of nigral degeneration in Parkinson's disease (PD). An ideal imaging marker would directly mirror the loss of substantia nigra dopaminergic neurones, which is most prominent in sub-regions called nigrosomes. High-resolution, iron-sensitive, magnetic resonance imaging (MRI) at 7T allows direct nigrosome-1 visualisation in healthy people but not in PD. Here, we investigated the feasibility of nigrosome-1 detection using 3T - susceptibility-weighted (SWI) MRI and the diagnostic accuracy that can be achieved for diagnosing PD in a clinical population. 114 high-resolution 3T - SWI-scans were reviewed consisting of a prospective case-control study in 19 subjects (10 PD, 9 controls) and a retrospective cross-sectional study in 95 consecutive patients undergoing routine clinical SWI-scans (>50 years, 9 PD, 81 non-PD, 5 non-diagnostic studies excluded). Two raters independently classified subjects into PD and non-PD according to absence or presence of nigrosome-1, followed by consensus reading. Diagnostic accuracy was assessed against clinical diagnosis as gold standard. Absolute inter- and intra-rater agreement was ≥94% (kappa≥0.82, p<0.001). In the prospective study 8/9 control and 8/10 PD; and in the retrospective study 77/81 non-PD and all 9 PD subjects were correctly classified. Diagnostic accuracy of the retrospective cohort was: sensitivity 100%, specificity 95%, NPV 1, PPV 0.69 and accuracy 96% which dropped to 91% when including non-diagnostic scans ('intent to diagnose'). The healthy nigrosome-1 can be readily depicted on high-resolution 3T - SWI giving rise to a 'swallow tail' appearance of the dorsolateral substantia nigra, and this feature is lost in PD. Visual radiological assessment yielded a high diagnostic accuracy for PD vs. an unselected clinical control population. Assessing the substantia nigra on SWI for the typical 'swallow tail' appearance has potential to become a new and easy applicable 3T MRI

  12. Should adrenaline be used in patients with hemodynamically stable anaphylaxis? Incident case control study nested within a retrospective cohort study.

    PubMed

    Ko, Byuk Sung; Kim, Ji Yeon; Seo, Dong-Woo; Kim, Won Young; Lee, Jae Ho; Sheikh, Aziz; Bates, David W

    2016-01-01

    Although adrenaline (epinephrine) is a cornerstone of initial anaphylaxis treatment, it is not often used. We sought to assess whether use of adrenaline in hemodynamically stable patients with anaphylaxis could prevent the development of hypotension. We conducted a retrospective cohort study of 761 adult patients with anaphylaxis presenting to the emergency department (ED) of a tertiary care hospital over a 10-year period. We divided the patients into two groups according to the occurrence of hypotension and compared demographic characteristics, clinical features, treatments and outcomes. Of the 340 patients with anaphylaxis who were normotensive at first presentation, 40 patients experienced hypotension during their ED stay. The ED stay of the hypotension group was significantly longer than that of patients who did not experience hypotension (496 min vs 253 min, P = 0.000). Adrenaline use in hemodynamically stable anaphylaxis patient was independently associated with a lower risk of developing in-hospital occurrence of hypotension: OR, 0.254 [95% CI, 0.091-0.706]. Adrenaline use in hemodynamically stable anaphylaxis patients was associated with a reduced risk of developing in-hospital occurrence of hypotension. Adverse events induced by adrenaline were rare when the intramuscular route was used. PMID:26837822

  13. An application of generalized predictive control to rotorcraft terrain-following flight

    NASA Technical Reports Server (NTRS)

    Hess, Ronald A.; Jung, Yoon C.

    1989-01-01

    Generalized predictive control (GPC) describes an algorithm for the control of dynamic systems in which a control input is generated which minimizes a quadratic cost function consisting of a weighted sum of errors between desired and predicted future system output and future predicted control increments. The output predictions are obtained from an internal model of the plant dynamics. The GPC algorithm is first applied to a simplified rotorcraft terrain-following problem, and GPC performance is compared to that of a conventional compensatory automatic system in terms of flight-path following, control activity, and control law implementation. Next, more realistic vehicle dynamics are utilized, and the GPC algorithm is applied to simultaneous terrain following and velocity control in the presence of atmospheric disturbances and errors in the internal model of the vehicle. The online computational and sensing requirements for implementing the GPC algorithm are minimal. Its use for manual control models appears promising.

  14. A Retrospective Review of Outcomes of Dental Treatment Performed for Special Needs Patients under General Anaesthesia: 2-Year Follow-Up

    PubMed Central

    Mallineni, Sreekanth Kumar; Yiu, Cynthia Kar Yung

    2014-01-01

    Objective. The purpose of the study was to evaluate the follow-up pattern of special needs patients (SNP) treated under general anaesthesia (GA) and the failure rates of different treatment procedures and restorative materials. Study Design. The treatment records of the patients who received dental treatment under GA during 2005 to 2009 were reviewed. The duration of follow-up periods, the outcomes of different treatment procedures, and the quality of different restorative materials were recorded and evaluated. Statistics were used for the comparison (SPSS 20.0). Pearson's chi-square test and post hoc analysis were used to evaluate the attendance of postoperative appointments and the associations of failure rates of different treatment procedures and restorative materials. Cohen kappa statistics was used for intraexaminer reliability. Results. A total of 177 patients were included in the study. The attendance of postoperative appointments showed a gradual decrease from 96% to 36% within 24 months (P < 0.05). Restorative procedures had the highest failure rates among all treatment procedures (P < 0.05). Stainless steel crowns showed higher survival rates among different restorative materials (P < 0.05). Pulp treatment in primary molars has higher success rate than primary incisors and canines. Composite restorations placed in primary canines have low survival rates. The intraexaminer reliability was good (k = 0.94). Conclusion. The attendance for postoperative follow-up appointments declined within two years. Restorative treatment was less successful when compared to preventive and pulp treatments. Stainless steel crowns were more reliable restorations with higher survival rates and composite restorations were less durable. PMID:25610913

  15. Five-year retrospective radiographic follow-up study of dental implants with sandblasting with large grit, and acid etching-treated surfaces

    PubMed Central

    2015-01-01

    Objectives The purpose of this study is to evaluate five-year radiographic follow-up results of the Korean sandblasting with large grit, and acid etching (SLA)-treated implant system. Materials and Methods The subjects of the study are 54 patients who have been followed-up to date, of the patients who underwent implant surgery from May 1, 2009 to April 30, 2011. In all, 176 implant placements were performed. Radiographs were taken before the first surgery, immediately after the first and second surgeries, immediately and six months after the final prosthesis installation, and every year after that. Bone loss was evaluated by the method suggested by Romanos and Nentwig. Results A total of 176 implant placements were performed-122 in men and 54 in women. These patients have been followed-up for an average of 4.9 years. In terms of prosthetic appliances, there were 156 bridges and 20 single prostheses. Nine implants installed in the maxillary molar area, three in the mandibular molar area and two in the maxillary premolar area were included in group M, with bone loss less than 2 mm at the crestal aspect of the implant. Of these, eight implants were single prostheses. In all, six implants failed-four in the mandible and two in the maxilla. All of these failures occurred in single-implant cases. The implant survival rate was 98.1% on the maxilla and 94.3% on the mandible, with an overall survival of 96.6%. Conclusion Within the limitations of this study, implants with the SLA surface have a very superior survival rate in relatively poor bone environments such as the maxilla. PMID:26734558

  16. Pathological complete response rate in hormone receptor-negative breast cancer treated with neoadjuvant FEC, followed by weekly paclitaxel administration: A retrospective study and review of the literature

    PubMed Central

    KIBA, TAKAYOSHI; MORII, NAO; TAKAHASHI, HIROTOSHI; OZAKI, SHINJI; ATSUMI, MISAO; MASUMOTO, FUMI; YAMASHIRO, HIROYASU

    2016-01-01

    While tumor size, the presence of inflammatory carcinoma and lymph node involvement are the main prognostic factors of women with locally advanced breast cancer, the prognostic value of the estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2) status has not been fully clarified. The present study examined the therapeutic efficacy of a neoadjuvant fluorouracil, epirubicin and cyclophosphamide regimen (FEC), followed by weekly paclitaxel and/or trastuzumab administration, in the treatment of hormone receptor-negative breast cancer patients. Between April 2012 and February 2014, 14 patients with hormone receptor-negative local breast cancer (triple-negative type, 9 patients; HER2 type, 5 patients) were included in the study. In all cases, the histological type of the primary cancer was invasive ductal carcinoma. Among the 14 women who received the regimen, 5 presented with stage I cancer (35.7%), 3 with stage IIA (21.4%), 3 with stage IIB (21.4%), 1 with stage IIIB (7.1%) and 2 with stage IIIC (14.3%), according to the American Joint Committee on Cancer staging system. With regard to the tumor-node-metastasis classification, 5 patients were T1N0M0 (35.7%), 3 were T2N0M0 (21.4%), 3 were T2N1M0 (21.4%), 2 were T3N3M0 (14.3%) and 1 was T4N1M0 (7.1%). The pathological response was evaluated using resected tissue following neoadjuvant chemotherapy, according to the criteria established by the Japanese Breast Cancer Society. Patients were classified into pathological responders (grades 2 and 3, 71.4% of all patients) and non-responders (grade 1, 28.6% of all patients). A pathological complete response (pCR) was achieved in 50.0% of all cases (7/14); 44.4% of triple-negative-type cases (4/9) and 60.0% of HER2-type cases (3/5). Hematological and non-hematological toxicity was reversible and manageable. No patients withdrew from treatment, and favorable compliance was achieved. The present study demonstrated that neoadjuvant FEC followed

  17. Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study—80 Case Studies and 6 Years of Follow-Up

    PubMed Central

    Poggetti, Andrea; Rosati, Marco; Castellini, Iacopo; Evangelisti, Gisberto; Battistini, Pietro; Parchi, Paolo; Lisanti, Michele

    2015-01-01

    Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head–trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV. PMID:26261746

  18. Lurasidone adjunctive with lithium or valproate for bipolar depression: A placebo-controlled trial utilizing prospective and retrospective enrolment cohorts.

    PubMed

    Suppes, Trisha; Kroger, Hans; Pikalov, Andrei; Loebel, Antony

    2016-07-01

    In this study, designed to evaluate the efficacy of lurasidone as adjunctive therapy with lithium or valproate, patients with bipolar I depression were randomized to 6 weeks of double-blind treatment with lurasidone (N = 180) or placebo (N = 176), added to background treatment with lithium or valproate. All patients were treated with lithium or valproate for a minimum of 4 weeks prior to screening. This was confirmed either by prospective treatment after study enrolment (run-in cohort), or retrospectively, with blood levels of lithium and valproate at screening (non-run-in cohort). Primary and key secondary endpoints were change from baseline to week 6 on the Montgomery-Åsberg Depression Rating Scale (MADRS) and depression severity score on the Clinical Global Impressions scale for use in bipolar illness (CGI-BP-S), respectively. Treatment with lurasidone was associated with non-significant improvement at week 6 vs. placebo for the MADRS total score (-11.8 vs -10.4; P = 0.176), and the CGI-BP-S score (-1.36 vs -1.13; P = 0.095). Significant separation from placebo was observed from weeks 2-5 for the MADRS and weeks 3-5 for the CGI-BP-S. Improvement in the placebo-subtracted MADRS total score was notably larger at week 6 for the non-run-in cohort compared to the run-in cohort (LS mean difference in endpoint change scores, -4.6; P = 0.009). Adverse events most frequently reported for lurasidone were akathisia, somnolence, and extrapyramidal side effects. In conclusion, lurasidone adjunctive with lithium or valproate demonstrated significant improvement in depressive symptoms based on the MADRS from weeks 2-5 but not at the primary week 6 endpoint. PMID:27089521

  19. Load-following control of an IGCC plant with CO2 capture

    SciTech Connect

    Bhattacharyya, D.; Turton, R.; Zitney, S.

    2011-01-01

    In this paper, a decentralized control strategy is considered for load-following control of an integrated gasification combined cycle (IGCC) plant with CO2 capture without flaring the syngas. The control strategy considered is gas turbine (GT) lead with gasifier follow. In this strategy, the GT controls the power load by manipulating its firing rate while the slurry feed flow to the gasifier is manipulated to control the syngas pressure at the GT inlet. However, the syngas pressure control is an integrating process with significant timedelay. In this work, a modified proportional-integral-derivative (PID) control is considered for syngas pressure control given that conventional PID controllers show poor control performance for integrating processes with large time delays. The conventional PID control is augmented with an internal feedback loop. The P-controller used in this internal loop converts the integrating process to an open-loop stable process. The resulting secondorder plus time delay model uses a PID controller where the tuning parameters are found by minimizing the integral time-weighted absolute error (ITAE) for disturbance rejection. A plant model with single integrator and time delay is identified by a P-control method. When a ramp change is introduced in the set-point of the load controller, the performance of both the load and pressure controllers with the modified PID control strategy is found to be superior to that using a traditional PID controller. Key

  20. View of Mission Control following splashdown of Skylab 4 command module

    NASA Technical Reports Server (NTRS)

    1974-01-01

    An overall view of activity in the Mission Operations Control Room in the Mission Control Cebter following the successful splashdown of the Skylab 4 command module in the Pacific Ocean. The three flight controllers in the foreground, left to right, are flight director Neil B. Hutchinson; flight director Donald R. Puddy; and Astronatu Robert L. Crippen, a spacecraft communicator (CAPCOM).

  1. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    PubMed Central

    2012-01-01

    Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD). While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02) who began a long-term course of treatment (≥90 days) with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively), and focused attention on accident-related encounters (e.g., for treatment of fractures) and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness). Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine), while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p<0.01); costs of accident-related encounters and other care that was possibly related to use of benzodiazepines increased by an average of $1099 ($1757 [$7656] vs $2856 [$14,836]; p=0.03). Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days) treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use. PMID:23088742

  2. Dependence of radiation dose on the behavioral patterns among school children: a retrospective analysis 18 to 20 months following the 2011 Fukushima nuclear incident in Japan

    PubMed Central

    Nomura, Shuhei; Tsubokura, Masaharu; Furutani, Tomoyuki; Hayano, Ryugo S.; Kami, Masahiro; Kanazawa, Yukio; Oikawa, Tomoyoshi

    2016-01-01

    After radioactive incidents, the exposure risk in daily activities among children is a major public concern. However, there are limited methods available for evaluation of this risk, which is essential to future health risk management. To this end, this study assessed the relationship between behavioral patterns of school children and radiation exposure for a period of 18–20 months following the 2011 Fukushima nuclear incident. The assessed population comprised 520 school children from Minamisoma city, located 20 km north of the nuclear plant. Data for the doses were obtained using individual dosimeters and from results of a behavior survey administered by the City Office. The mean value of the doses in the study period was 0.34 mSv, with a standard deviation of 0.14 mSv, indicating an annual dose of ∼1.36 mSv, which includes doses from natural sources. Our results showed that behavior with respect to outdoor activities had no statistically significant relationship to the dose. A 0.1 μSv/h increase in the air dose rate at home was associated with a 10% increase in the dose; however, a 0.01 μSv/h increase in the air dose rate on the school grounds was associated with a 2% increase in the dose. This study indicates that the air contamination levels at the places where children spend most of their day are the significant predictors of the dose, as opposed to the levels at those outdoor locations in which short periods of time spent. PMID:26612096

  3. The effect of autologous bone marrow mononuclear cell transplantation on the survival duration in Amyotrophic Lateral Sclerosis - a retrospective controlled study

    PubMed Central

    Sharma, Alok K; Sane, Hemangi M; Paranjape, Amruta A; Gokulchandran, Nandini; Nagrajan, Anjana; D’sa, Myola; Badhe, Prerna B

    2015-01-01

    Amyotrophic Lateral Sclerosis (ALS) is a rapidly progressive neurodegenerative disorder with fatal prognosis. Cellular therapy has been studied for ALS in various animal models and these advances have highlighted its potential to be a treatment modality. This is a retrospective controlled cohort study of total 57 patients. Out of these, 37 patients underwent autologous bone marrow mononuclear cell transplantation in addition to standard rehabilitation and Riluzole. Control group consisted of 20 patients who did not receive cell transplantation. The survival duration since the onset of the disease for both the groups was computed using a Kaplan-Meier Survival analysis and compared using log-rank test. Effect of age at onset, type of onset and lithium on survival duration in the intervention group was analyzed. Mean survival duration of patients in intervention group was 87.76 months which was higher than the control group mean survival duration of 57.38 months. Survival duration was significantly (p = 0.039) higher in people with the onset of the disease below 50 years of age. Limb onset and lithium also showed positive influence on the survival duration. Mean survival duration of the intervention group was also higher than the survival duration of ALS patients in previous epidemiological studies. In addition to the standard treatment with Riluzole, early intervention with combination of BMMNCs transplantation and Lithium may have a positive effect on the survival duration in ALS. Prospective randomized controlled studies with a larger sample size and rigorous methodology are required for conclusive findings. PMID:25973331

  4. Effectiveness of long-acting antipsychotics in clinical practice : 1. A retrospective, 18-month follow up and comparison between paliperidone palmitate, risperidone long-acting injection and zuclopenthixol decanoate

    PubMed Central

    Cordiner, Matthew; Shajahan, Polash; McAvoy, Sarah; Bashir, Muhammad; Taylor, Mark

    2016-01-01

    Objectives: In the UK, nine different compounds are available as long-acting antipsychotic injections (LAIs). There are few clinical guidelines for determining which LAIs are most effective in specific patient groups. To measure the clinical effectiveness of LAIs we aimed to determine the now-established concept of antipsychotic discontinuation rates and measure Clinical Global Impression (CGI) outcomes. Method: The population (n was approximately 560,000) was a secondary care NHS adult mental health service in Lanarkshire, Scotland, UK. This was a retrospective, electronic case note search of LAI-naïve patients commenced on paliperidone palmitate (n = 31), risperidone long-acting injection (RLAI) (n = 102) or zuclopenthixol decanoate (n = 105), with an 18-month follow up. Kaplan–Meier survival statistics for discontinuation rates and hospital admission were calculated. CGI severity and improvement scores were retrospectively assigned by the investigating team. Results: Paliperidone palmitate performed less favourably than risperidone long-acting injection (RLAI) or zuclopenthixol decanoate. Paliperidone palmitate had higher discontinuation rates due to any cause, inefficacy and increased hospitalization risk. Paliperidone palmitate had the smallest proportion of patients assigned a clinically desirable CGI-I score of 1 (very much improved) or 2 (much improved). Conclusions: Paliperidone palmitate had less favourable discontinuation and CGI outcomes compared with RLAI and zuclopenthixol decanoate. This could not be adequately explained by patients in the paliperidone group being more chronically or severely unwell, nor by the presence of comorbidities such as alcohol or substance misuse, or by the use of lower mean dosages compared with RLAI or zuclopenthixol decanoate. We considered that prescribers are familiarizing themselves with paliperidone and outcomes may improve over time. PMID:26913175

  5. Molecular mistletoe therapy: friend or foe in established anti-tumor protocols? A multicenter, controlled, retrospective pharmaco-epidemiological study in pancreas cancer.

    PubMed

    Matthes, H; Friedel, W E; Bock, P R; Zänker, K S

    2010-06-01

    Mistletoe is often used as complementary therapy in oncology. The anti-tumor effects of mistletoe (Iscador) are well documented in-vitro in respect to inhibition of cell proliferation, induction of apoptosis, segmental activation of immune competent cells and trapping of chemotherapeutic drugs within cancer cells by modulating the inhibitory potential of P-glycoprotein (P-gp)-mediated transport of cell toxifying substances (cytotoxic drugs). However, the clinical activity of mistletoe treatment remains still controversial. Implementation of mistletoe therapy as supportive care into anti-cancer programs should be based on the best evidence and must continually be evaluated to ensure safety, efficacy, collection of new data, and cost-effectiveness. Useful domains that can be evaluated include symptom control, adherence to conventional treatment protocols, quality of life, individual outcome and potential advantages of a whole-system health approach. Here we report the results of a multicenter, controlled, retrospective and observational pharmaco-epidemiological study in patients suffering from a pancreatic carcinoma. After surgery the patients were treated by adjuvant chemotherapy with gemcitabine supported by Iscador, or with gemcitabine alone, or any other best of care, but not including Iscador. Using a novel methodological pharmaco-epidemiological design and statistical approach it could be shown that Iscador offers benefits--symptom control, overall survival--as supportive care within gemcitabine protocols of patients with surgically resected pancreatic carcinoma. PMID:20455850

  6. Two consecutive singleton pregnancies versus one twins pregnancy as preferred outcome of in vitro fertilization for mothers and infants: a retrospective case-control study.

    PubMed

    La Sala, Giovanni Battista; Morini, Daria; Gizzo, Salvatore; Nicoli, Alessia; Palomba, Stefano

    2016-04-01

    Objective Many infertile couples request a multiple embryo transfer because they desire more than one child. Based on this consideration, the current study aimed to compare the reproductive and perinatal outcomes of two consecutive singleton pregnancies versus one twin pregnancy in a large cohort of in vitro fertilization (IVF) patients. Research design and methods Retrospective analysis of data from patients with clinical twin pregnancy after IVF fresh cycles and from patients with two consecutive IVF fresh cycles and clinical singleton pregnancy. Main outcome measures Miscarriage rate, delivery rate, gestational age at birth, neonatal birth weight, and perinatal complications. A sub-analysis of data according to vanishing twin syndrome (VTS) was also performed. Results A total of 18,703 autologous fresh cycles were analyzed. One hundred seven patients had two consecutive singleton clinical pregnancies, whereas one clinical twin pregnancy occurred in 641 women. In patients who had two consecutive singleton clinical pregnancies the rates of overall pregnancies lost (odds ratio [OR] 4.9, 95% confidence interval [CI] 3.4, 6.9) and live births (OR 0.2, 95% CI 0.1, 0.3) were, respectively, higher and lower when compared to patients who had one clinical twin pregnancy. That data did not change after sub-analysis for VTS. The overall risk of perinatal complications was significantly higher in patients who had one twin delivery rather than patients who had two consecutive singleton deliveries (OR 31.8, 95% CI 14.1, 71.5). No difference between groups was detected in terms of intrauterine/neonatal deaths, perinatal mortality and neonatal intensive care unit admission. Data did not change after adjusting for confounders. Conclusions When compared with two consecutive singleton pregnancies, twin pregnancies are characterized by higher success rates but worse perinatal outcomes irrespectively of VTS. Well designed prospective controlled studies are needed to confirm or rebut

  7. Survival and Success Rates of Dental Implants Placed Using Osteotome Sinus Floor Elevation Without Added Bone Grafting: A Retrospective Study with a Follow-up of up to 10 Years.

    PubMed

    French, David; Nadji, Nabil; Shariati, Batoul; Hatzimanolakis, Penny; Larjava, Hannu

    2016-01-01

    This retrospective study with a follow-up period of 4 months to 10 years evaluated survival, success, and complication rates of implants placed using osteotome sinus floor elevation (OSFE) without added bone grafting. A total of 926 implants were placed, including 530 short implants (6 mm to 8.5 mm) and 209 implants in low residual bone height (RBH) (< 5 mm). Bone levels were evaluated at approximately 3 months and at 1, 3, and 5 years, and in some cases up to 10 years after implants were placed. The implant survival rate was 98.3% at the 5-year follow-up. Twelve of the 926 implants failed (6 preprosthetic, 6 postprosthetic). The success rate was 95.4% at a threshold of less than 1 mm of bone loss for combined systems (Straumann; Nobel Biocare). Short implant survival and success rates were statistically comparable to conventional-length implants. Low-RBH implants had a lower but acceptable survival rate of 95.7%. Adverse events were rare, with one case of infection and zero cases of vertigo reported. The findings of this study indicate that implant placement with OSFE without added bone graft is highly successful, even when short implants are used in low RBH. PMID:27031637

  8. Childhood obsessive-compulsive traits in anorexia nervosa patients, their unaffected sisters and healthy controls: a retrospective study.

    PubMed

    Degortes, Daniela; Zanetti, Tatiana; Tenconi, Elena; Santonastaso, Paolo; Favaro, Angela

    2014-07-01

    Although there is evidence that childhood perfectionistic traits predate the onset of eating disorders, few studies to date have examined the prevalence and clinical correlates of these traits in patients with anorexia nervosa (AN) and their unaffected sisters. The aim of this work was to study the prevalence of childhood obsessive-compulsive traits in patients with lifetime AN, their unaffected sisters and healthy women. A total of 116 AN patients, 32 healthy sisters and 119 controls were assessed by the EATATE Interview to assess traits such as perfectionism, inflexibility, rule-bound traits, drive for order and symmetry, and excessive doubt and cautiousness. Both self-report and maternal reports were collected. AN patients reported more childhood obsessive-compulsive traits than their healthy sisters and controls. In contrast, no differences between healthy controls and unaffected sisters emerged. In patients with AN, a dose-response relationship was found between the number of childhood obsessive-compulsive traits and psychopathology, including body image distortion, thus indicating that these traits are an important feature to be considered in assessing and treating eating disorders. PMID:24851802

  9. Role of physiotherapy and patient education in lymphedema control following breast cancer surgery

    PubMed Central

    Lu, Shiang-Ru; Hong, Rong-Bin; Chou, Willy; Hsiao, Pei-Chi

    2015-01-01

    Introduction This retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL). Methods We analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415), who received neither education nor physiotherapy postsurgery; Group B (n=672), who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130), who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models. Results During the follow-up, 188 patients (15.4%) developed lymphedema, including 77 (18.6%) in Group A, 101 (15.0%) in Group B, and 10 (7.7%) in Group C (P=0.010). The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18–1.78). The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20) number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18–0.67, P=0.002). Conclusion Patient education that begins within the first week postsurgery and is followed by physiotherapy is effective in reducing the risk of BCRL in women with breast cancer. PMID:25750536

  10. Outcomes Following Operative Treatment of open Fractures of the Distal Radius: A Case Control Study

    PubMed Central

    MacKay, Brendan J; Montero, Nicole; Paksima, Nader; Egol, Kenneth A

    2013-01-01

    Purpose To report radiographic, clinical, and patient-based functional outcomes following contemporary operative treatment of patients who sustained an open distal radius fracture and compare them to a similar group of patients treated operatively for closed distal radius fractures. Methods Over five years, 601 patients with a distal radius fracture presented to our academic medical center, including one Level 1 trauma hospital, and were prospectively enrolled in an upper extremity trauma database. Patients with open distal radius fractures underwent irrigation, debridement, and operative fixation within 24 hours of presentation. Closed distal radius fractures requiring operative fixation were treated electively. Retrospective review of the database identified eighteen open fractures of the distal radius (11 type I, 6 type II, 1 type IIIa). The open fracture patients were individually matched with eighteen closed distal radius fracture patients who underwent surgical fixation based on age, sex, injury to dominant extremity, fracture pattern, and method of fracture fixation. Clinical, radiographic, patient- based functional outcomes, and complications were recorded at routine postoperative intervals. Results Follow-up was greater than 77% in both groups at all time points. The open and closed groups were similar in regards to age, gender, BMI, race, tobacco use, income, employment status, hand dominance, injury to dominant extremity, mechanism of injury, fracture classification, method of fracture fixation, and presence of concomitant injury. Postoperative complications and reoperation rates were similar between the open and closed groups. Union rates and radiographic alignment one year postoperatively were similar between the open and closed fracture groups. At final follow-up, range of motion parameters, grip strengths, DASH indices, and subjective pain scores were similar between both groups. Discussion Open distal radius fractures treated with early debridement

  11. Optimal control of a boiling water reactor load-following operation

    SciTech Connect

    Lin, C.; Lin, Z.P.; Jiang, W.J. . Dept. of Nuclear Engineering)

    1989-06-01

    The authors describe a method based on a forward dynamic programming technique applied to load-following control of a boiling water reactor. The control strategy obtained is optimal and satisfies operation constraints. A course-mesh, one-dimensional model using the two-group diffusion theory with Doppler, void, and xenon feedbacks is developed to reduce computer time. The control rods are assumed to be fixed during load maneuvers, and variations in core power are accomplished through core flow.

  12. The Joint Effects of Lifestyle Factors and Comorbidities on the Risk of Colorectal Cancer: A Large Chinese Retrospective Case-Control Study

    PubMed Central

    Hu, Hai; Zhou, Yangyang; Ren, Shujuan; Wu, Jiajin; Zhu, Meiying; Chen, Donghui; Yang, Haiyan; Wang, Liwei

    2015-01-01

    Background Colorectal cancer (CRC) is a major cause of cancer morbidity and mortality. In previous epidemiologic studies, the respective correlation between lifestyle factors and comorbidity and CRC has been extensively studied. However, little is known about their joint effects on CRC. Methods We conducted a retrospective case-control study of 1,144 diagnosed CRC patients and 60,549 community controls. A structured questionnaire was administered to the participants about their socio-demographic factors, anthropometric measures, comorbidity history and lifestyle factors. Logistic regression model was used to calculate the odds ratio (ORs) and 95% confidence intervals (95%CIs) for each factor. According to the results from logistic regression model, we further developed healthy lifestyle index (HLI) and comorbidity history index (CHI) to investigate their independent and joint effects on CRC risk. Results Four lifestyle factors (including physical activities, sleep, red meat and vegetable consumption) and four types of comorbidity (including diabetes, hyperlipidemia, history of inflammatory bowel disease and polyps) were found to be independently associated with the risk of CRC in multivariant logistic regression model. Intriguingly, their combined pattern- HLI and CHI demonstrated significant correlation with CRC risk independently (ORHLI: 3.91, 95%CI: 3.13–4.88; ORCHI: 2.49, 95%CI: 2.11–2.93) and jointly (OR: 10.33, 95%CI: 6.59–16.18). Conclusions There are synergistic effects of lifestyle factors and comorbidity on the risk of colorectal cancer in the Chinese population. PMID:26710070

  13. There Is No Difference in IQ between Suicide and Non-Suicide Psychiatric Patients: A Retrospective Case-Control Study

    PubMed Central

    Park, Sung-Jin; Yi, Kikyoung; Lee, Joon Deuk

    2015-01-01

    Objective The goal of this study was to examine the association between IQ and suicide in psychiatric patients. Methods We conducted a nested case-control study using data obtained from psychiatric patients affiliated with a general hospital in Seoul, Korea. In a one-to-two ratio the psychiatric patients who died of suicide (Suicide Group; n=35) were matched to those who didn't (Non-suicide Group; n=70) by age, gender, psychiatric diagnosis and approximate time of first treatment. IQ was measured using the Korean version of the Wechsler Adult Intelligence Scale-Revised. Results There were no significant differences in any type of IQ between suicide patients and non-suicide patients. Logistic regression showed no evidence of an association between IQ and suicide. Conclusion These results do not support the existence of an association between IQ and suicide. PMID:26207125

  14. Opposite Drug Prescription and Cost Trajectories following Integrative and Conventional Care for Pain – A Case-Control Study

    PubMed Central

    Sundberg, Tobias; Petzold, Max; Kohls, Niko; Falkenberg, Torkel

    2014-01-01

    Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC. PMID:24827981

  15. Modeling and path-following control of a vector-driven stratospheric satellite

    NASA Astrophysics Data System (ADS)

    Zheng, Zewei; Chen, Tian; Xu, Ming; Zhu, Ming

    2016-05-01

    The stratospheric satellite driven by steady prevailing winds in the stratosphere must be controlled in its longitudinal excursion to keep a latitudinal orbital flight. In a reliable and high-precision control system, an available system model must come first. In this paper, we study the 6 degree-of-freedom (DOF) modeling and path-following problem of a novel stratospheric satellite which consists of a high-altitude helium balloon, a truss and two vector-motor-driven propellers. To keep a latitudinal flight orbit, an algorithm for accurate latitudinal path following is proposed based on the theories of vector field and sliding mode control. Moreover, a forward velocity controller is added to the control algorithm to maintain a constant velocity. Finally, a series of open-loop control simulations are completed to verify the effectiveness of the model in the performance of the stratospheric satellite dynamics, and path-following control simulation results demonstrate the effectiveness of the proposed control algorithm.

  16. A master-follower type distributed scheme for reactor inlet temperature control

    SciTech Connect

    Garcia, H.E.; Dean, E.M.; Vilim, R.B.

    1995-06-01

    This paper describes the implementation of a computer-based controller for regulating reactor inlet temperature in a pool-type power plant. The elements of the control system are organized in a master-follower hierarchical architecture that takes advantage of existing in-plant hardware and software to minimize the need for plant modifications. Low level control algorithms are executed on existing local digital controllers (followers) with the high level algorithms executed on a new plant supervisory computer (master). A distributed computing strategy provides integration of the existing and additional computer platforms. The control system operates by having the master controller first estimate the secondary sodium flow needed to achieve a given reactor inlet temperature. The estimated flow is then used as a setpoint by the follower controller to regulate sodium flow using a motor-generator pump set. The control system has been implemented in a Hardware-In-the-Loop (FM) setup and qualified for operation in the Experimental Breader reactor 11 of Argonne National Laboratory. Some HIL results are provided.

  17. Prediction of Abstinence, Controlled Drinking, and Heavy Drinking Outcomes Following Behavioral Self-Control Training.

    ERIC Educational Resources Information Center

    Miller, William R.; Joyce, Mark A.

    1979-01-01

    Examined prognostic value of client characteristics for problem drinkers treated with an initial goal of controlled drinking. Clients achieving moderation had less severe symptoms and less family history of problem drinking than abstainers or uncontrolled cases. Females were more successful in attaining moderation. Males were overrepresented among…

  18. Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case–control study

    PubMed Central

    Yang, Ya-zi; Shi, Su-Fang; Chen, Yu-Qing; Chen, Min; Yang, Yi-He; Xie, Xin-Fang; Zou, Rong; Lv, Ji-Cheng; Liu, Li-Jun; Zhang, Hong

    2015-01-01

    Background The coexistence of IgA nephropathy (IgAN) and antineutrophil cytoplasmic autoantibodies (ANCAs) is relatively rare. Only a few studies have reported the features of these patients. Methods We studied the clinical and histological features of 20 ANCA-positive IgAN patients. They were compared with ANCA-negative IgAN patients (n = 40) and ANCA-associated systemic vasculitis (AASV) patients (n = 40) with a randomly selected and matched proportion of crescentic glomeruli. Furthermore, 9 ANCA-positive crescentic IgAN patients out of the 20 cases were compared with two control groups with crescentic nephritis. Results ANCA-positive IgAN patients showed older age, lower haemoglobin and higher inflammatory indicator levels at baseline, and a higher percentage of general symptoms and pulmonary involvement, compared with ANCA-negative IgAN patients, and were comparable to AASV patients. Histologically, there was a significantly higher percentage of fibrinoid necrosis in glomeruli in ANCA-positive IgAN patients and in AASV patients compared with ANCA-negative IgAN patients (35, 25 and 0%, respectively, P = 0.003). After immunosuppressive therapy, ANCA-positive crescentic IgAN patients were more likely to withdraw from dialysis (75 versus 9.1%, P = 0.03) and not to reach end-stage renal disease within 6 months (11.1 versus 66.7%, P = 0.01) compared with ANCA-negative crescentic IgAN patients. Conclusions IgAN patients with ANCA positivity showed more severe clinical and histological features when compared with ANCA-negative IgAN patients and were comparable to AASV patients. However, renal prognosis was relatively better in ANCA-positive crescentic IgAN patients after aggressive immunosuppressive therapy in the short term, compared with ANCA-negative patients. PMID:26413270

  19. Long-term Survival Outcomes Following Internal Mammary Node Irradiation in Stage II-III Breast Cancer: Results of a Large Retrospective Study With 12-Year Follow-up

    SciTech Connect

    Chang, Jee Suk; Park, Won; Kim, Yong Bae; Lee, Ik Jae; Keum, Ki Chang; Lee, Chang Geol; Choi, Doo Ho; Suh, Chang-Ok; Huh, Seung Jae

    2013-08-01

    Purpose: To examine the effect of internal mammary node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. Methods and Materials: Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%. Results: The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI (P<.001). Otherwise, disease and treatment characteristics were well balanced. The 10-year DFS with and without IMNI was 65% and 57%, respectively (P=.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P=.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively (P=.62). The 10-year DFS and OS were 61%, and 69%, respectively. Conclusions: Internal mammary node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of internal mammary nodes should be considered in postmastectomy radiation therapy.

  20. Ten years' experience with four cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, procarbazine (BEACOPP)-escalated followed by four cycles of baseline-dose BEACOPP in patients with advanced stage Hodgkin lymphoma: a single-center, retrospective study.

    PubMed

    Belada, David; Štěpánková, Pavla; Sýkorová, Alice; Žák, Pavel; Smolej, Lukáš

    2015-07-01

    The HD-9 trial showed that eight cycles of BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, procarbazine)-escalated led to significant improvements in response rate, progression-free survival and overall survival over COPP/ABVD (cyclophosphamide, vincristine, prednisone, procarbazine/doxorubicin, bleomycin, vinblastine, dacarbazine) therapy. This monocentric retrospective study was performed to evaluate 10 years of experience with four cycles of BEACOPP-escalated and four cycles of BEACOPP-baseline outside of clinical trials. The outcomes were assessed in 78 patients with newly diagnosed advanced stage Hodgkin lymphoma. A complete response after chemotherapy ± radiotherapy was achieved in 75 patients (96%). At the median follow-up of 74 months, the actuarial 5- and 10-year freedom from treatment failure (FFTF) rates were 91% and 89%, and actuarial 5- and 10-year overall survival rates for the entire group were 93% and 90%, respectively. These results suggest that the combination of escalated and baseline BEACOPP chemotherapy is feasible in routine practice with good efficacy and acceptable toxicity. PMID:25330440

  1. Photodynamic therapy with intralesional methylene blue and a 635 nm light-emitting diode lamp in hidradenitis suppurativa: a retrospective follow-up study in 7 patients and a review of the literature.

    PubMed

    Agut-Busquet, Eugènia; Romaní, Jorge; Gilaberte, Yolanda; García-Malinis, Ana; Ribera-Pibernat, Miquel; Luelmo, Jesús

    2016-08-01

    Hidradenitis suppurativa is a chronic inflammatory skin disease which has an estimated prevalence of 1%. It is characterized by the formation of recurrent painful suppurative nodules and abscesses in the flexural areas of the body. It is believed that its pathogenesis involves an aberrant, genetically-determined activation of innate immunity against the bacterial commensal flora of intertriginous areas. It has been found that the formation of antibiotic-resistant bacterial biofilms is a common finding in hidradenitis lesions. Photodynamic therapy with different compounds and light sources has demonstrated its efficacy in a number of infectious diseases such as nail mycosis and chronic periodontitis. We retrospectively report our experience in the treatment of hidradenitis with photodynamic therapy using intralesional methylene blue and a 635 nm light-emitting diode lamp in 7 patients. Two patients received one session whereas 5 patients received two sessions. At one month follow-up good response was achieved in 6 patients. After 6 months, 5 patients (71%) maintained remission of the disease in the treated area. In view of the results and literature review, we regard methylene blue as an ideal photosensitizer for photodynamic therapy in this disease. PMID:27417568

  2. Leader-following consensus of fractional-order multi-agent systems via adaptive pinning control

    NASA Astrophysics Data System (ADS)

    Yu, Zhiyong; Jiang, Haijun; Hu, Cheng; Yu, Juan

    2015-09-01

    In this paper, the leader-following consensus problem of fractional-order multi-agent systems is considered via adaptive pinning control. The dynamics of leader and all followers with linear and nonlinear functions are investigated, respectively. We assume that the node should be pinned if its in-degree is less than its out-degree in the paper. Under this assumption and based on the stability theory of fractional-order differential systems, some leader-following consensus criteria are derived, which are easily obtained by matrix inequalities. The control of each agent using local information is designed and detailed analysis of the leader-following consensus is presented. The design technique is based on algebraic graph theory and the Riccati inequality. Several simulation examples are presented to demonstrate the effectiveness of the proposed method.

  3. Distributed event-triggered cooperative attitude control of multiple rigid bodies with leader-follower architecture

    NASA Astrophysics Data System (ADS)

    Weng, Shengxuan; Yue, Dong

    2016-02-01

    In this note, the distributed event-triggered cooperative attitude control of multiple rigid bodies with leader-follower architecture is investigated, where both the cases of static and dynamic leaders are all considered. Two distributed triggering procedures are first introduced for the followers and leaders, and then the distributed cooperative controllers are designed under the proposed triggering schemes. Under the designed controllers with the event-triggered strategies, it is shown that the orientations of followers converge to the convex hull formed by the desired leaders' orientations with zero angular velocities. Moreover, the communication pressure in network is reduced and the energy of each agent is saved. Simulation results show the effectiveness of the proposed method.

  4. Clinical characteristics and risk factors for community-acquired Clostridium difficile infection: A retrospective, case-control study in a tertiary care hospital in Japan.

    PubMed

    Mori, Nobuaki; Aoki, Yasuko

    2015-12-01

    The epidemiology of Clostridium difficile infection (CDI) has changed in the past decade. The incidence, prevalence, and severity of community-acquired CDI (CA-CDI) have increased. However, the epidemiology of CA-CDI in Japan has not been investigated. To evaluate the clinical characteristics and risk factors for CA-CDI in Japan, we conducted a retrospective, case-control study of CA-CDI at the National Hospital Organization Tokyo Medical Center between January 2010 and December 2014. Two age- and sex-matched C. difficile toxin- and culture-negative controls were assigned for each case. A total of 26 patients were identified with CA-CDI were identified. The incidence rate for CA-CDI was 1.4 per 100,000 patient-years. Of the CA-CDI patients, 6 (23.1%) had no underlying comorbidity, 22 (84.6%) had prior exposure to antimicrobials, and 5 (19.2%) had prior exposure to antacids. Although 5 patients (19.2%) required hospitalization, none required intensive care or died. Recurrence was observed in 1 patient (3.8%). Patients with CA-CDI cases were more likely to have been recently exposed to antimicrobials compared to controls (odds ratio [OR]: 8.12, 95% confidence interval [CI]: 2.43-26.98). However, exposure to antacids was not associated with CA-CDI (OR: 0.59, 95% CI: 0.19-1.85). Our findings indicate that the incidence rate for CA-CDI in Japan is relatively low compared to the US and Europe, and that CA-CDI is usually not severe. Previous antimicrobial exposure was the main risk factor for CA-CDI, suggesting that clinicians should consider CDI in patients presenting with diarrhea who have recently received antimicrobials. PMID:26482373

  5. Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

    PubMed Central

    Aucott, Lorna S; Philip, Sam; Avenell, Alison; Afolabi, Ebenezer; Sattar, Naveed; Wild, Sarah

    2016-01-01

    Objectives To determine weight change patterns in Scottish patients 2 years after diagnosis of type 2 diabetes and to examine these in association with medium-term glycaemic, mortality and cardiovascular outcomes. Setting Using a retrospective cohort design, ethical approval was obtained to link the Scottish diabetes care database to hospital admission and mortality records. Participants 29 316 overweight/obese patients with incident diabetes diagnosed between 2002 and 2006 were identified with relevant information for ≥2 years. Primary and secondary outcome measures Weight records over time provided intrapatient weight change and variation and glycated haemoglobin (HbA1c) gave measures of glycaemic control. These characteristics and demographic variables at diagnosis were linked with notifications of death (2–5 years after diagnosis) and cardiovascular events (0–5 year after diagnosis). Results By 2 years, 36% of patients had lost ≥2.5% of their weight. Increasing age, being female and a higher body mass index at diagnosis were associated with larger proportions of weight lost (p<0.001). Multivariable modelling showed that inadequate glycaemic control at 2 years was associated with being younger at baseline, being male, having lower levels of obesity at diagnosis, gaining weight or being weight stable with weight change variability, and starting antidiabetic medication. While weight change itself was not related to mortality or cardiovascular outcomes, major weight variability was independently associated with poorer survival and increased cardiovascular outcome risks, as was deprivation. Conclusions Our results suggest that weight loss or being weight stable with little weight variability early after diabetes diagnosis, are associated with better glycaemic control and we identified groups less able to lose weight. With respect to mortality and cardiovascular outcomes, although weight change at 2 years was a weak predictor, major weight

  6. Control of Human-Following Robot Based on Cooperative Positioning with an Intelligent Space

    NASA Astrophysics Data System (ADS)

    Morioka, Kazuyuki; Oinaga, Yudai; Nakamura, Yuichi

    This paper proposes the localization method based on interactive communication between a mobile robot and a networked laser range scanner installed in an intelligent space and achieves human-following control of a mobile robot with the method. Generally, human tracking with cameras or laser range scanners on board the robots has been utilized for control of mobile robots to follow human walking. In addition to human tracking, mobile robots have to perform position estimation simultaneously. There is constraints in measurement for landmark detection or SLAM, because target human walks close to the robot while human following. Then, proposed system consiers to utilize an intelligent environment where sensors are distributed. The proposed system exchanges position and heading information estimated in the mobile robot and the networked laser range scanner with each other. The networked laser range scanner searches and detects target human and the robot based on the position information sent from the robot. The robot receives the detection results from the networked laser range scanner. Then, the estimate position is updated and reference velocities for human-following control are calculated with them. Estimation errors with odometry in the robot and unstable tracking of target in the networked laser range scanner are compensated with this system. In this paper, communication timing between the robot and the networked laser range scanners while human-following is discussed. Human-following experiments are performed and the results are shown.

  7. A retrospective classification of diagnoses in terms of DSM-5 for patients included in randomized controlled trials of Ginkgo biloba extract EGb 761(®).

    PubMed

    Hoerr, Robert; Zaudig, Michael

    2016-04-01

    When the early trials of Ginkgo biloba extract EGb 761(®) were conducted, different terms were used to denote ageing-associated neurocognitive disorders. With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a taxonomy covering dementia and pre-dementia stages of such disorders became available. DSM-5 diagnostic criteria for neurocognitive disorders (NCDs) were applied to patients with any type of ageing-associated cognitive impairment, including dementia, enrolled in randomized controlled clinical trials of EGb 761(®), taking into account the reported inclusion and exclusion criteria and patient characteristics at baseline. For 23 of 31 trials (74 %), the inclusion diagnoses could be classified as NCD in accordance with DSM-5. Thirteen trials enrolled patients with major NCD, four trials enrolled patients with mild NCD and six trials enrolled patients with NCD, who could not be classified unambiguously as having mild or major NCD. Although various terms were formerly used for neurocognitive disorders, the patients enrolled in the majority of clinical trials with EGb 761(®) could be classified retrospectively using modern DSM-5 diagnostic criteria. PMID:26267422

  8. Retrospective epidemiological evaluation of molecular and animal husbandry data within the bovine viral diarrhoea virus (BVDV) control programme in Western Austria during 2009-2014.

