Sample records for apache ii child-pugh

  1. Portal hypertensive gastropathy: association with Child-Pugh score in liver cirrhosis

    NASA Astrophysics Data System (ADS)

    Sungkar, T.; Zain, L. H.; Siregar, G. A.

    2018-03-01

    Portal Hypertensive Gastropathy (PHG) occurs as a complication of cirrhotic or non-cirrhotic portal hypertension. The association between the severity of portal hypertensive gastropathy and the hepatic function, as assessed by the Child-Pugh score in patients with liver cirrhosis are poorly defined. We evaluated association between PHG and Child-Pugh score in patients with liver cirrhosis. Adults liver cirrhosis patients admitted at Adam Malik Hospital Medan during January 2016-December 2016, were included in this study. Endoscopic PHG grade, Child-Pugh score were assessed. A total of 49 patients were enrolled. Majority of cases of liver cirrhosis are due to chronic viral hepatitis B infections (65.3 %). Portal hypertensive gastropathy were observed in 46 cases; twenty-five patients (51%) showed severe portal hypertensive gastropathy. The overall prevalence of PHG and the proportion of patients with severe PHG differ about the Child-Pugh classification. PHG was present in 66.7 % of patients from Child-Pugh class A, 96 % of patients with class B, and 95.2 % of those from class C, and severe forms were present in 0 %, 36 %, and 76.2 %, respectively (P< 0.000). In conclusions, the present data suggest that the severity of portal hypertensive gastropathy is related to Child-Pugh score.

  2. Vitamin D Deficiency and Its Relationship with Child-Pugh Class in Patients with Chronic Liver Disease

    PubMed Central

    Jamil, Zubia; Arif, Sharmin; Khan, Anum; Durrani, Asghar Aurangzeb; Yaqoob, Nayyar

    2018-01-01

    Abstract Background and Aims: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D deficiency has a central role in developing hepatic osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their relationship with disease advancement in these patients. Methods: Vitamin D levels were checked in 125 chronic liver disease patients. The patients were classified in three stages according to Child-Pugh score: A, B and C. The relationship of vitamin D levels with Child-Pugh score and other variables in the study was assessed by the contingency coefficient. Correlation and logistic regression analyses were also carried out to find additional predictors of low vitamin D levels. Results: Among the patients, 88% had either insufficient or deficient stores of vitamin D, while only 12% had sufficient vitamin D levels (p >0.05). Vitamin D levels were notably related to Child-Pugh class (contingency coefficient = 0.5, p <0.05). On univariate and multinomial regression analyses, age, female sex, MELD and Child-Pugh class were predictors of low vitamin D levels. Age, model of end-stage liver disease score and Child-Pugh score were negatively correlated to vitamin D levels (p <0.05). Conclusions: Vitamin D deficiency is notably related to age, female sex and model of end-stage liver disease score, in addition to Child-Pugh class of liver cirrhosis. Vitamin D levels should be routinely checked in patients with advanced liver cirrhosis (Child-Pugh class B and C) and this deficiency must be addressed in a timely manner to improve general well-being of cirrhotic patients.

  3. Ramucirumab as Second-Line Treatment in Patients With Advanced Hepatocellular Carcinoma: Analysis of REACH Trial Results by Child-Pugh Score.

    PubMed

    Zhu, Andrew X; Baron, Ari David; Malfertheiner, Peter; Kudo, Masatoshi; Kawazoe, Seiji; Pezet, Denis; Weissinger, Florian; Brandi, Giovanni; Barone, Carlo A; Okusaka, Takuji; Wada, Yoshiyuki; Park, Joon Oh; Ryoo, Baek-Yeol; Cho, Jae Yong; Chung, Hyun Cheol; Li, Chung-Pin; Yen, Chia-Jui; Lee, Kuan-Der; Chang, Shao-Chun; Yang, Ling; Abada, Paolo B; Chau, Ian

    2016-09-22

    REACH is the first phase 3 trial to provide information on hepatocellular cancer (HCC) in the second-line (postsorafenib) setting categorized by Child-Pugh score, a scoring system used to measure the severity of chronic liver disease. This exploratory analysis demonstrates the relationship between a potential ramucirumab survival benefit, severity of liver disease, and baseline α-fetoprotein (αFP). To assess treatment effects and tolerability of ramucirumab by Child-Pugh score in patients with HCC enrolled in the REACH trial. Randomized, double-blind, phase 3 trial of ramucirumab and best supportive care vs placebo and best supportive care as second-line treatment in patients with HCC enrolled between November 4, 2010 and April 18, 2013, from 154 global sites. Overall, 643 patients were randomized and included in this analysis; 565 patients considered Child-Pugh class A (Child-Pugh scores 5 and 6) and 78 patients considered class B (Child-Pugh scores 7 and 8). Ramucirumab (8 mg/kg) or placebo intravenously plus best supportive care every 2 weeks. Overall survival (OS), defined as time from randomization to death from any cause. In the randomized population of 643 patients (mean [SD] age, 62.8 [11.1] years) in this analysis, a potential ramucirumab OS benefit was observed for patients with a Child-Pugh score of 5 (hazard ratio [HR], 0.80; 95% CI, 0.63-1.02; P = .06) but no apparent benefit for patients with Child-Pugh scores of 6 or 7 and 8. In patients with baseline αFP levels of 400 ng/mL (to convert ng/mL to μg/L, multiply by 1.0) or more, a ramucirumab OS benefit was significant for a score of Child-Pugh 5 (HR, 0.61; 95% CI, 0.43-0.87; P = .01) and Child-Pugh 6 (HR, 0.64; 95% CI, 0.42-0.98; P = .04), but was not significant for Child-Pugh 7 and 8. The overall safety profile of ramucirumab, regardless of Child-Pugh score, was considered manageable. Regardless of treatment arm, patients with Child-Pugh scores of 7 and 8 experienced a higher

  4. Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit.