    PubMed

    Schoepf, Karl; Revilla-Fernández, Sandra; Steinrigl, Adolf; Fuchs, Reinhard; Sailer, Andreas; Weikel, Joachim; Schmoll, Friedrich

    2016-01-01

    A retrospective epidemiological investigation of molecular and animal husbandry data collected over an observation period of five years (2009-2014) within the compulsory bovine viral diarrhoea virus (BVDV) control programme in Western Austria, covering the federal provinces of Tyrol and Vorarlberg is presented in this study. Samples collected from 232 infected calves were phylogenetically classified based on the 5' untranslated region (5'UTR). All but 13 samples, which were typed as border disease virus subtype 3 (BDV-3), belonged to the bovine viral diarrhoea virus genotype 1 (BVDV-1) and clustered within six different subtypes (1b, 1e, 1f, 1h, 1d and 1k). Movement data and survival times from infected individual animals were analysed because of their potential of passing on infection to naive herds. From the moment of submission of the laboratory results, 180 animals were culled within the first month, 13 lived longer than two but not longer than six months and seven infected animals lived longer than one year. 13 of the infected animals were born on alpine pastures and eleven infected animals were grazed on mountain pastures during summer. The movement of infected animals and the role of trade in alpine areas are a possible source for spreading the infection, thus hampering the progress of eradication. PMID:27344911

  9. A Retrospective Analysis of Incidence and Its Associated Risk Factors of Upper Urinary Tract Recurrence following Radical Cystectomy for Bladder Cancer with Transitional Cell Carcinoma: The Significance of Local Pelvic Recurrence and Positive Lymph Node

    PubMed Central

    Kim, Sung Han; Yang, Hyung-Kook; Lee, Jung Hoon; Lee, Eun-Sik

    2014-01-01

    Objective The aim of this study is to examine the incidence and risk factors of upper urinary tract recurrence (UUTR) following radical cystectomy (RC) in bladder cancer and to evaluate its relationship with neobladder (Neo) or ileal conduit (IC). Materials and Methods All clinicopathologic parameters and perioperative parameters of 311 patients who underwent RC with either Neo or IC by a single surgeon from 1999 to 2012 were retrospectively included in this study. Patients with a history of renal surgery, concomitant UUTR, or a histopathology of non-transitional cell carcinoma were excluded. For statistical analyses of predictive risk factors of UUTR, a multivariate analysis was performed with known risk factors of UUTR, including type of urinary diversion with significance defined as P < 0.05. Results During the median follow-up period of 53 months, 143 (46.0%) IC and 168 (54.0%) Neo were performed, resulting in 11 (3.5%) cases of UUTR (Neo 7 and IC 4) after RC and all patients then underwent nephroureterectomy. No significant differences in incidence and overall survival in UUTR were observed according different types of urinary diversion (p = 483), and the prognosis for survival of Neo was insignificantly better than that of IC (5-year overall survival 78% vs 74%, respectively, p>0.05). Higher number of positive lymph nodes (HR 9.03) and the presence of pelvic local recurrence (HR 7286.08) were significant predictive factors of UUTR (p<0.05). Conclusion This study reports a UUTR rate of 3.5%, and positive lymph nodes and presence of local recurrence at the pelvis as important risk factors. No significant differences in incidence and survival were observed between Neo and IC. PMID:24798444

  10. Robust H∞ output-feedback control for path following of autonomous ground vehicles

    NASA Astrophysics Data System (ADS)

    Hu, Chuan; Jing, Hui; Wang, Rongrong; Yan, Fengjun; Chadli, Mohammed

    2016-03-01

    This paper presents a robust H∞ output-feedback control strategy for the path following of autonomous ground vehicles (AGVs). Considering the vehicle lateral velocity is usually hard to measure with low cost sensor, a robust H∞ static output-feedback controller based on the mixed genetic algorithms (GA)/linear matrix inequality (LMI) approach is proposed to realize the path following without the information of the lateral velocity. The proposed controller is robust to the parametric uncertainties and external disturbances, with the parameters including the tire cornering stiffness, vehicle longitudinal velocity, yaw rate and road curvature. Simulation results based on CarSim-Simulink joint platform using a high-fidelity and full-car model have verified the effectiveness of the proposed control approach.

  11. Robust leader-follower formation tracking control of multiple underactuated surface vessels

    NASA Astrophysics Data System (ADS)

    Peng, Zhou-hua; Wang, Dan; Lan, Wei-yao; Sun, Gang

    2012-09-01

    This paper is concerned with the formation control problem of multiple underactuated surface vessels moving in a leader-follower formation. The formation is achieved by the follower to track a virtual target defined relative to the leader. A robust adaptive target tracking law is proposed by using neural network and backstepping techniques. The advantage of the proposed control scheme is that the uncertain nonlinear dynamics caused by Coriolis/centripetal forces, nonlinear damping, unmodeled hydrodynamics and disturbances from the environment can be compensated by on line learning. Based on Lyapunov analysis, the proposed controller guarantees the tracking errors converge to a small neighborhood of the origin. Simulation results demonstrate the effectiveness of the control strategy.

  12. Self-tuning Generalized Predictive Control applied to terrain following flight

    NASA Technical Reports Server (NTRS)

    Hess, R. A.; Jung, Y. C.

    1989-01-01

    Generalized Predictive Control (GPC) describes an algorithm for the control of dynamic systems in which a control input is generated which minimizes a quadratic cost function consisting of a weighted sum of errors between desired and predicted future system output and future predicted control increments. The output predictions are obtained from an internal model of the plant dynamics. Self-tuning GPC refers to an implementation of the GPC algorithm in which the parameters of the internal model(s) are estimated on-line and the predictive control law tuned to the parameters so identified. The self-tuning GPC algorithm is applied to a problem of rotorcraft longitudinal/vertical terrain-following flight. The ability of the algorithm to tune to the initial vehicle parameters and to successfully adapt to a stability augmentation failure is demonstrated. Flight path performance is compared to a conventional, classically designed flight path control system.

  13. Rituximab in combination with CHOP chemotherapy for the treatment of diffuse large B cell lymphoma in China: a 10-year retrospective follow-up analysis of 437 cases from Shanghai Lymphoma Research Group.

    PubMed

    Li, Xiaoyang; Liu, Zhao; Cao, Junning; Hong, Xiaonan; Wang, Jianmin; Chen, Fangyuan; Wang, Chun; Zou, Shanhua; Li, Junmin; Shen, Zhixiang

    2012-06-01

    The purpose of the study is to evaluate the 10 years follow-up of the efficacy in Chinese patients receiving cyclophosphamide, doxorubicin/epirubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) regimen as the initial treatment for diffuse large B cell lymphoma (DLBCL). We have retrospectively analyzed 437 patients with DLBCL who were newly diagnosed and received CHOP or R-CHOP regimen in six university hospitals and closely followed up after the completion of treatment. For all patients, there were significant differences between R-CHOP and CHOP for overall survival (OS) (median follow-up 86 months, 84.1% vs 70.2%, p = 0.018) and progression-free survival (PFS) (81.5% vs 66.7%, p = 0.015), while elder patients (>60 years old) received higher OS (median follow-up 66 months, 80.7% vs 53.0%, p = 0.011). But for younger patients (≤60 years old), the treatments with rituximab did not demonstrate a significant effect on OS (85.5% vs 79.4%, p = 0.428). In the R-CHOP group, International Prognostic Index (IPI) distinguished three risk groups instead of four risk groups. But in the CHOP group, IPI still distinguished four risk groups. Furthermore, for 212 of 437 patients diagnosed with extranodal involvement DLBCL, R-CHOP regimen provided a longer OS than CHOP regimen did (OS, 89.9% vs 71.7%, p = 0.014). Moreover, patients with extranodal lymphoma had a significant longer survival in rituximab era (OS, 89.9% vs 79.2% for extranodal and nodal, respectively; p = 0.048). The results of this large-scale study suggested that R-CHOP provided a greater survival benefit in the initial treatment of DLBCL. As for the patients with extranodal lymphoma, R-CHOP was also a good choice as first-line treatment. Extranodal disease seems to be an independent good prognostic factor in rituximab era. PMID:22160255

  14. H{sub {infinity}} Control Theory Applied to Xenon Control for Load-Following Operation of a Nuclear Reactor

    SciTech Connect

    Chi, Sung Goo; Cho, Nam Zin

    2002-02-15

    A robust controller is designed by applying the H{sub {infinity}} optimal control theory to the xenon control for the load-following operation of a nuclear reactor. The set of reactor model equations for controller design is a stiff system. This singularly perturbed system arises from the interaction of slow dynamics modes (iodine and xenon concentrations) and fast dynamics modes (neutron density, fuel and coolant temperatures). The singular perturbation technique is used to overcome this stiffness problem. The design specifications are incorporated by the frequency weights using the mixed-sensitivity problem approach. The robustness of H{sub {infinity}} control is demonstrated by comparing it with linear quadratic Gaussian (LQG) control in the case of a measurement delay of the power measurement system.Since the gains and phase margins of H{sub {infinity}} control are larger than those of LQG control, the H{sub {infinity}} control is expected to provide excellent stability robustness and performance robustness against external disturbances and noises, model parameter variations, and modeling errors as well as hardware failures. It may also provide a practical design method because the design specifications can be easily implemented by the frequency weights.

  15. A Controlled Trial of the Making Choices Program: Six-Month Follow-up

    ERIC Educational Resources Information Center

    Fraser, Mark W.; Lee, Jung-Sook; Kupper, Lawrence L.; Day, Steven H.

    2011-01-01

    Objective: Six-month follow-up outcomes from a controlled trial of a program designed to prevent aggressive behavior in childhood are described. Method: Data were collected from three sequential cohorts of third graders in two public elementary schools (N = 443). The Year 1 cohort received a routine health curriculum. The Year 2 cohort received…

  16. Randomized Controlled Trial of Video Self-Modeling Following Speech Restructuring Treatment for Stuttering

    ERIC Educational Resources Information Center

    Cream, Angela; O'Brian, Sue; Jones, Mark; Block, Susan; Harrison, Elisabeth; Lincoln, Michelle; Hewat, Sally; Packman, Ann; Menzies, Ross; Onslow, Mark

    2010-01-01

    Purpose: In this study, the authors investigated the efficacy of video self-modeling (VSM) following speech restructuring treatment to improve the maintenance of treatment effects. Method: The design was an open-plan, parallel-group, randomized controlled trial. Participants were 89 adults and adolescents who undertook intensive speech…

  17. The Contribution of Maternal Care and Control to Adolescents' Adjustment Following War

    ERIC Educational Resources Information Center

    Dekel, Rachel; Solomon, Dan

    2016-01-01

    This study examined the contribution of maternal bonding to the adjustment of Israeli adolescents following the 2006 Lebanon War. In all, 2,858 seventh and eighth graders who lived in areas that were exposed to missile attacks completed the Parental Bonding Instrument (assessing maternal care and control) and questionnaires evaluating…

  18. Adaptive neural control for cooperative path following of marine surface vehicles: state and output feedback

    NASA Astrophysics Data System (ADS)

    Wang, H.; Wang, D.; Peng, Z. H.

    2016-01-01

    This paper addresses the cooperative path-following problem of multiple marine surface vehicles subject to dynamical uncertainties and ocean disturbances induced by unknown wind, wave and ocean current. The control design falls neatly into two parts. One is to steer individual marine surface vehicle to track a predefined path and the other is to synchronise the along-path speed and path variables under the constraints of an underlying communication network. Within these two formulations, a robust adaptive path-following controller is first designed for individual vehicles based on backstepping and neural network techniques. Then, a decentralised synchronisation control law is derived by means of consensus on along-path speed and path variables based on graph theory. The distinct feature of this design lies in that synchronised path following can be reached for any undirected connected communication graphs without accurate knowledge of the model. This result is further extended to the output feedback case, where an observer-based cooperative path-following controller is developed without measuring the velocity of each vehicle. For both designs, rigorous theoretical analysis demonstrate that all signals in the closed-loop system are semi-global uniformly ultimately bounded. Simulation results validate the performance and robustness improvement of the proposed strategy.

  19. Fault-tolerant adaptive control for load-following in static space nuclear power systems

    NASA Technical Reports Server (NTRS)

    Parlos, Alexander G.; Onbasioglu, Fetiye O.; Peddicord, Kenneth L.; Metzger, John D.

    1992-01-01

    The possible use of a dual-loop model-based adaptive control system for load following in static space nuclear power systems is investigated. The proposed approach has thus far been applied only to a thermoelectric space nuclear power system but is equally applicable to other static space nuclear power systems such as thermionic systems.

  20. Enhanced control of fine particles following Title IV coal switching and NOx control

    SciTech Connect

    Durham, M.D.; Baldrey, K.E.; Bustard, C.J.; Martin, C.

    1997-12-31

    Electrostatic precipitators (ESPs) serve as the primary particle control devices for a majority of coal-fired power generating units in the United States. ESPs are used to collect particulate matter that range in size from less than one micrometer in diameter to several hundred micrometers. Many of the options that utilities will use to respond to Title IV of the 1990 Clean Air Act Amendments will result in changes to the ash that will be detrimental to the performance of the ESP causing increased emissions of fine particles and higher opacity. For example, a switch to low-sulfur coal significantly increases particle resistivity while low-NO{sub x} burners increase the carbon content of ashes. Both of these changes could result in derating of the boiler to comply with emissions standards. ADA has developed a chemical additive that is designed to improve the operation of ESI`s to bring these systems into compliance operation without the need for expensive capital modifications. The additives provide advantages over competing technologies in terms of low capital cost, easy to handle chemicals, and relatively non-toxic chemicals. In addition, the new additive is insensitive to ash chemistry which will allow the utility complete flexibility to select the most economical coal. Results from full-scale and pilot plant demonstrations are reported.

  1. Multiobjective algebraic synthesis of neural control systems by implicit model following.

    PubMed

    Ferrari, Silvia

    2009-03-01

    The advantages brought about by using classical linear control theory in conjunction with neural approximators have long been recognized in the literature. In particular, using linear controllers to obtain the starting neural control design has been shown to be a key step for the successful development and implementation of adaptive-critic neural controllers. Despite their adaptive capabilities, neural controllers are often criticized for not providing the same performance and stability guarantees as classical linear designs. Therefore, this paper develops an algebraic synthesis procedure for designing dynamic output-feedback neural controllers that are closed-loop stable and meet the same performance objectives as any classical linear design. The performance synthesis problem is addressed by deriving implicit model-following algebraic relationships between model matrices, obtained from the classical design, and the neural control parameters. Additional linear matrix inequalities (LMIs) conditions for closed-loop exponential stability of the neural controller are derived using existing integral quadratic constraints (IQCs) for operators with repeated slope-restricted nonlinearities. The approach is demonstrated by designing a recurrent neural network controller for a highly maneuverable tailfin-controlled missile that meets multiple design objectives, including pole placement for transient tuning, H(infinity) and H(2) performance in the presence of parameter uncertainty, and command-input tracking. PMID:19203887

  2. Path-following control of wheeled planetary exploration robots moving on deformable rough terrain.

    PubMed

    Ding, Liang; Gao, Hai-bo; Deng, Zong-quan; Li, Zhijun; Xia, Ke-rui; Duan, Guang-ren

    2014-01-01

    The control of planetary rovers, which are high performance mobile robots that move on deformable rough terrain, is a challenging problem. Taking lateral skid into account, this paper presents a rough terrain model and nonholonomic kinematics model for planetary rovers. An approach is proposed in which the reference path is generated according to the planned path by combining look-ahead distance and path updating distance on the basis of the carrot following method. A path-following strategy for wheeled planetary exploration robots incorporating slip compensation is designed. Simulation results of a four-wheeled robot on deformable rough terrain verify that it can be controlled to follow a planned path with good precision, despite the fact that the wheels will obviously skid and slip. PMID:24790582

  3. Path-Following Control of Wheeled Planetary Exploration Robots Moving on Deformable Rough Terrain

    PubMed Central

    Ding, Liang; Gao, Hai-bo; Deng, Zong-quan; Li, Zhijun; Xia, Ke-rui; Duan, Guang-ren

    2014-01-01

    The control of planetary rovers, which are high performance mobile robots that move on deformable rough terrain, is a challenging problem. Taking lateral skid into account, this paper presents a rough terrain model and nonholonomic kinematics model for planetary rovers. An approach is proposed in which the reference path is generated according to the planned path by combining look-ahead distance and path updating distance on the basis of the carrot following method. A path-following strategy for wheeled planetary exploration robots incorporating slip compensation is designed. Simulation results of a four-wheeled robot on deformable rough terrain verify that it can be controlled to follow a planned path with good precision, despite the fact that the wheels will obviously skid and slip. PMID:24790582

  4. Mist control at a machining center, Part 2: Mist control following installation of air cleaners.

    PubMed

    Yacher, J M; Heitbrink, W A; Burroughs, G E

    2000-01-01

    At a machining center used to produce transaxle and transmission parts, aerosol instrumentation was used to quantitatively evaluate size-dependent mist generation of a synthetic metalworking fluid (MWF) consisting primarily of water and triethanolamine (TEA). This information was used to select an air cleaner for controlling the mist. During most machining operations, the MWF was flooded over the part. These machining operations were performed in a nearly complete enclosure that was exhausted to an air cleaner consisting of three sections: a fall-out chamber, a trifilter section to capture metal chips and mist, and a 1.13 m3/sec (2400 ft3/min) blower. The partnering company requested that National Institute for Occupational Safety and Health (NIOSH) researchers perform an evaluation of the effectiveness of a commercially available air cleaner. After NIOSH researchers characterized mist generation at the machining centers and found that performance of a test air cleaner appeared to be suitable, the company installed more than 25 air cleaners on different machining centers in this plant and enclosed the corresponding fluid filtration unit. The facility also has implemented a maintenance program for the air cleaners that involves regularly scheduled filter changes; performance is ensured by monitoring static pressure. A NIOSH-conducted air sampling evaluation showed that area TEA concentrations were reduced from a geometric mean of 0.25 to 0.03 mg/m3. Personal total particulate concentrations were reduced from a geometric mean of 0.22 to 0.06 mg/m3. These results show the effectiveness of this combination of enclosure, ventilation, and filtration to greatly reduce the exposure to MWF mist generated in modern machining centers. PMID:10782201

  5. Intercomparison of Retrospective Radon Detectors

    SciTech Connect

    Field, R W.; Steck, D J.; Parkhurst, Maryann ); Mahaffey, Judith A. ); Alavanja, M C.

    1998-11-01

    We performed both a laboratory and field intercomparison of two novel glass-based retrospective radon detectors previously used in major radon case-control studies performed in Missouri and Iowa. The new detectors estimate retrospective residential radon exposure from the accumulation of a long-lived radon decay product, Pb-210, in glass. The detectors use track registration material in direct contact with glass surfaces to measure the alpha emission of a Pb-210 decay product, Po-210. The detector's track density generation rate (tracks cm{sup -2} hr{sup -1}) is proportional to the surface alpha activity. In the absence of other strong sources of alpha emission in the glass, the implanted surface alpha activity should be proportional to the accumulated Po-210 and hence, the cumulative radon gas exposure. The goals of the intercomparison were to: (1) perform collocated measurements using two different glass-based retrospective radon detectors in a controlled laboratory environment to compare their relative response to implanted polonium in the absence of environmental variation, (2) perform collocated measurements using two different retrospective radon progeny detectors in a variety of residential settings to compare their detection of glass implanted polonium activities, and (3) examine the correlation between track density rates and contemporary radon gas concentrations. The laboratory results suggested that the materials and methods used by the studies produced similar track densities in detectors exposed to the same implanted Po-210 activity. The field phase of the intercomparison found excellent agreement between the track density rates for the two types of retrospective detectors. The correlation between the track density rates and direct contemporary radon concentration measurements was relatively high, considering that no adjustments were performed to account for either the residential depositional environment or glass surface type.

  6. Desmoid tumors: local control and patterns of relapse following radiation therapy

    SciTech Connect

    Leibel, S.A.; Wara, W.M.; Hill, D.R.; Bovill, E.G. Jr.; De Lorimier, A.A.; Beckstead, J.H.; Phillips, T.L.

    1983-08-01

    Desmoid tumors are benign neoplasms, arising from musculoaponeurotic tissues, which tend to be locally infiltrative, resulting in a high rate of local recurrence following surgical resection. Nineteen patients with desmoid tumors underwent radiation therapy at the University of California, San Francisco, between 1970 and 1980. Fifteen patients were referred with local recurrence following one or more surgical resections. Three patients were referred for initial radiation therapy with unresectable tumors, and one patient received planned postoperative irradiation following subtotal tumor resection. At the time of treatment, 8 patients had nonresectable disease measuring greater than 10 cm. The majority of patients were treated to a tumor dose of 50 to 55 Gy at 1.6 to 1.8 Gy per fraction. With a median follow-up of 8 years, 13 patients remained free of recurrent disease following radiation therapy. Local control was not related to the amount of disease present at the time of treatment. Of the 6 patients who developed recurrent disease, only 1 patient had a true in-field recurrence. Four patients recurred at the margin of the radiation field 1 to 5 years following therapy. Moderate dose radiation therapy to desmoid tumors can result in lasting local control when surgical resection is not possible. Post operative radiation can improve the rate of local control for patients with a high risk of recurrence. As desmoid tumors tend to be locally infiltrative, fields must be very generous to prevent marginal recurrence. Systemic chemotherapy offers an alternative to ablative surgery in the event of local failure following radiation therapy.

  7. Effect of a Multidisciplinary Outpatient Model of Care on Health Outcomes in Older Patients with Multimorbidity: A Retrospective Case Control Study

    PubMed Central

    Shakib, Sepehr; Dundon, Benjamin K.; Maddison, John; Thomas, Josephine; Stanners, Melinda; Caughey, Gillian E.; Clark, Robyn A.

    2016-01-01

    Objective To evaluate a holistic multidisciplinary outpatient model of care on hospital readmission, length of stay and mortality in older patients with multimorbidity following discharge from hospital. Design and Participants A pilot case-control study between March 2006 and June 2009 of patients referred on discharge to a multidisciplinary, integrated outpatient model of care that includes outpatient follow-up, timely GP communication and dial-in service compared with usual care following discharge, within a metropolitan, tertiary referral, public teaching hospital. Controls were matched in a 4:1 ratio with cases for age, gender, index admission diagnosis and length of stay. Main outcome measures Non-elective readmission rates, total readmission length of stay and overall survival. Results A total of 252 cases and 1008 control patients were included in the study. Despite the patients referred to the multidisciplinary model of care had slightly more comorbid conditions, significantly higher total length of hospital stay in the previous 12 months and increased prevalence of diabetes and heart failure by comparison to those who received usual care, they had significantly improved survival (adjusted hazard ratio 0.70 95% CI 0.51–0.96, p = 0.029) and no excess in the number of hospitalisations observed. Conclusion Following discharge from hospital, holistic multidisciplinary outpatient management is associated with improved survival in older patients with multimorbidity. The findings of this study warrant further examination in randomised and cost-effectiveness trials. PMID:27537395

  8. Sequential CCR5-Tropic HIV-1 Reactivation from Distinct Cellular Reservoirs following Perturbation of Elite Control

    PubMed Central

    Watters, Sarah A.; Mlcochova, Petra; Maldarelli, Frank; Goonetilleke, Nilu; Pillay, Deenan; Gupta, Ravindra K.

    2016-01-01

    Background HIV Elite Controllers may reveal insights into virus persistence given they harbour small reservoir sizes, akin to HIV non-controllers treated early with combination antiretroviral therapy. Both groups of patients represent the most promising candidates for interventions aimed at sustained remission or ‘cure’. Analytic treatment interruption (ATI) in the latter group leads to stochastic rebound of virus, though it is unclear whether loss of elite control is also associated with similar rebound characteristics. Methods We studied three discrete periods of virus rebound during myeloma related immune disruption over 2.5 years in an elite controller who previously underwent autologous stem cell transplantation (ASCT) in the absence of any antiretroviral therapy. Single genome sequencing of the V1-V4 region of env in PBMC and plasma was performed and phylogenies reconstructed. Average pairwise distance (APD) was calculated and non-parametric methods used to assess compartmentalisation. Coreceptor usage was predicted based on genotypic algorithms. Results 122 single genome sequences were obtained (median 26 sequences per rebound). The initial rebounding plasma env sequences following ASCT represented two distinct lineages, and clustered with proviral DNA sequences isolated prior to ASCT. One of the lineages was monophyletic, possibly indicating reactivation from clonally expanded cells. The second rebound occurred 470 days after spontaneous control of the first rebound and was phylogenetically distinct from the first, confirmed by compartmentalisation analysis, with a different cellular origin rather than ongoing replication. By contrast, third rebound viruses clustered with second rebound viruses, with evidence for ongoing evolution that was associated with lymphopenia and myeloma progression. Following ASCT a shift in tropism from CXCR4-tropic viruses to a CCR5-tropic population was observed to persist through to the third rebound. Conclusions Our data

  9. Intercomparison of retrospective radon detectors.

    PubMed Central

    Field, R W; Steck, D J; Parkhurst, M A; Mahaffey, J A; Alavanja, M C

    1999-01-01

    We performed both a laboratory and a field intercomparison of two novel glass-based retrospective radon detectors previously used in major radon case-control studies performed in Missouri and Iowa. The new detectors estimate retrospective residential radon exposure from the accumulation of a long-lived radon decay product, (210)Pb, in glass. The detectors use track registration material in direct contact with glass surfaces to measure the alpha-emission of a (210)Pb-decay product, (210)Po. The detector's track density generation rate (tracks per square centimeter per hour) is proportional to the surface alpha-activity. In the absence of other strong sources of alpha-emission in the glass, the implanted surface alpha-activity should be proportional to the accumulated (210)Po, and hence to the cumulative radon gas exposure. The goals of the intercomparison were to a) perform collocated measurements using two different glass-based retrospective radon detectors in a controlled laboratory environment to compare their relative response to implanted polonium in the absence of environmental variation, b) perform collocated measurements using two different retrospective radon progeny detectors in a variety of residential settings to compare their detection of glass-implanted polonium activities, and c) examine the correlation between track density rates and contemporary radon gas concentrations. The laboratory results suggested that the materials and methods used by the studies produced similar track densities in detectors exposed to the same implanted (210)Po activity. The field phase of the intercomparison found excellent agreement between the track density rates for the two types of retrospective detectors. The correlation between the track density rates and direct contemporary radon concentration measurements was relatively high, considering that no adjustments were performed to account for either the residential depositional environment or glass surface type

  10. A Retrospective, Multicenter Study of the Tolerance of Induction Chemotherapy With Docetaxel, Cisplatin, and 5-Fluorouracil Followed by Radiotherapy With Concomitant Cetuximab in 46 Cases of Squamous Cell Carcinoma of the Head and Neck

    SciTech Connect

    Buiret, Guillaume; Combe, Claire; Favrel, Veronique; Pommier, Pascal; Martin, Laurent; Ecochard, Rene; Fayette, Jerome; Tartas, Sophie; Ramade, Antoine; Ceruse, Philippe

    2010-06-01

    Purpose: To investigate, in a multicenter study, the tolerance of induction chemotherapy (ICT) and external radiotherapy (ERT) with concomitant cetuximab in the treatment of patients with squamous cell carcinoma of the head and neck (SCCHN). Patients and Methods: Clinical data from 46 patients with Stage III or IV nonmetastatic SCCHN who received docetaxel, cisplatin, and 5-fluorouracil as ICT, followed by ERT with concomitant cetuximab, were retrospectively analyzed. Clinical safety (weight, allergy, mucositis, and dermatitis) and paraclinical safety (levels of hemoglobin, polynuclear neutrophils, and creatinine clearance) were studied. The primary objective was the proportion of patients who completed the protocol. Results: The percentage of patients completing ICT was 73.9%, ERT 93.5%, and cetuximab 69.6%. Induction chemotherapy was better tolerated than that previously reported. The rates of temporary suspensions of radiation (39.1%, mean duration of 13 days) and hospitalization (26.1%) during ERT with concomitant cetuximab were high. Weight loss during treatment (21.4% of patients lost >10% of their body weight), radiodermatitis, and radiomucositis were the main causes of temporary suspension of treatment, although Grade 4 dermatitis was not experienced. There were no allergic reactions to cetuximab. Conclusion: The completed protocol rate for SCCHN patients receiving ICT and ERT with concomitant cetuximab is high and the toxicity acceptable. Future improvements to protocol will be possible through early action and systematic implementation of nutritional support coupled with antibiotic treatment upon the first signs of radiodermatitis. These data could be useful for prospective studies on the safety and efficacy of this protocol.

  11. Following the Water: A Controlled Study of Drinking Water Storage in Northern Coastal Ecuador

    PubMed Central

    Levy, Karen; Nelson, Kara L.; Hubbard, Alan; Eisenberg, Joseph N.S.

    2008-01-01

    Background To design the most appropriate interventions to improve water quality and supply, information is needed to assess water contamination in a variety of community settings, including those that rely primarily on unimproved surface sources of drinking water. Objectives We explored the role of initial source water conditions as well as household factors in determining household water quality, and how levels of contamination of drinking water change over time, in a rural setting in northern coastal Ecuador. Methods We sampled source waters concurrently with water collection by household members and followed this water over time, comparing Escherichia coli and enterococci concentrations in water stored in households with water stored under controlled conditions. Results We observed significant natural attenuation of indicator organisms in control containers and significant, although less pronounced, reductions of indicators between the source of drinking water and its point of use through the third day of sampling. These reductions were followed by recontamination in approximately half of the households. Conclusions Water quality improved after water was transferred from the source to household storage containers, but then declined because of recontamination in the home. Our experimental design allowed us to observe these dynamics by controlling for initial source water quality and following changes in water quality over time. These data, because of our controlled experimental design, may explain why recontamination has been reported in the literature as less prominent in areas or households with highly contaminated source waters. Our results also suggest that efforts to improve source water quality and sanitation remain important. PMID:19057707

  12. Pain phenotype as a predictor for drug response in painful polyneuropathy-a retrospective analysis of data from controlled clinical trials.

    PubMed

    Holbech, Jakob V; Bach, Flemming W; Finnerup, Nanna B; Jensen, Troels S; Sindrup, Søren H

    2016-06-01

    The drugs available for treatment of neuropathic pain have somewhat disappointing efficacy with many patients left with limited or no effect. Individualized treatment based on phenotype according to presumed underlying pain mechanism(s) has been proposed to improve outcomes. We report a retrospective analysis of phenotype-specific effects of several neuropathic pain drugs, which were studied in a series of crossover, placebo-controlled, clinical trials. The data originate from 7 trials with similar design and outcome recordings, which all had a thorough baseline registration of symptoms, signs, and quantitative sensory testing. The latter was used to phenotype patients into subgroups reflecting presumed pain mechanisms. There were a total of 361 patient records distributed over treatments with 4 antidepressants and 4 anticonvulsants. Five of the drugs reduced total pain significantly compared with placebo. Only a few phenotype-specific differences in total pain reduction were found within the investigated drugs. Thus, imipramine reduced total pain 1.84 (CI: 0.02-3.67) and pregabalin 0.81 (CI: -0.67 to 2.29) in patients with than without gain of sensory function. Pregabalin showed a better effect in patients with preserved large fiber function with a mean difference in total pain reduction 1.31 (CI: 0.15-2.47). No phenotype-specific effects were found for venlafaxine, escitalopram, oxcarbazepine, valproic acid, levetiracetam, or St. John's wort. Thus, this post hoc analysis of 8 drugs with mainly nonselective actions on neuropathic pain mechanisms found limited usefulness of sensory phenotyping in pain as the basis for individualized treatment. PMID:27007067

  13. Comparison of CATs, CURB-65 and PMEWS as Triage Tools in Pandemic Influenza Admissions to UK Hospitals: Case Control Analysis Using Retrospective Data

    PubMed Central

    Myles, Puja R.; Nguyen-Van-Tam, Jonathan S.; Lim, Wei Shen; Nicholson, Karl G.; Brett, Stephen J.; Enstone, Joanne E.; McMenamin, James; Openshaw, Peter J. M.; Read, Robert C.; Taylor, Bruce L.; Bannister, Barbara; Semple, Malcolm G.

    2012-01-01

    Triage tools have an important role in pandemics to identify those most likely to benefit from higher levels of care. We compared Community Assessment Tools (CATs), the CURB-65 score, and the Pandemic Medical Early Warning Score (PMEWS); to predict higher levels of care (high dependency - Level 2 or intensive care - Level 3) and/or death in patients at or shortly after admission to hospital with A/H1N1 2009 pandemic influenza. This was a case-control analysis using retrospectively collected data from the FLU-CIN cohort (1040 adults, 480 children) with PCR-confirmed A/H1N1 2009 influenza. Area under receiver operator curves (AUROC), sensitivity, specificity, positive predictive values and negative predictive values were calculated. CATs best predicted Level 2/3 admissions in both adults [AUROC (95% CI): CATs 0.77 (0.73, 0.80); CURB-65 0.68 (0.64, 0.72); PMEWS 0.68 (0.64, 0.73), p<0.001] and children [AUROC: CATs 0.74 (0.68, 0.80); CURB-65 0.52 (0.46, 0.59); PMEWS 0.69 (0.62, 0.75), p<0.001]. CURB-65 and CATs were similar in predicting death in adults with both performing better than PMEWS; and CATs best predicted death in children. CATs were the best predictor of Level 2/3 care and/or death for both adults and children. CATs are potentially useful triage tools for predicting need for higher levels of care and/or mortality in patients of all ages. PMID:22509303

  14. A Retrospective Case-Control Analysis of the Outpatient Expenditures for Western Medicine and Dental Treatment Modalities in CKD Patients in Taiwan

    PubMed Central

    Huang, Ren-Yeong; Lin, Yuh-Feng; Kao, Sen-Yeong; Shieh, Yi-Shing; Chen, Jin-Shuen

    2014-01-01

    Background To determine if expenditures for dentistry (DENT) correlate with severity of chronic kidney disease (CKD). Methods A total of 10,457 subjects were enrolled from January 2008 to December 2010, divided into three groups: healthy control (HC) group (n = 1,438), high risk (HR) group (n = 3,392), and CKD group (n = 5,627). Five stages were further categorized for the CKD group. OPD utilization and expenditures for western medicine (WM), DENT, and TCM (traditional Chinese medicine) were analyzed retrospectively (2000–2008) using Taiwan's National Health Insurance Research Database. Three major areas were analyzed among groups CKD, HR and HC in this study: 1) demographic data and medical history; 2) utilization (visits/person/year) and expenditures (9-year cumulative expenditure, expenditure/person/year) for OPD services in WM, DENT, and TCM; and 3) utilization and expenditures for dental OPD services, particularly in dental filling, root canal and periodontal therapy. Results OPD utilization and expenditures of WM increased significantly for the CKD group compared with the HR and HC groups, and increased steadily along with the severity of CKD stages. However, overall DENT and TCM utilization and expenditures did not increase for the CKD group. In comparison among different CKD stages, the average expenditures and utilization for DENT including restorative filling and periodontal therapy, but not root canal therapy, showed significant decreases according to severity of CKD stage, indicating less DENT OPD utilization with progression of CKD. Conclusions Patients with advanced CKD used DENT OPD service less frequently. However, the connection between CKD and DENT service utilization requires further study. PMID:24533085

  15. Control of lung ventilation following overwintering conditions in bullfrogs, Lithobates catesbeianus.

    PubMed

    Santin, Joseph M; Hartzler, Lynn K

    2016-07-01

    Ranid frogs in northern latitudes survive winter at cold temperatures in aquatic habitats often completely covered by ice. Cold-submerged frogs survive aerobically for several months relying exclusively on cutaneous gas exchange while maintaining temperature-specific acid-base balance. Depending on the overwintering hibernaculum, frogs in northern latitudes could spend several months without access to air, the need to breathe or the chemosensory drive to use neuromuscular processes that regulate and enable pulmonary ventilation. Therefore, we performed experiments to determine whether aspects of the respiratory control system of bullfrogs, Lithobates catesbeianus, are maintained or suppressed following minimal use of air breathing in overwintering environments. Based on the necessity for control of lung ventilation in early spring, we hypothesized that critical components of the respiratory control system of bullfrogs would be functional following simulated overwintering. We found that bullfrogs recently removed from simulated overwintering environments exhibited similar resting ventilation when assessed at 24°C compared with warm-acclimated control bullfrogs. Additionally, ventilation met resting metabolic and, presumably, acid-base regulation requirements, indicating preservation of basal respiratory function despite prolonged disuse in the cold. Recently emerged bullfrogs underwent similar increases in ventilation during acute oxygen lack (aerial hypoxia) compared with warm-acclimated frogs; however, CO2-related hyperventilation was significantly blunted following overwintering. Overcoming challenges to gas exchange during overwintering have garnered attention in ectothermic vertebrates, but this study uncovers robust and labile aspects of the respiratory control system at a time point correlating with early spring following minimal to no use of lung breathing in cold-aquatic overwintering habitats. PMID:27091862

  16. Modification of Motion Perception and Manual Control Following Short-Durations Spaceflight

    NASA Technical Reports Server (NTRS)

    Wood, S. J.; Vanya, R. D.; Esteves, J. T.; Rupert, A. H.; Clement, G.

    2011-01-01

    Adaptive changes during space flight in how the brain integrates vestibular cues with other sensory information can lead to impaired movement coordination and spatial disorientation following G-transitions. This ESA-NASA study was designed to examine both the physiological basis and operational implications for disorientation and tilt-translation disturbances following short-duration spaceflights. The goals of this study were to (1) examine the effects of stimulus frequency on adaptive changes in motion perception during passive tilt and translation motion, (2) quantify decrements in manual control of tilt motion, and (3) evaluate vibrotactile feedback as a sensorimotor countermeasure.

  17. The Stability Analysis for an Extended Car Following Model Based on Control Theory

    NASA Astrophysics Data System (ADS)

    Ge, Hong-Xia; Meng, Xiang-Pei; Zhu, Ke-Qiang; Cheng, Rong-Jun

    2014-08-01

    A new method is proposed to study the stability of the car-following model considering traffic interruption probability. The stability condition for the extended car-following model is obtained by using the Lyapunov function and the condition for no traffic jam is also given based on the control theory. Numerical simulations are conducted to demonstrate and verify the analytical results. Moreover, numerical simulations show that the traffic interruption probability has an influence on driving behavior and confirm the effectiveness of the method on the stability of traffic flow.

  18. Model-following output feedback controller for oblique-wing aircraft

    NASA Technical Reports Server (NTRS)

    Alag, Gurbux Singh

    1987-01-01

    A variable-skew oblique-wing offers a substantial aerodynamic performance advantage for aircraft missions that require both high efficiency in subsonic flight and supersonic dash or cruise. The most obvious characteristics of the oblique-wing concept is the asymmetry of the wing-skew angle that causes a significant aerodynamic and inertial cross coupling between the aircraft longitudinal and lateral-directional axes. This paper presents a technique for synthesizing a decoupling controller while providing the desired stability augmentation. The use of output feedback in control law synthesis without the requirement of state estimation is presented. An explicit model-following control system with output feedback is developed. The effectiveness of the control laws developed in achieving the desired decoupling is illustrated for a given flight condition for an oblique-wing aircraft.

  19. Feedback control for car following model based on two-lane traffic flow

    NASA Astrophysics Data System (ADS)

    Ge, Hong-xia; Meng, Xiang-pei; Zhu, Hui-bing; Li, Zhi-Peng

    2014-08-01

    In the paper, two-lane traffic flow considering lane changing behaviors has been discussed based on the control theory, and the friction interference which is from the neighbor lane has been taken into account. By using the control method, the stability condition is derived. The feedback signals, which include vehicular information from both lanes, acting on the two-lane traffic system have been introduced into the Full Velocity Difference car-following model. In the end, simulations are conducted to examine the validity and reasonability of the control method. It is proven that lane changing behaviors can aggravate the traffic perturbation. The traffic flow congestion could be suppressed by using the control method and the simulation results are in good agreement with the theoretical analysis.

  20. Leader-following control of multiple nonholonomic systems over directed communication graphs

    NASA Astrophysics Data System (ADS)

    Dong, Wenjie; Djapic, Vladimir

    2016-06-01

    This paper considers the leader-following control problem of multiple nonlinear systems with directed communication topology and a leader. If the state of each system is measurable, distributed state feedback controllers are proposed using neighbours' state information with the aid of Lyapunov techniques and properties of Laplacian matrix for time-invariant communication graph and time-varying communication graph. It is shown that the state of each system exponentially converges to the state of a leader. If the state of each system is not measurable, distributed observer-based output feedback control laws are proposed. As an application of the proposed results, formation control of wheeled mobile robots is studied. The simulation results show the effectiveness of the proposed results.

  1. Output model-following control synthesis for an oblique-wing aircraft

    NASA Technical Reports Server (NTRS)

    Pahle, Joseph W.

    1990-01-01

    Recent interest in oblique-wing aircraft has focused on the potential aerodynamic performance advantage of a variable-skew oblique wing over a conventional or symmetric sweep wing. Unfortunately, the resulting asymmetric configuration has significant aerodynamic and inertial cross-coupling between the aircraft longitudinal and lateral-directional axes. Presented here is a decoupling control law synthesis technique that integrates stability augmentation, decoupling, and the direct incorporation of desired handling qualities into an output feedback controller. The proposed design technique uses linear quadratic regulator concepts in the framework of explicit model following. The output feedback strategy used is a suboptimal projection from the state space to the output space. Dynamics are then introduced into the controller to improve steady-state performance and increase system robustness. Closed-loop performance is shown by application of the control laws to the linearized equations of motion and nonlinear simulation of an oblique-wing aircraft.

  2. Ecosystem Controls on C & N Sequestration Following Afforestation of Agricultural Lands

    SciTech Connect

    E.A. Paul, S.J. Morris, R.T. Conant

    2013-03-05

    In our project, we proposed to continue analysis of our available soil samples and data, and to develop new studies to answer the following objectives: Objective 1) Broaden field based studies of ecosystem C and N compartments to enhance current understanding of C and N sequestration and dynamics. Objective 2) Improve our understanding of mechanism controlling C and N stabilization and dynamics. Objective 3) Investigate the interrelated role of soil temperature and organism type and activity as controlling mechanism in SOC dynamics and sequestration.

  3. Coupled map car-following model and its delayed-feedback control

    NASA Astrophysics Data System (ADS)

    Konishi, Keiji; Kokame, Hideki; Hirata, Kentaro

    1999-10-01

    This paper proposes a coupled map car-following traffic model, which describes a dynamical behavior of a group of road vehicles running in a single lane without overtaking. This model consists of a lead vehicle and following vehicles, which have a piecewise linear optimal velocity function. When the lead-vehicle speed is varied, we can observe a traffic jam in the group of the vehicles. We derive a condition under which the traffic jam never occurs in our model. Furthermore, in order to suppress the traffic jam, for each vehicle we use a dynamic version of decentralized delayed-feedback control proposed in [Konishi, Hirai, and Kokame, Phys. Rev. E 58, 3055 (1998)], and provide a systematic procedure for designing the controller.

  4. Combination of bendamustine and rituximab as front-line therapy for patients with chronic lymphocytic leukaemia: multicenter, retrospective clinical practice experience with 279 cases outside of controlled clinical trials.

    PubMed

    Gentile, Massimo; Zirlik, Katja; Ciolli, Stefania; Mauro, Francesca R; Di Renzo, Nicola; Mastrullo, Lucia; Angrilli, Francesco; Molica, Stefano; Tripepi, Giovanni; Giordano, Annamaria; Di Raimondo, Francesco; Selleri, Carmine; Coscia, Marta; Musso, Maurizio; Orsucci, Lorella; Mannina, Donato; Rago, Angela; Giannotta, Angela; Ferrara, Felicetto; Herishanu, Yair; Shvidel, Lev; Tadmor, Tamar; Scortechini, Ilaria; Ilariucci, Fiorella; Murru, Roberta; Guarini, Attilio; Musuraca, Gerardo; Mineo, Giuseppe; Vincelli, Iolanda; Arcari, Annalisa; Tarantini, Giuseppe; Caparrotti, Giuseppe; Chiarenza, Annalisa; Levato, Luciano; Villa, Maria Rosaria; De Paolis, Maria Rosaria; Zinzani, Pier Luigi; Polliack, Aaron; Morabito, Fortunato

    2016-06-01

    Recently, encouraging results in terms of safety and efficacy have been obtained using bendamustine-rituximab (BR) in untreated chronic lymphocytic leukaemia (CLL) patients enrolled in a phase II study. Here, we report a retrospective international multicenter study of CLL patients treated with BR as front-line therapy. The cohort included 279 patients with progressive CLL from 33 centers (29 Italian, 3 Israeli and 1 German) who received at least 1 cycle of BR as first-line treatment during the 2008-2014 period. The primary objective of this study was to evaluate the efficacy and safety of BR administered as front-line therapy, outside of controlled clinical trials. Median age was 70 years (range, 43-86 years); 62.4% were males and 35.8% had Binet stage C. Forty-two patients (15.2%) were unfit (cumulative illness rating scale [CIRS] score ≥7), and 140 (50.2%) had creatinine clearance ≤70 ml/min. Fluorescent in situ hybridisation analysis, available for 192 cases, showed that 21 (10.9%) had del11q and 18 (9.4%) del17p. The overall response rate (ORR) was 86.4%, with a complete remission rate of 28%. Patients with del17p had an ORR of 66.7%. After median follow-up of 24 months, the 2-year progression-free survival (PFS) was 69.9%; CIRS ≥7, immunoglobulin heavy-chain variable-region (IGHV) unmutated status, del17p and BR dose intensity <80% were independently associated with shorter PFS. Grade III or IV neutropenia, thrombocytopenia, and anaemia were observed in 25.9%, 15.4%, and 15.1% of patients, respectively. Twenty-four patients (8.6%) had severe infections. BR is also an effective and safe regimen for untreated CLL patients, outside of controlled clinical trials. PMID:27127905

  5. Markedly Improved Glycemic Control in Poorly Controlled Type 2 Diabetes following Direct Acting Antiviral Treatment of Genotype 1 Hepatitis C

    PubMed Central

    Pashun, Raymond Anthony; Shen, Nicole T.; Jesudian, Arun

    2016-01-01

    Type 2 diabetes mellitus (T2DM) is often associated with hepatitis C virus (HCV) infection. Successful HCV treatment may improve glycemic control and potentially induce remission of T2DM. We report a case of an obese 52-year-old woman with mixed genotype 1a/1b HCV infection with compensated cirrhosis and a 10-year history of poorly controlled T2DM on insulin therapy. Following successful therapy with sofosbuvir, simeprevir, and ribavirin, her insulin requirements decreased and her glycosylated hemoglobin (HgA1c) normalized despite weight gain. This case suggests an association between HCV and T2DM and the potential for significant improvement in glycemic control with eradication of HCV. PMID:27293923

  6. Active following fuzzy output feedback sliding mode control of real-vehicle semi-active suspensions

    NASA Astrophysics Data System (ADS)

    Liu, H.; Nonami, K.; Hagiwara, T.

    2008-07-01

    Many semi-active suspension systems have been investigated in various literatures in order to achieve lower energy consumption and as good performance as full-active suspension systems. Full-active suspension systems can achieve a good ride quality by actuators; however, their implementation equipments are expensive. The full-active suspensions are perfect from the point of view of control; hence, semi-active control laws with performance similar to full-active controls have attracted the engineering community for their ease and lower cost of implementation. This paper presents a new active following fuzzy output feedback sliding mode control for a real-vehicle semi-active suspension system. The performance of the proposed controller has been verified by comparing it with passive control and also with the full-active target semi-active approximation control method. In the experiment, it was shown that the proposed method has the effectiveness in stabilizing heave, roll and pitch movement of the car body.

  7. A model following inverse controller with adaptive compensation for General Aviation aircraft

    NASA Astrophysics Data System (ADS)

    Bruner, Hugh S.

    The theory for an adaptive inverse flight controller, suitable for use on General Aviation aircraft, is developed in this research. The objectives of this controller are to separate the normally coupled modes of the basic aircraft and thereby permit direct control of airspeed and flight-path angle, meet prescribed performance characteristics as defined by damping ratio and natural frequency, adapt to uncertainties in the physical plant, and be computationally efficient. The three basic elements of the controller are a linear prefilter, an inverse transfer function, and an adaptive neural network compensator. The linear prefilter shapes accelerations required of the overall system in order to achieve the desired system performance characteristics. The inverse transfer function is used to compute the aircraft control inputs required to achieve the necessary accelerations. The adaptive neural network compensator is used to compensate for modeling errors during design or real-time changes in the physical plant. This architecture is patterned after the work of Calise, but differs by not requiring dynamic feedback of the state variables. The controller is coded in ANSI C and integrated with a simulation of a typical General Aviation aircraft. Twenty-three cases are simulated to prove that the objectives for the controller are met. Among these cases are simulated stability and controllability failures in the physical plant, as well as several simulated failures of the neural network. With the exception of some bounded speed-tracking error, the controller is capable of continued flight with any foreseeable failure of the neural network. Recommendations are provided for follow-on investigations by other researchers.

  8. Executive inhibitory control and cooperative behavior during early school years: a follow-up study.

    PubMed

    Ciairano, Silvia; Visu-Petra, Laura; Settanni, Michele

    2007-06-01

    Several links between aspects of executive functioning and the development of social competence have been established. The present study investigates the relation between executive inhibitory control and cooperative/non-cooperative behavior, in an ecological setting, and from a longitudinal perspective. Elementary school children (n=195) of three age groups (7, 9, 11 years, initially) were measured at two consecutive time points, at a one-year interval, with tasks tapping executive inhibitory control (the Stroop test), and social competence (a collaborative puzzle solving task). Executive inhibition was identified as the most influential stable predictor only in the case of non-cooperative behavior and presented strong concurrent relations with both cooperative and non-cooperative behavior at follow-up, even when controlling for previous level of the same behavior. The findings imply the need to consider the important role of executive inhibitory processes in multifactorial models of social competence development and in the refinement of present interventions. PMID:17226093

  9. Feedback control scheme of traffic jams based on the coupled map car-following model

    NASA Astrophysics Data System (ADS)

    Zhou, Tong; Sun, Di-Hua; Zhao, Min; Li, Hua-Min

    2013-09-01

    Based on the pioneering work of Konishi et al. [Phys. Rev. E (1999) 60 4000], a new feedback control scheme is presented to suppress traffic jams based on the coupled map car-following model under the open boundary condition. The effect of the safe headway on the traffic system is considered. According to the control theory, the condition under which traffic jams can be suppressed is analyzed. The results are compared with the previous results concerning congestion control. The simulations show that the suppression performance of our scheme on traffic jams is better than those of the previous schemes, although all the schemes can suppress traffic jams. The simulation results are consistent with theoretical analyses.

  10. Implicit theories about willpower predict the activation of a rest goal following self-control exertion.

    PubMed

    Job, Veronika; Bernecker, Katharina; Miketta, Stefanie; Friese, Malte

    2015-10-01

    Past research indicates that peoples' implicit theories about the nature of willpower moderate the ego-depletion effect. Only people who believe or were led to believe that willpower is a limited resource (limited-resource theory) showed lower self-control performance after an initial demanding task. As of yet, the underlying processes explaining this moderating effect by theories about willpower remain unknown. Here, we propose that the exertion of self-control activates the goal to preserve and replenish mental resources (rest goal) in people with a limited-resource theory. Five studies tested this hypothesis. In Study 1, individual differences in implicit theories about willpower predicted increased accessibility of a rest goal after self-control exertion. Furthermore, measured (Study 2) and manipulated (Study 3) willpower theories predicted an increased preference for rest-conducive objects. Finally, Studies 4 and 5 provide evidence that theories about willpower predict actual resting behavior: In Study 4, participants who held a limited-resource theory took a longer break following self-control exertion than participants with a nonlimited-resource theory. Longer resting time predicted decreased rest goal accessibility afterward. In Study 5, participants with an induced limited-resource theory sat longer on chairs in an ostensible product-testing task when they had engaged in a task requiring self-control beforehand. This research provides consistent support for a motivational shift toward rest after self-control exertion in people holding a limited-resource theory about willpower. PMID:26075793

  11. Emotional attentional control predicts changes in diurnal cortisol secretion following exposure to a prolonged psychosocial stressor.

    PubMed

    Lenaert, Bert; Barry, Tom J; Schruers, Koen; Vervliet, Bram; Hermans, Dirk

    2016-01-01

    Hypothalamic-pituitary-adrenal (HPA) axis irregularities have been associated with several psychological disorders. Hence, the identification of individual difference variables that predict variations in HPA-axis activity represents an important challenge for psychiatric research. We investigated whether self-reported attentional control in emotionally demanding situations prospectively predicted changes in diurnal salivary cortisol secretion following exposure to a prolonged psychosocial stressor. Low ability to voluntarily control attention has previously been associated with anxiety and depressive symptomatology. Attentional control was assessed using the Emotional Attentional Control Scale. In students who were preparing for academic examination, salivary cortisol was assessed before (time 1) and after (time 2) examination. Results showed that lower levels of self-reported emotional attentional control at time 1 (N=90) predicted higher absolute diurnal cortisol secretion and a slower decline in cortisol throughout the day at time 2 (N=71). Difficulty controlling attention during emotional experiences may lead to chronic HPA-axis hyperactivity after prolonged exposure to stress. These results indicate that screening for individual differences may foster prediction of HPA-axis disturbances, paving the way for targeted disorder prevention. PMID:26539967

  12. Monitoring recovery of gait balance control following concussion using an accelerometer.

    PubMed

    Howell, David; Osternig, Louis; Chou, Li-Shan

    2015-09-18

    Despite medical best-practice recommendations, no consistent standard exists to systematically monitor recovery from concussion. Studies utilizing camera-based systems have reported center-of-mass (COM) motion control deficits persisting in individuals with concussion up to two months post-injury. The use of an accelerometer may provide an efficient and sensitive method to monitor COM alterations following concussion that can be employed in clinical settings. This study examined: (1) frontal/sagittal plane acceleration characteristics during dual-task walking for individuals with concussion and healthy controls; and (2) the effectiveness of utilizing acceleration characteristics to classify concussed and healthy individuals via receiver operating characteristic (ROC) curve analyses. Individuals with concussion completed testing within 72 h as well as 1 week, 2 weeks, 1 month, and 2 months post-injury. Control subjects completed the same protocol in similar time increments. Participants walked and simultaneously completed a cognitive task while wearing an accelerometer attached to L5. Participants with concussion walked with significantly less peak medial-lateral acceleration during 55-75% gait cycle (p=0.04) throughout the testing period compared with controls. Moderate levels of sensitivity and specificity were found at the 72 h and 1 week testing times (sensitivity=0.70, specificity=0.71). ROC analysis revealed significant AUC values at the 72 h (AUC=0.889) and two week (AUC=0.810) time points. Accelerometer-derived measurements may assist in detecting frontal plane control deficits during dual-task walking post-concussion, consistent with camera-based studies. These initial findings demonstrate potential for using accelerometry as a tool for clinicians to monitor gait balance control following concussion. PMID:26152463

  13. Early postoperative albumin level following total knee arthroplasty is associated with acute kidney injury: A retrospective analysis of 1309 consecutive patients based on kidney disease improving global outcomes criteria.

    PubMed

    Kim, Ha-Jung; Koh, Won-Uk; Kim, Sae-Gyeol; Park, Hyeok-Seong; Song, Jun-Gol; Ro, Young-Jin; Yang, Hong-Seuk

    2016-08-01

    Hypoalbuminemia has been reported to be an independent risk factor for acute kidney injury (AKI). However, little is known about the relationship between the albumin level and the incidence of AKI in patients undergoing total knee arthroplasty (TKA). The aim of our study was to assess incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI following TKA.The study included a retrospective review of medical records of 1309 consecutive patients who underwent TKA between January 2008 and December 2014. The patients were divided into 2 groups according to the lowest serum albumin level within 2 postoperative days (POD2_alb level < 3.0 g/dL vs ≥3.0 g/dL). Multivariate logistic regression analysis was used to assess risk factors for AKI. A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis.Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria. Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65-5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26-1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48-4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08-87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09-3.37; P = 0.023). After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03-3.24, P = 0.041) and longer hospital stay (P = 0.001).In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA. PMID:27495094

  14. Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up

    PubMed Central

    Salturk, Cuneyt; Karakurt, Zuhal; Takir, Huriye Berk; Balci, Merih; Kargin, Feyza; Mocin, Ozlem Yazıcıoglu; Gungor, Gokay; Ozmen, Ipek; Oztas, Selahattin; Yalcinsoy, Murat; Evin, Ruya; Ozturk, Murat; Adiguzel, Nalan

    2015-01-01

    Introduction The objective of this study was to compare the change in 6-minute walking distance (6MWD) in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV) due to chronic hypercapnic respiratory failure (CHRF) caused by different etiologies. Methods This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD]), between January 2011 and January 2012. The results of arterial blood gas (ABG) analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA) and multiple linear regression (MLR) analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group). Results A total of 105 patients with a mean age (± standard deviation) of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical analysis. There were no significant differences between groups in the baseline and delta values of ABG and spirometry findings. Both univariate ANOVA and MLR showed that the OHS group had the lowest baseline 6MWD and the highest decrease in 1 year (linear regression coefficient −24.48; 95% CI −48.74 to −0.21, P=0.048); while the KS group had the best baseline values and the biggest improvement under home NIMV (linear regression coefficient 26.94; 95% CI −3.79 to 57.66, P=0.085). Conclusion The 6MWD measurements revealed improvement in exercise capacity test in CHRF patients receiving

  15. A randomised controlled trial evaluating family mediated exercise (FAME) therapy following stroke

    PubMed Central

    Galvin, Rose; Cusack, Tara; Stokes, Emma

    2008-01-01

    Background Stroke is a leading cause of disability among adults worldwide. Evidence suggests that increased duration of exercise therapy following stroke has a positive impact on functional outcome following stroke. The main objective of this randomised controlled trial is to evaluate the impact of additional family assisted exercise therapy in people with acute stroke. Methods/Design A prospective multi-centre single blind randomised controlled trial will be conducted. Forty patients with acute stroke will be randomised into either an experimental or control group. The experimental group will receive routine therapy and additional lower limb exercise therapy in the form of family assisted exercises. The control group will receive routine therapy with no additional formal input from their family members. Participants will be assessed at baseline, post intervention and followed up at three months using a series of standardised outcome measures. A secondary aim of the project is to evaluate the impact of the family mediated exercise programme on the person with stroke and the individual(s) assisting in the delivery of exercises using a qualitative methodology. The study has gained ethical approval from the Research Ethics Committees of each of the clinical sites involved in the study. Discussion This study will evaluate a structured programme of exercises that can be delivered to people with stroke by their 'family members/friends'. Given that the progressive increase in the population of older people is likely to lead to an increased prevalence of stroke in the future, it is important to reduce the burden of this illness on the individual, the family and society. Family mediated exercises can maximise the carry over outside formal physiotherapy sessions, giving patients the opportunity for informal practice. Trial Registration The protocol for this study is registered with the US NIH Clinical trials registry (NCT00666744) PMID:18570643

  16. Successful control of a Methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit: a retrospective, before-after study

    PubMed Central

    2013-01-01

    Background Aim of this study was to provide a detailed description of a Methicillin-resistant Staphylococcus aureus (MRSA) outbreak management strategy in the neonatal intensive care unit of a university hospital. Methods This was a retrospective, “before-after” study, over two consecutive 18-month periods. The outbreak management strategy was performed by a multidisciplinary team and included: extensive healthcare workers (HCW) involvement, education, continuous hand-hygiene training and active MRSA colonization surveillance. The actions implemented were identified based on an anonymous, voluntary, reporting system, carried out among all the HCW, and regular audit and feedback were provided to the nursing staff. The main measured outcome was the rate of MRSA infections before and after the implementation of the outbreak management strategy. Piecewise linear Poisson regression was performed and the model adjusted for confounding variables. The secondary outcome was the rate of laboratory-confirmed bloodstream infections before and after the outbreak management strategy. The rates of MRSA colonization, implementation of proposed actions, observed compliance for hand-hygiene and insertion/care of central lines were also recorded during the second period. Results 1015 newborns were included. The rate of MRSA infections throughout the two periods fell from 3.5 to 0.7 cases per 1000 patient-days (p=0.0005). The piecewise Poisson regression analysis adjusted for confounding variables showed a significant decrease in the MRSA infection rate after the outbreak management strategy (p=0.046). A significant decrease in positive laboratory confirmed blood cultures was observed over the two periods (160 vs 83; p<0.0001). A significant decline in the MRSA colonization rate occurred over the second period (p=0.001); 93% of the proposed actions were implemented. The compliance rate for hand-hygiene and insertion/care of central lines was respectively 95.9% and 62%. Conclusions

  17. A Retrospective Observational Study Examining the Effect of Thoracic Epidural and Patient Controlled Analgesia on Short-term Outcomes in Blunt Thoracic Trauma Injuries

    PubMed Central

    Baker, Edward James; Lee, Geraldine Ann

    2016-01-01

    Abstract Effective analgesia in the early stages after any major traumatic event remains pivotal to optimal trauma management. For patients with significant thoracic injuries, this is paramount to ensure ongoing efficient respiratory function. The aim of this study was to investigate the use of analgesic modes in the management of patients with a primary thoracic injury and blunt mechanism of injury. By understanding variables that influence the use of varying analgesic modes and influence the development of pulmonary complications, there should be more uniform evidence-based prescription in the future. This retrospective study considered analgesic use in patients admitted after blunt thoracic injuries at one major trauma center over a 2-year period. Pulmonary complications measured included both infective and ventilator-associated failure. Univariate and multivariate analyses were used to identify patient and injury severity characteristics and their association with respiratory complications. A total of 401 cases were reviewed and analyzed: 159 received Patient Controlled Analgesia (PCA), 32 received PCA and epidural analgesia (EA), 6 received EA alone, and 204 received interval-administered analgesia. There were no significant differences in the rates of complication when compared between analgesic modes. Patients who developed pneumonia had significantly increased number of thoracic fractures and underlying organ injury (P < 0.05). Logistic regression analysis highlighted duration of intercostal drain insertion (OR 1.377, P = 0.001) and premorbid cardiac disease (OR 2.624, P = 0.042) and ICU length of stay (OR: 1.146, P < 0.001) as significant predictors of developing pneumonia in this patient group. Examining the different analgesic modes, this study failed to identify a particular analgesic mode that was more effective in preventing pulmonary complications in blunt thoracic injuries. However, variables that may influence usage of different

  18. Functional capacity in healthy volunteers before and following beta-blockade with controlled-release metoprolol.

    PubMed

    Rønnevik, P K; Nordrehaug, J E; von der Lippe, G

    1995-01-01

    The effects of the beta 1-selective beta-adrenergic blocker metoprolol on physiological responses, exercise capacity and gas exchange parameters were measured in healthy men using different graded bicycle exercise protocols on separate days before and following administration of 200 mg controlled-release metoprolol. Eleven men performed in randomised order maximal cardiopulmonary exercise testing on 50-W/6-min stage, 50-W/3-min stage and ramp (15-W/min-1) protocols. Peak heart rate and peak heart rate-blood pressure products were similar on all exercise protocols, and were significantly reduced by metoprolol. Submaximal and peak oxygen consumption were similar before and following beta-adrenoceptor blockade. Depending on the exercise protocol applied, an insignificant decrease of 4-10% in maximal cumulated exercise capacity (work-rate x time integral) was observed following administration of metoprolol. It is concluded that in healthy men evaluated with different exercise protocols the beta 1-selective controlled-release beta-adrenoceptor blocker metoprolol does not influence exercise capacity despite a marked reduction of heart rate and rate-pressure product. PMID:7589026

  19. Donor CD47 controls T cell alloresponses and is required for tolerance induction following hepatocyte allotransplantation

    PubMed Central

    Zhang, Mingyou; Wang, Hui; Tan, Shulian; Navarro-Alvarez, Nalu; Zheng, Yang; Yang, Yong-Guang

    2016-01-01

    CD47-deficient hepatocyte transplantation induces rapid innate immune cell activation and subsequent associated graft loss in syngeneic recipients. However, the role of donor CD47 in regulation of T-cell alloresponses is poorly understood. We addressed this question by assessing OVA-specific immune responses in mice following hepatocyte transplantation from CD47-competent or -deficient OVA-transgenic donors. Compared to sham-operated controls, intrasplenic transplantation of CD47-deficient OVA+ hepatocytes significantly accelerated rejection of OVA+ skin grafted 7 days after hepatocyte transplantation. In contrast, mice receiving CD47-competent OVA+ hepatocytes showed prolonged and even indefinite survival of OVA+ skin allografts. T cells from mice receiving CD47-deficient, but not CD47-competent, OVA+ hepatocytes showed significantly enhanced responses to OVA+ stimulators compared to sham-operated controls. In contrast to the production of tolerogenic cytokines (IL-4 and IL-10) in the recipients of CD47-competent hepatocytes, mice receiving CD47-deficient hepatocytes showed elevated production of IFN-γ and IL-1α. Moreover, significant expansion of myeloid-derived suppressor cells was detected in the recipients of CD47-competent hepatocytes, which was required for tolerance induction in these mice. Thus, donor CD47 plays an important role in the control of T-cell alloresponses and tolerance induction following hepatocyte transplantation. Our data also suggest that intrasplenic hepatocyte transplantation may provide a means to induce allograft tolerance. PMID:27230788

  20. Heart rate dynamics after controlled training followed by a home-based exercise program.

    PubMed

    Hautala, Arto J; Mäkikallio, Timo H; Kiviniemi, Antti; Laukkanen, Raija T; Nissilä, Seppo; Huikuri, Heikki V; Tulppo, Mikko P

    2004-07-01

    Daily aerobic training results in autonomic control of the heart toward vagal dominance. The constancy of vagal dominance after controlled training followed by a home-based training program in accordance with contemporary guidelines is not known. We set out here to study whether the vagal dominance induced by 8 weeks of controlled aerobic training is preserved after a 10-month home-based training program. For the controlled study, healthy men were randomized as training (n=18) and control subjects (n=6). The training was started by a supervised 8-week period with six training sessions a week [45 (15) min each] at an intensity of 70-80% of maximum heart rate, followed by a home-based training program for 10 months in accordance with the American College of Sports Medicine recommendations. Cardiovascular autonomic function was assessed by analyzing HR variability over a 24-h period and separately during the night hours (midnight-6 a.m.). Maximal running performance improved during the controlled training 16 (7)% (range 4-31%, P<0.001) and remained 8 (8)% (range -3 to 23%, P<0.001) above the baseline level after the home-based training program. At night, the vagally mediated high-frequency (HF) power of R-R intervals increased during the controlled training from 6.7 (1.3) to 7.3 (1.1) ln ms2 ( P<0.001) and remained higher than the baseline after the home-based training [7.0 (1.3) ln ms2, P<0.05]. The changes in running performance correlated with the changes in HF power at night (r=0.41, P<0.05) and over 24 h (r=0.44, P<0.05) after the home-based training program. Similarly, the changes in body mass index correlated with the changes in HF power over 24 h (r=-0.44, P<0.05) after the home-based training program. The high vagal outflow to the heart after the home-based training is associated with good physical performance and body mass control. PMID:15083365

  1. Neuroprotective Activities of Granulocyte-Macrophage Colony Stimulating Factor Following Controlled Cortical Impact

    PubMed Central

    Kelso, Matthew L.; Elliott, Bret R.; Haverland, Nicole A.; Mosley, R. Lee; Gendelman, Howard E.

    2014-01-01

    Neurodegeneration after traumatic brain injury (TBI) is facilitated by innate and adaptive immunity and can be harnessed to effect brain repair. In mice subjected to controlled cortical impact (CCI) we show that treatment with granulocyte macrophage colony stimulating factor (GM-CSF) affects regulatory T cell numbers coincident with decreased lesion volumes and increased cortical tissue sparing. This paralleled increases in neurofilament and diminished reactive microglial staining. Transcriptomic analysis showed that GM-CSF induces robust immune neuroprotective responses seven days following CCI. Together, these results support the therapeutic potential of GM-CSF for TBI. PMID:25468272

  2. Control of Blood Pressure and Risk Attenuation: Post Trial Follow-Up of Randomized Groups

    PubMed Central

    Jafar, Tazeen H.; Jehan, Imtiaz; Liang, Feng; Barbier, Sylvaine; Islam, Muhammad; Bux, Rasool; Khan, Aamir Hameed; Nadkarni, Nivedita; Poulter, Neil; Chaturvedi, Nish; Ebrahim, Shah

    2015-01-01

    Background Evidence on long term effectiveness of public health strategies for lowering blood pressure (BP) is scarce. In the Control of Blood Pressure and Risk Attenuation (COBRA) Trial, a 2 x 2 factorial, cluster randomized controlled trial, the combined home health education (HHE) and trained general practitioner (GP) intervention delivered over 2 years was more effective than no intervention (usual care) in lowering systolic BP among adults with hypertension in urban Pakistan. However, it was not clear whether the effect would be sustained after the cessation of intervention. We conducted 7 years follow-up inclusive of 5 years of post intervention period of COBRA trial participants to assess the effectiveness of the interventions on BP during extended follow-up. Methods A total of 1341 individuals 40 years or older with hypertension (systolic BP 140 mm Hg or greater, diastolic BP 90 mm Hg or greater, or already receiving treatment) were followed by trained research staff masked to randomization status. BP was measured thrice with a calibrated automated device (Omron HEM-737 IntelliSense) in the sitting position after 5 minutes of rest. BP measurements were repeated after two weeks. Generalized estimating equations (GEE) were used to analyze the primary outcome of change in systolic BP from baseline to 7- year follow-up. The multivariable model was adjusted for clustering, age at baseline, sex, baseline systolic and diastolic BP, and presence of diabetes. Findings After 7 years of follow-up, systolic BP levels among those randomised to combined HHE plus trained GP intervention were significantly lower (2.1 [4.1–0.1] mm Hg) compared to those randomised to usual care, (P = 0.04). Participants receiving the combined intervention compared to usual care had a greater reduction in LDL-cholesterol (2.7 [4.8 to 0.6] mg/dl. Conclusions The benefit in systolic BP reduction observed in the original cohort assigned to the combined intervention was attenuated but still

  3. Motion Perception and Manual Control Performance During Passive Tilt and Translation Following Space Flight

    NASA Technical Reports Server (NTRS)

    Clement, Gilles; Wood, Scott J.

    2010-01-01

    This joint ESA-NASA study is examining changes in motion perception following Space Shuttle flights and the operational implications of post-flight tilt-translation ambiguity for manual control performance. Vibrotactile feedback of tilt orientation is also being evaluated as a countermeasure to improve performance during a closed-loop nulling task. METHODS. Data has been collected on 5 astronaut subjects during 3 preflight sessions and during the first 8 days after Shuttle landings. Variable radius centrifugation (216 deg/s) combined with body translation (12-22 cm, peak-to-peak) is utilized to elicit roll-tilt perception (equivalent to 20 deg, peak-to-peak). A forward-backward moving sled (24-390 cm, peak-to-peak) with or without chair tilting in pitch is utilized to elicit pitch tilt perception (equivalent to 20 deg, peak-to-peak). These combinations are elicited at 0.15, 0.3, and 0.6 Hz for evaluating the effect of motion frequency on tilt-translation ambiguity. In both devices, a closed-loop nulling task is also performed during pseudorandom motion with and without vibrotactile feedback of tilt. All tests are performed in complete darkness. PRELIMINARY RESULTS. Data collection is currently ongoing. Results to date suggest there is a trend for translation motion perception to be increased at the low and medium frequencies on landing day compared to pre-flight. Manual control performance is improved with vibrotactile feedback. DISCUSSION. The results of this study indicate that post-flight recovery of motion perception and manual control performance is complete within 8 days following short-duration space missions. Vibrotactile feedback of tilt improves manual control performance both before and after flight.

  4. Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: a Multicenter Prospective Controlled Study

    PubMed Central

    Loebstein, Ronen; Addis, Antonio; Ho, Elaine; Andreou, Roseann; Sage, Suzanne; Donnenfeld, Alan E.; Schick, Betsy; Bonati, Maurizio; Moretti, Myla; Lalkin, Arieh; Pastuszak, Anne; Koren, Gideon

    1998-01-01

    Concerns regarding the teratogenicity of fluoroquinolones have resulted in their restricted use during gestation. This is despite an increasing need for their use due to emerging bacterial resistance. The objectives of the present investigation were to evaluate pregnancy and fetal outcomes following maternal exposure to fluoroquinolones and to examine whether in utero exposure to quinolones is associated with clinically significant musculoskeletal dysfunctions. We prospectively enrolled and followed up 200 women exposed to fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin) during gestation. Pregnancy outcome was compared with that for 200 controls matched for age and for smoking and alcohol consumption habits. Controls were exposed to nonteratogenic, nonembryotoxic antimicrobial agents matched by indication, duration of therapy (±3 days), and trimester of exposure. Rates of major congenital malformations did not differ between the group exposed to quinolones in the first trimester (2.2%) and the control group (2.6%) (relative risk, 0.85; 95% confidence interval, 0.21 to 3.49). Women treated with quinolones had a tendency for an increased rate of therapeutic abortions compared with the rate among women exposed to nonteratogens (relative risk, 4.50; 95% confidence interval, 0.98 to 20.57), resulting in lower live-birth rates (86 versus 94%; P = 0.02). The rates of spontaneous abortions, fetal distress, and prematurity and the birth weight did not differ between the groups. Gross motor developmental milestone achievements did not differ between the children of the mothers in the two groups. We concluded that the use of fluoroquinolones during embryogenesis is not associated with an increased risk of major malformations. There were no clinically significant musculoskeletal dysfunctions in children exposed to fluoroquinolones in utero. The higher rate of therapeutic abortions observed in quinolone-exposed women compared to that for their controls may be secondary

  5. [The results of patients follow up at Gaziantep Number II Dispensary of Tuberculosis Control in the year 2004].

    PubMed

    Elbek, Osman; Yardi, Ahmet Doğan; Uyar, Meral; Tanriöver, Mustafa; Börekçi, Sermin; Dikensoy, Oner

    2006-01-01

    In this study, the aim was to investigate the performance of number-II Dispensary of Tuberculous Control (DTC) in Gaziantep in 2004. The patients diagnosed to have tuberculosis between 2004 January 1st and 2004 December 31st were included. The patients registries were evaluated retrospectively. The mean age of the patients was 28.92+/-14.43 years (ranged between 1-68), 70.5% of the cases were male, and 72.5% of the cases were between 15-44 years old. Forty-two (82.3%) of the cases had the diagnosis of lung tuberculosis. 47% of them did not have any health insurance. The symptoms detected in the patients were cough, night sweats, sputum and hemoptysis respectively. There was no symptom registry in ten patients (19.6%). Sputum analysis to detect acid-fast bacilli (AFB) was done in 18 patients (19.6%). AFB was perfomed in 3.9% of the patients following two-months of therapy, and in 1.9% of the patients at the end of the therapy. Diagnostic tuberculous culture was performed in only one patient (1.9%). There was no tuberculous culture performed neither at the second month nor at the end of the therapy course. AFB was found to be positive in direct or concentrated sputum samples in eight (44.4%) of the patients. All the patients were evaluated with radiographies. The eritrocyte sedimentation rate was measured in 33.3%, 9.8%, and 15.6% of the patients before the therapy, at the end of the two months of therapy, and at the end of the therapy, respectively. The diagnosis was established with radiology clinical findings in 34 patients (66.6%). Directly observed therapy was performed in one patient (1.9%). The cure rate among smear positive patients was 12.5%, and the 100% of the patients were completed the therapy. There exists many problems with tuberculosis "warfare" and we believe the solution lies in DOTS. PMID:17203420

  6. Clinical Benefits of Above-Standard Dose of Octreotide LAR in Patients With Neuroendocrine Tumors for Control of Carcinoid Syndrome Symptoms: A Multicenter Retrospective Chart Review Study

    PubMed Central

    Strosberg, Jonathan R.; Benson, Al B.; Huynh, Lynn; Goldman, Jamie; Sahai, Vaibhav; Rademaker, Alfred W.; Kulke, Matthew H.

    2014-01-01

    Background. Octreotide LAR is used in patients for control of carcinoid syndrome (CS) and other symptoms of hormone hypersecretion. The aim of this study was to examine reasons for octreotide LAR dose escalation and observe CS symptom improvement in patients with neuroendocrine tumors (NETs) who underwent octreotide LAR dose escalation at three cancer referral centers. Methods. Medical records for patients with diagnosis of carcinoid or pancreatic NET who had received one dose or more of octreotide LAR above 30 mg every 4 weeks from 2000 to 2012 were reviewed. Reasons for dose escalation and symptomatic outcomes were abstracted for each patient 3 months prior to and up to 12 months following the dose escalation. Results. Of the evaluated 239 NET patients, 53% were male, mean age at first dose escalation was 60 years (standard deviation [SD]: 11 years), and mean time from octreotide LAR initiation to first dose escalation was 1.7 years (SD: 2.0 years). The primary reasons reported for dose escalation were carcinoid or hormonal syndrome (62%) or radiographic progression (28%). The most common dose changes at the first dose escalation were 40 mg every 4 weeks (71%) and 60 mg every 4 weeks (18%). Of 90 patients in whom flushing was reported prior to first dose escalation, 73 (81%) were reported to have experienced improvement or resolution of their symptoms following the dose escalation. Of 107 patients who were reported to have experienced diarrhea before the first dose escalation, 85 (79%) were reported to have experienced improvement or resolution after first dose escalation. Conclusion. The goal of improved symptom control is a common reason for dose escalation of octreotide LAR. This study suggests that escalation to above the standard dose of octreotide LAR of 30 mg every 4 weeks may result in improved CS symptom control. PMID:25096997

  7. Neuronal gap junctions play a role in the secondary neuronal death following controlled cortical impact.

    PubMed

    Belousov, Andrei B; Wang, Yongfu; Song, Ji-Hoon; Denisova, Janna V; Berman, Nancy E; Fontes, Joseph D

    2012-08-22

    In the mammalian CNS, excessive release of glutamate and overactivation of glutamate receptors are responsible for the secondary (delayed) neuronal death following neuronal injury, including ischemia, traumatic brain injury (TBI) and epilepsy. Recent studies in mice showed a critical role for neuronal gap junctions in NMDA receptor-mediated excitotoxicity and ischemia-mediated neuronal death. Here, using controlled cortical impact (CCI) in adult mice, as a model of TBI, and Fluoro-Jade B staining for analysis of neuronal death, we set to determine whether neuronal gap junctions play a role in the CCI-mediated secondary neuronal death. We report that 24h post-CCI, substantial neuronal death is detected in a number of brain regions outside the injury core, including the striatum. The striatal neuronal death is reduced both in wild-type mice by systemic administration of mefloquine (a relatively selective blocker of neuronal gap junctions) and in knockout mice lacking connexin 36 (neuronal gap junction protein). It is also reduced by inactivation of group II metabotropic glutamate receptors (with LY341495) which, as reported previously, control the rapid increase in neuronal gap junction coupling following different types of neuronal injury. The results suggest that neuronal gap junctions play a critical role in the CCI-induced secondary neuronal death. PMID:22781494

  8. Pregnancy Rate after Controlled Ovarian Hyperstimulation and Intrauterine Insemination for the Treatment of Endometriosis following Surgery

    PubMed Central

    Keresztúri, Attila; Kozinszky, Zoltan; Daru, József; Pásztor, Norbert; Sikovanyecz, János; Zádori, János; Márton, Virág; Koloszár, Sándor; Szöllősi, János; Németh, Gábor

    2015-01-01

    Objective. To compare pregnancy rate after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) with no treatment in patients with endometriosis-associated infertility treated with laparoscopy. Design. A clinical cohort study. Setting. University-level tertiary care center. Patients. 238 women with various stages of endometriosis after laparoscopic treatment. Interventions. Either COH-IUI or follow-up for 12 months. Main Outcome Measures. The primary outcome measures were clinical pregnancy and live birth rate. Predictive factors evaluated were female age, maternal BMI, and duration of infertility. Results. The pregnancy rate attained after the integrated laparoscopy–COH-IUI approach was 53.4%, while it was significantly lower (38.5%) in the control group. Similarly, a significant difference was observed in live births (48.3% versus 34.2%). Patients with severe endometriosis were less likely to achieve pregnancy (38%) and live birth (35%) than their counterparts with milder forms (57% and 53%). Conclusions. In patients with endometriosis-based infertility, surgery followed by COH-IUI is more effective than surgery alone. PMID:26247014

  9. Improving Maternal Mental Health Following Preterm Birth Using an Expressive Writing Intervention: A Randomized Controlled Trial.

    PubMed

    Horsch, Antje; Tolsa, Jean-François; Gilbert, Leah; du Chêne, Lauranne Jan; Müller-Nix, Carole; Bickle Graz, Myriam

    2016-10-01

    Evaluations of evidence-based, easily accessible, psychological interventions to improve maternal mental health following very preterm birth are scarce. This study investigated the efficacy and acceptability of the expressive writing paradigm for mothers of very preterm infants. The level of maternal posttraumatic stress and depressive symptoms was the primary outcome. Participants were 67 mothers of very preterm babies who were randomly allocated into the intervention (expressive writing; n = 33) or control group (treatment-as-usual; n = 32) when their infant was aged 3 months (corrected age, CA). Measurements were taken at 3 months (pre-intervention), 4 months (post-intervention), and 6 months CA (follow-up). Results showed reduced maternal posttraumatic stress (d = 0.42), depressive symptoms (d = 0.67), and an improved mental health status (d = 1.20) in the intervention group, which were maintained at follow-up. Expressive writing is a brief, cost-effective, and acceptable therapeutic approach that could be offered as part of the NICU care. PMID:26659113

  10. Traumeel S® for pain relief following hallux valgus surgery: a randomized controlled trial

    PubMed Central

    2010-01-01

    Background In spite of recent advances in post-operative pain relief, pain following orthopedic surgery remains an ongoing challenge for clinicians. We examined whether a well known and frequently prescribed homeopathic preparation could mitigate post-operative pain. Method We performed a randomized, double blind, placebo-controlled trial to evaluate the efficacy of the homeopathic preparation Traumeel S® in minimizing post-operative pain and analgesic consumption following surgical correction of hallux valgus. Eighty consecutive patients were randomized to receive either Traumeel tablets or an indistinguishable placebo, and took primary and rescue oral analgesics as needed. Maximum numerical pain scores at rest and consumption of oral analgesics were recorded on day of surgery and for 13 days following surgery. Results Traumeel was not found superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial, however a transient reduction in the daily maximum post-operative pain score favoring the Traumeel arm was observed on the day of surgery, a finding supported by a treatment-time interaction test (p = 0.04). Conclusions Traumeel was not superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial. A transient reduction in the daily maximum post-operative pain score on the day of surgery is of questionable clinical importance. Trial Registration This study was registered at ClinicalTrials.gov. # NCT00279513 PMID:20380750

  11. Short term modulation of trunk neuromuscular responses following spinal manipulation: a control group study

    PubMed Central

    2013-01-01

    Background Low back pain (LBP) is one of the most frequent musculoskeletal conditions in industrialized countries and its economic impact is important. Spinal manipulation therapy (SMT) is believed to be a valid approach in the treatment of both acute and chronic LBP. It has also been shown that SMT can modulate the electromyographic (EMG) activity of the paraspinal muscle. The purpose of this study was to investigate, in a group of patients with low back pain, the persistence of changes observed in trunk neuromuscular responses after a spinal manipulation (SMT). Methods Sixty adult participants with LBP performed a block of 5 flexion-extension movements. Participants in the experimental group (n=30) received lumbar SMT whereas participants in the control group (n=30) were positioned similarly for the treatment but did not receive SMT. Blocks of flexion-extension movements were repeated immediately after the manipulation as well as 5 and 30 minutes after SMT (or control position). EMG activity of paraspinal muscles was recorded at L2 and L5 level and kinematic data were collected to evaluate the lumbo-pelvic kinematics. Pain intensity was noted after each block. Normalized EMG, pain intensity and lumbo-pelvic kinematics were compared across experimental conditions. Results Participants from the control group showed a significant increase in EMG activity during the last block (30 min) of flexion-extension trials in both flexion and full-flexion phases at L2. Increase in VAS scores was also observed in the last 2 blocks (5 min and 30 min) in the control group. No significant group x time interaction was seen at L5. No significant difference was observed in the lumbo-pelvic kinematics. Conclusion Changes in trunk neuromuscular control following HVLA spinal manipulation may reduce sensitization or muscle fatigue effects related to repetitive movement. Future studies should investigate short term changes in neuromuscular components, tissue properties and clinical

  12. Additional follow-up telephone counselling and initial smoking relapse: a longitudinal, controlled study

    PubMed Central

    Wu, Lei; He, Yao; Jiang, Bin; Zuo, Fang; Liu, Qinghui; Zhang, Li; Zhou, Changxi

    2016-01-01

    Objectives Smoking cessation services can help smokers to quit; however, many smoking relapse cases occur over time. Initial relapse prevention should play an important role in achieving the goal of long-term smoking cessation. Several studies have focused on the effect of extended telephone support in relapse prevention, but the conclusions remain conflicting. Design and setting From October 2008 to August 2013, a longitudinal, controlled study was performed in a large general hospital of Beijing. Participants The smokers who sought treatment at our smoking cessation clinic were non-randomised and divided into 2 groups: face-to-face individual counselling group (FC group), and face-to-face individual counselling plus telephone follow-up counselling group (FCF group). No pharmacotherapy was offered. Outcomes The timing of initial smoking relapse was compared between FC and FCF groups. Predictors of initial relapse were investigated during the first 180 days, using the Cox proportional hazards model. Results Of 547 eligible male smokers who volunteered to participate, 457 participants (117 in FC group and 340 in FCF group) achieved at least 24 h abstinence. The majority of the lapse episodes occurred during the first 2 weeks after the quit date. Smokers who did not receive the follow-up telephone counselling (FC group) tended to relapse to smoking earlier than those smokers who received the additional follow-up telephone counselling (FCF group), and the log-rank test was statistically significant (p=0.003). A Cox regression model showed that, in the FCF group, being married, and having a lower Fagerström test score, normal body mass index and doctor-diagnosed tobacco-related chronic diseases, were significantly independent protective predictors of smoking relapse. Conclusions Within the limitations of this study, it can be concluded that additional follow-up telephone counselling might be an effective strategy in preventing relapse. Further research is still

  13. A three-year follow-up of ocular onchocerciasis in an area of vector control*

    PubMed Central

    Thylefors, B.; Tønjum, A. M.

    1980-01-01

    An evaluation of the effects on onchocerciasis of a 3-year period of vector control was undertaken during 1978 in the Onchocerciasis Control Programme area in West Africa. The results revealed that the overall prevalence of ocular onchocerciasis showed only a slight decrease at the follow-up in 1978, but that there was significantly less infection among children in the age group 5-14 years as compared with 1975. There was a total incidence of ocular signs of onchocerciasis of 8.6% over the 3 years, but also a disappearance of those signs in 11.7% of the sample examined. The incidence of severe onchocercal eye manifestations was low, compared with similar areas of uncontrolled transmission. The particularly low incidence of sclerosing keratitis may be associated with the finding of a significantly decreased microfilarial load in the cornea, whereas the number of living microfilariae in the anterior chamber of the eye was apparently unchanged. The incidence of blindness due to onchocerciasis was low and confined to individuals who already presented severe eye manifestations of the disease before the beginning of the vector control campaign. PMID:6966541

  14. Henry's Law: A Retrospective

    ERIC Educational Resources Information Center

    Rosenberg, Robert M.; Peticolas, Warner L.

    2004-01-01

    A retrospective view of Henry's law and its applicability in any specific system at a finite concentration is tested. It can be concluded that Henry's law is only a limiting law and is adequate at low mole fractions but is useful for practical purposes where high precision is not required.

  15. Control system design for maintaining CO{sub 2} capture in IGCC power plants while loading-following

    SciTech Connect

    Bhattacharyya, D.; Turton, R.; Zitney, S.

    2012-01-01

    Load-following requirements for future integrated gasification combined cycle (IGCC) power plants with precombustion CO{sub 2} capture are expected to be far more challenging as electricity produced by renewable energy is connected to the grid and strict environmental limits become mandatory requirements. In this work, loadfollowing studies are performed using a comprehensive dynamic model of an IGCC plant with pre-combustion CO{sub 2} capture developed in Aspen Engineering Suite (AES). Considering multiple single-loop controllers for power demand load following, the preferred IGCC control strategy from the perspective of a power producer is gas turbine (GT) lead with gasifier follow. In this strategy, the GT controls the load by manipulating its firing rate while the slurry feed flow to the gasifier is manipulated to control the syngas pressure at the GT inlet. The syngas pressure control is an integrating process with significant time delay mainly because of the large piping and equipment volumes between the gasifier and the GT inlet. A modified proportional–integral–derivative (PID) control is considered for IGCC syngas pressure control. The desired CO{sub 2} capture rate must be maintained while the IGCC plant follows the load. For maintaining the desired CO{sub 2} capture rate, the control performance of PID control is compared with linear model predictive control (LMPC). The results show that the LMPC outperforms PID control for maintaining CO{sub 2} capture rates in an IGCC power plant while load following.

  16. The influence of intraoperative resection control modalities on survival following gross total resection of glioblastoma.

    PubMed

    Neidert, Marian C; Hostettler, Isabel C; Burkhardt, Jan-Karl; Mohme, Malte; Held, Ulrike; Kofmehl, Reto; Eisele, Günter; Woernle, Christoph M; Regli, Luca; Bozinov, Oliver

    2016-07-01

    The purpose of the present study is to analyze the impact of intraoperative resection control modalities on overall survival (OS) and progression-free survival (PFS) following gross total resection (GTR) of glioblastoma. We analyzed data of 76 glioblastoma patients (30f, mean age 57.4 ± 11.6 years) operated at our institution between 2009 and 2012. Patients were only included if GTR was achieved as judged by early postoperative high-field MRI. Intraoperative technical resection control modalities comprised intraoperative ultrasound (ioUS, n = 48), intraoperative low-field MRI (ioMRI, n = 22), and a control group without either modality (n = 11). The primary endpoint of our study was OS, and the secondary endpoint was PFS-both analyzed in Kaplan-Meier plots and Cox proportional hazards models. Median OS in all 76 glioblastoma patients after GTR was 20.4 months (95 % confidence interval (CI) 18.5-29.0)-median OS in patients where GTR was achieved using ioUS was prolonged (21.9 months) compared to those without ioUS usage (18.8 months). A multiple Cox model adjusting for age, preop Karnofsky performance status, tumor volume, and the use of 5-aminolevulinic acid showed a beneficial effect of ioUS use, and the estimated hazard ratio was 0.63 (95 % CI 0.31-1.2, p = 0.18) in favor of ioUS, however not reaching statistical significance. A similar effect was found for PFS (hazard ratio 0.59, p = 0.072). GTR of glioblastoma performed with ioUS guidance was associated with prolonged OS and PFS. IoUS should be compared to other resection control devices in larger patient cohorts. PMID:26860420

  17. A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial.

    PubMed

    Khan, R J K; Fick, D; Yao, F; Tang, K; Hurworth, M; Nivbrant, B; Wood, D

    2006-02-01

    We carried out a blinded prospective randomised controlled trial comparing 2-octylcyanoacrylate (OCA), subcuticular suture (monocryl) and skin staples for skin closure following total hip and total knee arthroplasty. We included 102 hip replacements and 85 of the knee.OCA was associated with less wound discharge in the first 24 hours for both the hip and the knee. However, with total knee replacement there was a trend for a more prolonged wound discharge with OCA. With total hip replacement there was no significant difference between the groups for either early or late complications. Closure of the wound with skin staples was significantly faster than with OCA or suture. There was no significant difference in the length of stay in hospital, Hollander wound evaluation score (cosmesis) or patient satisfaction between the groups at six weeks for either hips or knees. We consider that skin staples are the skin closure of choice for both hip and knee replacements. PMID:16434531

  18. Reduction in Dynamic Visual Acuity Reveals Gaze Control Changes Following Spaceflight

    NASA Technical Reports Server (NTRS)

    Peters, Brian T.; Brady, Rachel A.; Miller, Chris; Lawrence, Emily L.; Mulavara Ajitkumar P.; Bloomberg, Jacob J.

    2010-01-01

    INTRODUCTION: Exposure to microgravity causes adaptive changes in eye-head coordination that can lead to altered gaze control. This could affect postflight visual acuity during head and body motion. The goal of this study was to characterize changes in dynamic visual acuity after long-duration spaceflight. METHODS: Dynamic Visual Acuity (DVA) data from 14 astro/cosmonauts were collected after long-duration (6 months) spaceflight. The difference in acuity between seated and walking conditions provided a metric of change in the subjects ability to maintain gaze fixation during self-motion. In each condition, a psychophysical threshold detection algorithm was used to display Landolt ring optotypes at a size that was near each subject s acuity threshold. Verbal responses regarding the orientation of the gap were recorded as the optotypes appeared sequentially on a computer display 4 meters away. During the walking trials, subjects walked at 6.4 km/h on a motorized treadmill. RESULTS: A decrement in mean postflight DVA was found, with mean values returning to baseline within 1 week. The population mean showed a consistent improvement in DVA performance, but it was accompanied by high variability. A closer examination of the individual subject s recovery curves revealed that many did not follow a pattern of continuous improvement with each passing day. When adjusted on the basis of previous long-duration flight experience, the population mean shows a "bounce" in the re-adaptation curve. CONCLUSION: Gaze control during self-motion is altered following long-duration spaceflight and changes in postflight DVA performance indicate that vestibular re-adaptation may be more complex than a gradual return to normal.

  19. Long-term cognitive follow-up of Parkinson's disease patients with impulse control disorders.

    PubMed

    Siri, Chiara; Cilia, Roberto; Reali, Elisa; Pozzi, Beatrice; Cereda, Emanuele; Colombo, Aurora; Meucci, Nicoletta; Canesi, Margherita; Zecchinelli, Anna L; Tesei, Silvana; Mariani, Claudio B; Sacilotto, Giorgio; Zini, Michela; Pezzoli, Gianni

    2015-04-15

    This study investigated cognitive functions in Parkinson's disease (PD) patients with impulse control disorders (ICDs) and aimed to identify possible predictors of behavioral outcome. In this longitudinal cohort study, 40 PD outpatients with ICDs and 40 without, were matched for sex, age at PD onset, age and disease duration at cognitive assessment. All patients had two neuropsychological assessments at least 2 years apart (mean, 3.5 years). Multivariate logistic regression analysis was performed to identify predictors of ICDs remission at follow-up. The PD patients with and without ICDs had overall comparable cognitive performance at baseline. When evaluating changes between baseline and follow-up, we found significant group × time interactions in several frontal lobe-related tests, with the ICDs group showing a less pronounced worsening over time. ICDs remission was associated with better performance at baseline in working memory-related tasks, such as digit span (odds ratio [OR] = 2.69 [95% confidence interval (CI), 1.09-6.66]) and attentive matrices (OR=1.19 [95%CI, 1.03-1.37]). ICDs remitters and non-remitters had no remarkable differences in baseline PD-related features and therapy management strategies (including the extent of dopamine agonist dose reduction). In conclusion, ICDs in PD patients are not related to greater cognitive impairment or executive dysfunction, but rather show relatively lower cognitive decline over time. The impaired top-down inhibitory control characterizing ICDs is likely attributable to a drug-induced overstimulation of relatively preserved prefrontal cognitive functions. Full behavioral remission in the long term was predicted by better working memory abilities. © 2015 International Parkinson and Movement Disorder Society. PMID:25757654

  20. GPR18 Controls Reconstitution of Mouse Small Intestine Intraepithelial Lymphocytes following Bone Marrow Transplantation.

    PubMed

    Becker, Amy M; Callahan, Derrick J; Richner, Justin M; Choi, Jaebok; DiPersio, John F; Diamond, Michael S; Bhattacharya, Deepta

    2015-01-01

    Specific G protein coupled receptors (GPRs) regulate the proper positioning, function, and development of immune lineage subsets. Here, we demonstrate that GPR18 regulates the reconstitution of intraepithelial lymphocytes (IELs) of the small intestine following bone marrow transplantation. Through analysis of transcriptional microarray data, we find that GPR18 is highly expressed in IELs, lymphoid progenitors, and mature follicular B cells. To establish the physiological role of this largely uncharacterized GPR, we generated Gpr18-/- mice. Despite high levels of GPR18 expression in specific hematopoietic progenitors, Gpr18-/- mice have no defects in lymphopoiesis or myelopoiesis. Moreover, antibody responses following immunization with hapten-protein conjugates or infection with West Nile virus are normal in Gpr18-/- mice. Steady-state numbers of IELs are also normal in Gpr18-/- mice. However, competitive bone marrow reconstitution experiments demonstrate that GPR18 is cell-intrinsically required for the optimal restoration of small intestine TCRγδ+ and TCRαβ+ CD8αα+ IELs. In contrast, GPR18 is dispensable for the reconstitution of large intestine IELs. Moreover, Gpr18-/- bone marrow reconstitutes small intestine IELs similarly to controls in athymic recipients. Gpr18-/- chimeras show no changes in susceptibility to intestinal insults such as Citrobacter rodentium infections or graft versus host disease. These data reveal highly specific requirements for GPR18 in the development and reconstitution of thymus-derived intestinal IEL subsets in the steady-state and after bone marrow transplantation. PMID:26197390

  1. GPR18 Controls Reconstitution of Mouse Small Intestine Intraepithelial Lymphocytes following Bone Marrow Transplantation

    PubMed Central

    Becker, Amy M.; Callahan, Derrick J.; Richner, Justin M.; Choi, Jaebok; DiPersio, John F.; Diamond, Michael S.; Bhattacharya, Deepta

    2015-01-01

    Specific G protein coupled receptors (GPRs) regulate the proper positioning, function, and development of immune lineage subsets. Here, we demonstrate that GPR18 regulates the reconstitution of intraepithelial lymphocytes (IELs) of the small intestine following bone marrow transplantation. Through analysis of transcriptional microarray data, we find that GPR18 is highly expressed in IELs, lymphoid progenitors, and mature follicular B cells. To establish the physiological role of this largely uncharacterized GPR, we generated Gpr18-/- mice. Despite high levels of GPR18 expression in specific hematopoietic progenitors, Gpr18-/- mice have no defects in lymphopoiesis or myelopoiesis. Moreover, antibody responses following immunization with hapten-protein conjugates or infection with West Nile virus are normal in Gpr18-/- mice. Steady-state numbers of IELs are also normal in Gpr18-/- mice. However, competitive bone marrow reconstitution experiments demonstrate that GPR18 is cell-intrinsically required for the optimal restoration of small intestine TCRγδ+ and TCRαβ+ CD8αα+ IELs. In contrast, GPR18 is dispensable for the reconstitution of large intestine IELs. Moreover, Gpr18-/- bone marrow reconstitutes small intestine IELs similarly to controls in athymic recipients. Gpr18-/- chimeras show no changes in susceptibility to intestinal insults such as Citrobacter rodentium infections or graft versus host disease. These data reveal highly specific requirements for GPR18 in the development and reconstitution of thymus-derived intestinal IEL subsets in the steady-state and after bone marrow transplantation. PMID:26197390

  2. Executive Functioning in Alcoholics Following an mHealth Cognitive Stimulation Program: Randomized Controlled Trial

    PubMed Central

    Oliveira, Jorge; Lopes, Paulo; Brito, Rodrigo; Morais, Diogo; Silva, Diana; Silva, Ana; Rebelo, Sara; Bastos, Marta; Deus, Alberto

    2014-01-01

    Background The consequences of alcohol dependence are severe and may range from physical disease to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. Conventional neuropsychological interventions (paper-and-pencil cognitive stimulation training) have a positive effect but are time-consuming, costly, and not motivating for patients. Objective Our goal was to test the cognitive effects of a novel approach to neuropsychological intervention, using mobile technology and serious games, on patients with alcohol dependence. Methods The trial design consisted of a two-arm study assessing the cognitive outcomes of neuropsychological intervention with mobile serious games (mHealth) versus control (treatment-as-usual with no neuropsychological intervention) in patients undergoing treatment for alcohol dependence syndrome. Sixty-eight patients were recruited from an alcohol-rehab clinic and randomly assigned to the mHealth (n=33) or control condition (n=35). The intervention on the experimental group consisted of a therapist-assisted cognitive stimulation therapy for 4 weeks on a 2-3 days/week basis. Results Fourteen patients dropped out of the study. The results of the neuropsychological assessments with the remaining 54 patients showed an overall increase (P<.05) of general cognitive abilities, mental flexibility, psychomotor processing speed, and attentional ability in both experimental (n=26) and control groups (n=28). However, there was a more pronounced improvement (P=.01) specifically in frontal lobe functions from baseline (mean 13.89, SE 0.58) to follow-up (mean 15.50, SE 0.46) in the experimental group but not in the control group. Conclusions The overall increase in general cognitive function for both experimental and control groups supports the beneficial role of existing alcohol treatment protocols aimed at minimizing withdrawal symptoms, but the differential

  3. Back seat driving: hindlimb corticospinal neurons assume forelimb control following ischaemic stroke.

    PubMed

    Starkey, Michelle Louise; Bleul, Christiane; Zörner, Björn; Lindau, Nicolas Thomas; Mueggler, Thomas; Rudin, Markus; Schwab, Martin Ernst

    2012-11-01

    Whereas large injuries to the brain lead to considerable irreversible functional impairments, smaller strokes or traumatic lesions are often associated with good recovery. This recovery occurs spontaneously, and there is ample evidence from preclinical studies to suggest that adjacent undamaged areas (also known as peri-infarct regions) of the cortex 'take over' control of the disrupted functions. In rodents, sprouting of axons and dendrites has been observed in this region following stroke, while reduced inhibition from horizontal or callosal connections, or plastic changes in subcortical connections, could also occur. The exact mechanisms underlying functional recovery after small- to medium-sized strokes remain undetermined but are of utmost importance for understanding the human situation and for designing effective treatments and rehabilitation strategies. In the present study, we selectively destroyed large parts of the forelimb motor and premotor cortex of adult rats with an ischaemic injury. A behavioural test requiring highly skilled, cortically controlled forelimb movements showed that some animals recovered well from this lesion whereas others did not. To investigate the reasons behind these differences, we used anterograde and retrograde tracing techniques and intracortical microstimulation. Retrograde tracing from the cervical spinal cord showed a correlation between the number of cervically projecting corticospinal neurons present in the hindlimb sensory-motor cortex and good behavioural recovery. Anterograde tracing from the hindlimb sensory-motor cortex also showed a positive correlation between the degree of functional recovery and the sprouting of neurons from this region into the cervical spinal cord. Finally, intracortical microstimulation confirmed the positive correlation between rewiring of the hindlimb sensory-motor cortex and the degree of forelimb motor recovery. In conclusion, these experiments suggest that following stroke to the

  4. Retrospective Conversion of Music Collection. Project Manual.

    ERIC Educational Resources Information Center

    Bayne, Pauline S.; And Others

    This manual describes procedures followed by the University of Tennessee, Knoxville Library Cataloging Department in its Music Retrospective Conversion Project. The goal of the project, running from October 1, 1983 to December 31, 1984, is full conversion of bibliographic records for scores, recordings, and music monographs to machine readable…

  5. Retrospective Analysis of Local Control and Cosmetic Outcome of 147 Periorificial Carcinomas of the Face Treated With Low-Dose Rate Interstitial Brachytherapy

    SciTech Connect

    Ducassou, Anne; David, Isabelle; Filleron, Thomas; Rives, Michel; Bonnet, Jacques; Delannes, Martine

    2011-11-01

    Purpose: Skin cancer is the most common malignancy in white populations. We evaluated the local cure rate and cosmetic outcome of patients with basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) of the face treated with low-dose rate brachytherapy. Methods and Materials: Between February 1990 and May 2000, 147 facial carcinomas in 132 patients were treated by {sup 192}Ir wire implantation. Side effects of brachytherapy were noted. Follow-up was 2 years or more. Locoregional recurrence-free survival (LRFS) and overall survival were recorded. Group A included patients treated by primary brachytherapy, and Group B included those treated after recurrence. Results: A total of 121 carcinomas were BCCs (82.3%) and 26 were SCCs (17.7%); the median tumor size was 10 mm. Of the tumors, 86 (58.5%) were in men and 61 (41.5%) were in women; the median age was 71 years. Group A comprised 116 lesions (78.9%), and Group B, 31 (21.1%). There were 17 relapses (11.6%) after a median follow-up of 72 months: 12 local, 4 nodal, and 1 local and nodal. Locoregional-free survival was 96.6% at 2 years and 87.3% at 5 years. Five-year LRFS was 82.6% in men and 93.3% in women (p = 0.027). After adjustment for gender, LRFS was better after primary treatment than after recurrence (hasard ratio HR, 2.91; 95% confidence interval, 1.06-8.03; p = 0.039). Five-year LRFS was 90.4% for BCC and 70.8% for SCC (p = 0.03). There were no Grade 3 complications. Conclusions: Low-dose rate brachytherapy offers good local control and cosmetic outcome in patients with periorificial skin carcinomas, with no Grade 3 complications. Brchytherapy is more efficient when used as primary treatment.

  6. Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study

    PubMed Central

    Dong, Chenhui; Wang, Yunjiao; Wang, Ziming; Wang, Yu; Wu, Siyu; Du, Quanyin; Wang, Aimin

    2016-01-01

    Background Chronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients. Methods In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained. Results Of a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18) or delayed (3–10 days; n = 10) surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty) was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10). During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups. Conclusion In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events. PMID:27149117

  7. Methamphetamine and amphetamine isomer concentrations in human urine following controlled Vicks VapoInhaler administration.

    PubMed

    Smith, Michael L; Nichols, Daniel C; Underwood, Paula; Fuller, Zachary; Moser, Matthew A; Flegel, Ron; Gorelick, David A; Newmeyer, Matthew N; Concheiro, Marta; Huestis, Marilyn A

    2014-10-01

    Legitimate use of legal intranasal decongestants containing l-methamphetamine may complicate interpretation of urine drug tests positive for amphetamines. Our study hypotheses were that commonly used immunoassays would produce no false-positive results and a recently developed enantiomer-specific gas chromatography-mass spectrometry (GC-MS) procedure would find no d-amphetamine or d-methamphetamine in urine following controlled Vicks VapoInhaler administration at manufacturer's recommended doses. To evaluate these hypotheses, 22 healthy adults were each administered one dose (two inhalations in each nostril) of a Vicks VapoInhaler every 2 h for 10 h on Day 1 (six doses), followed by a single dose on Day 2. Every urine specimen was collected as an individual void for 32 h after the first dose and assayed for d- and l-amphetamines specific isomers with a GC-MS method with >99% purity of R-(-)-α-methoxy-α-(trifluoromethyl)phenylacetyl derivatives and 10 µg/L lower limits of quantification. No d-methamphetamine or d-amphetamine was detected in any urine specimen by GC-MS. The median l-methamphetamine maximum concentration was 62.8 µg/L (range: 11.0-1,440). Only two subjects had detectable l-amphetamine, with maximum concentrations coinciding with l-methamphetamine peak levels, and always ≤ 4% of the parent's maximum. Three commercial immunoassays for amphetamines EMIT(®) II Plus, KIMS(®) II and DRI(®) had sensitivities, specificities and efficiencies of 100, 97.8, 97.8; 100, 99.6, 99.6 and 100, 100, 100%, respectively. The immunoassays had high efficiencies, but our first hypothesis was not affirmed. The EMIT(®) II Plus assay produced 2.2% false-positive results, requiring an enantiomer-specific confirmation. PMID:25217541

  8. Time-critical cooperative path-following control of multiple unmanned aerial vehicles

    NASA Astrophysics Data System (ADS)

    Xargay Mata, Enric

    This thesis addresses the problem of steering a fleet of unmanned aerial vehicles (UAVs) along desired 3D spatial paths while meeting stringent relative temporal constraints. A representative example is the challenging mission scenario where the UAVs are tasked to cooperatively execute collision-free maneuvers and arrive at their final destinations at the same time, or at different times so as to meet a desired inter-vehicle schedule. In the proposed framework, the UAVs are assigned nominal spatial paths and speed profiles along those, and then the vehicles are requested to execute cooperative path following, rather than "open-loop" trajectory-tracking maneuvers. This strategy yields robust behavior against external disturbances by allowing the UAVs to negotiate their speeds along the paths in response to information exchanged over a supporting inter-vehicle communications network. The proposed approach addresses explicitly the situation where each vehicle transmits coordination-relevant information to only a subset of the other vehicles, as determined by the time-varying communications topology. Furthermore, the thesis considers the case where the graph that captures the underlying communications topology is disconnected during some interval of time or even fails to be connected at all times. Conditions are given under which the complete time-critical cooperative path-following closed-loop system is stable and yields convergence of a conveniently defined cooperation error to a neighborhood of the origin. The thesis also derives lower bounds on the convergence rate of the coordination dynamics as a function of the quality of service of the supporting network, and proposes a coordination algorithm to improve the rate of convergence of the coordination dynamics in low-connectivity scenarios. Moreover, motivated by the exchange of information over networks with finite-rate communication links, the effect of quantization on vehicle coordination is also analyzed

  9. Analysis of Early Postoperative Pain in the First and Second Knee in Staged Bilateral Total Knee Arthroplasty: A Retrospective Controlled Study

    PubMed Central

    Sun, Jiuyi; Li, Lintao; Yuan, Shuai; Zhou, Yiqin

    2015-01-01

    Objective A retrospective analysis of early postoperative pain in the first and second knee in staged bilateral total knee arthroplasty (TKA) to provide a clinical evidence for the change of analgesic strategy. Methods From January 2009 to January 2013, 87 cases which meet the inclusion criterion were retrospectively reviewed. In stage TKA, the postoperative pain in the first and second knee at 24h, 48h, 72h after operation were compared using the visual analogue scale (VAS) score in the rest and maximum knee flexion position. The difference in pain scores (ΔVAS) was also compared between the second and first knee at different time intervals (less than 6 months, 6-12 months, more than 12 months). Results The VAS scores in the second knee were significantly higher than those in the first knee at 24h, 48h after surgery, but with no difference at 72h. The ΔVAS in the group of less than 6 months was significantly higher than of those more than 6 months, and there was no difference in ΔVAS between group of 6-12 months and group of more than 12 months. Conclusions Patient receiving staged bilateral TKA experiences greater postoperative pain within 48h after operation in the second knee than in the first knee, which can provide a clinical evidence to enhance the analgesic strategy in the second operation of the staged bilateral TKA. And for the management of postoperative pain in staged bilateral TKA, it’s better to recommend that the interval between two operations should be more than 6 months, which may reduce the postoperative pain in the second knee, improve patient satisfaction, and speed up patient‘s rehabilitation process. PMID:26068371

  10. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up.

    PubMed

    Trouillas, Jacqueline; Roy, Pascal; Sturm, Nathalie; Dantony, Emmanuelle; Cortet-Rudelli, Christine; Viennet, Gabriel; Bonneville, Jean-François; Assaker, Richard; Auger, Carole; Brue, Thierry; Cornelius, Aurélie; Dufour, Henry; Jouanneau, Emmanuel; François, Patrick; Galland, Françoise; Mougel, François; Chapuis, François; Villeneuve, Laurent; Maurage, Claude-Alain; Figarella-Branger, Dominique; Raverot, Gérald; Barlier, A; Bernier, M; Bonnet, F; Borson-Chazot, F; Brassier, G; Caulet-Maugendre, S; Chabre, O; Chanson, P; Cottier, J F; Delemer, B; Delgrange, E; Di Tommaso, L; Eimer, S; Gaillard, S; Jan, M; Girard, J J; Lapras, V; Loiseau, H; Passagia, J G; Patey, M; Penfornis, A; Poirier, J Y; Perrin, G; Tabarin, A

    2013-07-01

    Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case-control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy. PMID:23400299

  11. Control of Legionella Contamination and Risk of Corrosion in Hospital Water Networks following Various Disinfection Procedures.

    PubMed

    Marchesi, Isabella; Ferranti, Greta; Mansi, Antonella; Marcelloni, Anna M; Proietto, Anna R; Saini, Navneet; Borella, Paola; Bargellini, Annalisa

    2016-05-15

    Physical and chemical disinfection methods have been proposed with the aim of controlling Legionella water contamination. To date, the most effective procedures for reducing bacterial contamination have not yet been defined. The aim of this study was to assess the long-term effectiveness of various disinfection procedures in order to reduce both culturable and nonculturable (NC) legionellae in different hospital water networks treated with heat, chlorine dioxide, monochloramine, and hydrogen peroxide. The temperature levels and biocide concentrations that proved to give reliable results were analyzed. In order to study the possible effects on the water pipes, we verified the extent of corrosion on experimental coupons after applying each method for 6 months. The percentage of positive points was at its lowest after treatment with monochloramine, followed by chlorine dioxide, hydrogen peroxide, and hyperthermia. Different selections of Legionella spp. were observed, as networks treated with chlorine-based disinfectants were contaminated mainly by Legionella pneumophila serogroup 1, hyperthermia was associated with serogroups 2 to 14, and hydrogen peroxide treatment was associated mainly with non-pneumophila species. NC cells were detected only in heat-treated waters, and also when the temperature was approximately 60°C. The corrosion rates of the coupons were within a satisfactory limit for water networks, but the morphologies differed. We confirm here that chemical disinfection controls Legionella colonization more effectively than hyperthermia does. Monochloramine was the most effective treatment, while hydrogen peroxide may be a promising alternative to chlorine-based disinfectants due to its ability to select for other, less virulent or nonpathogenic species. PMID:26969696

  12. An assistive control approach for a lower-limb exoskeleton to facilitate recovery of walking following stroke.

    PubMed

    Murray, Spencer A; Ha, Kevin H; Hartigan, Clare; Goldfarb, Michael

    2015-05-01

    This paper presents a control approach for a lower-limb exoskeleton intended to facilitate recovery of walking in individuals with lower-extremity hemiparesis after stroke. The authors hypothesize that such recovery is facilitated by allowing the patient rather than the exoskeleton to provide movement coordination. As such, an assistive controller that provides walking assistance without dictating the spatiotemporal nature of joint movement is described here. Following a description of the control laws and finite state structure of the controller, the authors present the results of an experimental implementation and preliminary validation of the control approach, in which the control architecture was implemented on a lower limb exoskeleton, and the exoskeleton implemented in an experimental protocol on three subjects with hemiparesis following stroke. In a series of sessions in which each patient used the exoskeleton, all patients showed substantial single-session improvements in all measured gait outcomes, presumably as a result of using the assistive controller and exoskeleton. PMID:25134084

  13. Effect of controlled adventitial heparin delivery on smooth muscle cell proliferation following endothelial injury.

    PubMed

    Edelman, E R; Adams, D H; Karnovsky, M J

    1990-05-01

    Continuous intravenous infusion of heparin suppresses smooth muscle cell proliferation in rats after endothelial injury but may lead to hemorrhage and other complications. The anticoagulant property has been removed from chemically modified heparin without loss of antiproliferative effect but use of such compounds is still limited. In this study ethylene-vinyl acetate copolymer matrices containing standard and modified heparin were placed adjacent to rat carotid arteries at the time of balloon dendothelialization. After 14 days arterial occlusion by smooth muscle cell proliferation was defined. Matrix delivery of both heparin compounds effectively diminished this proliferation in comparison to controls without producing systemic anticoagulation or side effects. In addition, this mode of therapy appeared more effective than the administration of the same agents by either intravenous pumps or heparin/polymer matrices placed in a subcutaneous site distant from the injured carotid artery. Thus, heparin's inhibition of smooth muscle cell proliferation after vascular injury might be most effective within the microenvironment of the injured vessel wall, and the accelerated atherosclerosis or restenosis that often follows angioplasty and other vascular interventions might best be treated with site-specific therapy. PMID:2339120

  14. Flurbiprofen 0.03% for the control of inflammation following cataract extraction by phacoemulsification.

    PubMed

    Blaydes, J E; Kelley, E P; Walt, J G; DeGryse, R E; Harper, D G; Novack, G D

    1993-07-01

    We conducted a double-masked, vehicle-controlled study to evaluate the anti-inflammatory effect of topical flurbiprofen in cataract surgery by phacoemulsification and implantation of a posterior chamber intraocular lens. The 233 patients were randomized to receive either flurbiprofen or vehicle immediately prior to and for two weeks following surgery. No concomitant corticosteroid use was allowed. The flurbiprofen group had significantly less anterior chamber cells and flare at day 7 and significantly less conjunctival erythema, corneal edema, and lid edema at day 14. The investigator's global effectiveness rating was higher in the flurbiprofen group at day 14. Blood-aqueous barrier disruption, as measured by aqueous fluorophotometry, was statistically significantly diminished in the flurbiprofen group. Burning and stinging were rated significantly greater in the flurbiprofen group than in the vehicle group. Foreign-body sensation and photophobia were significantly more severe in the vehicle group than in the flurbiprofen group. Flurbiprofen provided postsurgical anti-inflammatory efficacy in clinical signs of inflammation and in blood-aqueous barrier disruption, and also showed improved subjective signs. PMID:8355154

  15. Separations in steels subjected to controlled rolling, followed by accelerated cooling

    NASA Astrophysics Data System (ADS)

    Farber, V. M.; Khotinov, V. A.; Belikov, S. V.; Selivanova, O. V.; Lezhnin, N. V.; Morozova, A. N.; Karabonalov, M. S.; Zhilyakov, A. Yu.

    2016-04-01

    Zones on the fracture surfaces of Charpy specimens and profiles of the fractures of these specimens are examined using impact-bending tests carried out in the temperature range of +20 to-90°C and fractography. The specimens were cut out of hot-rolled plates produced from 05G2B super-low-carbon steels that contained Ti, Nb, V, and Cu microadditives using controlled rolling, followed by accelerated cooling. A detailed analysis of separations, including a study of the morphology, number, area of separations, and the surrounding stress-relaxation zones, and the structure of the walls, has allowed us to identify the mechanisms of the origination and growth of the separations. It has been found that the correlated changes in the length, width, and depth of the separations are accompanied by the formation and expansion of the stress-relaxation zones around the separations. The rate of expansion of the area of these zones is higher than that of the area of the separations, which favors the macroplastic fracture of the specimens.

  16. Costs of a limited patient notification exercise following infection control failures in a dental surgery.

    PubMed

    Conrad, D; Dardamissis, E; Oyinloye, A; Vivancos, R; Ratcliffe, P

    2011-08-01

    In February 2008, a primary care trust in Cheshire Merseyside was notified of failures in the infection control practises of a dentist working in a large group practice. On advice from national experts, a look-back was undertaken to identify any patients infected with hepatitis followed by a notification exercise of patients who had received invasive treatment immediately afterwards. One patient with hepatitis C (HCV) was identified. Sixty patients were notified by letter and offered advice and HCV screening. The total cost of the patient notification exercise (PNE) was estimated at £85,936, equating to £1,562.47 per patient who responded to the notification (55), or £2,455.31 per patient screened (35). All results were negative. While this adds to evidence that the risk to patients in such incidents is small, failing to investigate the possibility that BBV transmission has occurred would carry public health, reputational and legal risks. Conducting a PNE in the first instance for those patients at highest risk, with the option of extending it if evidence of patient-to-patient transmission is found, ensures that the total costs of dealing appropriately with such incidents - while still substantial - are at least kept to a minimum. PMID:21869792

  17. Retrospective Birth Dating of Cells

    SciTech Connect

    L.Spalding, K; Bhardwaj, R D; Buchholz, B A; Druid, H; Frisen, J

    2005-04-19

    The generation of cells in the human body has been difficult to study and our understanding of cell turnover is limited. Extensive testing of nuclear weapons resulted in a dramatic global increase in the levels of the isotope {sup 14}C in the atmosphere, followed by an exponential decrease after the test ban treaty in 1963. We show that the level of {sup 14}C in genomic DNA closely parallels atmospheric levels, and can be used to establish the time point when the DNA was synthesized and cells were born. We use this strategy to determine the age of cells in the cortex of the adult human brain, and show that whereas non-neuronal cells are exchanged, occipital neurons are as old as the individual, supporting the view that postnatal neurogenesis does not take place in this region. Retrospective birth dating is a generally applicable strategy that can be used to measure cell turnover in man under physiological and pathological conditions.

  18. Determinants of death among tuberculosis patients in a semi urban diagnostic and treatment centre of Bafoussam, West Cameroon: a retrospective case-control study

    PubMed Central

    Djouma, Fabrice Nembot; Noubom, Michel; Ngomba, Armelle Viviane; Donfack, Hubert; Kouomboua, Patrick Stéphane Mfin; Saah, Michael Amede Fopa

    2015-01-01

    Introduction Tuberculosis (TB) remains a worldwide public health problem with 8.6 millions of new cases and 1.3 millions of death annually. Despite the progress recorded in fighting against this disease in the recent years, Africa is still not on the track to achieve the objective to reduce by half the death rate due to this disease by 2015. Methods A case-control study was conducted on data of patients admitted for tuberculosis between 1996 and 2011 in the Diagnostic and Treatment Center of Baleng. Cases were patients who died from any cause during anti tuberculosis treatment. Logistic regression model was used to identify factors associated to death. Results In 4201 patients treated during the study period, 3245 (77.24%) were included in the study. The mean age was 35.9 (SD 14.2) and male represent 62.2% (CI 60.6- 63.9) of them. At the end of the follow up, 2883 patients were successfully treated, 362 died during treatment and 132 (36.5%) deaths occurred during the first two months of TB treatment. HIV positive status, Extra-pulmonary TB, sputum smear-negative pulmonary TB and male sex were significant independent risk factors of death with adjusted odds ratio of 4.8 (CI 3.2- 7.4); 3.0 (CI 1.6- 5.4); 2.7 (CI 1.7- 4.4) and 1.5 (CI 1.0- 2.3) respectively. Conclusion The mortality rate of TB patients undergoing TB treatment remains high. Studies are needed to identify and test efficient interventions of mortality reduction among TB patients in resource limiting settings. PMID:26958116

  19. Worsening anatomic outcomes following aflibercept for neovascular age-related macular degeneration in eyes previously well controlled with ranibizumab

    PubMed Central

    Nudleman, Eric; Wolfe, Jeremy D; Woodward, Maria A; Yonekawa, Yoshihiro; Williams, George A; Hassan, Tarek S

    2016-01-01

    Purpose Antivascular endothelial growth factor injection is the mainstay of treating neovascular age-related macular degeneration (AMD). Previous studies have shown that switching treatment from ranibizumab to aflibercept led to an improvement in eyes with recalcitrant activity. Herein, we identify a unique subset of patients whose eyes with neovascular AMD were previously well controlled with ranibizumab injections were then worsened after being switched to aflibercept. Methods This is a retrospective interventional case series. Eyes with neovascular AMD, previously well controlled with monthly injections of ranibizumab, which then developed worsening of subretinal fluid after being switched to aflibercept were included. Results A total of 17 eyes were included. All eyes developed increased subretinal fluid when switched from ranibizumab to aflibercept. Fourteen patients were switched back to ranibizumab after a single injection of aflibercept and had subsequent rapid resolution of subretinal fluid. Three patients continued with monthly aflibercept injections for two subsequent months and demonstrated the persistence of the increased subretinal fluid until they were switched back to treatment with ranibizumab at which time the fluid resolved. No eye had persistent decline in visual acuity. Conclusion Switching from intravitreal ranibizumab to aflibercept in eyes with well-controlled neovascular AMD may result in worsening in a subset of patients and resolves when therapy is switched back to ranibizumab. PMID:27354759

  20. Effect of luteal-phase support on endometrial microRNA expression following controlled ovarian stimulation

    PubMed Central

    2012-01-01

    Background Studies suggested that microRNAs influence cellular activities in the uterus including cell differentiation and embryo implantation. In assisted reproduction cycles, luteal phase support, given to improve endometrial characteristics and to facilitate the implantation process, has been a standard practice. The effect of different types of luteal phase support using steroid hormones in relation to endometrial miRNA profiles during the peri-implantation period has not seen described. This study was designed to evaluate the expression of miRNAs during the luteal phase following controlled ovarian stimulation for IVF and the influence of different luteal phase support protocols on miRNA profiles. Methods The study was approved by the Johns Hopkins Hospital Institutional Review Board. Endometrial biopsies were obtained on the day of oocyte retrieval from 9 oocyte donors (group I). An additional endometrial biopsy was obtained 3–5 days later (Group II) after the donors were randomized into three groups. Group IIa had no luteal-phase support, group IIb had luteal support with micronized progesterone (P), and Group IIc had luteal support with progesterone plus 17-beta-estradiol (P + E). Total RNA was isolated and microarray analysis was performed using an Illumina miRNA expression panel. Results A total of 526 miRNAs were identified. Out of those, 216 miRNAs were differentially regulated (p < 0.05) between the comparison groups. As compared to the day of retrieval, 19, 11 and 6 miRNAs were differentially regulated more than 2 fold in the groups of no support, in the P support only, and in the P + E support respectively, 3–5 days after retrieval. During the peri-implantation period (3–5 days after retrieval) the expression of 33 and 6 miRNAs increased, while the expression of 3 and 0 miRNAs decreased, in the P alone and in the P + E group respectively as compared to the no steroid supplementation group. Conclusion Luteal support

  1. Incorporation of methamphetamine and amphetamine in human hair following controlled oral methamphetamine administration

    PubMed Central

    Polettini, Aldo; Cone, Edward J.; Gorelick, David A.; Huestis, Marilyn A.

    2012-01-01

    Background Although hair testing is well established for the assessment of past drug exposure, uncertainties persist about mechanisms of drug incorporation into hair and interpretation of results. The aim of this study was to administer methamphetamine (MAMP) under controlled conditions as a model drug to investigate drug incorporation into human hair. Material and Methods Seven volunteers with a history of stimulant use received 4×10 mg (low) doses of sustained release S-(+)-MAMP HCl within one week, with weekly head hair samples collected by shaving. 3 weeks later, 4 of them received 4×20 mg (high) doses. After extensive isopropanol/phosphate buffer washing of the hair, MAMP and its metabolite amphetamine (AMP) concentrations were determined in all weekly hair samples by LC-MS-MS in selected reaction monitoring mode with the undeca- and deca-deuterated drugs, respectively, as internal standards (LLOQ, 0.005 ng/mg). Results MAMP Tmax occurred from 1 to 2 weeks after both doses, with Cmax ranging from 0.6–3.5 ng/mg after the low and 1.2–5.3 ng/mg after the high MAMP doses. AMP Cmax in hair was 0.1–0.3 ng/mg and 0.2–0.5 ng/mg, respectively, for low and high doses. Highly dose–related concentrations within subjects, but large variability between subjects were observed. MAMP concentrations were above the 0.2 ng/mg cutoff for at least two weeks following administration of both low and high doses. The overall AMP/MAMP ratio ranged from 0.07 to 0.37 with a mean value of 0.15±0.07, and a median of 0.13. The percentage of MAMP and AMP removed with the washing procedure decreased with time after administration. A strong correlation was found between area under the curve of MAMP (r2=0.90, p=0.00) and AMP (r2=0.94, p=0.00) concentrations calculated for the 3-week period following administration and the total melanin concentration in hair. Significant correlations were observed also between Cmax and melanin. Conclusions This study demonstrated that despite large

  2. PC-based pseudo-model following discrete integral variable structure control of positions in slider-crank mechanisms

    NASA Astrophysics Data System (ADS)

    Chuang, Chin-Wen

    2007-04-01

    This paper proposes a pseudo-model following (PMF) discrete integral variable structure control (DIVSC) scheme to control the position of a slider crank coupled with a pseudo-model (PM) synchronous motor. Applying the Grey modeling method, the reference model and plant are on-line converted to pseudo-reference model and accumulated model, respectively. The advantage is that the least data and memory are used in this modeling procedure. The DIVSC is introduced to guide the model following motion. The integral controller is used to reduce the steady-state error. The switching controller is used to finish the sliding motion. The two existing condition of the discrete sliding mode are introduced in this paper, too. Finally, the position control of the slider crank is used to show the performance of the proposed control scheme. The simulation and experimental results show the robustness and the practicability.

  3. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial

    PubMed Central

    Bleidorn, Jutta; Hummers-Pradier, Eva; Schmiemann, Guido; Wiese, Birgitt; Gágyor, Ildikó

    2016-01-01

    Background: Uncomplicated urinary tract infections (UTI) are common in general practice, and are usually treated with antibiotics. Recurrent UTI often pose a serious problem for affected women. Little is known about recurrent UTI and complications when uncomplicated UTI are treated without antibiotics. With ICUTI (Immediate vs. conditional antibiotic use in uncomplicated UTI, funded by BMBF No. 01KG1105) we assessed whether initial symptomatic treatment with ibuprofen could be a treatment alternative for uncomplicated UTI. The presented analysis aims to assess the influence of initial (non-)antibiotic treatment on recurrent UTI rates and pyelonephritis after day 28 up to 6 months after trial participation. Methods: This study is a retrospective long-term follow-up analysis of ICUTI patients, surveyed telephonically six months after inclusion in the trial. Recurrent UTI, pyelonephritis or hospitalizations were documented. Statistical evaluation was performed by descriptive and multivariate analyses with SPSS 21. Results: For the six months follow-up survey, 386 trial participants could be contacted (494 had been included in ICUTI initially, 446 had completed the trial). From day 28 until 6 months after inclusion in ICUTI, 84 recurrent UTI were reported by 80 patients. Univariate and multivariate analyses showed no effect of initial treatment group or antibiotic treatment on number of patients with recurrent UTI. Yet, both analyses showed that patients with a history of previous UTI had significantly more often recurrent UTI. Pyelonephritis occurred in two patients of the antibiotic group and in one patient in the non-antibiotic group. Conclusion: This follow-up analysis of a trial comparing antibiotic vs. symptomatic treatment for uncomplicated UTI showed that non-antibiotic treatment has no negative impact on recurrent UTI rates or pyelonephritis after day 28 and up to six months after initial treatment. Thus, a four week follow-up in UTI trials seems adequate

  4. Controls upon microbial accessibility to soil organic matter following woody plant encroachment into grasslands

    NASA Astrophysics Data System (ADS)

    Creamer, C. A.; Boutton, T. W.; Filley, T. R.

    2009-12-01

    Woody plant encroachment (WPE) into savannas and grasslands is a global phenomenon that alters soil organic matter (SOM) dynamics through changes in litter quality and quantity, soil structure, microbial ecology, and soil hydrology. To elucidate the controls upon microbial accessibility to SOM, bulk soils from a chronosequence of progressive WPE into native grasslands at the Texas A&M Agricultural Experimental Station La Copita Research Area were incubated for one year. The quantity and stable carbon isotope composition of respired CO2, plant biopolymer chemistry in SOM, and microbial community structure were tracked. Respiration rates declined steadily over the course of the experiment with 15-25% of the total CO2 respired released in the first month of incubation. Between 8 and 18% of the total carbon was mineralized to CO2 throughout the incubation. After day 84 a significantly (p < 0.05) greater portion of carbon was mineralized from soils of older woody clusters (34-86 years) than from soils of younger clusters (14-23 years) and the native grassland. Approximately 80% of patterns seen in cumulative CO2 loss could be explained by the proportions of macro- and micro-aggregates within each soil, suggesting soil structure is a major controlling factor of respiration rates. Despite documented carbon accrual within La Copita soils due to WPE, we observed no evidence of enhanced carbon stabilization in these respiration experiments. In fact, a greater proportion of total carbon was lost from the soil of mature woody stands than from young stands, suggesting carbon accumulation observed with WPE may be due to greater input rates or microbial dynamics not captured in the laboratory incubation. A cluster approximately 34 years in age represents a transition point in WPE where respiration dynamics become distinct between grassland and wooded elements. By day 84 of the incubation CO2 respired from all soils was depleted with respect to bulk SOM (1.5 to 5‰) and this

  5. Morphine and codeine concentrations in human urine following controlled poppy seeds administration of known opiate content.

    PubMed

    Smith, Michael L; Nichols, Daniel C; Underwood, Paula; Fuller, Zachary; Moser, Matthew A; LoDico, Charles; Gorelick, David A; Newmeyer, Matthew N; Concheiro, Marta; Huestis, Marilyn A

    2014-08-01

    Opiates are an important component for drug testing due to their high abuse potential. Proper urine opiate interpretation includes ruling out poppy seed ingestion; however, detailed elimination studies after controlled poppy seed administration with known morphine and codeine doses are not available. Therefore, we investigated urine opiate pharmacokinetics after controlled oral administration of uncooked poppy seeds with known morphine and codeine content. Participants were administered two 45 g oral poppy seed doses 8 h apart, each containing 15.7 mg morphine and 3mg codeine. Urine was collected ad libitum up to 32 h after the first dose. Specimens were analyzed with the Roche Opiates II immunoassay at 2000 and 300 μg/L cutoffs, and the ThermoFisher CEDIA(®) heroin metabolite (6-acetylmorphine, 6-AM) and Lin-Zhi 6-AM immunoassays with 10 μg/L cutoffs to determine if poppy seed ingestion could produce positive results in these heroin marker assays. In addition, all specimens were quantified for morphine and codeine by GC/MS. Participants (N=22) provided 391 urine specimens over 32 h following dosing; 26.6% and 83.4% were positive for morphine at 2000 and 300 μg/L GC/MS cutoffs, respectively. For the 19 subjects who completed the study, morphine concentrations ranged from <300 to 7522 μg/L with a median peak concentration of 5239 μg/L. The median first morphine-positive urine sample at 2000 μg/L cutoff concentration occurred at 6.6 h (1.2-12.1), with the last positive from 2.6 to 18 h after the second dose. No specimens were positive for codeine at a cutoff concentration of 2000 μg/L, but 20.2% exceeded 300 μg/L, with peak concentrations of 658 μg/L (284-1540). The Roche Opiates II immunoassay had efficiencies greater than 96% for the 2000 and 300 μg/L cutoffs. The CEDIA 6-AM immunoassay had a specificity of 91%, while the Lin-Zhi assay had no false positive results. These data provide valuable information for interpreting urine opiate results. PMID

  6. Conventional vs. Tablet Computer-Based Patient Education following Lung Transplantation – A Randomized Controlled Trial

    PubMed Central

    Suhling, Hendrik; Rademacher, Jessica; Zinowsky, Imke; Fuge, Jan; Greer, Mark; Warnecke, Gregor; Smits, Jacqueline M.; Bertram, Anna; Haverich, Axel; Welte, Tobias; Gottlieb, Jens

    2014-01-01

    Background Accurate immunosuppression is of critical importance in preventing rejection, while avoiding toxicity following lung transplantation. The mainstay immunosuppressants are calcineurin inhibitors, which require regular monitoring due to interactions with other medications and diet. Adherence to immunosuppression and patient knowledge is vital and can be improved through patient education. Education using tablet-computers was investigated. Objective To compare tablet-PC education and conventional education in improving immunosuppression trough levels in target range 6 months after a single education. Secondary parameters were ratio of immunosuppression level measurements divided by per protocol recommended measurements, time and patient satisfaction regarding education. Design Single-centre, open labelled randomised controlled trial. Participants Patients >6 months after lung-transplantation with <50% of calcineurin inhibitor trough levels in target range. Intervention Tablet-pc education versus personal, nurse-led education. Measurements Calcineurin inhibitor levels in target range 6 months after education, level variability, interval adherence, knowledge and adherence was studied. As outcome parameter, renal function was measured and adverse events registered. Results Sixty-four patients were 1:1 randomised for either intervention. Levels of immunosuppression 6 months after education were equal (tablet-PC 58% vs. conventional 48%, p = 0.27), both groups improved in achieving a CNI trough level within target range by either education method (delta tablet-PC 29% vs. conventional 20%). In all patients, level variability decreased (−20.4%), whereas interval adherence remained unchanged. Knowledge about immunosuppression improved by 7% and compliance tests demonstrated universal improvements with no significant difference between groups. Conclusion Education is a simple, effective tool in improving adherence to immunosuppression. Tablet-PC education was

  7. Targeted metabolomics of Gammarus pulex following controlled exposures to selected pharmaceuticals in water.

    PubMed

    Gómez-Canela, Cristian; Miller, Thomas H; Bury, Nicolas R; Tauler, Romà; Barron, Leon P

    2016-08-15

    The effects of pharmaceuticals and personal care products (PPCPs) on aquatic organisms represent a significant current concern. Herein, a targeted metabolomics approach using liquid chromatography-high resolution mass spectrometry (LC-HRMS) is presented to characterise concentration changes in 29 selected metabolites following exposures of aquatic invertebrates, Gammarus pulex, to pharmaceuticals. Method performance revealed excellent linearity (R(2)>0.99), precision (0.1-19%) and lower instrumental limits of detection (0.002-0.20ng) for all metabolites studied. Three pharmaceuticals were selected representing the low, middle and high range of measured acute measured toxicities (of a total of 26 compounds). Gammarids were exposed to both the no-observed-adverse-effect-level (NOAEL) and the lowest-observed-adverse-effect-level (LOAEL) of triclosan (0.1 and 0.3mgL(-1)), nimesulide (0.5 and 1.4mgL(-1)) and propranolol (100 and 153mgL(-1)) over 24h. Quantitative metabolite profiling was then performed. Significant changes in metabolite concentrations relative to controls are presented and display distinct clustered trends for each pharmaceutical. Approximately 37% (triclosan), 33% (nimesulide) and 46% (propranolol) of metabolites showed statistically significant time-related effects. Observed changes are also discussed with respect to internal concentrations of the three pharmaceuticals measured using a method based on pulverised liquid extraction, solid phase extraction and LC-MS/MS. Potential metabolic pathways that may be affected by such exposures are also discussed. This represents the first study focussing on quantitative, targeted metabolomics of this lower trophic level benthic invertebrate that may elucidate biomarkers for future risk assessment. PMID:27110989

  8. Trastuzumab improves locoregional control in HER2-positive breast cancer patients following adjuvant radiotherapy

    PubMed Central

    Cao, Lu; Cai, Gang; Xu, Fei; Yang, Zhao-Zhi; Yu, Xiao-Li; Ma, Jin-Li; Zhang, Qian; Wu, Jiong; Guo, Xiao-Mao; Chen, Jia-Yi

    2016-01-01

    Abstract The benefit of adjuvant trastuzumab in disease-free and overall survival for human epidermal receptor 2–positive (HER2+) breast cancer patients is well established. However, the effect of trastuzumab on locoregional control remains unclear, particularly in patients treated with adjuvant radiotherapy (RT). In this study, we investigated the locoregional benefit of trastuzumab in patients with HER2+ breast cancer after adjuvant RT. Using a single institutional database, we identified 278 patients with stage II/III invasive HER2+ breast tumors receiving adjuvant RT between January 2008 and July 2011. We compared the locoregional outcomes of 134 patients who received trastuzumab to 144 patients without trastuzumab within the same period. Clinical and biological factors that might impact on the locoregional benefit of trastuzumab were also assessed. At the median follow-up of 45 months, trastuzumab significantly lowered the risk of locoregional recurrence (LRR) with a 3-year LRR rate of 2.4% versus 7.5% for the cohort with and without trastuzumab (P = 0.019). Trastuzumab was associated with a more significant locoregional benefit in the hormone receptor–positive (HR+)/HER2+ subgroup, with a 3-year LRR of 0% versus 6.7% in the cohort with and without trastuzumab (P = 0.027). For HR−/HER2+ breast tumor patients, the 3-year LRR rate was still lower for the cohort with trastuzumab (4.7% vs 8.6%). However, statistical significance was not found (P = 0.179). Both univariate and multivariate analyses confirmed that trastuzumab treatment was the only significant predictive factor for LRR (hazard ratio, 4.05; 95% confidence interval, 1.07–15.35; P = 0.039). Adjuvant trastuzumab in addition to RT is associated with significant reduced LRR risk in HER2+ breast cancer. PMID:27512838

  9. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  10. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  11. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  12. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  13. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  14. Retrospective Proteomic Analysis of Cellular Immune Responses and Protective Correlates of p24 Vaccination in an HIV Elite Controller Using Antibody Arrays

    PubMed Central

    Perera, Suneth S.; Wang, Bin; Damian, Arturo; Dyer, Wayne; Zhou, Li; Conceicao, Viviane; Saksena, Nitin K.

    2016-01-01

    Background: HIV p24 is an extracellular HIV antigen involved in viral replication. Falling p24 antibody responses are associated with clinical disease progression and their preservation with non-progressive disease. Stimulation of p24 antibody production by immunization to delay progression was the basis of discontinued p24 vaccine. We studied a therapy-naive HIV+ man from Sydney, Australia, infected in 1988. He received the HIV-p24-virus like particle (VLP) vaccine in 1993, and continues to show vigorous p24 antigen responses (>4% p24-specific CD4+ T cells), coupled with undetectable plasma viremia. We defined immune-protective correlates of p24 vaccination at the proteomic level through parallel retrospective analysis of cellular immune responses to p24 antigen in CD4+ and CD8+ T cells and CD14+ monocytes at viremic and aviremic phases using antibody-array. We found statistically significant coordinated up-regulation by all three cell-types with high fold-changes in fractalkine, ITAC, IGFBP-2, and MIP-1α in the aviremic phase. TECK and TRAIL-R4 were down-regulated in the viremic phase and up-regulated in the aviremic phase. The up-regulation of fractalkine in all three cell-types coincided with protective effect, whereas the dysfunction in anti-apoptotic chemokines with the loss of immune function. This study highlights the fact that induction of HIV-1-specific helper cells together with coordinated cellular immune response (p < 0.001) might be important in immunotherapeutic interventions and HIV vaccine development. PMID:27600080

  15. Out-of-Hospital Hypertonic Resuscitation Following Severe Traumatic Brain Injury: A Randomized Controlled Trial

    PubMed Central

    Bulger, Eileen M.; May, Susanne; Brasel, Karen J.; Schreiber, Martin; Kerby, Jeffrey D.; Tisherman, Samuel A.; Newgard, Craig; Slutsky, Arthur; Coimbra, Raul; Emerson, Scott; Minei, Joseph P.; Bardarson, Berit; Kudenchuk, Peter; Baker, Andrew; Christenson, Jim; Idris, Ahamed; Davis, Daniel; Fabian, Timothy C.; Aufderheide, Tom P.; Callaway, Clifton; Williams, Carolyn; Banek, Jane; Vaillancourt, Christian; van Heest, Rardi; Sopko, George; Hata, J. Steven; Hoyt, David B.

    2010-01-01

    Context Hypertonic fluids restore cerebral perfusion with reduced cerebral edema and modulate inflammatory response to reduce subsequent neuronal injury and thus have potential benefit in resuscitation of patients with traumatic brain injury (TBI). Objective To determine whether out-of-hospital administration of hypertonic fluids improves neurologic outcome following severe TBI. Design, Setting, and Participants Multicenter, double-blind, randomized, placebo-controlled clinical trial involving 114 North American emergency medical services agencies within the Resuscitation Outcomes Consortium, conducted between May 2006 and May 2009 among patients 15 years or older with blunt trauma and a prehospital Glasgow Coma Scale score of 8 or less who did not meet criteria for hypovolemic shock. Planned enrollment was 2122 patients. Intervention A single 250-mL bolus of 7.5% saline/6% dextran 70 (hypertonic saline/dextran), 7.5% saline (hypertonic saline), or 0.9% saline (normal saline) initiated in the out-of-hospital setting. Main Outcome Measure Six-month neurologic outcome based on the Extended Glasgow Outcome Scale (GOSE) (dichotomized as >4 or ≤4). Results The study was terminated by the data and safety monitoring board after randomization of 1331 patients, having met prespecified futility criteria. Among the 1282 patients enrolled, 6-month outcomes data were available for 1087 (85%). Baseline characteristics of the groups were equivalent. There was no difference in 6-month neurologic outcome among groups with regard to proportions of patients with severe TBI (GOSE ≤4) (hypertonic saline/dextran vs normal saline: 53.7% vs 51.5%; difference, 2.2% [95% CI, −4.5% to 9.0%]; hypertonic saline vs normal saline: 54.3% vs 51.5%; difference, 2.9% [95% CI, −4.0% to 9.7%]; P=.67). There were no statistically significant differences in distribution of GOSE category or Disability Rating Score by treatment group. Survival at 28 days was 74.3% with hypertonic saline

  16. Follow-up study of chrysotile asbestos textile workers: cohort mortality and case-control analyses.

    PubMed

    Dement, J M; Brown, D P; Okun, A

    1994-10-01

    Previous studies of mortality among white males employed in a Charleston, South Carolina asbestos textile plant using chrysotile demonstrated significant excess mortality due to asbestos-related disease and a steep exposure-response relationship for lung cancer. This cohort was further studied by adding 15 years of follow-up and including mortality among white female and black male workers. Nested case-control analyses were undertaken to further explore possible differences in lung cancer risk by textile operation as well as possible confounding by mineral oil exposures. Preliminary data for white males have been previously published. White males experienced statistically significant excess mortality due to lung cancer (standardized mortality ratio [SMR] = 2.30; confidence interval [CI] = 1.88-2.79), all causes (SMR = 1.48; CI = 1.38-158), all cancers (SMR = 1.50; CI = 1.29-1.72), diabetes mellitus (SMR = 2.05; CI = 1.18-3.33), heart disease (SMR = 1.41; CI = 1.26-1.58), cerebrovascular disease (SMR = 1.50; CI = 1.08-2.02), pneumoconiosis and other respiratory diseases (SMR = 4.10; CI = 3.10-5.31), and accidents (SMR = 1.49; CI = 1.15-1.91). Among white females, statistically significant excesses occurred for lung cancer (SMR = 2.75; CI = 2.06-3.61), all causes (SMR = 1.21; CI = 1.11-1.32), pneumoconiosis and other respiratory diseases (SMR = 2.40; CI = 1.53-3.60), and other respiratory cancers (SMR = 14.98; CI = 4.08-38.7). Among the total cohort of black males, the only statistically significant excess observed was for pneumoconiosis (SMR = 2.19; CI = 1.23-3.62). Based on historical exposure measurements at the plant, there was a positive exposure-response relationship for both lung cancer and pneumoconiosis. Data for the entire cohort demonstrate an increase in the lung cancer relative risk of 2-3% for each fiber/cc-year of cumulative chrysotile exposure. This relationship was more consistent for the white male workers. The excess risk for lung cancer among

  17. Electron Paramagnetic Resonance Retrospective Dosimetry

    SciTech Connect

    Romanyukha, Alex; Trompier, Francois

    2011-05-05

    Necessity for, principles of, and general concepts of the electron paramagnetic resonance (EPR) retrospective dosimetry are presented. Also presented and given in details are examples of EPR retrospective dosimetry applications in tooth enamel, bone, and fingernails with focus on general approaches for solving technical and methodological problems. Advantages, drawbacks, and possible future developments are discussed and an extensive bibliography on EPR retrospective dosimetry is provided.

  18. Dose-related distribution of codeine, cocaine, and metabolites into human hair following controlled oral codeine and subcutaneous cocaine administration.

    PubMed

    Scheidweiler, Karl B; Cone, Edward J; Moolchan, Eric T; Huestis, Marilyn A

    2005-05-01

    Hair testing for the determination of drug exposure has many useful applications. Drug incorporated into hair can be found for extended periods following drug exposure. There are few controlled drug administration studies investigating drug distribution into human hair. Ten volunteers participated in a 10-week controlled cocaine and codeine administration study while residing in the secure research ward. Weekly hair samples were collected by electric razor. During the low-dose week (week 4), volunteers received 75 mg/70 kg cocaine subcutaneously and 60 mg/70 kg codeine orally on alternating days, a total of three doses for each drug. Similarly, during week 7, volunteers received three doses 150 mg/70 kg cocaine and 120 mg/70 kg codeine. Maximum hair concentrations (C(max)) were found 1 to 3 weeks after low and high doses. Dose-related C(max) values of cocaine, benzoylecgonine, ecgonine methyl ester, norcocaine, cocaethylene, and codeine were found following low and high doses. Hair analysis was performed using liquid chromatography tandem mass spectrometry. A positive linear relationship was found between total melanin content of hair and C(max) of codeine, cocaine, and metabolites following high dosing. This study demonstrated dose-related concentrations of cocaine and metabolites in human hair following controlled cocaine administration. These data are the first demonstrating melanin-related incorporation of cocaine and metabolites into human hair following controlled cocaine administration. PMID:15743923

  19. The Efficacy of Percutaneous Transhepatic Gallbladder Drainage on Acute Cholecystitis in High-Risk Elderly Patients Based on the Tokyo Guidelines: A Retrospective Case-Control Study.

    PubMed

    Ni, Qingqiang; Chen, Dongbo; Xu, Rui; Shang, Dong

    2015-08-01

    To evaluate the efficacy of percutaneous transhepatic gallbladder drainage (PTGD) for high-risk elderly patients with acute cholecystitis.Retrospective analysis of 159 acute cholecystitis patients who were admitted to General Surgery Division III of the First Affiliated Hospital of Dalian Medical University between January 2005 and November 2012. A total of 123 patients underwent laparoscopic cholecystectomy (LC), and 36 received only PTGD treatment. The LC patients were divided into 3 groups based on their preoperative treatment: group A, emergency patients (33 patients); group B (26 patients), patients who were treated with PTGD prior to LC; and group C (64 patients), patients who received nonsurgical treatment prior to LC. General conditions, LC surgery duration, intraoperative blood loss, rate of conversion to open surgery, incidence of postoperative complications, total fasting time, and total hospitalization time were analyzed and compared among the 3 groups.The remission rates of patients in the PTGD treatment groups (including group B and PTGD treatment only group) were significantly higher within 24 and 48 hours than those of patients who received nonsurgical treatment prior to LC (P < 0.05). Among the patients in the 3 surgery groups, the operation conversion rate (19.2%) of group B was significantly higher than that of group A (3.0%) and group C (1.6%) (P < 0.05). The total hospitalization time of the patients in group B (18.5 ± 4.5 days) was longer than that of the patients in group A (8.2 ± 3.9 days) and group C (10.5 ± 6.4 days). The total fasting time of the patients in group A (2.4 ± 1.2 days) was significantly shorter than that of those in group B (4.1 ± 1.7 days) and group C (3.4 ± 2.7 days) (P < 0.05).For high-risk elderly patients, if there is any emergency surgery contraindication, PTGD therapy may be safe and effective and can relieve the symptoms within a short time. For acute cholecystitis patients

  20. Timescales and controls on phosphorus loss from a grassland hillslope following a cessation in P application.

    NASA Astrophysics Data System (ADS)

    Cassidy, Rachel; Doody, Donnacha; Watson, Catherine

    2016-04-01

    Despite the implementation of EU regulations controlling the use of fertilisers in agriculture, reserves of phosphorus (P) in soils continue to pose a threat to water quality. Mobilisation and transport of legacy P from soil to surface waters has been highlighted as a probable cause of many water bodies continuing to fail to achieve targets under the Water Framework Directive. However, the rates and quantities lost from farmland, and the timescales for positive change to water quality, following cessation of P inputs, remain poorly understood. Monitoring data from an instrumented grassland research site in Northern Ireland provide some insights. The site is located in a hydrologically 'flashy' landscape characterised by steep gradients and poorly drained soils over impermeable bedrock. Between 2000 and 2005 soil Olsen P concentrations were altered in five 0.2 ha hydrologically isolated grazed grassland plots through chemical fertiliser applications of 0, 10, 20, 40, 80 kg P ha‑1yr‑1. By 2004 this had resulted in soil Olsen P concentrations of 19, 24, 28, 38 and 67 mg P L‑1 across the plots, after which applications ceased. Subsequently, until 2012, changes in soil Olsen P across the plots and losses to overland flow and drainage were monitored, with near-continuous flow measurement and water samples abstracted for chemical analysis. Runoff events were sampled at 20 minute intervals while drainage flows were taken as a weekly composite of 4-hourly samples. Overland flow events were defined by at least 24 hours without flow being recorded at the respective plot outlets. Drainage flow was examined on a weekly basis as it was continuous except during prolonged dry periods. To examine the hydrological drivers of overland flow and drainage losses the dissolved reactive P (DRP) and total P (TP) time series were synchronised with rainfall data and modelled soil moisture deficits. Results demonstrated that from 2005-2012 there was no significant difference among plots

  1. Controls on microbial accessibility to soil organic carbon following woody plant encroachment into grasslands

    NASA Astrophysics Data System (ADS)

    Creamer, Courtney; Boutton, Thomas; Olk, Dan; Filley, Timothy

    2010-05-01

    Woody plant encroachment (WPE) into savannas and grasslands is a global phenomenon that alters soil organic carbon (SOC) dynamics through changes in litter quality and quantity, soil structure, microbial ecology, and hydrology. To elucidate the controls on microbial accessibility to SOC, bulk soils from a chronosequence of progressive WPE into native grasslands at the Texas Agrilife La Copita Research Area were incubated for one year. The quantity and stable carbon isotope composition of respired CO2, and plant biopolymer chemistry in SOC were tracked. Respiration rates declined exponentially over the course of the experiment with 15-25% of the total CO2 respired released in the first month of incubation. Between 8 and 18% of the total SOC was mineralized to CO2 throughout the incubation. After day 84 a significantly (p<0.05) greater portion of SOC was mineralized from soils of older woody clusters (34-86 years) than from soils of younger woody clusters (14-23 years) and the native grassland. Invading woody stands of ≃≥35 years of age represent a transition point in WPE where respiration dynamics become distinct in wooded elements compared to grasslands; this distinction has been previously observed through changes in belowground SOC accrual, C input chemistry, and mycorrhizal productivity. Despite documented SOC accrual following WPE at La Copita, we observed no evidence of enhanced SOC stabilization in these respiration experiments. In fact, a greater proportion of total SOC was lost from the soil of mature woody stands than from young stands, suggesting SOC accumulation observed with WPE may be due to greater input rates or microbial dynamics not captured in the laboratory incubation. Compound-specific analyses indicated there was a significant (p<0.05) loss of C from carbohydrates, amino acids, and amino sugars during the incubation. Amino nitrogen tended to become more concentrated during the incubation, although the trend was not significant. Relatively

  2. Study of the application of an implicit model-following flight controller to lift-fan VTOL aircraft

    NASA Technical Reports Server (NTRS)

    Merrick, V. K.

    1977-01-01

    An implicit model-following flight controller is proposed. This controller is relatively simple in concept: it provides an input/output relationship that is approximately that of any selected second order system; it provides good gust alleviation; and it is self-trimming. The flight controller was applied to all axes of a comprehensive mathematical model of a lift-fan V/STOL transport. Power management controls and displays were designed to match the various modes of control provided by the flight controller. A piloted simulation was performed using a six degree of freedom simulator. The fixed-operating-point handling qualities throughout the powered lift flight envelope received pilot ratings of 3-1/2 or better. Approaches and vertical landings in IFR zero-zero conditions received pilot ratings varying from 2-1/2 to 4 depending on the type of approach and weather conditions.

  3. Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

    PubMed Central

    Tang, Shangfeng; Bishwajit, Ghose; Ji, Lu; Feng, Da; Fang, Haiqing; Fu, Hang; Shao, Tian; Shao, Piaopiao; Liu, Chunyan; Feng, Zhanchun; Luba, Tegene R.

    2016-01-01

    Abstract Proactive attitude of hypertensive patients seeking follow-up services (FUS) lies at the core of self-efficacy. However, few evidence have shown the activeness of seeking FUS in the context of blood pressure control among hypertensive patients. Improvements in follow-up visits may not just by services itself cause better control of blood pressure among hypertensive patients, rather due to the patient's pro-active attitude of the patient in seeking FUS. A cross-sectional study was carried out in selected rural regions of China to explore the association between blood pressure control and sociodemographic and economic variables and activeness of hypertensive patients in seeking FUS. The primary clinical outcome for this study was blood pressure control (systolic blood pressure <140 mmHg or diastolic blood pressure <90 mmHg) Out of the total 2321 participants with hypertension aged 35 years or older participated in this survey. Number of proactive FUS seekers were 3.17 times greater than those of passive seekers (odds ratio [OR] = 3.17, 95% confidence interval [CI] = 2.56–3.93, P < 0.001). In all subgroups, hypertensive patients who were seeking FUS actively were more likely to control blood pressure better than those seeking FUS passively. Proactive attitude of seeking follow-up services can improve blood pressure control among hypertensive patients. PMID:27057859

  4. Integrated orbital servicing study follow-on. Volume 3: Engineering test unit and controls

    NASA Technical Reports Server (NTRS)

    1978-01-01

    A one-g servicing demonstration system which can be used to investigate and develop, in a real time hands-on situation, a wide variety of the mechanism and control system aspects of orbital servicing in the form of module exchange is described including the engineering test unit and the servicer servo drive console. A series of recommendations for future work is given concerning the control problem and more efficient module exchanges, mechanical elements, and electronics.

  5. Retrospective CMORPH Reprocessing Efforts

    NASA Astrophysics Data System (ADS)

    Yarosh, Y.; Joyce, R.; Xie, P.

    2008-05-01

    constellation, there is enough to retrospectively reprocess CMORPH well beyond the current archive start. Also IR based PMW calibrated rainfall estimates will be calculated as part of the retrospective reprocessing. These estimates will be blended for times and locations that the PMW information is too old for relative accuracy. This blended method (CMORPH-IR) combines the CMORPH and IR based estimates via an error model developed by running test CMORPH processing, albeit withholding random high quality PMW estimates, and determining the error/skill of the CMORPH relative to the IR-based rainfall as a function of season, surface type, region, and age of PMW information in half hourly increments from PMW scan time. The retrospective processing will be performed for Year 2002 and proceed backward. Detailed results will be reported at the meeting.

  6. Psychological Vulnerability in Children Next-Born after Stillbirth: A Case-Control Follow-Up Study

    ERIC Educational Resources Information Center

    Turton, Penelope; Badenhorst, William; Pawlby, Susan; White, Sarah; Hughes, Patricia

    2009-01-01

    Background: Case studies and anecdotal accounts suggest that perinatal loss may impact upon other children in the family, including those born subsequent to loss. However, there is a dearth of systematically collected quantitative data on this potentially vulnerable group. Methods: Case-controlled follow-up of 52 mothers with history of stillbirth…

  7. Self-Control in the Treatment of Gilles de la Tourette's Syndrome: Case Study with 18-Month Follow-Up.

    ERIC Educational Resources Information Center

    Friedman, Steven

    1980-01-01

    The client was taught to gradually substitute nonobscene phrases whenever she felt the urge to vocalize an obscenity. The rate of coprolalia quickly diminished. The client was taught relaxation and positive imagery as self-control techniques. Follow-up indicated maintenance of therapeutic gains. (Author)

  8. HORMONAL CONTROL OF OVARIAN FUNCTION FOLLOWING CHLOROTRIAZINE EXPOSURE: EFFECT ON REPRODUCTIVE FUNCTION AND MAMMARY GLAND TUMOR DEVELOPMENT

    EPA Science Inventory

    Hormonal Control of Ovarian Function Following Chlorotriazine Exposure: Effect on Reproductive Function and Mammary Gland Tumor Development.

    Ralph L. Cooper, Susan C. Laws, Michael G. Narotsky, Jerome M. Goldman, and Tammy E. Stoker

    Abstract
    The studies review...

  9. [Surgical treatment of iatrogenic bile duct injuries following laparoscopic cholecystectomy: analysis of long-term results. Retrospective clinical study in 51 patients operated in the Campania region from 1991 to 2003].

    PubMed

    Conzo, Giovanni; Amato, Giuseppe; Angrisani, Luigi; Bardi, Ugo; Barone, Giovanni; Belli, Giulio; Brancaccio, Umberto; Calise, Fulvio; Caliendo, Angelo; Celsi, Salvatore; Corcione, Francesco; Cuccurullo, Diego; De Falco, Giuseppe; Delrio, Paolo; De Werra, Carlo; De Sena, Guido; Docimo, Giovanni; Esposito, Maria Grazia; Fantini, Corrado; Giardiello, Cristiano; Musella, Mario; Molino, Carlo; Muto, Crescenzo; Pennetti, Lucio; Puziello, Alessandro; Porcelli, Alberto; Rea, Roberto; Rendano, Franco; Palazzo, Antonietta; Santangelo, Michele; Santaniello, Walter; Santini, Luigi; Sperlongano, Pasquale; Stanzione, Francesco; Tartaglia, Alberto; Tricarico, Annunziato; Vincenti, Rodolfo; Lorenzo, Michele

    2005-01-01

    An higher incidence rate of iatrogenic bile duct injuries is reported in cholecystectomy performed with the laparoscopy than with the laparotomy approach. The aim of this study was to provide a multicentre report on surgical treatment and the outcome of biliary complications during and following laparoscopic cholecystectomy. A questionnaire was mailed to all surgeons with experience in laparoscopic cholecystectomy in the Campania region. Data were collected from January 1991 to December 2003. Each patient was requested to indicate age, gender, associated diseases, site and type of lesion, surgical experience, diagnosis, treatment and complications. Twenty-six surgeons answered the questionnaire. Fifty-one patients (36 F/15 M; mean age: 42.5 +/- 11.9, range 13-91 years) with bile duct injuries following laparoscopic cholecystectomy were reported. The most frequent lesions were main bile duct partial or total transection. The intraoperative mortality rate was 1/51 (1.9%) due to a complex biliary and vascular injury. The postoperative mortality rate of revision surgery was 5/50 (10%). T-tube positioning (n = 20) and Roux-en-Y hepato-jejunostomy (n = 20) were the procedures most frequently performed. The complication rate in patients treated with the T-tube was significantly higher than in those treated with hepatico-jejunostomy. Surgical treatment of biliary injuries following laparoscopic cholecystectomy was characterized by unusually high mortality and morbidity for a non-neoplastic disease. Roux-en-Y hepato-jejunostomy remains the procedure of choice for these injuries. PMID:16060179

  10. Restoration of grasp following paralysis through brain-controlled stimulation of muscles.

    PubMed

    Ethier, C; Oby, E R; Bauman, M J; Miller, L E

    2012-05-17

    Patients with spinal cord injury lack the connections between brain and spinal cord circuits that are essential for voluntary movement. Clinical systems that achieve muscle contraction through functional electrical stimulation (FES) have proven to be effective in allowing patients with tetraplegia to regain control of hand movements and to achieve a greater measure of independence in daily activities. In existing clinical systems, the patient uses residual proximal limb movements to trigger pre-programmed stimulation that causes the paralysed muscles to contract, allowing use of one or two basic grasps. Instead, we have developed an FES system in primates that is controlled by recordings made from microelectrodes permanently implanted in the brain. We simulated some of the effects of the paralysis caused by C5 or C6 spinal cord injury by injecting rhesus monkeys with a local anaesthetic to block the median and ulnar nerves at the elbow. Then, using recordings from approximately 100 neurons in the motor cortex, we predicted the intended activity of several of the paralysed muscles, and used these predictions to control the intensity of stimulation of the same muscles. This process essentially bypassed the spinal cord, restoring to the monkeys voluntary control of their paralysed muscles. This achievement is a major advance towards similar restoration of hand function in human patients through brain-controlled FES. We anticipate that in human patients, this neuroprosthesis would allow much more flexible and dexterous use of the hand than is possible with existing FES systems. PMID:22522928

  11. Restoration of grasp following paralysis through brain-controlled stimulation of muscles

    PubMed Central

    Ethier, C.; Oby, E.R.; Bauman, M.J.; Miller, L.E.

    2012-01-01

    Patients with spinal cord injury lack the connections between brain and spinal cord circuits essential for voluntary movement. Clinical systems that achieve muscle contraction through functional electrical stimulation (FES) have proven to be effective in allowing patients with tetraplegia to regain control of hand movement and to achieve a greater measure of independence in activities of daily living 1,2. In typical systems, the patient uses residual proximal limb movements to trigger pre-programmed stimulation that causes the paralyzed muscles to contract, allowing use of one or two basic grasps. Instead, we have developed, in primates, an FES system that is controlled by recordings made from microelectrodes permanently implanted in the brain. We simulated some of the effects of the paralysis caused by C5-C6 spinal cord injury 3 by injecting a local anesthetic to block the median and ulnar nerves at the elbow. Then, using recordings from approximately 100 neurons in the motor cortex, we predicted the intended activity of several of the paralyzed muscles, and used these predictions to control the intensity of stimulation of the same muscles. This process essentially bypassed the spinal cord, restoring to the monkeys voluntary control of their paralyzed muscles. This achievement represents a major advance toward similar restoration of hand function in human patients through brain-controlled FES. We anticipate that in human patients, this neuroprosthesis would allow much more flexible and dexterous use of the hand than is possible with existing FES systems. PMID:22522928

  12. Controlled five-year follow-up study of laser trabeculoplasty as primary therapy for open-angle glaucoma

    SciTech Connect

    Tuulonen, A.; Niva, A.K.; Alanko, H.I.

    1987-10-15

    We followed up 32 eyes of 32 patients with early glaucoma (22 with capsular glaucoma and ten with simple glaucoma) who received laser trabeculoplasty as a primary therapy. These eyes were compared with a matched control group of 32 eyes treated with medication initially. The success rate (intraocular pressure below 22 mm Hg with laser alone or medication alone) at five years was 50% (16 of 32 eyes) in the laser-treated group and 22% (seven of 32 eyes) in the control group (P less than .02). The control group required more modifications of their therapy to control intraocular pressure. The neuroretinal rim area in the control eyes decreased 2.5 times as much as in the laser group (P = .017). Changes in the Friedmann visual fields did not differ significantly between the two groups.

  13. Effect of Dosimetric Factors on Occurrence and Volume of Temporal Lobe Necrosis Following Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma: A Case-Control Study

    SciTech Connect

    Zhou, Xin; Ou, Xiaomin; Xu, Tingting; Wang, Xiaosheng; Shen, Chunying; Ding, Jianhui; Hu, Chaosu

    2014-10-01

    Purpose: To determine dosimetric risk factors for the occurrence of temporal lobe necrosis (TLN) among nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiation therapy (IMRT) and to investigate the impact of dose-volume histogram (DVH) parameters on the volume of TLN lesions (V-N). Methods and Materials: Forty-three NPC patients who had developed TLN following IMRT and 43 control subjects free of TLN were retrospectively assessed. DVH parameters included maximum dose (Dmax), minimum dose (Dmin), mean dose (Dmean), absolute volumes receiving specific dose (Vds) from 20 to 76 Gy (V20-V76), and doses covering certain volumes (Dvs) from 0.25 to 6.0 cm{sup 3} (D0.25-D6.0). V-Ns were quantified with axial magnetic resonance images. Results: DVH parameters were ubiquitously higher in temporal lobes with necrosis than in healthy temporal lobes. Increased Vds and Dvs were significantly associated with higher risk of TLN occurrence (P<.05). In particular, Vds at a dose of ≥70 Gy were found with the highest odds ratios. A common increasing trend was detected between V-N and DVH parameters through trend tests (P for trend of <.05). Linear regression analysis showed that V45 had the strongest predictive power for V-N (adjusted R{sup 2} = 0.305, P<.0001). V45 of <15.1 cm{sup 3} was relatively safe as the dose constraint for preventing large TLN lesions with V-N of >5 cm{sup 3}. Conclusions: Dosimetric parameters are significantly associated with TLN occurrence and the extent of temporal lobe injury. To better manage TLN, it would be important to avoid both focal high dose and moderate dose delivered to a large area in TLs.

  14. Decentralized Control of Centipede-like Multi-legged Robots with Passive Intersegment Joints Based on Follow-the-Contact-Point Gait Control

    NASA Astrophysics Data System (ADS)

    Inagaki, Shinkichi; Niwa, Tomoya; Suzuki, Tatsuya

    This paper proposes a novel locomotion control, called Follow-the-Contact-Point (FCP) gait control, for a centipede-like multi-legged robot. The centipede-like multi-legged robot is composed by connecting segments, which have a trunk and a pair of legs, via a passive joint. This control method is motivated from behavioral knowledge of a centipede that each leg always contacts on the point which the anterior leg contacted. The FCP gait control realizes the walking behavior of centipede via decentralized event-driven control structure. In addition, merely by planning and allocating the contact point of legs of a head segment adequately, the robot can change the moving direction and also climb over an obstacle. We clarify the feasibility of the FCP gait control by showing the result of physical simulation of a 20-legged robot.

  15. Undesirable Consequences of Insecticide Resistance following Aedes aegypti Control Activities Due to a Dengue Outbreak

    PubMed Central

    Maciel-de-Freitas, Rafael; Avendanho, Fernando Campos; Santos, Rosangela; Sylvestre, Gabriel; Araújo, Simone Costa; Lima, José Bento Pereira; Martins, Ademir Jesus; Coelho, Giovanini Evelim; Valle, Denise

    2014-01-01

    Background During a dengue outbreak with co-circulation of DENV-1 and -2 in the city of Boa Vista, one patient was diagnosed with DENV-4, a serotype supposed absent from Brazil for almost 30 years. The re-emergence of DENV-4 triggered the intensification of mechanical and chemical Aedes aegypti control activities in order to reduce vector density and avoid DENV-4 dissemination throughout the country. Methods/Principal Findings Vector control activities consisted of (a) source reduction, (b) application of diflubenzuron against larvae and (c) vehicle-mounted space spraying of 2% deltamethrin to eliminate adults. Control activity efficacy was monitored by comparing the infestation levels and the number of eggs collected in ovitraps before and after interventions, performed in 22 Boa Vista districts, covering an area of ∼80% of the city and encompassing 56,837 dwellings. A total of 94,325 containers were eliminated or treated with diflubenzuron. The most frequently positive containers were small miscellaneous receptacles, which corresponded to 59% of all positive breeding sites. Insecticide resistance to deltamethrin was assessed before, during and after interventions by dose-response bioassays adopting WHO-based protocols. The intense use of the pyrethroid increased fourfold the resistance ratio of the local Ae. aegypti population only six months after the beginning of vector control. Curiously, this trend was also observed in the districts in which no deltamethrin was applied by the public health services. On the other hand, changes in the resistance ratio to the organophosphate temephos seemed less influenced by insecticide in Boa Vista. Conclusions Despite the intense effort, mosquito infestation levels were only slightly reduced. Besides, the median number of eggs in ovitraps remained unaltered after control activity intensification. The great and rapid increase in pyrethroid resistance levels of natural Ae. aegypti populations is discussed in the context of

  16. Microfracture in the hip: a matched-control study with average 3-year follow-up

    PubMed Central

    Lodhia, Parth; Gui, Chengcheng; Chandrasekaran, Sivashankar; Suarez-Ahedo, Carlos; Vemula, S. Pavan; Domb, Benjamin G.

    2015-01-01

    There is a paucity of literature regarding microfracture surgery in the hip. The purpose of this study was to compare outcomes in patients undergoing hip arthroscopy predominantly for labral tears with focal full thickness chondral damage on the acetabulum or femoral head treated with microfracture and a matched control group that did not have focal full thickness chondral damage. A prospective matched-control study was performed examining four patient-reported outcome (PRO) scores: modified Harris Hip Score (mHHS), non-arthritic hip score, Hip Outcome Score—Activities of Daily Living (HOS-ADL), and Hip Outcome Score—Sports Specific Subscale (HOS-SSS) at minimum 2 years post-operatively between 35 patients undergoing microfracture for chondral defects during hip arthroscopy and 70 patients in a control group that did not have chondral defects. The patients were matched based on gender, age within 7 years, Workman’s compensation claim, labral treatment and acetabular crossover percentage less than or greater than 20. There was no significant difference (P > 0.05) in PRO scores preoperatively between the groups. Both groups demonstrated significant improvement (P < 0.05) in all post-operative PRO scores at all time points. There was no statistically significant difference (P > 0.05) in post-operative PRO scores between the microfracture and control groups, except for HOS-ADL and the visual analog scale (VAS) score, both of which were superior in the control group (P < 0.05). Patient satisfaction was 6.9 for the microfracture group and 7.7 for the control group (P > 0.05). Arthroscopic microfracture of the hip during treatment of labral tears results in favorable outcomes that are similar to the results arthroscopic treatment of labral tears in patients without full thickness chondral damage. PMID:27011867

  17. The use of a subfascial vicryl mesh buttress to aid in the closure of massive ventral hernias following damage-control laparotomy.

    PubMed

    Tobias, Adam M; Low, David W

    2003-09-01

    Damage control laparotomy for life-threatening abdominal conditions has gained wide acceptance in the management of exsanguinating trauma patients as well as septic patients with acute abdomen. Survivors considered too ill to undergo definitive abdominal wall closure are temporized, often with skin grafting on granulated viscera. These maneuvers compromise the integrity of the anterior abdominal wall and result in a subset of patients with loss of abdominal domain and massive, debilitating ventral hernias. A retrospective review was conducted of 21 such patients (16 men, five women) who underwent elective abdominal wall reconstruction at the Hospital of the University of Pennsylvania between November of 1998 and October of 2000. The purpose of this study was to report the authors' experience with these complex abdominal wall reconstructions. A double-layer, subfascial Vicryl mesh buttress was used in all repairs to aid in reestablishing abdominal wall integrity. The mean hernia size was 813 cm2 (range, 75 to 1836 cm2), and the average interval to definitive repair was 24.4 months (range, 3 weeks to 11 years). Mean follow-up was 13.5 months (range, 1 month to 40 months). Twenty patients (95 percent) had successful ventral hernia repair. Four patients with massive hernias (924 to 1836 cm2) required submuscular Marlex mesh implantation. Two patients (10 percent) developed abdominal compartment syndrome that required surgical decompression. One patient (5 percent) developed an incisional hernia at a prior colostomy site. Four patients (19 percent) had superficial skin dehiscence that healed secondarily with daily wound care. There were no mesh infections. In most cases, successful single-stage repair of large ventral hernias following damage control laparotomy can be achieved using a subfascial Vicryl mesh buttress in combination with other established reconstructive techniques. Massive defects exceeding 900 cm2 typically require permanent mesh implantation to achieve

  18. M-matrix strategies for pinning-controlled leader-following consensus in multiagent systems with nonlinear dynamics.

    PubMed

    Song, Qiang; Liu, Fang; Cao, Jinde; Yu, Wenwu

    2013-12-01

    This paper considers the leader-following consensus problem for multiagent systems with inherent nonlinear dynamics. Some M-matrix strategies are developed to address several challenging issues in the pinning control of multiagent systems by using algebraic graph theory and the properties of nonnegative matrices. It is shown that second-order leader-following consensus in a nonlinear multiagent system can be reached if the virtual leader has a directed path to every follower and a derived quantity is greater than a positive threshold. In particular, this paper analytically proves that leader-following consensus may be easier to be achieved by pinning more agents or increasing the pinning feedback gains. A selective pinning scheme is then proposed for nonlinear multiagent systems with directed network topologies. Numerical results are given to verify the theoretical analysis. PMID:24273144

  19. COMPRESSION SOCKS AND FUNCTIONAL RECOVERY FOLLOWING MARATHON RUNNING: A RANDOMISED CONTROLLED TRIAL.

    PubMed

    Armstrong, Stuart A; Till, Eloise S; Maloney, Stephen; Harris, Gregory

    2014-09-01

    Compression socks have become a popular recovery aid for distance running athletes. Although some physiological markers have been shown to be influenced by wearing these garments, scant evidence exists on their effects on functional recovery. This research aims to shed light onto whether the wearing of compression socks for 48 hours after marathon running can improve functional recovery, as measured by a timed treadmill test to exhaustion 14 days following marathon running.Athletes (n=33, age = 38.5 ±7.2yrs) participating in the 2012 Melbourne, 2013 Canberra or 2013 Gold Coast marathons were recruited and randomised into the compression sock or placebo group. A graded treadmill test to exhaustion was performed 2 weeks prior and 2 weeks following each marathon. Time to exhaustion, average and maximum heart rates were recorded. Participants were asked to wear their socks for 48 hours immediately after completion of the marathon. The change in treadmill times (seconds) was recorded for each participant.33 participants completed the treadmill protocols. In the compression group average treadmill run to exhaustion time 2 weeks following the marathon increased by 2.6% (52s ±103s). In the placebo group run to exhaustion time decreased by 3.4% (-62s ±130s). P=0.009. This shows a significant beneficial effect of compression socks on recovery compared to placebo.The wearing of below knee compression socks for 48 hours after marathon running has been shown to improve functional recovery as measured by a graduated treadmill test to exhaustion 2 weeks following the event. PMID:25187242

  20. The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture: A retrospective case-control study.

    PubMed

    Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

    2016-08-01

    The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate. PMID:27537579

  1. Executive Inhibitory Control and Cooperative Behavior during Early School Years: A Follow-Up Study

    ERIC Educational Resources Information Center

    Ciairano, Silvia; Visu-Petra, Laura; Settanni, Michele

    2007-01-01

    Several links between aspects of executive functioning and the development of social competence have been established. The present study investigates the relation between executive inhibitory control and cooperative/non-cooperative behavior, in an ecological setting, and from a longitudinal perspective. Elementary school children (n = 195) of…

  2. Five-Year Blood Pressure Control and Mortality Following Health Education for Hypertensive Patients.

    ERIC Educational Resources Information Center

    Morisky, Donald E.; And Others

    1983-01-01

    Three health education interventions for urban poor hypertensive patients were introduced in a randomized factorial design. Two-year data on compliance with therapy and five-year mortality data indicate the success of such educational programs in the long-term management and control of high blood pressure. (Author/GC)

  3. Insect control and walnut quality following large-scale industrial radio frequency treatments

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Industrial-scale radio frequency (RF) treatments producing a minimum temperature of 52°C for 5 min were developed to control insect pests in in-shell walnuts. RF treatments for both unwashed and air dried walnuts resulted in 100% mortality of fifth-instar navel orangeworm larvae, the most heat toler...

  4. Locus of Control and School Adjustment Following the Loss of a Parent.

    ERIC Educational Resources Information Center

    Enos, Thomas A.; Hartman, Bruce W.

    This study investigates whether students experiencing difficulty adapting to parental loss also feel they have little or no control over life events; whether an inability to adapt to the stress of parental loss surfaces as a school adjustment problem; and whether these relationships are stronger for students losing a parent through death than…

  5. Motion of the two-control airplane in rectilinear flight after initial disturbances with introduction of controls following an exponential law

    NASA Technical Reports Server (NTRS)

    Klemin, Alexander

    1937-01-01

    An airplane in steady rectilinear flight was assumed to experience an initial disturbance in rolling or yawing velocity. The equations of motion were solved to see if it was possible to hasten recovery of a stable airplane or to secure recovery of an unstable airplane by the application of a single lateral control following an exponential law. The sample computations indicate that, for initial disturbances complex in character, it would be difficult to secure correlation with any type of exponential control. The possibility is visualized that the two-control operation may seriously impair the ability to hasten recovery or counteract instability.

  6. Paroxetine Controlled Release for Premenstrual Dysphoric Disorder: Remission Analysis Following a Randomized, Double-Blind, Placebo-Controlled Trial

    PubMed Central

    Pearlstein, Teri B.; Bellew, Kevin M.; Endicott, Jean; Steiner, Meir

    2005-01-01

    Objective: To compare the efficacy and safety of paroxetine controlled release (CR) (12.5 mg/day or 25 mg/day) versus placebo in premenstrual dysphoric disorder (PMDD). Method: A double-blind, randomized, placebo-controlled trial was conducted over 3 menstrual cycles in women aged 18–45 years with confirmed DSM-IV PMDD in 47 outpatient centers across the United States and Canada from November 1999 to January 2002. The primary efficacy measure was the visual analog scale (VAS)-Mood, which is the mean of 4 core symptoms: irritability, tension, depressed mood, and affective lability. Results: A statistically significant difference was observed in favor of paroxetine CR 25 mg versus placebo on the VAS-Mood (adjusted mean difference = −12.58 mm, 95% CI = −18.40 to −6.76; p < .001) and for paroxetine CR 12.5 mg versus placebo (adjusted mean difference = −7.51 mm, 95% CI = −13.40 to −1.62; p = .013). Paroxetine CR was generally well tolerated. Conclusion: Paroxetine CR doses of 12.5 mg/day and 25 mg/day are effective in treating PMDD and are well tolerated. PMID:15841196

  7. Retrospective estimation of exposure to benzene in a leukaemia case-control study of petroleum marketing and distribution workers in the United Kingdom.

    PubMed Central

    Lewis, S J; Bell, G M; Cordingley, N; Pearlman, E D; Rushton, L

    1997-01-01

    OBJECTIVE: To provide quantitative estimates of exposure to benzene for cases and controls in an epidemiology study to investigate the risk of leukaemia in petroleum distribution workers. METHODS: Work histories were obtained for cases and controls together with detailed information on the distribution sites. For each job in the work history, an estimate of exposure (parts per million (ppm)) was obtained by multiplying a measure derived from exposure data by modifying factors to reflect the differences between the conditions that existed at the time of measurement and those at the time of interest. The modifying factors used related to job activity, the number of road tankers loaded, the benzene content of the gasoline, the mixture of products handled, temperature, and loading technology. Cumulative exposures for each case and control were obtained by multiplying the exposure estimates for each job by the duration of time in the respective jobs, and summing these over all jobs in the work history. Peak exposure and exposure through dermal contact were quantitatively classified for each job. RESULTS: Measured exposures were obtained for 30 job categories, and ranged from 0.003 to 8.20 ppm. 40% of work histories were assigned background exposures, with a further 34% assigned the exposure estimate for a driver carrying out top submerged loading of motor fuel into road tankers. Cumulative exposures ranged from < 1 to > 200 ppm-years, although 81% were < 5 ppm-years. Comparison of the exposure estimates for selected jobs with data from sources not used in the study showed similar results. CONCLUSION: The estimates of exposure to benzene in this study provide a sound basis for the epidemiological analyses. PMID:9155777

  8. Oral Bisphosphonates and Upper Gastrointestinal Cancer Risks in Asians with Osteoporosis: A Nested Case-Control Study Using National Retrospective Cohort Sample Data from Korea

    PubMed Central

    Park, Eun-Ja; Suh, Hae Sun; Park, Ji-Won; Kwon, Jin-Won

    2016-01-01

    Background Bisphosphonate can irritate the gastrointestinal mucosa and increase the risk of esophageal or gastric cancer. The relatively high prevalence of upper gastrointestinal cancers and the widespread use of bisphosphonate in Korea call for further investigation. We conducted a case-control study to evaluate the risk of esophageal or gastric cancer after exposure to oral bisphosphonates in Korean patients with osteoporosis. Methods We used the National Health Insurance Service-National Sample Cohort database of Korea from 2002 to 2013. Among osteoporotic patients (>40 years), cases were defined as incident diagnosis of esophageal or gastric cancer between 2006 and 2013. For each case, four controls were matched for age, sex, and income level by type of insurance. We categorized bisphosphonate use as non-user, recent user, past user, and past and recent user, depending on prescription in two periods (1 to 2 years and 2 to 4 years prior to the index date). We also assessed the duration of bisphosphonate use by measuring cumulative duration of exposure (CDE). To examine the association between oral bisphosphonates and esophageal or gastric cancer, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using conditional logistic regression analysis, adjusting for concomitant diseases. Results A total of 1,708 cases and 6,832 controls were identified. The aORs (95% CIs) of recent, past, and continuous bisphosphonate use compared to non-users were 1.18 (0.93–1.51), 1.04 (0.83–1.29), and 1.25 (0.95–1.58)), respectively. In addition, no significant association was observed by CDE, even when different outcome definitions were applied. Conclusions This study did not prove an increased risk of esophageal or gastric cancer risk associated with bisphosphonate use, with respect to both risk windows and duration of exposure, in an Asian population-based, real-world setting. PMID:26937968

  9. Carbon monoxide exposures from propane-powered floor burnishers following addition of emissions controls

    SciTech Connect

    Demer, F.R.

    1998-11-01

    Previous published work by this author suggests that propane-powered floor burnisher use represents a potentially serious health hazard from carbon monoxide exposures, particularly for susceptible individuals. This earlier study was repeated using burnishers retrofitted with emission controls consisting of self-aspirating catalytic mufflers and computerized air/fuel monitors and alarms. Real-time carbon monoxide detectors with data-logging capabilities were placed on the burnishers in the breathing zones of operators during burnisher use. Carbon monoxide levels were recorded every 30 seconds. Ventilation and physical characteristics of the spaces of burnisher use were characterized, as were burnisher maintenance practices. Thirteen burnishing events were monitored under conditions comparable to previously published monitoring. All carbon monoxide exposures were well below even the most conservative recommended limits from the American Conference of Governmental Industrial Hygienists. Potential failures of the emission controls were also identified and included air filter blockage, spark plug malfunction, and faulty alarm function design.

  10. Cognitive-affective neural plasticity following active-controlled mindfulness intervention

    PubMed Central

    Allen, Micah; Dietz, Martin; Blair, Karina S.; van Beek, Martijn; Rees, Geraint; Vestergaard-Poulsen, Peter; Lutz, Antoine; Roepstorff, Andreas

    2015-01-01

    Mindfulness meditation is a set of attention-based, regulatory and self-inquiry training regimes. Although the impact of mindfulness meditation training (MT) on self-regulation is well established, the neural mechanisms supporting such plasticity are poorly understood. MT is thought to act on attention through interoceptive salience and attentional control mechanisms, but until now conflicting evidence from behavioral and neural measures has made it difficult to distinguish the role of these mechanisms. To resolve this question we conducted a fully randomized 6-week longitudinal trial of MT, explicitly controlling for cognitive and treatment effects with an active control group. We measured behavioral metacognition and whole-brain Blood Oxygenation Level Dependent (BOLD) signals using functional MRI during an affective Stroop task before and after intervention. Although both groups improved significantly on a response-inhibition task, only the MT group showed reduced affective Stroop conflict. Moreover, the MT group displayed greater dorsolateral prefrontal cortex (DLPFC) responses during executive processing, consistent with increased recruitment of top-down mechanisms to resolve conflict. In contrast, we did not observe overall group by time interactions on negative affect-related RTs or BOLD responses. However, only participants with the greatest amount of MT practice showed improvements in response-inhibition and increased recruitment of dorsal anterior cingulate cortex (dACC), medial prefrontal cortex (mPFC), and right anterior insula during negative valence processing. Collectively our findings highlight the importance of active control in MT research, and indicate unique neural mechanisms for progressive stages of mindfulness training. PMID:23115195

  11. Beep tones attenuate pain following Pavlovian conditioning of an endogenous pain control mechanism.

    PubMed

    Scheuren, Raymonde; Anton, Fernand; Erpelding, Nathalie; Michaux, Gilles

    2014-01-01

    Heterotopic noxious counter-stimulation (HNCS) is commonly used to study endogenous pain control systems. The resulting pain inhibition is primarily based on spinal cord-brainstem loops. Recently, functional imaging studies have shown that limbic structures like the anterior cingulate cortex and amygdala are also implicated. Since these structures are involved in learning processes, it is possible that the HNCS-induced pain inhibition may depend on specific cues from the environment that have been associated with pain reduction through associative learning. We investigated the influence of Pavlovian conditioning on HNCS-induced pain inhibition in 32 healthy subjects by using a differential conditioning paradigm in which two different acoustic stimuli were either repeatedly paired or unpaired with HNCS. Series of noxious electrical pulse trains delivered to the non-dominant foot served as test stimuli. Diffuse noxious inhibitory control (DNIC)-like effects were induced by concurrent application of tonic HNCS (immersion of the contralateral hand in ice water). Subjective pain intensity and pain unpleasantness ratings and electromyographic recordings of the facial corrugator muscle and the nocifensive RIII flexion reflex were used to measure changes in pain sensitivity. HNCS induced significant pain and reflex inhibitions. In the post-conditioning phase, only the paired auditory cue was able to significantly reduce pain perceptions and corrugator muscle activity. No conditioned effect could be observed in RIII reflex responses. Our results indicate that the functional state of endogenous pain control systems may depend on associative learning processes that, like in the present study, may lead to an attenuation of pain perception. Similar albeit opposite conditioning of pain control mechanisms may significantly be involved in the exacerbation and chronification of pain states. PMID:24551138

  12. Beep Tones Attenuate Pain following Pavlovian Conditioning of an Endogenous Pain Control Mechanism

    PubMed Central

    Scheuren, Raymonde; Anton, Fernand; Erpelding, Nathalie; Michaux, Gilles

    2014-01-01

    Heterotopic noxious counter-stimulation (HNCS) is commonly used to study endogenous pain control systems. The resulting pain inhibition is primarily based on spinal cord-brainstem loops. Recently, functional imaging studies have shown that limbic structures like the anterior cingulate cortex and amygdala are also implicated. Since these structures are involved in learning processes, it is possible that the HNCS-induced pain inhibition may depend on specific cues from the environment that have been associated with pain reduction through associative learning. We investigated the influence of Pavlovian conditioning on HNCS-induced pain inhibition in 32 healthy subjects by using a differential conditioning paradigm in which two different acoustic stimuli were either repeatedly paired or unpaired with HNCS. Series of noxious electrical pulse trains delivered to the non-dominant foot served as test stimuli. Diffuse noxious inhibitory control (DNIC)-like effects were induced by concurrent application of tonic HNCS (immersion of the contralateral hand in ice water). Subjective pain intensity and pain unpleasantness ratings and electromyographic recordings of the facial corrugator muscle and the nocifensive RIII flexion reflex were used to measure changes in pain sensitivity. HNCS induced significant pain and reflex inhibitions. In the post-conditioning phase, only the paired auditory cue was able to significantly reduce pain perceptions and corrugator muscle activity. No conditioned effect could be observed in RIII reflex responses. Our results indicate that the functional state of endogenous pain control systems may depend on associative learning processes that, like in the present study, may lead to an attenuation of pain perception. Similar albeit opposite conditioning of pain control mechanisms may significantly be involved in the exacerbation and chronification of pain states. PMID:24551138

  13. Oxidation and hydration of U3O8 materials following controlled exposure to temperature and humidity.

    PubMed

    Tamasi, Alison L; Boland, Kevin S; Czerwinski, Kenneth; Ellis, Jason K; Kozimor, Stosh A; Martin, Richard L; Pugmire, Alison L; Reilly, Dallas; Scott, Brian L; Sutton, Andrew D; Wagner, Gregory L; Walensky, Justin R; Wilkerson, Marianne P

    2015-04-21

    Chemical signatures correlated with uranium oxide processing are of interest to forensic science for inferring sample provenance. Identification of temporal changes in chemical structures of process uranium materials as a function of controlled temperatures and relative humidities may provide additional information regarding sample history. In this study, a high-purity α-U3O8 sample and three other uranium oxide samples synthesized from reaction routes used in nuclear conversion processes were stored under controlled conditions over 2-3.5 years, and powder X-ray diffraction analysis and X-ray absorption spectroscopy were employed to characterize chemical speciation. Signatures measured from the α-U3O8 sample indicated that the material oxidized and hydrated after storage under high humidity conditions over time. Impurities, such as uranyl fluoride or schoepites, were initially detectable in the other uranium oxide samples. After storage under controlled conditions, the analyses of the samples revealed oxidation over time, although the signature of the uranyl fluoride impurity diminished. The presence of schoepite phases in older uranium oxide material is likely indicative of storage under high humidity and should be taken into account for assessing sample history. The absence of a signature from a chemical impurity, such as uranyl fluoride hydrate, in an older material may not preclude its presence at the initial time of production. LA-UR-15-21495. PMID:25786096

  14. Viability of platelets following storage in the irradiated state. A pair-controlled study

    SciTech Connect

    Read, E.J.; Kodis, C.; Carter, C.S.; Leitman, S.F.

    1988-09-01

    Gamma irradiation of blood products is a standard practice recommended for the prevention of posttransfusion graft-versus-host disease in susceptible hosts. We studied the effects of irradiation on stored platelet concentrates and evaluated whether platelets could be stored for 5 days in the irradiated state without adverse effects on their viability. Using a pair-controlled design in which each of six normal subjects acted as his or her own control, we compared in vitro storage characteristics and in vivo kinetics of platelet concentrates exposed to 30 Gy and stored for 5 days with those of platelet concentrates simply stored for 5 days without irradiation. Irradiation had no significant effects on in vitro storage characteristics (platelet count, mean platelet volume, pH, and white cell count) or on in vivo kinetics, including initial recovery and mean platelet survival. Using the multiple-hit model, initial recovery was 49.6 +/- 10.8 percent, and mean platelet survival was 5.6 +/- 1.05 days for irradiated concentrates, compared with 51.3 +/- 13.0 percent and 5.9 +/- 0.50 days, respectively, for the unirradiated control concentrates. We conclude that irradiation of platelet concentrates with up to 30 Gy has no effect on their in vivo recovery or survival, and that irradiation administered before storage of platelet concentrates does not interfere with their clinical efficacy.

  15. Concordance of Text Message Ecological Momentary Assessment and Retrospective Survey Data Among Substance-Using Men Who Have Sex With Men: A Secondary Analysis of a Randomized Controlled Trial

    PubMed Central

    Hern, Jaclyn; DeMartini, Anna; Jennings, Danielle; Sommers, Mathew; Walker, John; Santos, Glenn-Milo

    2016-01-01

    Background Alcohol and illicit drug use is more prevalent among men who have sex with men (MSM) compared to the general population and has been linked to HIV transmission in this population. Research assessing individual patterns of substance use often utilizes questionnaires or interviews that rely on retrospective self-reported information, which can be subject to recall bias. Ecological momentary assessment (EMA) is a set of methods developed to mitigate recall bias by collecting data about subjects’ mental states and behaviors on a near real-time basis. EMA remains underutilized in substance use and HIV research. Objective To assess the concordance between daily reports of substance use collected by EMA text messages (short message service, SMS) and retrospective questionnaires and identify predictors of daily concordance in a sample of MSM. Methods We conducted a secondary analysis of EMA text responses (regarding behavior on the previous day) and audio computer-assisted self-interview (ACASI) survey data (14-day recall) from June 2013 to September 2014 as part of a randomized controlled trial assessing a pharmacologic intervention to reduce methamphetamine and alcohol use among nondependent MSM in San Francisco, California. Reports of daily methamphetamine use, alcohol use, and binge alcohol use (5 or more drinks on one occasion) were collected via EMA and ACASI and compared using McNemar’s tests. Demographic and behavioral correlates of daily concordance between EMA and ACASI were assessed for each substance, using separate multivariable logistic regression models, fit with generalized estimating equations. Results Among 30 MSM, a total of 994 days were included in the analysis for methamphetamine use, 987 for alcohol use, and 981 for binge alcohol use. Methamphetamine (EMA 20%, ACASI 11%, P<.001) and alcohol use (EMA 40%, ACASI 35%, P=.001) were reported significantly more frequently via EMA versus ACASI. In multivariable analysis, text reporting of

  16. Morphology of U3O8 materials following storage under controlled conditions of temperature and relative humidity

    DOE PAGESBeta

    Tamasi, Alison L.; Cash, Leigh J.; Mullen, William Tyler; Pugmire, Alison L.; Ross, Amy R.; Ruggiero, Christy E.; Scott, Brian L.; Wagner, Gregory L.; Walensky, Justin R.; Wilkerson, Marianne P.

    2016-07-05

    Changes in the visual characteristics of uranium oxide surfaces and morphology following storage under different conditions of temperature and relative humidity may provide insight into the history of an unknown sample. Sub-samples of three α-U3O8 materials—one that was phase-pure and two that were phase-impure—were stored under controlled conditions for two years. We used scanning electron microscopy to image the oxides before and after storage, and a morphology lexicon was used to characterize the images. Finally, temporal changes in morphology were observed in some sub-samples, and changes were greatest following exposure to high relative humidity.

  17. Substrate Utilization and Cycling Performance Following Palatinose™ Ingestion: A Randomized, Double-Blind, Controlled Trial.

    PubMed

    König, Daniel; Zdzieblik, Denise; Holz, Anja; Theis, Stephan; Gollhofer, Albert

    2016-01-01

    (1) OBJECTIVE: To compare the effects of isomaltulose (Palatinose™, PSE) vs. maltodextrin (MDX) ingestion on substrate utilization during endurance exercise and subsequent time trial performance; (2) METHODS: 20 male athletes performed two experimental trials with ingestion of either 75 g PSE or MDX 45 min before the start of exercise. The exercise protocol consisted of 90 min cycling (60% VO₂max) followed by a time trial; (3) RESULTS: Time trial finishing time (-2.7%, 90% CI: ±3.0%, 89% likely beneficial; p = 0.147) and power output during the final 5 min (+4.6%, 90% CI: ±4.0%, 93% likely beneficial; p = 0.053) were improved with PSE compared with MDX. The blood glucose profile differed between trials (p = 0.013) with PSE resulting in lower glycemia during rest (95%-99% likelihood) and higher blood glucose concentrations during exercise (63%-86% likelihood). In comparison to MDX, fat oxidation was higher (88%-99% likelihood; p = 0.005) and carbohydrate oxidation was lower following PSE intake (85%-96% likelihood; p = 0.002). (4) CONCLUSION: PSE maintained a more stable blood glucose profile and higher fat oxidation during exercise which resulted in improved cycling performance compared with MDX. These results could be explained by the slower availability and the low-glycemic properties of Palatinose™ allowing a greater reliance on fat oxidation and sparing of glycogen during the initial endurance exercise. PMID:27347996

  18. Substrate Utilization and Cycling Performance Following Palatinose™ Ingestion: A Randomized, Double-Blind, Controlled Trial

    PubMed Central

    König, Daniel; Zdzieblik, Denise; Holz, Anja; Theis, Stephan; Gollhofer, Albert

    2016-01-01

    (1) Objective: To compare the effects of isomaltulose (Palatinose™, PSE) vs. maltodextrin (MDX) ingestion on substrate utilization during endurance exercise and subsequent time trial performance; (2) Methods: 20 male athletes performed two experimental trials with ingestion of either 75 g PSE or MDX 45 min before the start of exercise. The exercise protocol consisted of 90 min cycling (60% VO2max) followed by a time trial; (3) Results: Time trial finishing time (−2.7%, 90% CI: ±3.0%, 89% likely beneficial; p = 0.147) and power output during the final 5 min (+4.6%, 90% CI: ±4.0%, 93% likely beneficial; p = 0.053) were improved with PSE compared with MDX. The blood glucose profile differed between trials (p = 0.013) with PSE resulting in lower glycemia during rest (95%–99% likelihood) and higher blood glucose concentrations during exercise (63%–86% likelihood). In comparison to MDX, fat oxidation was higher (88%–99% likelihood; p = 0.005) and carbohydrate oxidation was lower following PSE intake (85%–96% likelihood; p = 0.002). (4) Conclusion: PSE maintained a more stable blood glucose profile and higher fat oxidation during exercise which resulted in improved cycling performance compared with MDX. These results could be explained by the slower availability and the low-glycemic properties of Palatinose™ allowing a greater reliance on fat oxidation and sparing of glycogen during the initial endurance exercise. PMID:27347996

  19. Radiation therapy for T2N0 laryngeal cancer: A retrospective analysis for the impact of concurrent chemotherapy on local control

    SciTech Connect

    Akimoto, Tetsuo . E-mail: takimoto@showa.gunma-u.ac.jp; Nonaka, Tetsuo; Kitamoto, Yoshizumi; Ishikawa, Hitoshi; Ninomiya, Hiroshi; Chikamatsu, Kazuaki; Furuya, Nobuhiko; Hayakawa, Kazushige; Mitsuhashi, Norio; Nakano, Takashi

    2006-03-15

    Purpose: The impact of concurrent chemotherapy on the local control in patients with T2N0 laryngeal cancer who receive radiation therapy (RT) was evaluated. Methods and Materials: Sixty-three patients with T2N0 laryngeal cancer who were treated by definitive RT were analyzed. The primary site of the cancer was the glottis in 50 patients, the supraglottis in 9 patients, and the subglottis in 4 patients. Thirty-six patients were treated by RT alone and the remaining 27 patients received concurrent chemoradiotherapy (CRT). Results: Complete response (CR) was obtained in 92% of the patients who received RT alone and 100% of the patients who received CRT. Voice preservation in the group who received CRT (89%) was significantly higher than that in the group treated by RT alone (61%). The 5-year disease-free survival rates in those who received concurrent CRT was significantly superior to that in the patients who received RT alone, although no significant difference was seen in the cause-specific survival rate between the 2 groups. The multivariate analysis revealed that the treatment method (RT alone vs. CRT) was the most significant risk factor that predicted recurrence after RT. Conclusion: Concurrent CRT had a positive impact on the local control of T2N0 laryngeal cancer.

  20. Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case-control study.

    PubMed

    Clemente, W; Vidal, E; Girão, E; Ramos, A S D; Govedic, F; Merino, E; Muñoz, P; Sabé, N; Cervera, C; Cota, G F; Cordero, E; Mena, A; Montejo, M; López-Medrano, F; Aguado, J M; Fernandes, P; Valerio, M; Carratalá, J; Moreno, A; Oliveira, J; Mourão, P H O; Torre-Cisneros, J

    2015-01-01

    Visceral leishmaniasis (VL) is a rare disease in solid-organ transplant (SOT) recipients. Therefore, little is known about the risk factors and disease behavior in the transplant setting. This multicenter, matched case-control study (1:2 ratio) was designed to determine the risk factors, clinical features and outcomes of VL among this population. Control and case subjects were matched by center, transplant type and timing. Thirty-six VL cases were identified among 25 139 SOT recipients (0.1%). VL occurred 5.7-fold more frequently in Brazil than in Spain, presenting a median time of 11 months after transplantation. High-dose prednisone in the preceding 6 months was associated with VL. Patients were diagnosed over 1 month after symptom onset in 25% of cases. Thirty-one patients (86%) were febrile upon diagnosis, 81% exhibited visceromegaly and 47% showed pancytopenia. Concomitant infection was common. Parasites were identified in 89% of patients; the remaining patients were diagnosed by serology. The majority of the patients received amphotericin B. Relapses occurred in 25.7% of cases, and the crude mortality rate was 2.8%. VL after SOT is related to the VL prevalence in the general population. Delayed diagnosis frequently occurs. Liposomal amphotericin is the most commonly used therapy; mortality is low, although relapses are common. PMID:25636932

  1. Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes. Methods Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education ‘booster’ sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves. Results Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, −0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of €772 (P value, 0.020; 95% CI, −1,415 to −128: ICC, 0.016) per patient. At alternative threshold values of €5,000, €15,000, €25,000, €35,000, and €45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively. Conclusions The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes. Trial registration Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007). PMID:24927851

  2. Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis

    PubMed Central

    Ye, Ming; Jacobs, Angela; Khan, Muhammad Naeem; Jaipaul, Joy; Oda, Joanna; Johnson, Marcia; Doroshenko, Alexander

    2016-01-01

    Objectives To evaluate the impact of oseltamivir prophylaxis in the management and control of influenza outbreaks in long-term care facilities in Alberta, Canada. Setting and participants Long-term care facilities where 127 influenza outbreaks were reported to public health authorities in Alberta, Canada, during two influenza seasons from 2013 to 2015. Design and outcome measures Using routinely collected surveillance and administrative data, we examined the association between decision-making time for oseltamivir recommendation as prophylaxis strategy for influenza outbreaks in long-term care facilities (explanatory variable) and the duration of an influenza outbreak, the postprophylaxis risk of influenza-like illness and hospitalisation among residents of long-term care facilities in Alberta (outcome variables) using multivariable linear and Poisson regression models. Results Oseltamivir prophylaxis decision-making time was positively associated with the postintervention duration of an outbreak, with a 1-day delay in making decision on oseltamivir prophylaxis associated with 2.22 (95% CI 1.37 to 3.06) more days of the duration of an outbreak after controlling for potential confounding effect of the number of residents at risk at intervention, outbreak progression time, prevalence of influenza-like illness during outbreak progression, facility location, presence of mixed strain and based on optimal timing of oseltamivir prophylaxis. Although not statistically significant, a 1-day delay in making decision on oseltamivir prophylaxis was associated with a 5% (95% CI −1% to 11%) increase in the postintervention risk of influenza-like illness, and a 6% (95% CI −8% to 22%) increase in the postintervention risk of hospitalisation after controlling for the same potential confounders. Conclusions Our study demonstrated benefits of using oseltamivir prophylaxis to shorten the duration of influenza outbreaks; however, there were no significant differences in the

  3. The DAO Retrospective Data Assimilation System

    NASA Technical Reports Server (NTRS)

    Todling, Richardo; Zhu, Yanqiu; Einaudi, Franco (Technical Monitor)

    2000-01-01

    The fixed-lag Kalman smoother of Cohn et al. (1994), or a version of a more computationally feasible approximation of it developed by Todling et al. (1998), is under implementation at the Data Assimilation Office (DAO) to build a retrospective data assimilation system (RDAS). The initial version of the RDAS uses the physical-space statistical analysis system and a modification of the incremental analysis update (IAU) procedure of Bloom et al. (1996); a follow up version of the RDAS Nill require the use of the adjoint of the DAO general circulation model (developed by Y. Yang and M Navon). The retrospective procedure is designed to produce improved analyses as well as improved assimilated fields consequently providing an improved climate representation through data assimilation.

  4. Comparing nurses' knowledge retention following electronic continuous education and educational booklet: a controlled trial study

    PubMed Central

    Badiei, Mahmud; Gharib, Mitra; Zolfaghari, Mitra; Mojtahedzadeh, Rita

    2016-01-01

    Background: Training methods that enhance nurses’ learning and retention will increase the quality of patient care. This study aimed to compare the effectiveness of electronic learning and educational booklet on the nurses’ retention of diabetes updates. Methods: In this controlled trial study, convenience sampling was used to select 123 nurses from the endocrinology and internal medicine wards of three hospitals affiliated to Tehran University of Medical Sciences (Tehran, Iran). The participants were allocated to three groups of manual, electronic learning, and control. The booklet and electronic learning groups were trained using educational booklet and electronic continuous medical education (CME) website, respectively. The control group did not receive any intervention. In all the three groups, the nurses' knowledge was measured before the intervention, and one and four weeks after the intervention. Data were collected by a questionnaire. Results: Significant differences were observed between the mean scores of the three groups one and four weeks after the intervention (F=26.17, p=0.001 and F=4.07, p=0.020, respectively), and post hoc test showed that this difference was due to the higher score in e-learning group. Both e-learning and booklet methods could effectively improve nurses' knowledge (χ²=23.03, p=0.001 and χ²=51.71, p=0.001, respectively). Conclusion: According to the results of this study, electronic learning was more effective than booklet in enhancing the learning and retention of knowledge. Electronic learning is suggested as a more suitable method as it provides appropriate interactions and attractive virtual environments to motivate the learners and promote retention. PMID:27493908

  5. Gm-Realization of Controlled-Gain Current Follower Transconductance Amplifier

    PubMed Central

    Tangsrirat, Worapong

    2013-01-01

    This paper describes the conception of the current follower transconductance amplifier (CFTA) with electronically and linearly current tunable. The newly modified element is realized based on the use of transconductance cells (Gms) as core circuits. The advantage of this element is that the current transfer ratios (iz/ip and ix/iz) can be tuned electronically and linearly by adjusting external DC bias currents. The circuit is designed and analyzed in 0.35 μm TSMC CMOS technology. Simulation results for the circuit with ±1.25 V supply voltages show that it consumes only 0.43 mw quiescent power with 70 MHz bandwidth. As an application example, a current-mode KHN biquad filter is designed and simulated. PMID:24381513

  6. [Pelvic limb damage control following a complex foot injury. Case report].

    PubMed

    Velázquez-Vélez, D; Durán-Martínez, N; Peñafort-García, J A; Romero-Peña, A

    2015-01-01

    More than 20% of the tarsometatarsal joint injuries (Lisfranc injuries) occur during motor vehicle accidents. This kind of trauma is infrequent and in 50% of cases closed reduction is used. A 18 year-old male patient sustained a high-energy trauma resulting in a Gustilo and Anderson III B open Lisfranc fracture dislocation of the left foot. Surgical debridement, open reduction and internal fixation, and immediate skin coverage were performed. The secondary complication rate may decrease with stringent treatment adherence and proper care of severe orthopedic injuries. Treatment of the latter, including bone and soft tissue injuries (skin, subcutaneous tissue, fascias, musculotendinous junctions, ligaments, periosteum, and neurovascular structures) should follow a multidisciplinary protocol: extensive debridement of nonviable tissue, eradication of infections, and tissue reconstruction or coverage. Thus, any orthopedic surgeon should possess basic knowledge of this protocol. Proper management, using the right technique in each case, and the right timing of treatment are of the utmost importance. PMID:27218253

  7. Combination Therapy with Cyclosporine and Psoralen Plus Ultraviolet A in the Patients with Severe Alopecia Areata: A Retrospective Study with a Self-Controlled Design

    PubMed Central

    Park, Kui Young; Jang, Woo Sun; Son, In Pyeong; Choi, Sun Young; Lee, Moo Yeol; Kim, Myeung Nam; Ro, Byung In

    2013-01-01

    Background Alopecia areata (AA) is believed to be an organ-specific autoimmune disease in which a mononuclear cell infiltrate develops in and around anagen hair follicles. There is no definitive therapy for AA. Objective We sought to determine whether the combination therapy of cyclosporine and psoralen plus ultraviolet A (PUVA) could be an effective treatment for severe AA. Methods A total of 41 patients with severe AA were treated with oral cyclosporine and topical PUVA. Cyclosporine was given at an initial daily dose of 200 mg for adult and 100 mg for children for periods of up to 16 weeks. Eight-methoxypsoralen (Methoxsalen) was applied topically 20 minutes prior to ultraviolet A (UVA) exposure, and the patients were irradiated with UVA twice a week for 16 weeks. Results Of the total 41 patients, 2 (7.3%) patients were lost to follow-up, and 1 (2.4%) patient discontinued the treatment due to abdominal discomfort. Six (14.6%) patients were treated for less than 12 weeks. Of remaining 32 patients, 3 (9.4%) showed excellent response, 3 (9.4%) showed good response, 12 (37.5%) showed fair response, and 14 (43.7%) showed poor response. Conclusion Although limited by its uncontrolled character, this study shows that the combination therapy with cyclosporine and PUVA may be an additional choice for severe and recalcitrant AA. PMID:23467536

  8. [Second-order retrospective revaluation in human contingency learning].

    PubMed

    Numata, Keitaro; Shimazaki, Tsuneo

    2009-04-01

    We demonstrated second-order retrospective revaluation with three cues (T1, T2, and C) and an outcome, in human contingency learning. Experimental task, PC-controlled video game in which participants were required to observe about the relations between firing missiles and the tank destruction, consisted of three training phases and two rating phases. Groups C+ and C- consisted of same first two training phases, CT+ (cues C and T with an outcome) and T1T2+ followed by C+, or C- training for Groups C+, C-, respectively. In rating phases, it is clearly demonstrated that the judgment of predictive value for the outcome of the T2 were higher by C+ training (second-order unovershadowing) and lowered by C- training (second-order backward blocking). The results for Groups RC+ and RC-, in which the orders of the first two training phase for Groups C+ and C- were interchanged, also showed second-order unovershadowing and second-order backward blocking. These results, the robustness of second-order retrospective revaluation against the order of the first training phases, can be explained by the extended comparator hypothesis and probabilistic contrast model. However, these results cannot be explained by traditional associative learning models. PMID:19489431

  9. Recovery of chronically lame dairy cows following treatment for claw horn lesions: a randomised controlled trial

    PubMed Central

    Thomas, H. J.; Remnant, J. G.; Bollard, N. J.; Burrows, A.; Whay, H. R.; Bell, N. J.; Mason, C.; Huxley, J. N.

    2016-01-01

    A positively controlled, randomised controlled trial (RCT) was undertaken to test recovery of cows with claw horn lesions resulting in lameness of greater than two weeks duration. Cows on seven commercial farms were mobility scored fortnightly and selected by lameness severity and chronicity. Study cows all received a therapeutic trim then random allocation of: no further treatment (trim only (TRM)), plastic shoe (TS) or plastic shoe and NSAID (TSN). Recovery was assessed by mobility score at 42 (±4) days post treatment by an observer blind to treatment group. Multivariable analysis showed no significant effect of treatment with an almost identical, low response rate to treatment across all groups (Percentage non-lame at outcome: TRM – 15 per cent, TS – 15 per cent, TSN – 16 per cent). When compared with results of a similar RCT on acutely lame cows, where response rates to treatment were substantially higher, it can be concluded that any delay in treatment is likely to reduce the rate of recovery, suggesting early identification and treatment is key. Thirty-eight per cent of animals treated in this study were lame on the contralateral limb at outcome suggesting that both hindlimbs should be examined and a preventive or if necessary a therapeutic foot trim performed when lameness is identified particularly if the duration of lameness is unknown. PMID:26811441

  10. Recovery of chronically lame dairy cows following treatment for claw horn lesions: a randomised controlled trial.

    PubMed

    Thomas, H J; Remnant, J G; Bollard, N J; Burrows, A; Whay, H R; Bell, N J; Mason, C; Huxley, J N

    2016-01-30

    A positively controlled, randomised controlled trial (RCT) was undertaken to test recovery of cows with claw horn lesions resulting in lameness of greater than two weeks duration. Cows on seven commercial farms were mobility scored fortnightly and selected by lameness severity and chronicity. Study cows all received a therapeutic trim then random allocation of: no further treatment (trim only (TRM)), plastic shoe (TS) or plastic shoe and NSAID (TSN). Recovery was assessed by mobility score at 42 (±4) days post treatment by an observer blind to treatment group. Multivariable analysis showed no significant effect of treatment with an almost identical, low response rate to treatment across all groups (Percentage non-lame at outcome: TRM - 15 per cent, TS - 15 per cent, TSN - 16 per cent). When compared with results of a similar RCT on acutely lame cows, where response rates to treatment were substantially higher, it can be concluded that any delay in treatment is likely to reduce the rate of recovery, suggesting early identification and treatment is key. Thirty-eight per cent of animals treated in this study were lame on the contralateral limb at outcome suggesting that both hindlimbs should be examined and a preventive or if necessary a therapeutic foot trim performed when lameness is identified particularly if the duration of lameness is unknown. PMID:26811441

  11. Stray dog population demographics in Jodhpur, India following a population control/rabies vaccination program.

    PubMed

    Totton, Sarah C; Wandeler, Alex I; Zinsstag, Jakob; Bauch, Chris T; Ribble, Carl S; Rosatte, Rick C; McEwen, Scott A

    2010-10-01

    Animal Birth Control (ABC) is a program by which stray dogs are sterilized and vaccinated against rabies with the aim of controlling both dog population size and rabies. Population size and demographics of stray dogs were measured before and after implementation of an ABC program in Jodhpur, India. Dog population size declined (p<0.05) in three of five areas surveyed, showed a decreasing trend (p>0.05) in 1 area, and remained stable in 1 area between 2005 and 2007. By 2007, 61.8-86.5% of the free-roaming dog population was surgically sterilized and vaccinated for rabies in the areas surveyed. In March-May, 2007, adults comprised 80-96% of the free-roaming dog population, while subadults and puppies comprised 0-18 and 0-4%, respectively. The male:female ratio among dogs>3 months old was 1.4:1. A population demographic model predicted that at the current level of sterilization/rabies vaccination, vaccination coverage would remain above 70%, and the dog population would decrease by 69% reaching stability after 13-18 years. A surgical sterilization coverage under 40% would maintain the dog population at current levels. PMID:20696487

  12. Glycemic control in inpatients with diabetes following august changeover of trainee doctors in England.

    PubMed

    Rajendran, Rajesh; Jankovic, Dina; Rayman, Gerry

    2016-03-01

    The first Wednesday of August is the day of changeover of trainee doctors in England. It is widely perceived that inexperience and nonfamiliarity with the new hospital systems and policies in these first few weeks lead to increased medical errors, mismanagement, and mortality. The aim of this study was to analyze the impact of the August changeover of trainee doctors on inpatient glycemic control in a single English hospital. This is currently unknown in England. Overall, 16,870 patient-day capillary glucose reading measures in 2730 inpatients with diabetes were analyzed for 4 weeks before and after the changeover period for the years 2012, 2013, and 2014. Only inpatients hospitalized for longer than 1 day were included. Contrary to expectations, inpatient glycemic control did not worsen in the first 4 weeks after changeover compared to the preceding 4 weeks before changeover in the 3-year period. This may be due to forethought and planning by the deanery foundation school and the inpatient diabetes team in this hospital. PMID:26505469

  13. Control of soilborne plant pathogens by incorporating fresh organic amendments followed by tarping.

    PubMed

    Blok, W J; Lamers, J G; Termorshuizen, A J; Bollen, G J

    2000-03-01

    ABSTRACT A new method for the control of soilborne plant pathogens was tested for its efficacy in two field experiments during two years. Plots were amended with fresh broccoli or grass (3.4 to 4.0 kg fresh weight m(-2)) or left nonamended, and covered with an airtight plastic cover (0.135 mm thick) or left noncovered. In plots amended with broccoli or grass and covered with plastic sheeting, anaerobic and strongly reducing soil conditions developed quickly, as indicated by rapid depletion of oxygen and a decrease in redox potential values to as low as -200 mV. After 15 weeks, survival of Fusarium oxysporum f. sp. asparagi, Rhizoctonia solani, and Verticillium dahliae in inoculum samples buried 15 cm deep was strongly reduced in amended, covered plots in both experiments. The pathogens were not or hardly inactivated in amended, noncovered soil or nonamended, covered soil. The latter indicates that thermal inactivation due to increased soil temperatures under the plastic cover was not involved in pathogen inactivation. The results show the potential for this approach to control various soilborne pathogens and that it may serve as an alternative to chemical soil disinfestation for high-value crops under conditions where other alternatives, such as solarization or soil flooding, are not effective or not feasible. PMID:18944617

  14. Cough Reflex Testing in Dysphagia Following Stroke: A Randomized Controlled Trial

    PubMed Central

    Miles, Anna; Zeng, Irene S.L.; McLauchlan, Helen; Huckabee, Maggie-Lee

    2013-01-01

    Background Significant health issues and service delivery costs are associated with post-stroke pneumonia related to dysphagia. Silent aspiration is known to increase pneumonia and mortality in this population. The utility of cough reflex testing (CRT) for reducing pneumonia in acute stroke patients was the subject of this randomised, controlled trial. Methods Patients referred for swallowing evaluation (N = 311) were assigned to either 1) a control group receiving standard evaluation or 2) an experimental group receiving standard evaluation with CRT. Participants in the experimental group were administered nebulised citric acid with test results contributing to clinical decisions. Outcomes for both groups were measured by pneumonia rates at 3 months post evaluation and other clinical indices of swallowing management. Results Analysis of the data identified no significant differences between groups in pneumonia rate (P = 0.38) or mortality (P = 0.15). Results of CRT were shown to influence diet recommendations (P < 0.0001) and referrals for instrumental assessment (P < 0.0001). Conclusions Despite differences in clinical management between groups, the end goal of reducing pneumonia in post stroke dysphagia was not achieved. PMID:23671548

  15. Eating disorders among patients incarcerated only for repeated shoplifting: a retrospective quasi-case-control study in a medical prison in Japan

    PubMed Central

    2014-01-01

    Background Shoplifting is a serious problem among patients with eating disorders. For more than a decade, we have treated many patients with eating disorders incarcerated in Hachioji Medical Prison only for repeated shoplifting. Methods We analyzed the prison records and medical records of female psychiatric patients transferred to Hachioji Medical Prison between 2002 and 2011. Based on the offense listed at the time of sentencing, we extracted a shoplifting group and a drug-offense group from among all patients with eating disorders. One patient from the former group who had used substances and two from the latter group who had never shoplifted were excluded from the study. The groups had 41 and 14 patients, respectively. A control group comprised patients with other mental disorders (n = 34). We compared eating disorder histories and subtypes, weight changes, comorbidities, life histories, past behavioral problems, and clinical behavioral problems among the three groups. Results The shoplifting group exhibited less impulsive behavior, substance abuse, antisocial features, borderline personality disorder, and past bulimia than did the drug-offense and control groups. The shoplifting group had higher educational achievement and steadier employment; however, their eating disorder histories and interpersonal dysfunction were more severe, and they had a higher psychiatric treatment dropout rate. There were also significant relationships with low body weight, anorexia nervosa-restricting type, obsessive–compulsive behaviors, and obsessive–compulsive personality disorder in the shoplifting group. During the clinical course, food refusal, excessive exercise, food hoarding, and falsification of dietary intake amounts were more frequently observed in the shoplifting group. Conversely, drug requests and occurrences of self-harm were less frequent in the shoplifting group than in the drug-offense group. Conclusions Although these results may be associated with

  16. Oral fluid/plasma cannabinoid ratios following controlled oral THC and smoked cannabis administration.

    PubMed

    Lee, Dayong; Vandrey, Ryan; Milman, Garry; Bergamaschi, Mateus; Mendu, Damodara R; Murray, Jeannie A; Barnes, Allan J; Huestis, Marilyn A

    2013-09-01

    Oral fluid (OF) is a valuable biological alternative for clinical and forensic drug testing. Evaluating OF to plasma (OF/P) cannabinoid ratios provides important pharmacokinetic data on the disposition of drug and factors influencing partition between matrices. Eleven chronic cannabis smokers resided on a closed research unit for 51 days. There were four 5-day sessions of 0, 30, 60, and 120 mg oral ∆(9)-tetrahydrocannabinol (THC)/day followed by a five-puff smoked cannabis challenge on Day 5. Each session was separated by 9 days ad libitum cannabis smoking. OF and plasma specimens were analyzed for THC and metabolites. During ad libitum smoking, OF/P THC ratios were high (median, 6.1; range, 0.2-348.5) within 1 h after last smoking, decreasing to 0.1-20.7 (median, 2.1) by 13.0-17.1 h. OF/P THC ratios also decreased during 5-days oral THC dosing, and after the smoked cannabis challenge, median OF/P THC ratios decreased from 1.4 to 5.5 (0.04-245.6) at 0.25 h to 0.12 to 0.17 (0.04-5.1) at 10.5 h post-smoking. In other studies, longer exposure to more potent cannabis smoke and oromucosal cannabis spray was associated with increased OF/P THC peak ratios. Median OF/P 11-nor-9-carboxy-THC (THCCOOH) ratios were 0.3-2.5 (range, 0.1-14.7) ng/μg, much more consistent in various dosing conditions over time. OF/P THC, but not THCCOOH, ratios were significantly influenced by oral cavity contamination after smoking or oromucosal spray of cannabinoid products, followed by time-dependent decreases. Establishing relationships between OF and plasma cannabinoid concentrations is essential for making inferences of impairment or other clinical outcomes from OF concentrations. PMID:23831756

  17. Changes in cholesterol kinetics following sugar cane policosanol supplementation: a randomized control trial

    PubMed Central

    Kassis, Amira N; Jones, Peter JH

    2008-01-01

    Background Sugar cane policosanols (SCP) have been shown to exert cholesterol-modulating properties in various studies conducted in Cuba by substantially reducing cholesterol synthesis. Independent research examining changes in cholesterol kinetics in response to SCP is limited to few studies, none of which was able to replicate findings of the original research. Moreover, no data are available on the effect of SCP on cholesterol absorption to date. The present study was undertaken to determine effects on cholesterol kinetics, namely synthesis and absorption, within hypercholesterolemic individuals consuming a SCP treatment. Twenty-one otherwise healthy hypercholesterolemic subjects participated in a randomized double-blind crossover study where they received 10 mg/day of policosanols or a placebo incorporated in margarine as an evening snack for a period of 28 days. The last week of the study phase, subjects were given 13C labelled cholesterol and deuterated water for the measurement of cholesterol absorption and synthesis respectively. Blood was collected on the first two and last five days of the trial. Cholesterol absorption and synthesis were determined by measuring red cell cholesterol 13C and deuterium enrichment, respectively. Results There was no significant change in LDL cholesterol levels as compared to control. In addition, the area under the curve for red cell cholesterol 13C enrichment across 96 hours was not significantly different in the SCP group as compared to control. Similarly, no difference was observed in the fractional rate of cholesterol synthesis over the period of 24 hours between the two treatment groups. Conclusion The findings of the present study fail to support previous research concerning efficacy and mechanism of action for policosanols. PMID:18447941

  18. Mortality reduction following the air pollution control measures during the 2010 Asian Games

    NASA Astrophysics Data System (ADS)

    Lin, Hualiang; Zhang, Yonghui; Liu, Tao; Xiao, Jianpeng; Xu, Yanjun; Xu, Xiaojun; Qian, Zhenmin; Tong, Shilu; Luo, Yuan; Zeng, Weilin; Ma, Wenjun

    2014-07-01

    Though increased particulate air pollution has been consistently associated with elevated mortality, evidence regarding whether diminished particulate air pollution would lead to mortality reduction is limited. Citywide air pollution mitigation program during the 2010 Asian Games in Guangzhou, China, provided such an opportunity. Daily mortality from non-accidental, cardiovascular and respiratory diseases was compared for 51 intervention days (November 1-December 21) in 2010 with the same calendar date of baseline years (2006-2009 and 2011). Relative risk (RR) and 95% confidence interval (95% CI) were estimated using a time series Poisson model, adjusting for day of week, public holidays, daily mean temperature and relative humidity. Daily PM10 (particle with aerodynamic diameter less than 10 μm) decreased from 88.64 μg/m3 during the baseline period to 80.61 μg/m3 during the Asian Games period. Other measured air pollutants and weather variables did not differ substantially. Daily mortality from non-accidental, cardiovascular and respiratory diseases decreased from 32, 11 and 6 during the baseline period to 25, 8 and 5 during the Games period, the corresponding RR for the Games period compared with the baseline period was 0.79 (95% CI: 0.73-0.86), 0.77 (95% CI: 0.66-0.89) and 0.68 (95% CI: 0.57-0.80), respectively. No significant decreases were observed in other months of 2010 in Guangzhou and intervention period in two control cities. This finding supports the efforts to reduce air pollution and improve public health through transportation restriction and industrial emission control.

  19. Thromboembolism Following Shoulder Arthroscopy

    PubMed Central

    Schick, Cameron W.; Westermann, Robert W.; Gao, Yubo; Abboud, Joseph A.; Wolf, Brian R.

    2014-01-01

    Background: Thromboembolism following shoulder arthroscopy is considered an uncommon complication, with fewer than 50 cases reported in the literature. Arthroscopy of the shoulder is one of the most commonly performed orthopaedic procedures, with low associated risks. Purpose: To identify potential risk factors for the development of venous thromboembolism (VTE) following shoulder arthroscopy and to determine the overall incidence of this complication. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective case-control review was performed of patients who developed symptomatic deep venous thrombosis (DVT) or pulmonary embolism (PE) following shoulder arthroscopy. Multiple surgeons from across North America were queried. For every case of DVT or PE identified, 2 control cases of shoulder arthroscopy were analyzed. The incidence of DVT/PE following shoulder arthroscopy was determined. A univariate analysis and a multivariate logistic regression model were conducted to identify any potential risk factors for the development of VTE following shoulder arthroscopy. Results: A total of 17 surgeons participated in this study and had performed a total of 15,033 cases of shoulder arthroscopy from September 2002 through August 2011. Eleven of the 17 participating surgeons had had a patient with a VTE complication during this time frame. The incidence of VTE in the 15,033 cases was 0.15%; 22 patients of the 15,033 patients had a DVT (n = 15) and/or PE (n = 8). Forty-four control cases were also analyzed. Univariate and multivariate analyses were performed. No significant risk factors were identified other than patient positioning. All cases and controls were positioned in the beach-chair position for surgery. Conclusion: The results of this study show that although rare, VTE occurs following shoulder arthroscopy at a rate of 0.15%. The variables analyzed in the cases of VTE compared with the control cases did not show any significant risk factors. All

  20. Clinical evaluation of 860 anterior and posterior lithium disilicate restorations: retrospective study with a mean follow-up of 3 years and a maximum observational period of 6 years.

    PubMed

    Fabbri, Giacomo; Zarone, Fernando; Dellificorelli, Gianluca; Cannistraro, Giorgio; De Lorenzi, Marco; Mosca, Alberto; Sorrentino, Roberto

    2014-01-01

    This study aimed to assess the clinical performance of lithium disilicate restorations supported by natural teeth or implants. Eight hundred sixty lithium disilicate adhesive restorations, including crowns on natural teeth and implant abutments, veneers, and onlays, were made in 312 patients. Parafunctional patients were included, but subjects with uncontrolled periodontitis and gingival inflammation were excluded. Veneers up to 0.5 mm thick were luted with flowable composite resin or light curing cements, while dual-curing composite systems were used with veneers up to 0.8 mm thick. Onlays up to 2 mm in thickness were luted with flowable composite resins or dual-curing composite cements. Crowns up to 1 mm in thickness were cemented with self-adhesive or dual-curing resin cements. The observational period ranged from 12 to 72 months, with a mean follow-up of 3 years. The mechanical and esthetic outcomes of the restorations were evaluated according to the modified California Dental Association (CDA) criteria. Data were analyzed with descriptive statistics. Twenty-six mechanical complications were observed: 17 porcelain chippings, 5 fractures, and 4 losses of retention. Structural drawbacks occurred mainly in posterior segments, and monolithic restorations showed the lowest number of mechanical complications. The clinical ratings of the successful restorations, both monolithic and layered, were satisfactory according to the modified CDA criteria for color match, porcelain surface, and marginal integrity. The cumulative survival rates of lithium disilicate restorations ranged from 95.46% to 100%, while cumulative success rates ranged from 95.39% to 100%. All restorations recorded very high survival and success rates. The use of lithium disilicate restorations in fixed prosthodontics proved to be effective and reliable in the short- and medium-term. PMID:24600653

  1. Compliance with the proper use of an individual radiation dosimeter among children and the effects of improper use on the measured dose: a retrospective study 18–20 months following Japan's 2011 Fukushima nuclear incident

    PubMed Central

    Nomura, Shuhei; Tsubokura, Masaharu; Hayano, Ryugo; Yoneoka, Daisuke; Ozaki, Akihiko; Shimada, Yuki; Furutani, Tomoyuki; Kanazawa, Yukio; Oikawa, Tomoyoshi

    2015-01-01

    Objectives To identify profiles of children who did not properly use individual radiation dosimeters following Japan's 2011 Fukushima nuclear incident, and to assess how much error is generated by improper dosimeter use. Participants The participants in this study comprised 1637 school children who participated in the external radiation exposure screening programme administrated by Minamisoma City (located 20–30 km from the Fukushima nuclear plant) between 18 and 20 months after the Fukushima incident. Methods We assessed the factors associated with improper use (non-use) of the dosimeters at specific time periods during the day (school commuting hours, at school, at home, outdoors and at bedtime) using logistic regression analyses. Ratios of the measured dose to regression estimates of the ‘expected’ dose (referred to as an error due to non-use) were also examined. Results Only 119 children (7.3%) used the dosimeters properly in all time periods. This low rate was attributed primarily to non-use when children were in the home and outdoors, rather than at school. School level, air dose rate at home, gender, membership in outdoor sports clubs and time spent outdoors on weekends, were significantly associated with improper use, after adjustment for covariates. Data from children who did not wear the dosimeters to school and outdoors had statistically significant (but clinically insignificant) errors (ratio: 1.13, p<0.01; and 0.97, p<0.05, respectively), whereas improper use of the dosimeters at school, at home and at bedtime did not generate significant errors. Conclusions Well-targeted rigorous instructions on the use of the dosimeter are required, with particular focus on time periods other than school hours. However, given the small dose error due to the improper use of the dosimeters, even if the dosimeters are improperly used, solid evaluation of the radiation exposure may be possible with some accuracy. PMID:26719319

  2. Altered Differential Control of Sympathetic Outflow Following Sedentary Conditions: Role of Subregional Neuroplasticity in the RVLM

    PubMed Central

    Subramanian, Madhan; Mueller, Patrick J.

    2016-01-01

    Despite the classically held belief of an “all-or-none” activation of the sympathetic nervous system, differential responses in sympathetic nerve activity (SNA) can occur acutely at varying magnitudes and in opposing directions. Sympathetic nerves also appear to contribute differentially to various disease states including hypertension and heart failure. Previously we have reported that sedentary conditions enhanced responses of splanchnic SNA (SSNA) but not lumbar SNA (LSNA) to activation of the rostral ventrolateral medulla (RVLM) in rats. Bulbospinal RVLM neurons from sedentary rats also exhibit increased dendritic branching in rostral regions of the RVLM. We hypothesized that regionally specific structural neuroplasticity would manifest as enhanced SSNA but not LSNA following activation of the rostral RVLM. To test this hypothesis, groups of physically active (10–12 weeks on running wheels) or sedentary, male Sprague-Dawley rats were instrumented to record mean arterial pressure, LSNA and SSNA under Inactin anesthesia and during microinjections of glutamate (30 nl, 10 mM) into multiple sites within the RVLM. Sedentary conditions enhanced SSNA but not LSNA responses and SSNA responses were enhanced at more central and rostral sites. Results suggest that enhanced SSNA responses in rostral RVLM coincide with enhanced dendritic branching in rostral RVLM observed previously. Identifying structural and functional neuroplasticity in specific populations of RVLM neurons may help identify new treatments for cardiovascular diseases, known to be more prevalent in sedentary individuals. PMID:27486405

  3. Control of breathing in children with mild sleep apnea: A six-year follow up study

    PubMed Central

    Rice, Amber; Costy-Bennett, Seres; Goodwin, James L.; Quan, Stuart F.; Fregosi, Ralph F.

    2010-01-01

    We previously showed that children (average age 9 y) with mildly elevated obstructive apnea-hypopnea indices (OAHI) retained CO2 at rest. Here, we report the results of a six-year follow up study on 14 children from that study. Lung ventilation rate (VE) and the partial pressure of end-tidal CO2 (PETCO2) were measured during hypercapnic challenge. OAHI fell from 7.5 ± 4.7 to 2.5 ± 1.8 from age 9 to age 15 (P < 0.001), despite an increase in BMI from 20 ± 4.6 to 26 ± 5.7 (P < 0.0001). Eupneic VE increased from 4.1 ± 0.31 to 5.9 ± 0.4 L/min/m2 (P< 0.01), while PET CO2 fell from 44.1 ± 0.8 to 33 ± 1.0 mmHg (P< 0.001). The VE - PETCO2 obtained during hypercapnia was left-shifted, such that VE at a PETCO2 of 50 mmHg increased from 24 L/min at age 9, to 36 L/min at age 15. Central respiratory drive did not change. We hypothesize that somatic growth of the pharynx coupled with a regression of tonsillar tissue mass with age lead to enlargement of the upper airway lumen, a reduction in airway resistance and increased respiratory airflow at a given level of ventilatory drive. PMID:19574325

  4. Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial

    PubMed Central

    Hewlett, Sarah; Kirwan, John; Pollock, Jon; Mitchell, Kathryn; Hehir, Maggie; Blair, Peter S; Memel, David; Perry, Mark G

    2005-01-01

    Objectives To determine whether direct access to hospital review initiated by patients with rheumatoid arthritis would result in improved clinical and psychological outcome, reduced overall use of healthcare resources, and greater satisfaction with care than seen in patients receiving regular review initiated by a rheumatologist. Design Two year randomised controlled trial extended to six years. Setting Rheumatology outpatient department in teaching hospital. Participants 209 consecutive patients with rheumatoid arthritis for over two years; 68 (65%) in the direct access group and 52 (50%) in the control group completed the study (P = 0.04). Main outcome measures Clinical outcome: pain, disease activity, early morning stiffness, inflammatory indices, disability, grip strength, range of movement in joints, and bone erosion. Psychological status: anxiety, depression, helplessness, self efficacy, satisfaction, and confidence in the system. Number of visits to hospital physician and general practitioner for arthritis. Results Participants were well matched at baseline. After six years there was only one significant difference between the two groups for the 14 clinical outcomes measured (deterioration in range of movement in elbow was less in direct access patients). There were no significant differences between groups for median change in psychological status. Satisfaction and confidence in the system were significantly higher in the direct access group at two, four, and six years: confidence 9.8 v 8.4, 9.4 v 8.0, 8.7 v 6.9; satisfaction 9.3 v 8.3, 9.3 v 7.7, 8.9 v 7.1 (all P < 0.02). Patients in the direct access group had 38% fewer hospital appointments (median 8 v 13, P < 0.0001). Conclusions Over six years, patients with rheumatoid arthritis who initiated their reviews through direct access were clinically and psychologically at least as well as patients having traditional reviews initiated by a physician. They requested fewer appointments, found direct access more

  5. Compression socks and functional recovery following marathon running: a randomized controlled trial.

    PubMed

    Armstrong, Stuart A; Till, Eloise S; Maloney, Stephen R; Harris, Gregory A

    2015-02-01

    Compression socks have become a popular recovery aid for distance running athletes. Although some physiological markers have been shown to be influenced by wearing these garments, scant evidence exists on their effects on functional recovery. This research aims to shed light onto whether the wearing of compression socks for 48 hours after marathon running can improve functional recovery, as measured by a timed treadmill test to exhaustion 14 days following marathon running. Athletes (n = 33, age, 38.5 ± 7.2 years) participating in the 2012 Melbourne, 2013 Canberra, or 2013 Gold Coast marathons were recruited and randomized into the compression sock or placebo group. A graded treadmill test to exhaustion was performed 2 weeks before and 2 weeks after each marathon. Time to exhaustion, average and maximum heart rates were recorded. Participants were asked to wear their socks for 48 hours immediately after completion of the marathon. The change in treadmill times (seconds) was recorded for each participant. Thirty-three participants completed the treadmill protocols. In the compression group, average treadmill run to exhaustion time 2 weeks after the marathon increased by 2.6% (52 ± 103 seconds). In the placebo group, run to exhaustion time decreased by 3.4% (-62 ± 130 seconds), P = 0.009. This shows a significant beneficial effect of compression socks on recovery compared with placebo. The wearing of below-knee compression socks for 48 hours after marathon running has been shown to improve functional recovery as measured by a graduated treadmill test to exhaustion 2 weeks after the event. PMID:25627452

  6. Losing control under ketamine: suppressed cortico-hippocampal drive following acute ketamine in rats.

    PubMed

    Moran, Rosalyn J; Jones, Matthew W; Blockeel, Anthony J; Adams, Rick A; Stephan, Klaas E; Friston, Karl J

    2015-01-01

    Systemic doses of the psychotomimetic ketamine alter the spectral characteristics of hippocampal and prefrontal cortical network activity. Using dynamic causal modeling (DCM) of cross-spectral densities, we quantify the putative synaptic mechanisms underlying ketamine effects in terms of changes in directed, effective connectivity between dorsal hippocampus and medial prefrontal (dCA1-mPFC) cortex of freely moving rats. We parameterize dose-dependent changes in spectral signatures of dCA1-mPFC local field potential recordings, using neural mass models of glutamatergic and GABAergic circuits. Optimizing DCMs of theta and gamma frequency range responses, model comparisons suggest that both enhanced gamma and depressed theta power result from a reduction in top-down connectivity from mPFC to the hippocampus, mediated by postsynaptic NMDA receptors (NMDARs). This is accompanied by an alteration in the bottom-up pathway from dCA1 to mPFC, which exhibits a distinct asymmetry: here, feed-forward drive at AMPA receptors increases in the presence of decreased NMDAR-mediated inputs. Setting these findings in the context of predictive coding suggests that NMDAR antagonism by ketamine in recurrent hierarchical networks may result in the failure of top-down connections from higher cortical regions to signal predictions to lower regions in the hierarchy, which consequently fail to respond consistently to errors. Given that NMDAR dysfunction has a central role in pathophysiological theories of schizophrenia and that theta and gamma rhythm abnormalities are evident in schizophrenic patients, the approach followed here may furnish a framework for the study of aberrant hierarchical message passing (of prediction errors) in schizophrenia-and the false perceptual inferences that ensue. PMID:25053181

  7. Serum bile acids and GLP-1 decrease following telemetric induced weight loss: results of a randomized controlled trial.

    PubMed

    Biemann, Ronald; Penner, Marina; Borucki, Katrin; Westphal, Sabine; Luley, Claus; Rönicke, Raik; Biemann, Kathleen; Weikert, Cornelia; Lux, Anke; Goncharenko, Nikolai; Marschall, Hanns-Ulrich; Schneider, Jochen G; Isermann, Berend

    2016-01-01

    Bile acids (BAs) are increasingly recognised as metabolic regulators, potentially improving insulin sensitivity following bariatric surgery. However, physiological relevance of such observations remains unknown. Hence, we analysed serum BA composition and associated gut-derived hormone levels following lifestyle-induced weight loss in individuals with metabolic syndrome (MetS). 74 non-smoking men (45-55 yr) with MetS were randomised to a lifestyle-induced weight loss program (supervision via telemonitoring) or to a control arm. Before and after a 6 months intervention period clinical and laboratory parameters, body composition, serum BA profile, FGF-19, and GLP-1 concentrations were determined in fasting blood samples. 30 participants in the control and 33 participants in the treatment arm completed the study and were included in the data analysis. In participants of the treatment arm lifestyle-induced weight loss resulted in markedly improved insulin sensitivity. Serum levels of BA species and total GLP-1 decreased, while FGF-19 remained stable. Serum BA composition changed towards an increased 12α-hydroxylated/non-12α-hydroxylated ratio. None of these parameters changed in participants of the control arm. Our results demonstrate that improved metabolic control by lifestyle modifications lowers serum levels of BAs and GLP-1 and changes serum BA composition towards an increased 12α/non-12α ratio (ICTRP Trial Number: U1111-1158-3672). PMID:27452603

  8. Serum bile acids and GLP-1 decrease following telemetric induced weight loss: results of a randomized controlled trial

    PubMed Central

    Biemann, Ronald; Penner, Marina; Borucki, Katrin; Westphal, Sabine; Luley, Claus; Rönicke, Raik; Biemann, Kathleen; Weikert, Cornelia; Lux, Anke; Goncharenko, Nikolai; Marschall, Hanns-Ulrich; Schneider, Jochen G.; Isermann, Berend

    2016-01-01

    Bile acids (BAs) are increasingly recognised as metabolic regulators, potentially improving insulin sensitivity following bariatric surgery. However, physiological relevance of such observations remains unknown. Hence, we analysed serum BA composition and associated gut-derived hormone levels following lifestyle-induced weight loss in individuals with metabolic syndrome (MetS). 74 non-smoking men (45–55 yr) with MetS were randomised to a lifestyle-induced weight loss program (supervision via telemonitoring) or to a control arm. Before and after a 6 months intervention period clinical and laboratory parameters, body composition, serum BA profile, FGF-19, and GLP-1 concentrations were determined in fasting blood samples. 30 participants in the control and 33 participants in the treatment arm completed the study and were included in the data analysis. In participants of the treatment arm lifestyle-induced weight loss resulted in markedly improved insulin sensitivity. Serum levels of BA species and total GLP-1 decreased, while FGF-19 remained stable. Serum BA composition changed towards an increased 12α-hydroxylated/non-12α-hydroxylated ratio. None of these parameters changed in participants of the control arm. Our results demonstrate that improved metabolic control by lifestyle modifications lowers serum levels of BAs and GLP-1 and changes serum BA composition towards an increased 12α/non-12α ratio (ICTRP Trial Number: U1111-1158-3672). PMID:27452603

  9. Matching for Several Sparse Nominal Variables in a Case-Control Study of Readmission Following Surgery

    PubMed Central

    Zubizarreta, José R.; Reinke, Caroline E.; Kelz, Rachel R.; Silber, Jeffrey H.; Rosenbaum, Paul R.

    2014-01-01

    Matching for several nominal covariates with many levels has usually been thought to be difficult because these covariates combine to form an enormous number of interaction categories with few if any people in most such categories. Moreover, because nominal variables are not ordered, there is often no notion of a “close substitute” when an exact match is unavailable. In a case-control study of the risk factors for read-mission within 30 days of surgery in the Medicare population, we wished to match for 47 hospitals, 15 surgical procedures grouped or nested within 5 procedure groups, two genders, or 47 × 15 × 2 = 1410 categories. In addition, we wished to match as closely as possible for the continuous variable age (65–80 years). There were 1380 readmitted patients or cases. A fractional factorial experiment may balance main effects and low-order interactions without achieving balance for high-order interactions. In an analogous fashion, we balance certain main effects and low-order interactions among the covariates; moreover, we use as many exactly matched pairs as possible. This is done by creating a match that is exact for several variables, with a close match for age, and both a “near-exact match” and a “finely balanced match” for another nominal variable, in this case a 47 × 5 = 235 category variable representing the interaction of the 47 hospitals and the five surgical procedure groups. The method is easily implemented in R. PMID:25418991

  10. Executive Control Circuitry Differentiates Degree of Success in Weight Loss Following Gastric-Bypass Surgery

    PubMed Central

    Borckardt, Jeffrey J.; Madan, Alok; Byrne, T. Karl; George, Mark S.; O'Neil, Patrick M.; Hanlon, Colleen A.

    2014-01-01

    Objective While overall success rates of bariatric surgery are high, approximately 20% of patients either regain or never lose the expected amount of weight. The purpose of this study was to determine whether, after gastric-bypass surgery, the degree of weight loss can be differentiated based on the neural response to food cues. Design and Methods In this functional MRI study, 31 post-surgical patients viewed food and neutral images in two counterbalanced runs during which they were either instructed to “crave” or to “resist” craving. The neural response to food cues was assessed within and between runs for all participants, and further analyzed between more successful (n = 24) and less successful (n = 7) groups. More successful was defined by meeting 50% excess weight loss. Results Overall, instructions to “crave” elicited significant activity in the dorsomedial prefrontal cortex (PFC) whereas “resist” elicited significant activity in the dorsolateral PFC (DLPFC). Between groups there was no brain difference when instructed to “crave.” The more successful participants however had significantly more activity in the DLPFC when instructed to “resist.” Conclusions These findings suggest that the ability to mobilize neural circuits involved in executive control post-gastric-bypass surgery may be a unique component of successful outcome post-surgery. PMID:24136926

  11. Single-leg drop landing motor control strategies following acute ankle sprain injury.

    PubMed

    Doherty, C; Bleakley, C; Hertel, J; Caulfield, B; Ryan, J; Delahunt, E

    2015-08-01

    No research currently exists investigating the effect of acute injury on single-limb landing strategies. The aim of the current study was to analyze the coordination strategies of participants in the acute phase of lateral ankle sprain (LAS) injury. Thirty-seven participants with acute, first-time LAS and 19 uninjured participants completed a single-leg drop landing task on both limbs. Three-dimensional kinematic (angular displacement) and sagittal plane kinetic (moment-of-force) data were acquired for the joints of the lower extremity from 200 ms pre-initial contact (IC) to 200 ms post-IC. The peak magnitude of the vertical component of the ground reaction force (GRF) was also computed. Injured participants displayed a bilateral increase in hip flexion, with altered transverse plane kinematic profiles at the knee and ankle for both limbs (P < 0.05). This coincided with a reduction in the net-supporting flexor moment of the lower extremity (P < 0.05) and magnitude of the peak vertical GRF for the injured limb (21.82 ± 2.44 N/kg vs 24.09 ± 2.77 N/kg; P = 0.013) in injured participants compared to control participants. These results demonstrate that compensatory movement strategies are utilized by participants with acute LAS to successfully reduce the impact forces of landing. PMID:24975875

  12. Memorable Experiences in Therapeutic Assessment: Inviting the Patient's Perspective Following a Pretreatment Randomized Controlled Trial.

    PubMed

    De Saeger, Hilde; Bartak, Anna; Eder, Eva-Emily; Kamphuis, Jan H

    2016-01-01

    Accumulating evidence documents the efficacy of Therapeutic Assessment (TA) in terms of symptom reduction and other outcomes, but only minimal data speak to the patient's perspective of what is memorable, or potentially important, about this intervention. In line with the humanistic and phenomenological philosophy of TA, we solicited patient input by asking personality disorder (PD) patients who participated in a recent randomized controlled trial (De Saeger et al., 2014 ) about their experiences. We report on 10 PD patients who were administered semistructured interviews designed to assess an in-depth perspective of undergoing TA. Our methodological approach can be described as phenomenological and integrative, approximating guidelines provided by the Consensual Qualitative Research paradigm (Hill, 2012 ). Four core content domains emerged from the transcribed and coded interview protocols: (a) relationship aspects, (b) new insight into personal dynamics, (c) sense of empowerment, and (d) validation of self. Novel experiences were mostly of a relational nature, and pertained to feeling of being treated like an equal and essential partner in a highly individualized venture. Research and clinical implications of these patient reports of TA participation are discussed. PMID:26829376

  13. Behavioral and Neural Plasticity of Ocular Motor Control: Changes in Performance and fMRI Activity Following Antisaccade Training

    PubMed Central

    Jamadar, Sharna D.; Johnson, Beth P.; Clough, Meaghan; Egan, Gary F.; Fielding, Joanne

    2015-01-01

    The antisaccade task provides a model paradigm that sets the inhibition of a reflexively driven behavior against the volitional control of a goal-directed behavior. The stability and adaptability of antisaccade performance was investigated in 23 neurologically healthy individuals. Behavior and brain function were measured using functional magnetic resonance imaging (fMRI) prior to and immediately following 2 weeks of daily antisaccade training. Participants performed antisaccade trials faster with no change in directional error rate following 2 weeks of training; however this increased speed came at the cost of the spatial accuracy of the saccade (gain) which became more hypometric following training. Training on the antisaccade task resulted in increases in fMRI activity in the fronto-basal ganglia-parietal-cerebellar ocular motor network. Following training, antisaccade latency was positively associated with fMRI activity in the frontal and supplementary eye fields, anterior cingulate and intraparietal sulcus; antisaccade gain was negatively associated with fMRI activity in supplementary eye fields, anterior cingulate, intraparietal sulcus, and cerebellar vermis. In sum, the results suggest that following training, larger antisaccade latency is associated with larger activity in fronto-parietal-cerebellar ocular motor regions, and smaller antisaccade gain is associated with larger activity in fronto-parietal ocular motor regions. PMID:26733841

  14. Evaluating rehabilitation efforts following the Milford Flat Fire: successes, failures, and controlling factors

    USGS Publications Warehouse

    Duniway, Michael C.; Palmquist, Emily C.; Miller, Mark E.

    2015-01-01

    Uncontrolled wildfire in arid and semiarid ecosystems has become an increasing concern in recent decades. Active rehabilitation of fire-affected areas is often quickly initiated to minimize long-term ecosystem damage. However, the complex soil-geomorphic-vegetation patterns and low and variable moisture conditions in these regions makes restoration challenging. To further inform these post-fire management decisions, we present results from 5 years of vegetation and sediment flux monitoring following the Milford Flat Fire in west-central Utah, USA. Our sampling design includes monitoring plots in areas not burned, areas burned but where no rehabilitation was attempted, and burned areas where various rehabilitation approaches were implemented. At each of the 25 plots, vegetation cover and composition data were collected annually, and wind-driven sediment flux was measured using passive dust traps. To evaluate effectiveness of post-fire rehabilitation treatments in establishing desired species and limiting dominance of undesired species, we analyzed the temporal response of individual species and functional groups as well as community-level multivariate responses. The warm and dry conditions that persisted for approximately 12 months post-treatment, coupled with the surface disturbing rehabilitation approaches used, resulted in near-surface dust fluxes several orders of magnitude higher in treated areas than in unburned or burned areas where no rehabilitation occurred. These dry conditions and high surface sediment flux limited the establishment of seeded species in rehabilitation areas for nearly 3 years. Post-fire rehabilitation did not limit dominance by invasive annual species of concern. Perennial species composition in the areas burned but not subject to post-fire rehabilitation was relatively similar to unburned throughout the study period. In contrast, the burned plots where rehabilitation was attempted were characterized by no (<3%) perennial cover or, in

  15. Oral fluid cannabinoid concentrations following controlled smoked cannabis in chronic frequent and occasional smokers.

    PubMed

    Anizan, Sebastien; Milman, Garry; Desrosiers, Nathalie; Barnes, Allan J; Gorelick, David A; Huestis, Marilyn A

    2013-10-01

    Oral fluid (OF) is an alternative biological matrix for monitoring cannabis intake in drug testing, and drugged driving (DUID) programs, but OF cannabinoid test interpretation is challenging. Controlled cannabinoid administration studies provide a scientific database for interpreting cannabinoid OF tests. We compared differences in OF cannabinoid concentrations from 19 h before to 30 h after smoking a 6.8% THC cigarette in chronic frequent and occasional cannabis smokers. OF was collected with the Statsure Saliva Sampler™ OF device. 2D-GC-MS was used to quantify cannabinoids in 357 OF specimens; 65 had inadequate OF volume within 3 h after smoking. All OF specimens were THC-positive for up to 13.5 h after smoking, without significant differences between frequent and occasional smokers over 30 h. Cannabidiol (CBD) and cannabinol (CBN) had short median last detection times (2.5-4 h for CBD and 6-8 h for CBN) in both groups. THCCOOH was detected in 25 and 212 occasional and frequent smokers' OF samples, respectively. THCCOOH provided longer detection windows than THC in all frequent smokers. As THCCOOH is not present in cannabis smoke, its presence in OF minimizes the potential for false positive results from passive environmental smoke exposure, and can identify oral THC ingestion, while OF THC cannot. THC ≥ 1 μg/L, in addition to CBD ≥ 1 μg/L or CBN ≥ 1 μg/L suggested recent cannabis intake (≤13.5 h), important for DUID cases, whereas THC ≥ 1 μg/L or THC ≥ 2 μg/L cutoffs had longer detection windows (≥30 h), important for workplace testing. THCCOOH windows of detection for chronic, frequent cannabis smokers extended beyond 30 h, while they were shorter (0-24 h) for occasional cannabis smokers. PMID:23954944

  16. Reduced Metabolsim in Brain 'Control Networks' Following Cocaine-Cues Exposure in Female Cocaine Abusers

    SciTech Connect

    Volkow, N.D.; Wang, G.; Volkow, N.D.; Tomasi, D.; Wang, G.-J.; Fowler, J.S.; Telang, F.; Goldstein, R.Z.; Alia-Klein, N.; Wong, C.T.

    2011-03-01

    Gender differences in vulnerability for cocaine addiction have been reported. Though the mechanisms are not understood, here we hypothesize that gender differences in reactivity to conditioned-cues, which contributes to relapse, are involved. To test this we compared brain metabolism (using PET and {sup 18}FDG) between female (n = 10) and male (n = 16) active cocaine abusers when they watched a neutral video (nature scenes) versus a cocaine-cues video. Self-reports of craving increased with the cocaine-cue video but responses did not differ between genders. In contrast, changes in whole brain metabolism with cocaine-cues differed by gender (p<0.05); females significantly decreased metabolism (-8.6% {+-} 10) whereas males tended to increase it (+5.5% {+-} 18). SPM analysis (Cocaine-cues vs Neutral) in females revealed decreases in frontal, cingulate and parietal cortices, thalamus and midbrain (p<0.001) whereas males showed increases in right inferior frontal gyrus (BA 44/45) (only at p<0.005). The gender-cue interaction showed greater decrements with Cocaine-cues in females than males (p<0.001) in frontal (BA 8, 9, 10), anterior cingulate (BA 24, 32), posterior cingulate (BA 23, 31), inferior parietal (BA 40) and thalamus (dorsomedial nucleus). Females showed greater brain reactivity to cocaine-cues than males but no differences in craving, suggesting that there may be gender differences in response to cues that are not linked with craving but could affect subsequent drug use. Specifically deactivation of brain regions from 'control networks' (prefrontal, cingulate, inferior parietal, thalamus) in females could increase their vulnerability to relapse since it would interfere with executive function (cognitive inhibition). This highlights the importance of gender tailored interventions for cocaine addiction.

  17. Boron and Coumaphos Residues in Hive Materials Following Treatments for the Control of Aethina tumida Murray.

    PubMed

    Valdovinos-Flores, Cesar; Gaspar-Ramírez, Octavio; Heras-Ramírez, María Elena; Lara-Álvarez, Carlos; Dorantes-Ugalde, José Antonio; Saldaña-Loza, Luz María

    2016-01-01

    In the search of alternatives for controlling Aethina tumida Murray, we recently proposed the BAA trap which uses boric acid and an attractant which mimics the process of fermentation caused by Kodamaea ohmeri in the hive. This yeast is excreted in the feces of A. tumida causing the fermentation of pollen and honey of infested hives and releasing compounds that function as aggregation pheromones to A. tumida. Since the boron is the toxic element in boric acid, the aim of this article is to assess the amount of boron residues in honey and beeswax from hives treated with the BAA trap. For this aim, the amount of bioaccumulated boron in products of untreated hives was first determined and then compared with the amount of boron of products from hives treated with the BAA trap in two distinct climatic and soil conditions. The study was conducted in the cities of Padilla, Tamaulipas, and Valladolid, Yucatan (Mexico) from August 2014 to March 2015. The quantity of boron in honey was significantly less in Yucatan than in Tamaulipas; this agrees with the boron deficiency among Luvisol and Leptosol soils found in Yucatan compared to the Vertisol soil found in Tamaulipas. In fact, the honey from Yucatan has lower boron levels than those reported in the literature. The BAA treatment was applied for four months, results show that the BAA trap does not have any residual effect in either honey or wax; i.e., there is no significant difference in boron content before and after treatment. On the other hand, the organophosphate pesticide coumaphos was found in 100% of wax samples and in 64% of honey samples collected from Yucatan. The concentration of coumaphos in honey ranges from 0.005 to 0.040 mg/kg, which are below Maximum Residue Limit (MRL) allowed in the European Union (0.1 mg/kg) but 7.14% of samples exceeded the MRL allowed in Canada (0.02 mg/kg). PMID:27092938

  18. Oral fluid cannabinoid concentrations following controlled smoked cannabis in chronic frequent and occasional smokers

    PubMed Central

    Anizan, Sebastien; Milman, Garry; Desrosiers, Nathalie; Barnes, Allan J.; Gorelick, David A.; Huestis, Marilyn A.

    2013-01-01

    Background Oral fluid (OF) is an alternative biological matrix for monitoring cannabis intake in drug testing, and drugged driving (DUID) programs, but OF cannabinoid test interpretation is challenging. Controlled cannabinoid administration studies provide a scientific database for interpreting cannabinoid OF tests. Methods We compared differences in OF cannabinoid concentrations from 19h before to 30h after smoking a 6.8% THC cigarette in chronic frequent and occasional cannabis smokers. OF was collected with the Statsure Saliva Sampler™ OF device. 2D-GC-MS was used to quantify cannabinoids in 357 OF specimens; 65 had inadequate OF volume within 3h after smoking. Results All OF specimens were THC-positive for up to 13.5h after smoking, without significant differences between frequent and occasional smokers over 30h. CBD and CBN had short median last detection times (2.5–4h for CBD and 6–8h for CBN) in both groups. THCCOOH was detected in 25 and 212 occasional and frequent smokers’ OF samples, respectively. THCCOOH provided longer detection windows than THC in all frequent smokers. As THCCOOH is not present in cannabis smoke, it’s presence in OF minimizes the potential for false positive results from passive environmental smoke exposure, and can identify oral THC ingestion, while OF THC cannot. THC≥1μg/L, in addition to CBD≥1μg/L or CBN≥1μg/L suggested recent cannabis intake (≤13.5h), important for DUID cases, whereas THC≥1μg/L or THC≥2μg/L cutoffs had longer detection windows (≥30h), important for workplace testing. THCCOOH windows of detection for chronic, frequent cannabis smokers extended beyond 30 h, while they were shorter (0–24h) for occasional cannabis smokers. PMID:23954944

  19. Reducing the illusion of control when an action is followed by an undesired outcome.

    PubMed

    Matute, Helena; Blanco, Fernando

    2014-08-01

    The illusion of control is the belief that our behavior produces an effect that is actually independent from it. This illusion is often at the core of superstitious and pseudoscientific thinking. Although recent research has proposed several evidence-based strategies that can be used to reduce the illusion, the majority of these experiments have involved positive illusions-that is, those in which the potential outcomes are desired (e.g., recovery from illness or earning points). By contrast, many real-life superstitions and pseudosciences are tied to negative illusions-that is, those in which the potential consequences are undesired. Examples are walking under a ladder, breaking a mirror, or sitting in row 13, all of which are supposed to generate bad luck. Thus, the question is whether the available evidence on how to reduce positive illusions would also apply to situations in which the outcomes are undesired. We conducted an experiment in which participants were exposed to undesired outcomes that occurred independently of their behavior. One strategy that has been shown to reduce positive illusions consists of warning people that the outcomes might have alternative causes, other than the participants' actions, and telling them that the best they can do to find out whether an alternative cause is at work is to act on only about 50% of the trials. When we gave our participants this information in an experiment in which the outcomes were undesired, their illusion was enhanced rather than reduced, contrary to what happens when the outcome is desired. This suggests that the strategies that reduce positive illusions may work in just the opposite way when the outcome is undesired. PMID:24448764

  20. Boron and Coumaphos Residues in Hive Materials Following Treatments for the Control of Aethina tumida Murray

    PubMed Central

    Valdovinos-Flores, Cesar; Gaspar-Ramírez, Octavio; Heras–Ramírez, María Elena; Dorantes-Ugalde, José Antonio; Saldaña-Loza, Luz María

    2016-01-01

    In the search of alternatives for controlling Aethina tumida Murray, we recently proposed the BAA trap which uses boric acid and an attractant which mimics the process of fermentation caused by Kodamaea ohmeri in the hive. This yeast is excreted in the feces of A. tumida causing the fermentation of pollen and honey of infested hives and releasing compounds that function as aggregation pheromones to A. tumida. Since the boron is the toxic element in boric acid, the aim of this article is to assess the amount of boron residues in honey and beeswax from hives treated with the BAA trap. For this aim, the amount of bioaccumulated boron in products of untreated hives was first determined and then compared with the amount of boron of products from hives treated with the BAA trap in two distinct climatic and soil conditions. The study was conducted in the cities of Padilla, Tamaulipas, and Valladolid, Yucatan (Mexico) from August 2014 to March 2015. The quantity of boron in honey was significantly less in Yucatan than in Tamaulipas; this agrees with the boron deficiency among Luvisol and Leptosol soils found in Yucatan compared to the Vertisol soil found in Tamaulipas. In fact, the honey from Yucatan has lower boron levels than those reported in the literature. The BAA treatment was applied for four months, results show that the BAA trap does not have any residual effect in either honey or wax; i.e., there is no significant difference in boron content before and after treatment. On the other hand, the organophosphate pesticide coumaphos was found in 100% of wax samples and in 64% of honey samples collected from Yucatan. The concentration of coumaphos in honey ranges from 0.005 to 0.040 mg/kg, which are below Maximum Residue Limit (MRL) allowed in the European Union (0.1 mg/kg) but 7.14% of samples exceeded the MRL allowed in Canada (0.02 mg/kg). PMID:27092938

  1. Oral fluid cocaine and benzoylecgonine concentrations following controlled intravenous cocaine administration.

    PubMed

    Ellefsen, Kayla N; Concheiro, Marta; Pirard, Sandrine; Gorelick, David A; Huestis, Marilyn A

    2016-03-01

    Limited oral fluid (OF) pharmacokinetic data collected with commercially available collection devices after controlled cocaine administration hinder OF result interpretations. Ten cocaine-using adults provided OF, collected with Oral-Eze(®) (OE) and StatSure Saliva Sampler™ (SS) devices, an hour prior to and up to 69 h after 25mg intravenous (IV) cocaine administration. Cocaine and benzoylecgonine (BE) were quantified by a validated 2D-GC-MS method. Large inter-subject variability was observed. Cocaine was detected in OF in the first 0.17 h sample after IV administration, with much more rapid elimination than BE. OE observed Cmax median (range) concentrations were 932 (394-1574)μg/L for cocaine and 248 (96.9-953)μg/L for BE. SS observed cocaine and BE Cmax median (range) concentrations trended lower at 732 (83.3-1892)μg/L and 360 (77.2-836)μg/L, respectively. OE and SS cocaine OF detection times were 12.5 and 6.5h and for BE 30.5 and 28.0 h, respectively at 1 μg/L. There were no significant pharmacokinetic differences between OE and SS OF collection devices, except cocaine half-life was significantly shorter in SS OF specimens. This difference could be attributed to differences in stabilizing buffers present in OF collection devices, which may affect cocaine stability in OF specimens, or decreased recovery from collection pads. Both OE and SS OF collection devices were effective in monitoring cocaine and metabolite concentrations with similar detection windows. Furthermore, we demonstrated that different confirmatory OF cutoffs can be selected to produce shorter or longer cocaine and metabolite detection windows to address specific needs of clinical and forensic drug testing programs. PMID:26851651

  2. Dietary restraint and control over "wanting" following consumption of "forbidden" food.

    PubMed

    Lemmens, Sofie G; Born, Jurriaan M; Rutters, Femke; Schoffelen, Paul F; Wouters, Loek; Westerterp-Plantenga, Margriet S

    2010-10-01

    Eating behavior can be influenced by the rewarding value of food, i.e., "liking" and "wanting." The objective of this study was to assess in normal-weight dietary restrained (NR) vs. unrestrained (NU) eaters how rewarding value of food is affected by satiety, and by eating a nonhealthy perceived, dessert-specific food vs. a healthy perceived, neutral food (chocolate mousse vs. cottage cheese). Subjects (24NR age = 25.0 ± 8.2 years, BMI = 22.3 ± 2.1 kg/m(2); 26NU age = 24.8 ± 8.0 years, BMI = 22.1 ± 1.7 kg/m(2)) came to the university twice, fasted (randomized crossover design). Per test-session "liking" and "wanting" for 72 items divided in six categories (bread, filling, drinks, dessert, sweets, stationery (placebo)) was measured, before and after consumption of chocolate mousse/cottage cheese, matched for energy content (5.6 kJ/g) and individual daily energy requirements (10%). Chocolate mousse was liked more than cottage cheese (P < 0.05). After consumption of chocolate mousse or cottage cheese, appetite and "liking" vs. placebo were decreased in NR and NU (P < 0.03), whereas "wanting" was only decreased in NR vs. NU (P ≤ 0.01). In NR vs. NU "wanting" was specifically decreased after chocolate mousse vs. cottage cheese; this decrease concerned especially "wanting" for bread and filling (P < 0.05). To conclude, despite similar decreases in appetite and "liking" after a meal in NR and NU, NR decrease "wanting" in contrast to NU. NR decrease "wanting" specifically for a nonhealthy perceived, "delicious," dessert-specific food vs. a nutritional identical, yet healthy perceived, slightly less "delicious," "neutral" food. A healthy perceived food may thus impose greater risk for control of energy intake in NR. PMID:20186140

  3. Restoration of Glycemic Control in Patients with Type 2 Diabetes Following Bariatric Surgery is Associated with Reduction in Microparticles

    PubMed Central

    Cheng, V.; Kashyap, S.R.; Schauer, P.R.; Kirwan, J.P.; McCrae, K.R.

    2011-01-01

    Background Microparticles bud from cellular elements during inflammation and are associated with vascular dysfunction related to type 2 diabetes. Although weight loss is known to reduce inflammation, the metabolic effects of bariatric surgery on microparticle concentration and composition are not known. Objectives To determine the effect of bariatric surgery on microparticle concentration and correlate these changes with clinical parameters. Setting Multispecialty group practice Methods We studied 14 obese subjects with type 2 diabetes two weeks before and at one and 12 months following bariatric surgery. Nine of the patients underwent Roux-en-Y gastric bypass and 5 received gastric restrictive surgery. Results One month following surgery, body mass index was reduced by ~10%, glycemic control improved dramatically (P < 0.01), and there was a >60% reduction in endothelial, platelet microparticles and CRP levels (P < 0.05). Tissue factor microparticles reduced by 40% ( p = 0.1). Twelve months following surgery, BMI was reduced by ~20%, glycemic control was maintained (P < 0.01), and there was a >50% reduction in monocyte microparticles compared to pre-surgery. The reduction in monocyte microparticles one month after surgery was strongly associated with the reduction in hemoglobin A1c (P < 0.05). The reduction in monocyte microparticles 12 months following surgery correlated strongly with the reduction in body mass index (P < 0.05). Conclusion The reduction in microparticles after bariatric surgery in patients with type 2 diabetes reflects an attenuation of inflammation and this mechanism may contribute to normalization of glycemic control. PMID:22093380

  4. Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs. epidural analgesia following liver resection surgery

    PubMed Central

    Revie, Erica J; McKeown, Dermot W; Wilson, John A; Garden, O James; Wigmore, Stephen J

    2012-01-01

    Objectives Epidural analgesia is recommended for the provision of analgesia following major abdominal surgery. Continuous local anaesthetic wound infiltration may be an effective alternative. A prospective randomized trial was undertaken to compare these two methods following open liver resection. The primary outcome was length of time required to fulfil criteria for discharge from hospital. Methods Patients undergoing open liver resection were randomized to receive either epidural (EP group) or local anaesthetic wound infiltration plus patient-controlled opiate analgesia (WI group) for the first 2 days postoperatively. All other care followed a standardized enhanced recovery protocol. Time to fulfil discharge criteria, pain scores, physical activity measurements and complications were recorded. Results Between August 2009 and July 2010, 65 patients were randomized to EP (n= 32) or WI (n= 33). The mean time required to fulfil discharge criteria was 4.5 days (range: 2.5–63.5 days) in the WI group and 6.0 days (range: 3.0–42.5 days) in the EP group (P= 0.044). During the first 48 h following surgery, pain scores were significantly lower in the EP group both at rest and on movement. Resting pain scores within both groups were rated as mild (range: 0–3). There was no significant difference between the groups in time to first mobilization or overall complication rate (48.5% in the WI group vs. 58.1% in the EP group; P= 0.443). Conclusions Local anaesthetic wound infiltration combined with patient-controlled opiate analgesia reduces the length of time required to fulfil criteria for discharge from hospital compared with epidural analgesia following open liver resection. Epidural analgesia provides superior analgesia, but does not confer benefits in terms of faster mobilization or recovery. PMID:22882198

  5. Effects of Intra-Operative Total Intravenous Anaesthesia with Propofol versus Inhalational Anaesthesia with Sevoflurane on Post-Operative Pain in Liver Surgery: A Retrospective Case-Control Study

    PubMed Central

    Choi, Siu Wai; Wong, Stanley Sau Ching; Chan, Albert Chi Yan; Irwin, Michael G; Cheung, Chi Wai

    2016-01-01

    Background Patients receiving total intravenous anesthesia (TIVA) with propofol have been shown to experience less postoperative pain. We evaluated the post-operative analgesic effects of propofol compared with sevoflurane maintenance of anesthesia in liver surgery. This study was registered at ClinicalTrials.gov (NCT02179437). Methods In this retrospective study, records of patients who underwent liver surgery between 2010 and 2013 were reviewed. Ninety-five patients anesthetized with propofol TIVA were matched with 95 patients anesthetized with sevoflurane. Numeric pain rating scale (NRS) pain scores, postoperative morphine consumption, side effects and patients’ satisfaction with pain relief were evaluated. Results The TIVA group reported lower NRS pain scores during coughing on postoperative days 1 and 2 but not 3 (p = 0.0127, p = 0.0472, p = 0.4556 respectively). They also consumed significantly less daily (p = 0.001 on day 1, p = 0.0231 on day 2, p = 0.0004 on day 3), accumulative (p = 0.001 on day 1, p<0.0001 on day 2 and p = 0.0064 on day 3) and total morphine (p = 0.03) when compared with the sevoflurane group. There were no differences in total duration of intravenous patient controlled analgesia (PCA) morphine use and patient satisfaction. No difference was found in reported side effects. Conclusion Patients anesthetized with propofol TIVA reported less pain during coughing and consumed less daily, accumulative and total morphine after liver surgery. PMID:26901037

  6. Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk.

    PubMed

    Culvenor, Adam G; Alexander, Bryce C; Clark, Ross A; Collins, Natalie J; Ageberg, Eva; Morris, Hayden G; Whitehead, Timothy S; Crossley, Kay M

    2016-05-01

    Study Design Cross-sectional, controlled laboratory study. Background Postural control following anterior cruciate ligament reconstruction (ACLR) primarily has been investigated during static single-leg balance tasks. Little is known about dynamic postural control deficits post-ACLR. Objectives To compare dynamic postural control (bilaterally) in individuals who have undergone ACLR and in healthy controls, and to evaluate the relationship between dynamic postural control and self-reported and objective function. Methods Ninety-seven participants (66 male; median age, 28 years) 12 months post-ACLR and 48 healthy controls (20 male; median age, 30 years) underwent balance assessment using a Nintendo Wii Balance Board during a single-leg squat. Center-of-pressure (CoP) path velocity, as well as CoP amplitude and standard deviation, in both mediolateral (ML) and anteroposterior (AP) directions were recorded. Self-reported function was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), while hop for distance was used to evaluate functional status. Results Compared to healthy controls, the ACLR group had greater mean CoP path velocity (16% higher, P = .004), ML range (23%, P<.001), ML SD (28%, P<.001), AP range (14%, P = .009), and AP SD (15%, P = .013), indicating worse dynamic balance post-ACLR. Dynamic balance performance was similar between the ACLR limb and the uninjured contralateral limb. The AP SD was weakly associated with hop performance (β = -.2, P = .046); no balance measures were associated with IKDC score. Conclusion Individuals who have undergone ACLR demonstrate impaired dynamic balance bilaterally when performing a single-leg squat, which may have implications for physical function and future injury risk. Routine dynamic balance assessment may help identify patients who could benefit from targeted neuromuscular training programs to improve objective function and potentially lower reinjury risk. J Orthop

  7. Simultaneous Treatment with Subcutaneous Injection of Golimumab and Intra-articular Injection of Triamcinolone Acetonide (K-Method) in Patients with Rheumatoid Arthritis Undergoing Switching of Biologics: Retrospective Case–Control Study

    PubMed Central

    Kanbe, Katsuaki; Chiba, Junji; Inoue, Yasuo; Taguchi, Masashi; Yabuki, Akiko; Deguchi, Tomohiko

    2016-01-01

    BACKGROUND Tight control of severe rheumatoid arthritis (RA) in patients with high disease activity, even when using biologics, is sometimes difficult using a treat-to-target strategy. Switching from one biologic to another is associated with lower efficacy than that in treatment-naive cases. We developed the K-method that involves simultaneous treatment with golimumab and intra-articular joint injection of triamcinolone acetonide (TA) in patients undergoing switching of biologics. We performed this retrospective case–control study to investigate the efficacy of achieving an immediate treatment response using the K-method. METHODS This study involved 20 patients with RA (control group, 10 patients; K-method group, 10 patients). Patients in the control group were switched to golimumab from other biologics without intra-articular injection of TA. The K-method involved injection of 1 mL of TA (40 mg/mL) and 2 mL of 1% lidocaine hydrochloride into swollen or painful joints on the same day as golimumab treatment. A quick response one day after treatment was compared between the two groups according to the disease activity score 28 based on C-reactive protein (DAS28 CRP), clinical disease activity index (CDAI), simplified disease activity index (SDAI), European League Against Rheumatism (EULAR) response, and remission rate. These parameters were investigated for 24 weeks. RESULTS The K-method group showed significant improvements in DAS28 CRP, CDAI, and SDAI at one day, 12 weeks, and 24 weeks compared with the control group. The number of swollen and tender joints and the patient and doctor global visual analog scale scores were also significantly different between the two groups. The remission rates based on DAS28 CRP were 30% at one day, 50% at 12 weeks, and 60% at 24 weeks in the K-method group. The EULAR good/moderate response rates were 80% at one day, 90% at 12 weeks, and 90% at 24 weeks in the K-method group; however, these rates were only 10%, 40%, and 40

  8. The efficacy of peritubal analgesic infiltration in postoperative pain following percutaneous nephrolithotomy – A prospective randomized controlled study

    PubMed Central

    Lojanapiwat, Bannakij; Chureemas, Tanarit; Kittirattarakarn, Pruit

    2015-01-01

    ABSTRACT Objective: To study the efficacy of peritubal infiltration in postoperative pain following percutaneous nephrolithotomy in general PCNL patients and PCNL patients with supracostal renal access. Patients and Methods: A total of 105 PCNL patients were randomized into two groups, 53 patients receiving peritubal analgesic infiltration (study group) and 52 patients as the control group. Of these patients, supracostal access was performed in 22 patients of study group and 23 patients of control group. The study group received peritubal injection with 10mL of bupivacain. Postoperative pain as the primary outcome was assessed by using visual analogue scale at 1, 4, 12, 24 and 48 hours postoperatively. The secondary outcomes were the total postoperative morphine usage in 24 hours and time of the first analgesic demand. Results: The average VAS pain at 1 and 4 hours after the operation in the study group were significant lower in the control group (P≤0.001 and 0.026). Doses of morphine usage for controlling postoperative pain and the first analgesic demand were significantly lower and longer in study group. Among patients submitted to supracostal access, the average VAS pain at 1 hour after operation in the study group was lower (P=0.018). Doses of morphine usage for controlling postoperative pain also was lower in the study group (P=0.012). Conclusion: The peritubal local anesthetic infiltration is effective in alleviating immediate postoperative pain after percutaneous nephrolithotomy even with supracostal access. PMID:26689520

  9. Fully Automatic Guidance and Control for Rotorcraft Nap-of-the-earth Flight Following Planned Profiles. Volume 2: Mathematical Model

    NASA Technical Reports Server (NTRS)

    Clement, Warren F.; Gorder, Peter J.; Jewell, Wayne F.

    1991-01-01

    Developing a single-pilot, all-weather nap-of-the-earth (NOE) capability requires fully automatic NOE (ANOE) navigation and flight control. Innovative guidance and control concepts are investigated in a four-fold research effort that: (1) organizes the on-board computer-based storage and real-time updating of NOE terrain profiles and obstacles in course-oriented coordinates indexed to the mission flight plan; (2) defines a class of automatic anticipative pursuit guidance algorithms and necessary data preview requirements to follow the vertical, lateral, and longitudinal guidance commands dictated by the updated flight profiles; (3) automates a decision-making process for unexpected obstacle avoidance; and (4) provides several rapid response maneuvers. Acquired knowledge from the sensed environment is correlated with the forehand knowledge of the recorded environment (terrain, cultural features, threats, and targets), which is then used to determine an appropriate evasive maneuver if a nonconformity of the sensed and recorded environments is observed. This four-fold research effort was evaluated in both fixed-base and moving-base real-time piloted simulations; thereby, providing a practical demonstration for evaluating pilot acceptance of the automated concepts, supervisory override, manual operation, and re-engagement of the automatic system. Volume one describes the major components of the guidance and control laws as well as the results of the piloted simulations. Volume two describes the complete mathematical model of the fully automatic guidance system for rotorcraft NOE flight following planned flight profiles.

  10. Driving following Kava Use and Road Traffic Injuries: A Population-Based Case-Control Study in Fiji (TRIP 14)

    PubMed Central

    Wainiqolo, Iris; Kafoa, Berlin; Kool, Bridget; Robinson, Elizabeth; Herman, Josephine; McCaig, Eddie; Ameratunga, Shanthi

    2016-01-01

    Objective To investigate the association between kava use and the risk of four-wheeled motor vehicle crashes in Fiji. Kava is a traditional beverage commonly consumed in many Pacific Island Countries. Herbal anxiolytics containing smaller doses of kava are more widely available. Methods Data for this population-based case-control study were collected from drivers of ‘case’ vehicles involved in serious injury-involved crashes (where at least one road user was killed or admitted to hospital for 12 hours or more) and ‘control’ vehicles representative of ‘driving time’ in the study base. Structured interviewer administered questionnaires collected self-reported participant data on demographic characteristics and a range of risk factors including kava use and potential confounders. Unconditional logistic regression models estimated odds ratios relating to the association between kava use and injury-involved crash risk. Findings Overall, 23% and 4% of drivers of case and control vehicles, respectively, reported consuming kava in the 12 hours prior to the crash or road survey. After controlling for assessed confounders, driving following kava use was associated with a four-fold increase in the odds of crash involvement (Odds ratio: 4.70; 95% CI: 1.90–11.63). The related population attributable risk was 18.37% (95% CI: 13.77–22.72). Acknowledging limited statistical power, we did not find a significant interaction in this association with concurrent alcohol use. Conclusion In this study conducted in a setting where recreational kava consumption is common, driving following the use of kava was associated with a significant excess of serious-injury involved road crashes. The precautionary principle would suggest road safety strategies should explicitly recommend avoiding driving following kava use, particularly in communities where recreational use is common. PMID:26930404

  11. Effect of telenursing (telephone follow-up) on glycemic control and body mass index (BMI) of type 2 diabetes patients

    PubMed Central

    Borhani, Fariba; Lashkari, Tahereh; Sabzevari, Sakineh; Abbaszadeh, Abbas

    2013-01-01

    Background: Telenursing includes every nursing and care-giving services conducted remotely. In telenursing, telephone as a device, which is available for most of the people, is being used increasingly. In a telephone-based system, patients are being contacted by health care providers on regular bases and they would be provided with some information about their illness and their treatment method. This study was conducted to determine the effect of phone-based follow-ups on diabetes patients’ metabolic control in the city of Kerman in Iran. Materials and Methods: This is a quasi-experimental study conducted on 50 type II diabetes patients in Kerman during 2011. Data were collected using a demographic questionnaire and also by taking physiological measurement of fasting blood suger (FBS), Glycated Hemoglobin (HbA1c), and postprandial glucose (PPG). Participants’ body mass index (BMI) was calculated by measuring height and weight. Patients completed the questionnaire at the beginning of the study and 12 weeks later. The patients were randomly divided into two groups of experiment and control. Patients in the experimental group received phone calls by the researcher for 12 weeks, and the follow-ups included instructions on self-care and advices to follow their diets, exercise, and insulin titration. Data analysis was done using descriptive and inferential statistical methods (chi-square, analysis of variance [ANOVA], independent t-test, and paired t-test). Results: The decrease of HbA1c and PPG was significantly more in the intervention group compared with the controls (P < 0.001). However, there was no significant difference between the mean of FBS (P = 0.42), and BMI (P = 0.31) in both groups after the intervention. Conclusions: According to the results of this study, telenursing was able to improve the metabolic indices of the patients. Therefore, using this method is recommended for patients with type II diabetes. PMID:24554942

  12. Outcome following physician supervised prehospital resuscitation: a retrospective study

    PubMed Central

    Mikkelsen, Søren; Krüger, Andreas J; Zwisler, Stine T; Brøchner, Anne C

    2015-01-01

    Background Prehospital care provided by specially trained, physician-based emergency services (P-EMS) is an integrated part of the emergency medical systems in many developed countries. To what extent P-EMS increases survival and favourable outcomes is still unclear. The aim of the study was thus to investigate ambulance runs initially assigned ‘life-saving missions’ with emphasis on long-term outcome in patients treated by the Mobile Emergency Care Unit (MECU) in Odense, Denmark Methods All MECU runs are registered in a database by the attending physician, stating, among other parameters, the treatment given, outcome of the treatment and the patient's diagnosis. Over a period of 80 months from May 1 2006 to December 31 2012, all missions in which the outcome of the treatment was registered as ‘life saving’ were scrutinised. Initial outcome, level of competence of the caretaker and diagnosis of each patient were manually established in each case in a combined audit of the prehospital database, the discharge summary of the MECU and the medical records from the hospital. Outcome parameters were final outcome, the aetiology of the life-threatening condition and the level of competences necessary to treat the patient. Results Of 25 647 patients treated by the MECU, 701 (2.7%) received prehospital ‘life saving treatment’. In 596 (2.3%) patients this treatment exceeded the competences of the attending emergency medical technician or paramedic. Of these patients, 225 (0.9%) were ultimately discharged to their own home. Conclusions The present study demonstrates that anaesthesiologist administrated prehospital therapy increases the level of treatment modalities leading to an increased survival in relation to a prehospital system consisting of emergency medical technicians and paramedics alone and thus supports the concept of applying specialists in anaesthesiology in the prehospital setting especially when treating patients with cardiac arrest, patients in need of respiratory support and trauma patients. PMID:25567065

  13. [Rwanda, a retrospective to aid rendered following the 1994 genocide].

    PubMed

    Veeken, H

    1997-04-19

    Some 700,000 Tutsi were killed in Rwanda in 1994, and 1.2 million Hutu fled to neighbouring countries. The United Nations and the non-governmental organizations recently issued a document assessing the aid given. Several matters could have been better. Security in the camps, for instance, was a crucial problem and relief workers and armed forces were unprepared for the involuntary cooperation. Also, estimates of numbers of refugees were inadequate and such estimates were manipulated for political purposes. Relief organizations resorted too quickly to import of goods that were available locally, thereby making the aid unnecessarily expensive. The refugees themselves were involved too little in establishing relief priorities. Life of the original population round the camps was disrupted, a fact that received hardly any attention. PMID:9213801

  14. Maternal fish oil supplementation in pregnancy: a 12 year follow-up of a randomised controlled trial.

    PubMed

    Meldrum, Suzanne; Dunstan, Janet A; Foster, Jonathan K; Simmer, Karen; Prescott, Susan L

    2015-03-01

    A number of trials have been undertaken to assess whether the intake of omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) during pregnancy can influence the neurological development of the offspring, yet no consensus from these trials has been reached. We aimed to investigate the long-term effects (12 years) of fish oil supplementation in pregnancy on neurodevelopment, including cognition, language and fine motor skills. In a follow up of a previously published randomised controlled trial of 98 pregnant women, their children were assessed at 12 years of age using a battery of neurodevelopmental assessments. Fifty participants were assessed at 12 years, with 25 participant's mothers receiving fish oil supplementation, and 25 receiving control capsules. There were no significant differences for any of the assessment measures completed. Our data indicate that fish oil supplementation during pregnancy does not influence the cognition, language or fine motor skills of children in late primary school (12 years of age). PMID:25803546

  15. Apollo: A retrospective analysis

    NASA Technical Reports Server (NTRS)

    Launius, Roger D.

    1994-01-01

    Since the completion of Project Apollo more than twenty years ago there have been a plethora of books, studies, reports, and articles about its origin, execution, and meaning. At the time of the twenty-fifth anniversary of the first landing, it is appropriate to reflect on the effort and its place in U.S. and NASA history. This monograph has been written as a means to this end. It presents a short narrative account of Apollo from its origin through its assessment. That is followed by a mission by mission summary of the Apollo flights and concluded by a series of key documents relative to the program reproduced in facsimile. The intent of this monograph is to provide a basic history along with primary documents that may be useful to NASA personnel and others desiring information about Apollo.

  16. Secondary Prevention following CABG: Findings of a National Randomized Controlled Trial and Sustained Society-Led Incorporation into Practice

    PubMed Central

    Williams, Judson B.; DeLong, Elizabeth R.; Peterson, Eric D.; Dokholyan, Rachel S.; Ou, Fang-Shu; Ferguson, T. Bruce

    2013-01-01

    Background Despite evidence supporting the use of aspirin, B-blockers, ACE inhibitors, and lipid-lowering therapies in eligible patients, adoption of these secondary prevention measures following coronary artery bypass grafting (CABG) has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement (CQI) interventions can be used to speed secondary prevention adherence following CABG. Methods and Results A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361,328 patients undergoing isolated CABG were randomized to either a control or an intervention group. The intervention group received CQI materials designed to influence the prescription of the secondary prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted secondary prevention medications at intervention vs. control sites, assessed by measuring pre-intervention and post-intervention site differences. Pre-randomization treatment patterns and baseline data were similar in the control (N=234) and treatment (N=224) groups. Individual medication use as well as composite adherence increased over 24 months in both groups, with a markedly more rapid rate of adherence uptake among the intervention hospitals and a statistically significant therapy hazard ratio in the intervention vs. control group for all 4 secondary prevention medications. Conclusions Provider-led, low-intensity CQI efforts can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure. The findings of the present trial have led to the incorporation of study outcome metrics into a medical society rating system for ongoing quality improvement. PMID:21173357

  17. Trends in U.S. Hospitalizations Rates and Rhythm Control Therapies Following Publication of the AFFIRM and RACE Trials

    PubMed Central

    Martin-Doyle, William; Essebag, Vidal; Zimetbaum, Peter; Reynolds, Matthew R.

    2010-01-01

    Introduction The impact of trials comparing rate vs. rhythm control for AF on subsequent use of rhythm control therapies and hospitalizations at a national level has not been described. Methods and Results We queried the Healthcare Cost & Utilization Project on the frequency of hospital admissions and performance of specific rhythm control procedures from 1998–2006. We analyzed trends in hospitalization for AF as principal diagnosis before and after the publication of key rate vs. rhythm trials in 2002. We also reviewed the use of electrical cardioversion and catheter ablation as principal procedures during hospital admissions for any cause and for AF as principal diagnosis. We additionally appraised the overall outpatient utilization of antiarrhythmic drugs during this same time frame using IMS Health’s National Prescription Audit.™ Admissions for AF as a principal diagnosis increased at 5%/year from 1998–2002. Following publication of the AFFIRM and RACE trials in 2002, admissions declined by 2%/year from 2002–2004, before rising again from 2004–06. In-hospital electrical cardioversion followed a similar pattern. National prescription volumes for antiarrhythmic drugs grew at <1%/yr from 2002–06, with a marked decline in the use of Class I-A agents, while catheter ablations during admissions for AF as the principal diagnosis increased at 30%/year. Conclusion The use of rhythm control therapies in the U.S. declined significantly in the first few years after publication of AFFIRM and RACE. This trend reversed by 2005, at which time rapid growth in the use of catheter ablation for AF was observed. PMID:21087329

  18. Changes in the burden of malaria following scale up of malaria control interventions in Mutasa District, Zimbabwe

    PubMed Central

    2013-01-01

    Background To better understand trends in the burden of malaria and their temporal relationship to control activities, a survey was conducted to assess reported cases of malaria and malaria control activities in Mutasa District, Zimbabwe. Methods Data on reported malaria cases were abstracted from available records at all three district hospitals, three rural hospitals and 25 rural health clinics in Mutasa District from 2003 to 2011. Results Malaria control interventions were scaled up through the support of the Roll Back Malaria Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and The President’s Malaria Initiative. The recommended first-line treatment regimen changed from chloroquine or a combination of chloroquine plus sulphadoxine/pyrimethamine to artemisinin-based combination therapy, the latter adopted by 70%, 95% and 100% of health clinics by 2008, 2009 and 2010, respectively. Diagnostic capacity improved, with rapid diagnostic tests (RDTs) available in all health clinics by 2008. Vector control consisted of indoor residual spraying and distribution of long-lasting insecticidal nets. The number of reported malaria cases initially increased from levels in 2003 to a peak in 2008 but then declined 39% from 2008 to 2010. The proportion of suspected cases of malaria in older children and adults remained high, ranging from 75% to 80%. From 2008 to 2010, the number of RDT positive cases of malaria decreased 35% but the decrease was greater for children younger than five years of age (60%) compared to older children and adults (26%). Conclusions The burden of malaria in Mutasa District decreased following the scale up of malaria control interventions. However, the persistent high number of cases in older children and adults highlights the need for strategies to identify locally effective control measures that target all age groups. PMID:23815862

  19. Arterial baroreceptor reflex control of renal sympathetic nerve activity following chronic myocardial infarction in male, female, and ovariectomized female rats.

    PubMed

    Pinkham, Maximilian I; Whalley, Gillian A; Guild, Sarah-Jane; Malpas, Simon C; Barrett, Carolyn J

    2015-07-15

    There is controversy regarding whether the arterial baroreflex control of renal sympathetic nerve activity (SNA) in heart failure is altered. We investigated the impact of sex and ovarian hormones on changes in the arterial baroreflex control of renal SNA following a chronic myocardial infarction (MI). Renal SNA and arterial pressure were recorded in chloralose-urethane anesthetized male, female, and ovariectomized female (OVX) Wistar rats 6-7 wk postsham or MI surgery. Animals were grouped according to MI size (sham, small and large MI). Ovary-intact females had a lower mortality rate post-MI (24%) compared with both males (38%) and OVX (50%) (P < 0.05). Males and OVX with large MI, but not small MI, displayed an impaired ability of the arterial baroreflex to inhibit renal SNA. As a result, the male large MI group (49 ± 6 vs. 84 ± 5% in male sham group) and OVX large MI group (37 ± 3 vs. 75 ± 5% in OVX sham group) displayed significantly reduced arterial baroreflex range of control of normalized renal SNA (P < 0.05). In ovary-intact females, arterial baroreflex control of normalized renal SNA was unchanged regardless of MI size. In males and OVX there was a significant, positive correlation between left ventricle (LV) ejection fraction and arterial baroreflex range of control of normalized renal SNA, but not absolute renal SNA, that was not evident in ovary-intact females. The current findings demonstrate that the arterial baroreflex control of renal SNA post-MI is preserved in ovary-intact females, and the state of left ventricular dysfunction significantly impacts on the changes in the arterial baroreflex post-MI. PMID:25994953

  20. Is a single low dose of intrathecal morphine a useful adjunct to patient-controlled analgesia for postoperative pain control following lumbar spine surgery? A preliminary report

    PubMed Central

    Yen, David; Turner, Kim; Mark, David

    2015-01-01

    BACKGROUND: Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid- to high-dose ITM, or not in conjunction with morphine patient-controlled analgesia (PCA). OBJECTIVES: To determine whether low-dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults. METHODS: Thirty-two patients were enrolled in a double-blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step-down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded. RESULTS: The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group. CONCLUSIONS: ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay. PMID:25996764

  1. ANTICHOLINESTERASE INSECTICIDE RETROSPECTIVE

    PubMed Central

    Casida, John E.; Durkin, Kathleen A.

    2012-01-01

    The anticholinesterase (antiChE) organophosphorus (OP) and methylcarbamate (MC) insecticides have been used very effectively as contact and systemic plant protectants for seven decades. About 90 of these compounds are still in use – the largest number for any insecticide chemotype or mode of action. In both insects and mammals, AChE inhibition and acetylcholine accumulation leads to excitation and death. The cholinergic system of insects is located centrally (where it is protected from ionized OPs and MCs) but not at the neuromuscular junction. Structural differences between insect and mammalian AChE are also evident in their genomics, amino acid sequences and active site conformations. Species selectivity is determined in part by inhibitor and target site specificity. Pest population selection with OPs and MCs has resulted in a multitude of modified AChEs of altered inhibitor specificity some conferring insecticide resistance and others enhancing sensitivity. Much of the success of antiChE insecticides results from a suitable balance of bioactivation and detoxification by families of CYP450 oxidases, hydrolases, glutathione S-transferases and others. Known inhibitors for these enzymes block detoxification and enhance potency which is particularly important in resistant strains. The current market for OPs and MCs of 19% of worldwide insecticide sales is only half of that of 10 years ago for several reasons: there have been no major new compounds for 30 years; resistance has eroded their effectiveness; human toxicity problems are still encountered; the patents have expired reducing the incentive to update registration packages; alternative chemotypes or control methods have been developed. Despite this decline, they still play a major role in pest control and the increasing knowledge on their target sites and metabolism may make it possible to redesign the inhibitors for insensitive AChEs and to target new sites in the cholinergic system. The OPs and MCs are down

  2. Effects of a Prekindergarten Educational Intervention on Adult Health: 37-Year Follow-Up Results of a Randomized Controlled Trial

    PubMed Central

    Schweinhart, Lawrence; Montie, Jeanne; Neidell, Matthew

    2009-01-01

    Objectives. We used 37 years of follow-up data from a randomized controlled trial to explore the linkage between an early educational intervention and adult health. Methods. We analyzed data from the High/Scope Perry Preschool Program (PPP), an early school-based intervention in which 123 children were randomized to a prekindergarten education group or a control group. In addition to exploring the effects of the program on health behavioral risk factors and health outcomes, we examined the extent to which educational attainment, income, family environment, and health insurance access mediated the relationship between randomization to PPP and behavioral and health outcomes. Results. The PPP led to improvements in educational attainment, health insurance, income, and family environment Improvements in these domains, in turn, lead to improvements in an array of behavioral risk factors and health (P = .01). However, despite these reductions in behavioral risk factors, participants did not exhibit any overall improvement in physical health outcomes by the age of 40 years. Conclusions. Early education reduces health behavioral risk factors by enhancing educational attainment, health insurance coverage, income, and family environments. Further follow-up will be needed to determine the long-term health effects of PPP. PMID:19542034

  3. Rewiring the Brain: Potential Role of the Premotor Cortex in Motor Control, Learning, and Recovery of Function Following Brain Injury

    PubMed Central

    Kantak, Shailesh S.; Stinear, James W.; Buch, Ethan R.; Cohen, Leonardo G.

    2016-01-01

    The brain is a plastic organ with a capability to reorganize in response to behavior and/or injury. Following injury to the motor cortex or emergent corticospinal pathways, recovery of function depends on the capacity of surviving anatomical resources to recover and repair in response to task-specific training. One such area implicated in poststroke reorganization to promote recovery of upper extremity recovery is the premotor cortex (PMC). This study reviews the role of distinct subdivisions of PMC: dorsal (PMd) and ventral (PMv) premotor cortices as critical anatomical and physiological nodes within the neural networks for the control and learning of goal-oriented reach and grasp actions in healthy individuals and individuals with stroke. Based on evidence emerging from studies of intrinsic and extrinsic connectivity, transcranial magnetic stimulation, functional neuroimaging, and experimental studies in animals and humans, the authors propose 2 distinct patterns of reorganization that differentially engage ipsilesional and contralesional PMC. Research directions that may offer further insights into the role of PMC in motor control, learning, and poststroke recovery are also proposed. This research may facilitate neuroplasticity for maximal recovery of function following brain injury. PMID:21926382

  4. Apollo: A Retrospective Analysis

    NASA Technical Reports Server (NTRS)

    Launius, Roger D.

    2004-01-01

    The program to land an American on the Moon and return safely to Earth in the 1960s has been called by some observers a defining event of the twentieth century. Pulitzer Prize-winning historian Arthur M. Schlesinger, Jr., even suggested that when Americans two centuries hence study the twentieth century, they will view the Apollo lunar landing as the critical event of the century. While that conclusion might be premature, there can be little doubt but that the flight of Apollo 11 in particular and the overall Apollo program in general was a high point in humanity s quest to explore the universe beyond Earth. Since the completion of Project Apollo more than twenty years ago there have been a plethora of books, studies, reports, and articles about its origin, execution, and meaning. At the time of the twenty-fifth anniversary of the first landing, it is appropriate to reflect on the effort and its place in U.S. and NASA history. This monograph has been written as a means to this end. It presents a short narrative account of Apollo from its origin through its assessment. That is followed by a mission by mission summary of the Apollo flights and concluded by a series of key documents relative to the program reproduced in facsimile. The intent of this monograph is to provide a basic history along with primary documents that may be useful to NASA personnel and others desiring information about Apollo.

  5. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes

    SciTech Connect

    Stone, Nelson N.; Stock, Richard G.; Cesaretti, Jamie A.; Unger, Pam

    2010-02-01

    Purpose: To determine factors that influence local control and systemic relapse in patients undergoing permanent prostate brachytherapy (PPB). Methods and Materials: A total of 584 patients receiving PPB alone or PPB with external beam radiation therapy (19.5%) agreed to undergo prostate biopsy (PB) at 2 years postimplantion and yearly if results were positive or if the prostate-specific antigen (PSA) level increased. Short-term hormone therapy was used with 280 (47.9%) patients. Radiation doses were converted to biologically effective doses (BED) (using alpha/beta = 2). Comparisons were made by chi-square analysis and linear regression. Survival was determined by the Kaplan-Meier method. Results: The median PSA concentration was 7.1 ng/ml, and the median follow-up period was 7.1 years. PB results were positive for 48/584 (8.2%) patients. Positive biopsy results by BED group were as follows: 22/121 (18.2%) patients received a BED of <=150 Gy; 15/244 (6.1%) patients received >150 to 200 Gy; and 6/193 (3.1%; p < 0.001) patients received >200 Gy. Significant associations of positive PB results by risk group were low-risk group BED (p = 0.019), intermediate-risk group hormone therapy (p = 0.011) and BED (p = 0.040), and high-risk group BED (p = 0.004). Biochemical freedom from failure rate at 7 years was 82.7%. Biochemical freedom from failure rate by PB result was 84.7% for negative results vs. 59.2% for positive results (p < 0.001). Cox regression analysis revealed significant associations with BED (p = 0.038) and PB results (p = 0.002) in low-risk patients, with BED (p = 0.003) in intermediate-risk patients, and with Gleason score (p = 0.006), PSA level (p < 0.001), and PB result (p = 0.038) in high-risk patients. Fifty-three (9.1%) patients died, of which eight deaths were due to prostate cancer. Cause-specific survival was 99.2% for negative PB results vs. 87.6% for positive PB results (p < 0.001). Conclusions: Higher radiation doses are required to achieve local

  6. Effects of Weight-Bearing Biofeedback Training on Functional Movement Patterns Following Total Knee Arthroplasty: A Randomized Controlled Trial

    PubMed Central

    Christiansen, Cory L.; Bade, Michael J.; Davidson, Bradley S.; Dayton, Michael R.; Stevens-Lapsley, Jennifer E.

    2015-01-01

    STUDY DESIGN Randomized controlled trial. OBJECTIVES Examine the effects of weight-bearing (WB) biofeedback training on WB symmetry and functional joint moments following unilateral total knee arthroplasty (TKA). BACKGROUND Individuals post unilateral TKA place more weight on the non-surgical limb compared to the surgical limb during function. It is unknown if targeted intervention can improve surgical limb use and resolve altered movement patterns. METHODS Twenty-six patients were randomized to 2 groups: RELOAD or CONTROL. The RELOAD group had standard of care rehabilitation augmented with WB biofeedback training and the CONTROL group had dose-matched standard of care. Lower limb weight-bearing ratios (WBRs) were measured preoperatively and 6 and 26 weeks after TKA during a Five Times Sit-to-Stand Test (FTSST) and walking. Secondary outcomes were FTSST time, walking speed, and lower limb joint moments during the FTSST and walking. RESULTS No between-group differences were found in WBR. FTSST time improved in the RELOAD group compared to the CONTROL group at 6 (P=.021) and 26 weeks (P=.021) and there was a tendency for improved walking speed in the RELOAD group at 26 weeks (P=.068). There were no between-group differences in knee extension moment during the FTSST. Surgical-limb knee extension moments during walking increased from baseline to 26 weeks in the RELOAD group and decreased in the CONTROL group (P=.008). CONCLUSION WB biofeedback training had no effect on functional WB symmetry or knee extension moments during the FTSST. However, the biofeedback training resulted in increases of knee extension moments during gait and improved FTSST times. LEVEL OF EVIDENCE Therapy, level 2b. PMID:26207975

  7. Modification of Otolith-Ocular Reflexes, Motion Perception and Manual Control During Variable Radius Centrifugation Following Space Flight

    NASA Technical Reports Server (NTRS)

    Wood, Scott J.; Clarke, A. H.; Rupert, A. H.; Harm, D. L.; Clement, G. R.

    2009-01-01

    Two joint ESA-NASA studies are examining changes in otolith-ocular reflexes and motion perception following short duration space flights, and the operational implications of post-flight tilt-translation ambiguity for manual control performance. Vibrotactile feedback of tilt orientation is also being evaluated as a countermeasure to improve performance during a closed-loop nulling task. Data is currently being collected on astronaut subjects during 3 preflight sessions and during the first 8 days after Shuttle landings. Variable radius centrifugation is utilized to elicit otolith reflexes in the lateral plane without concordant roll canal cues. Unilateral centrifugation (400 deg/s, 3.5 cm radius) stimulates one otolith positioned off-axis while the opposite side is centered over the axis of rotation. During this paradigm, roll-tilt perception is measured using a subjective visual vertical task and ocular counter-rolling is obtained using binocular video-oculography. During a second paradigm (216 deg/s, less than 20 cm radius), the effects of stimulus frequency (0.15 - 0.6 Hz) are examined on eye movements and motion perception. A closed-loop nulling task is also performed with and without vibrotactile display feedback of chair radial position. Data collection is currently ongoing. Results to date suggest there is a trend for perceived tilt and translation amplitudes to be increased at the low and medium frequencies on landing day compared to pre-flight. Manual control performance is improved with vibrotactile feedback. One result of this study will be to characterize the variability (gain, asymmetry) in both otolith-ocular responses and motion perception during variable radius centrifugation, and measure the time course of post-flight recovery. This study will also address how adaptive changes in otolith-mediated reflexes correspond to one's ability to perform closed-loop nulling tasks following G-transitions, and whether manual control performance can be improved

  8. Dark Period Following UV-C Treatment Enhances Killing of Botrytis cinerea Conidia and Controls Gray Mold of Strawberries.

    PubMed

    Janisiewicz, Wojciech J; Takeda, Fumiomi; Glenn, D Michael; Camp, Mary J; Jurick, Wayne M

    2016-04-01

    Strawberries are available throughout the year either from production in the field or from high and low tunnel culture. Diversity of production conditions results in new challenges in controlling diseases before and after harvest. Fungicides have traditionally been used to control these diseases; however, their limitations necessitate a search for new approaches. We found that UV-C irradiation of Botrytis cinerea, a major pathogen of strawberry, can effectively kill this fungus if a dark period follows the treatment. The inclusion of a 4-h dark period resulted in almost complete kill of B. cinerea conidia on agar media at a dose of 12.36 J/m2. The UV-C dose did not cause a reduction in photosynthesis in strawberry leaves or discoloration of sepals, even after exposing plants repeatedly (twice a week) for 7 weeks. Although irradiation of dry conidia of B. cinerea with this dose resulted in some survival, the conidia were not infective and not able to cause decay even when inoculated onto a highly susceptible mature apple fruit. Irradiation of strawberry pollen at 12.36 J/m2 did not affect pollen germination, tube growth and length in vitro, or germination and tube growth in the style of hand-pollinated emasculated strawberry flowers. No negative effect of the UV-C treatment was observed on fruit yield and quality in high tunnel culture. In the fruit and flower petal inoculation tests, the UV-C treatment was highly effective in reducing fruit decay and petal infection. This UV-C treatment with an exposure time of 60 s may be useful in controlling gray mold in tunnel production of strawberries and may also have the potential for use in intensive field and indoor production of other fruits and vegetables providing that a 4-h dark period follows the irradiation. PMID:26714103

  9. GLUCOSE CONTROL IN RWANDAN YOUTH WITH TYPE 1 DIABETES FOLLOWING ESTABLISHMENT OF SYSTEMATIC, HBA1C BASED, CARE AND EDUCATION

    PubMed Central

    Marshall, Sara L.; Edidin, Deborah; Arena, Vincent C.; Becker, Dorothy J.; Bunker, Clareann H.; Gishoma, Crispin; Gishoma, Francois; LaPorte, Ronald E.; Kaberuka, Vedaste; Ogle, Graham; Sibomana, Laurien; Orchard, Trevor J.

    2014-01-01

    AIMS To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined. METHODS A 1–2 year follow-up of 214 members of the Rwanda Life for a Child program (aged < 26 years) with a first HbA1c between June 2009 and November 2010 was conducted. Data were analyzed for the entire cohort and by age (< 18 years, ≥ 18 years). Trajectory analysis was performed to identify trends in HbA1c. RESULTS Mean overall HbA1c decreased significantly from baseline (11.2±2.7%; 99±30 mmol/mol) to one- (10.2±2.6%; 88±28 mmol/mol) and two- (9.8±26%; 84±25 mmol/mol) year follow up visits. The prevalence of microalbuminuria did not significantly change (21.0%, 18.8%, and 19.6%), nor did nephropathy (4.7%, 7.8%, and 5.4%). However, rates of hypertension (31.8%, 44.9%, and 40.3%) were higher than expected. Five HbA1c groups were identified by trajectory analysis, and those with the worst control monitored their glucose significantly fewer times per week. CONCLUSIONS The establishment of regular care, HbA1c testing, and increased education is associated with significant improvements in glycemic control in youth with type 1 diabetes (T1D) in sub-Saharan Africa, but the high prevalence of hypertension is of concern. PMID:25458328

  10. A control method applied to mixed traffic flow for the coupled-map car-following model

    NASA Astrophysics Data System (ADS)

    Cheng, Rong-Jun; Han, Xiang-Lin; Lo, Siu-Ming; Ge, Hong-Xia

    2014-03-01

    In light of previous work [Phys. Rev. E 60 4000 (1999)], a modified coupled-map car-following model is proposed by considering the headways of two successive vehicles in front of a considered vehicle described by the optimal velocity function. The non-jam conditions are given on the basis of control theory. Through simulation, we find that our model can exhibit a better effect as p = 0.65, which is a parameter in the optimal velocity function. The control scheme, which was proposed by Zhao and Gao, is introduced into the modified model and the feedback gain range is determined. In addition, a modified control method is applied to a mixed traffic system that consists of two types of vehicle. The range of gains is also obtained by theoretical analysis. Comparisons between our method and that of Zhao and Gao are carried out, and the corresponding numerical simulation results demonstrate that the temporal behavior of traffic flow obtained using our method is better than that proposed by Zhao and Gao in mixed traffic systems.

  11. Chiral Plasma Pharmacokinetics of 3,4-Methylenedioxymethamphetamine and its Phase I and II Metabolites following Controlled Administration to Humans.

    PubMed

    Steuer, Andrea E; Schmidhauser, Corina; Schmid, Yasmin; Rickli, Anna; Liechti, Matthias E; Kraemer, Thomas

    2015-12-01

    Generally, pharmacokinetic studies on 3,4-methylenedioxymethamphetamine (MDMA) in blood have been performed after conjugate cleavage, without taking into account that phase II metabolites represent distinct chemical entities with their own effects and stereoselective pharmacokinetics. The aim of the present study was to stereoselectively investigate the pharmacokinetics of intact glucuronide and sulfate metabolites of MDMA in blood plasma after a controlled single MDMA dose. Plasma samples from 16 healthy participants receiving 125 mg of MDMA orally in a controlled study were analyzed using liquid chromatography-tandem mass spectroscopy after chiral derivatization. Pharmacokinetic parameters of R- and S-stereoisomers were determined. Sulfates of 3,4-dihydroxymethamphetamine (DHMA), and sulfate and glucuronide of 4-hydroxy-3-methoxymethamphetamine (HMMA) were identified, whereas free phase I metabolites were not detected. Stereoselective differences in Cmax and AUC24 were observed with the following preferences: R>S for MDMA and DHMA 4-sulfate; S>R for 3,4-methylenedioxyamphetamine (MDA), DHMA 3-sulfate, and HMMA glucuronide; and no preference in Cmax for HMMA sulfate. R/S ratios were >1 for all analytes after 24 hours, independent of the initial chiral preference. These are the first data on chiral pharmacokinetics of MDMA phase II metabolites in human plasma in vivo after controlled administration. The main human MDMA metabolites were shown to be sulfate and glucuronide conjugates. PMID:26395866

  12. Medial open transversus abdominis plane (MOTAP) catheters for analgesia following open liver resection: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background The current standard for pain control following liver surgery is intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. We have developed a modification of a regional technique called medial open transversus abdominis plane (MOTAP) catheter analgesia. The MOTAP technique involves surgically placed catheters through the open surgical site into a plane between the internal oblique muscle and the transverse abdominis muscle superiorly. The objective of this trial is to assess the efficacy of this technique. Methods/design This protocol describes a multicentre, prospective, blinded, randomized controlled trial. One hundred and twenty patients scheduled for open liver resection through a subcostal incision will be enrolled. All patients will have two MOTAP catheters placed at the conclusion of surgery. Patients will be randomized to one of two parallel groups: experimental (local anaesthetic through MOTAP catheters) or placebo (normal saline through MOTAP catheters). Both groups will also receive IV PCA. The primary endpoint is mean cumulative postoperative opioid consumption over the first 2 postoperative days (48 hours). Secondary outcomes include pain intensity, patient functional outcomes, and the incidence of complications. Discussion This trial has been approved by the ethics boards at participating centres and is currently enrolling patients. Data collection will be completed by the end of 2014 with analysis mid-2015 and publication by the end of 2015. Trial registration The study is registered with http://clinicaltrials.gov ( NCT01960049; 23 September 2013) PMID:24950773

  13. Annual Energy Outlook Retrospective Review

    EIA Publications

    2015-01-01

    The Annual Energy Outlook Retrospective Review provides a yearly comparison between realized energy outcomes and the Reference case projections included in previous Annual Energy Outlooks (AEO) beginning with 1982. This edition of the report adds the AEO 2012 projections and updates the historical data to incorporate the latest data revisions.

  14. Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial

    PubMed Central

    2015-01-01

    Objective To assess whether systematic follow-up by general practitioners (GPs) of cases of deliberate self-poisoning (DSP) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice. Design Randomised clinical trial with two parallel groups. Setting General practices in Oslo and the eastern part of Akershus County. Participants Patients aged 18–75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge. Intervention The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78) or treatment as usual (n = 98). Main Outcome Measures Primary outcome measure was the Beck Scale for Suicide Ideation (SSI). Secondary outcomes were Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS), self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA). We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records. Results There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009). Readmissions to general hospitals were similar (13% in both groups (P = 0.963), while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103). Conclusion Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation

  15. Transport of Black Carbon Across the Terrestrial-Aquatic Interface Following Wildfire: Contributions of Short and Long-term Controls

    NASA Astrophysics Data System (ADS)

    Boot, C. M.; Cotrufo, M. F.; Haddix, M. L.; Schmeer, S.; Kampf, S. K.; Brogan, D. J.; Nelson, P. A.; Rhoades, C.; Ryan, S. E.; Rathburn, S. L.; Hall, E.

    2014-12-01

    Black carbon (BC) is a ubiquitous component of the carbon cycle, yet controls on its landscape-level distribution, including the relative importance of mechanisms for transport across the terrestrial aquatic interface, are relatively unknown. In June 2012, the High Park Fire (HPF) burned 353 km2 of land in the Cache la Poudre (CLP) watershed just northwest of Fort Collins, CO. Following independent efforts of our group to quantify the effects of the HPF on biogeochemical pools and landscape geomorphology, we aimed to synthesize our respective datasets with two main objectives: 1. determine and relate BC content in different parts of the watershed including litter, soils, river bank sediments and dissolved and particulate organic materials in river water, 2. develop a conceptual framework for mechanisms that contribute to BC export from the CLP on short and long-term time scales. Using the benzene polycarboxylic acid (BPCA) method as a molecular proxy for BC concentrations, we found that the majority of BC deposited on the landscape by the HPF was located in the litter, coarse plant fraction of river bank sediments, and DOC, suggesting that BC mobilized on the landscape is transported downstream through the river network. In 2012, following the HPF, the 30-minute rainfall intensity required to mobilize sediment on hillslopes (critical I30) was 3.6 mm/hr, and in summer 2013, the critical I30 increased to 8.1 mm/hr, likely due to vegetation recovery. The low critical I30 in the first season following the fire indicated that BC could have been easily mobilized, even in small storms. Our working conceptual framework is that post fire, there are two phases of BC export from an ecosystem. In the first phase, BC export is primarily driven by transport of particulate material controlled by precipitation intensity and duration, along with the burn severity and slope of the landscape. The second phase of BC export is primarily in the dissolved form, and is driven by climatic

  16. Home-Based Psychiatric Outpatient Care Through Videoconferencing for Depression: A Randomized Controlled Follow-Up Trial

    PubMed Central

    Rössler, Wulf

    2016-01-01

    Background There is a tremendous opportunity for innovative mental health care solutions such as psychiatric care through videoconferencing to increase the number of people who have access to quality care. However, studies are needed to generate empirical evidence on the use of psychiatric outpatient care via videoconferencing, particularly in low- and middle-income countries and clinically unsupervised settings. Objective The objective of this study was to evaluate the effectiveness and feasibility of home-based treatment for mild depression through psychiatric consultations via videoconferencing. Methods A randomized controlled trial with a 6- and 12-month follow-up including adults with mild depression treated in an ambulatory setting was conducted. In total, 107 participants were randomly allocated to the videoconferencing intervention group (n=53) or the face-to-face group (F2F; n=54). The groups did not differ with respect to demographic characteristics at baseline. The F2F group completed monthly follow-up consultations in person. The videoconferencing group received monthly follow-up consultations with a psychiatrist through videoconferencing at home. At baseline and after 6 and 12 months, in-person assessments were conducted with all participants. Clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence were assessed. Results The severity of depression decreased significantly over the 12-month follow-up in both the groups. There was a significant difference between groups regarding treatment outcomes throughout the follow-up period, with better results in the videoconferencing group. There were 4 relapses in the F2F group and only 1 in the videoconferencing group. No significant differences between groups regarding mental health status, satisfaction with treatment, therapeutic

  17. Trends in Staphylococcus aureus bacteraemia and impacts of infection control practices including universal MRSA admission screening in a hospital in Scotland, 2006–2010: retrospective cohort study and time-series intervention analysis

    PubMed Central

    Edwards, Becky; López-Lozano, José-Maria; Gould, Ian

    2012-01-01

    Objectives To describe secular trends in Staphylococcus aureus bacteraemia (SAB) and to assess the impacts of infection control practices, including universal methicillin-resistant Staphylococcus aureus (MRSA) admission screening on associated clinical burdens. Design Retrospective cohort study and multivariate time-series analysis linking microbiology, patient management and health intelligence databases. Setting Teaching hospital in North East Scotland. Participants All patients admitted to Aberdeen Royal Infirmary between 1 January 2006 and 31 December 2010: n=420 452 admissions and 1 430 052 acute occupied bed days (AOBDs). Intervention Universal admission screening programme for MRSA (August 2008) incorporating isolation and decolonisation. Primary and secondary measures Hospital-wide prevalence density, hospital-associated incidence density and death within 30 days of MRSA or methicillin-sensitive Staphylococcus aureus (MSSA) bacteraemia. Results Between 2006 and 2010, prevalence density of all SAB declined by 41%, from 0.73 to 0.50 cases/1000 AOBDs (p=0.002 for trend), and 30-day mortality from 26% to 14% (p=0.013). Significant reductions were observed in MRSA bacteraemia only. Overnight admissions screened for MRSA rose from 43% during selective screening to >90% within 4 months of universal screening. In multivariate time-series analysis (R2 0.45 to 0.68), universal screening was associated with a 19% reduction in prevalence density of MRSA bacteraemia (−0.035, 95% CI −0.049 to −0.021/1000 AOBDs; p<0.001), a 29% fall in hospital-associated incidence density (−0.029, 95% CI −0.035 to −0.023/1000 AOBDs; p<0.001) and a 46% reduction in 30-day mortality (−15.6, 95% CI −24.1% to −7.1%; p<0.001). Positive associations with fluoroquinolone and cephalosporin use suggested that antibiotic stewardship reduced prevalence density of MRSA bacteraemia by 0.027 (95% CI 0.015 to 0.039)/1000 AOBDs. Rates of MSSA bacteraemia were not

  18. Increased carriage of macrolide-resistant fecal E. coli following mass distribution of azithromycin for trachoma control

    PubMed Central

    Seidman, Jessica C; Coles, Christian L; Silbergeld, Ellen K; Levens, Joshua; Mkocha, Harran; Johnson, Lashaunda B; Muñoz, Beatriz; West, Sheila K

    2014-01-01

    Background: Mass drug treatment with azithromycin (MDA) is part of the WHO-endorsed ‘SAFE’ strategy for trachoma control in endemic communities. MDA has been associated with reduced trachoma prevalence and short-term reductions in other bacterial infections, but can also lead to increased circulation of macrolide-resistant bacteria. Methods: We prospectively monitored macrolide resistance in fecal E. coli collected from young children participating in the PRET+ Study in rural Tanzania. MDA was administered in four villages with >10% trachoma prevalence. Four nearby communities with lower trachoma prevalence served as controls. Rectal swabs were collected during cross-sectional surveys performed at baseline, 1, 3 and 6 months after MDA. Fecal E. coli isolates were screened for macrolide susceptibility using disc diffusion and minimum inhibitory concentration methods. Cross-sectional and longitudinal differences in resistance prevalence by MDA exposure were compared using t-tests and logistic regression. Results: There was no difference in the proportion of individuals carrying azithromycin-resistant E. coli at baseline (0.21 vs 0.16, P > 0.05). Azithromycin resistance carriage prevalence remained stable over follow-up in non-MDA villages but increased sharply in MDA villages (0.61 at 1 month, 0.42 at 3 months and 0.31 at 6 months). MDA exposure was highly associated with azithromycin resistance carriage at 1 month post-MDA (OR 15.27, P < 0.001) and subsequent surveys. Younger age and recent diarrhoea were also associated with increased odds of resistance (P < 0.01). Conclusions: MDA resulted in significantly increased prevalence of macrolide resistance in E. coli. Although MDA is effective for trachoma elimination, it has costs; it is essential to monitor antimicrobial resistance following MDA. PMID:24659584

  19. Unlearning chronic pain: A randomized controlled trial to investigate changes in intrinsic brain connectivity following Cognitive Behavioral Therapy

    PubMed Central

    Shpaner, Marina; Kelly, Clare; Lieberman, Greg; Perelman, Hayley; Davis, Marcia; Keefe, Francis J.; Naylor, Magdalena R.

    2014-01-01

    Chronic pain is a complex physiological and psychological phenomenon. Implicit learning mechanisms contribute to the development of chronic pain and to persistent changes in the central nervous system. We hypothesized that these central abnormalities can be remedied with Cognitive Behavioral Therapy (CBT). Specifically, since regions of the anterior Default Mode Network (DMN) are centrally involved in emotional regulation via connections with limbic regions, such as the amygdala, remediation of maladaptive behavioral and cognitive patterns as a result of CBT for chronic pain would manifest itself as a change in the intrinsic functional connectivity (iFC) between these prefrontal and limbic regions. Resting-state functional neuroimaging was performed in patients with chronic pain before and after 11-week CBT (n = 19), as well as a matched (ages 19–59, both sexes) active control group of patients who received educational materials (n = 19). Participants were randomized prior to the intervention. To investigate the differential impact of treatment on intrinsic functional connectivity (iFC), we compared pre–post differences in iFC between groups. In addition, we performed exploratory whole brain analyses of changes in fractional amplitude of low frequency fluctuations (fALFF). The course of CBT led to significant improvements in clinical measures of pain and self-efficacy for coping with chronic pain. Significant group differences in pre–post changes in both iFC and fALFF were correlated with clinical outcomes. Compared to control patients, iFC between the anterior DMN and the amygdala/periaqueductal gray decreased following CBT, whereas iFC between the basal ganglia network and the right secondary somatosensory cortex increased following CBT. CBT patients also had increased post-therapy fALFF in the bilateral posterior cingulate and the cerebellum. By delineating neuroplasticity associated with CBT-related improvements, these results add to mounting evidence

  20. Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial.

    PubMed

    Nieminen, Katri; Berg, Ida; Frankenstein, Katri; Viita, Lina; Larsson, Kamilla; Persson, Ulrika; Spånberger, Loviisa; Wretman, Anna; Silfvernagel, Kristin; Andersson, Gerhard; Wijma, Klaas

    2016-06-01

    The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale-Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects. PMID:27152849

  1. Prescription opioids. III. Disposition of oxycodone in oral fluid and blood following controlled single-dose administration.

    PubMed

    Cone, Edward J; DePriest, Anne Z; Heltsley, Rebecca; Black, David L; Mitchell, John M; LoDico, Charles; Flegel, Ron

    2015-04-01

    Oxycodone (OC) is recommended to be included as an analyte tested in the proposed Substance Abuse and Mental Health Services Administration (SAMHSA's) Mandatory Guidelines for Federal Workplace Drug Testing Programs using Oral Fluid (OF) Specimens. This study demonstrates the time course of OC and metabolites, noroxycodone (NOC), oxymorphone (OM) and noroxymorphone (NOM), in near-simultaneous paired OF and whole blood (BL) specimens by liquid chromatography-tandem mass spectrometry (LC-MS-MS) (limit of detection = 1 ng/mL OF, 5 ng/mL BL). A single dose of OC 20 mg controlled-release was administered to 12 healthy subjects followed by specimen collections for 52 h. Analyte prevalence was as follows: OF, OC > NOC > OM; and BL, OC > NOC > NOM. OC and NOC were frequently detected within 15-30 min in OF and 30 min to 2 h in BL. NOM and OM appeared between 1.5-5 h post-dose. The mean OF-to-BL (OF:BL) ratios and correlations were 5.4 for OC (r = 0.719) and 1.0 for NOC (r = 0.651). The period of detection for OF exceeded BL by ∼2-fold at similar cutoff concentrations. At a 1 ng/mL cutoff for OF, the mean detection time was 34 h for OC and NOC. These data provide new information that should facilitate interpretation of OC test results. PMID:25589778

  2. Endoscopically controlled hydraulic sinus lift in combination with rotary instruments: one-year follow-up of a case series.

    PubMed

    Andreasi Bassi, M; Andrisani, C; Lopez, M A; Gaudio, R M; Lombardo, L; Lauritano, D

    2016-01-01

    The aim of this study was to evaluate a sinus lift via crestal approach (SLVCA) case series, performed with rotary instruments and hydraulic pressure, analyzed under endoscopic control. Sixteen patients (11 female, 5 male, mean age 47.13±8.07 years) candidates for SLVCA were enrolled in this study. Twenty-two cylindrical two-piece implants were placed. After a suitable period of time needed for the consolidation of the graft (mean value 5.78±1.49 months), the bone augmentation was assessed by means of intraoral X-ray exams before the surgical procedure of re-entry. After a functional load with temporary acrylic fixed prosthesis, on Peek abutments, for a span of 4 months, the cases were finalized with cemented metal-ceramic prosthesis (10 single crowns, 6 bridges). The post finalization follow-up was at 12 months. During the perforation of the sinus floor via rotary instruments no perforations of the sinus membrane were observed either during the hydraulic detachment or simultaneous filling of the subantral space with the graft material. Survival rate was 94.5% since one fixture was lost, but immediately replaced with a new one. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. The SLVCA performed with rotary instruments and hydraulic pressure is a reliable grafting procedure for oral rehabilitation of maxillary edentulous sites. PMID:27469544

  3. RhoB controls coordination of adult angiogenesis and lymphangiogenesis following injury by regulating VEZF1-mediated transcription

    NASA Astrophysics Data System (ADS)

    Gerald, Damien; Adini, Irit; Shechter, Sharon; Perruzzi, Carole; Varnau, Joseph; Hopkins, Benjamin; Kazerounian, Shiva; Kurschat, Peter; Blachon, Stephanie; Khedkar, Santosh; Bagchi, Mandrita; Sherris, David; Prendergast, George C.; Klagsbrun, Michael; Stuhlmann, Heidi; Rigby, Alan C.; Nagy, Janice A.; Benjamin, Laura E.

    2013-11-01

    Mechanisms governing the distinct temporal dynamics that characterize post-natal angiogenesis and lymphangiogenesis elicited by cutaneous wounds and inflammation remain unclear. RhoB, a stress-induced small GTPase, modulates cellular responses to growth factors, genotoxic stress and neoplastic transformation. Here we show, using RhoB null mice, that loss of RhoB decreases pathological angiogenesis in the ischaemic retina and reduces angiogenesis in response to cutaneous wounding, but enhances lymphangiogenesis following both dermal wounding and inflammatory challenge. We link these unique and opposing roles of RhoB in blood versus lymphatic vasculatures to the RhoB-mediated differential regulation of sprouting and proliferation in primary human blood versus lymphatic endothelial cells. We demonstrate that nuclear RhoB-GTP controls expression of distinct gene sets in each endothelial lineage by regulating VEZF1-mediated transcription. Finally, we identify a small-molecule inhibitor of VEZF1-DNA interaction that recapitulates RhoB loss in ischaemic retinopathy. Our findings establish the first intra-endothelial molecular pathway governing the phased response of angiogenesis and lymphangiogenesis following injury.

  4. Randomized controlled trial of anterior-chamber intraocular lenses in Nepal: long-term follow-up.

    PubMed Central

    Evans, J. R.; Henning, A.; Pradhan, D.; Foster, A.; Lagnado, R.; Poulson, A.; Johnson, G. J.; Wormald, R. P.

    2000-01-01

    Most of the estimated 20 million people who are blind with cataracts live in rural areas of developing countries, where expert surgical resources are scarce. We have studied the use of multiflex open-loop anterior-chamber intraocular lenses (ACIOL) in high-volume low-cost surgery. Between 1992 and 1995, a total of 2000 people attending Lahan Eye Hospital, Nepal, with bilateral cataracts reducing vision to < or = 6/36 were randomly allocated to receive intracapsular extraction (ICCE) with aphakic spectacles, or ICCE with an ACIOL. We re-examined the cohort (1305/2000, 65%) between November 1996 and April 1997 and report the findings in this article. There were 13 new cases of poor visual outcome (best corrected v