    PubMed

    Cholongitas, E; Senzolo, M; Patch, D; Kwong, K; Nikolopoulou, V; Leandro, G; Shaw, S; Burroughs, A K

    2006-04-01

    Prognostic scores in an intensive care unit (ICU) evaluate outcomes, but derive from cohorts containing few cirrhotic patients. To evaluate 6-week mortality in cirrhotic patients admitted to an ICU, and to compare general and liver-specific prognostic scores. A total of 312 consecutive cirrhotic patients (65% alcoholic; mean age 49.6 years). Multivariable logistic regression to evaluate admission factors associated with survival. Child-Pugh, Model for End-stage Liver Disease (MELD), Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were compared by receiver operating characteristic curves. Major indication for admission was respiratory failure (35.6%). Median (range) Child-Pugh, APACHE II, MELD and SOFA scores were 11 (5-15), 18 (0-44), 24 (6-40) and 11 (0-21), respectively; 65% (n = 203) died. Survival improved over time (P = 0.005). Multivariate model factors: more organs failing (FOS) (<3 = 49.5%, > or =3 = 90%), higher FiO(2), lactate, urea and bilirubin; resulting in good discrimination [area under receiver operating characteristic curve (AUC) = 0.83], similar to SOFA and MELD (AUC = 0.83 and 0.81, respectively) and superior to APACHE II and Child-Pugh (AUC = 0.78 and 0.72, respectively). Cirrhotics admitted to ICU with > or =3 failing organ systems have 90% mortality. The Royal Free model discriminated well and contained key variables of organ function. SOFA and MELD were better predictors than APACHE II or Child-Pugh scores.

  5. [Validity of APACHE II, APACHE III, SAPS 2, SAPS 3 and SOFA scales in obstetric patients with sepsis].

    PubMed

    Zabolotskikh, I B; Musaeva, T S; Denisova, E A

    2012-01-01

    to estimate efficiency of APACHE II, APACHE III, SAPS II, SAPS III, SOFA scales for obstetric patients with heavy sepsis. 186 medical cards retrospective analysis of pregnant women with pulmonary sepsis, 40 women with urosepsis and puerperas with abdominal sepsis--66 was performed. Middle age of women was 26.7 (22.4-34.5). In population of puerperas with abdominal sepsis APACHE II, APACHE III, SAPS 2, SAPS 3, SOFA scales showed to good calibration, however, high resolution was observed only in APACHE III, SAPS 3 and SOFA (AUROC 0.95; 0.93; 0.92 respectively). APACHE III and SOFA scales provided qualitative prognosis in pregnant women with urosepsis; resolution ratio of these scales considerably exceeds APACHE II, SAPS 2 and SAPS 3 (AUROC 0.73; 0.74; 0.79 respectively). APACHE II scale is inapplicable because of a lack of calibration (X2 = 13.1; p < 0.01), and at other scales (APACHE III, SAPS 2, SAPS 3, SOFA) was observed the insufficient resolution (AUROC < 0.9) in pregnant women with pulmonary sepsis. Prognostic possibilities assessment of score scales showed that APACHE III, SAPS 3 and SOFA scales can be used for a lethality prognosis for puerperas with abdominal sepsis, in population of pregnant women with urosepsis--only APACHE III and SOFA, and with pulmonary sepsis--SAPS 3 and APACHE III only in case of additional clinical information.

  6. Updating prognosis of cirrhosis by Cox's regression model using Child-Pugh score and aminopyrine breath test as time-dependent covariates.

    PubMed

    Merkel, C; Morabito, A; Sacerdoti, D; Bolognesi, M; Angeli, P; Gatta, A

    1998-06-01

    The determination of aminopyrine breath test on entry into the study was recently shown to improve the accuracy of prediction of death based on the Child-Pugh classification, but the possible usefulness of serial determinations of both parameters has not been assessed. In the present study, we aimed at evaluating whether serial determinations of aminopyrine breath test and Child-Pugh score improve prognostic accuracy in patients with cirrhosis, compared with determinations obtained only on admission. In 74 patients with liver cirrhosis aminopyrine breath test and Child-Pugh score were obtained upon entry into the study. Patients were followed with sequential aminopyrine breath tests and assessments of the Child-Pugh score every 4-6 months. A total number of 232 determinations were obtained. During follow-up 45 patients died, on average after 12 months of follow-up. Child-Pugh score improved in the beginning of follow-up, and then remained fairly constant; aminopyrine breath test showed no improvement in the beginning of follow-up, but rather a slowly progressive decline. In patients who died, both the Child-Pugh score and the metabolism of aminopyrine were significantly more impaired in the last year preceding death (p < 0.05). Applying Cox's regression model with time-dependent covariates, Child-Pugh score and aminopyrine breath test were independent significant predictors of survival. The model with time-dependent covariates explained the observed survival much better than the model with time-fixed covariates (chi-sq. explained by regression = 31.45 vs 11.97; d.f. = 2; p = 0.0000001 vs 0.003). These data suggest that serial determinations of Child-Pugh score and aminopyrine breath test can be used to efficiently update prognosis of cirrhosis.

  7. Systematic review: The model for end-stage liver disease--should it replace Child-Pugh's classification for assessing prognosis in cirrhosis?

    PubMed

    Cholongitas, E; Papatheodoridis, G V; Vangeli, M; Terreni, N; Patch, D; Burroughs, A K

    2005-12-01

    Prognosis in cirrhotic patients has had a resurgence of interest because of liver transplantation and new therapies for complications of end-stage cirrhosis. The model for end-stage liver disease score is now used for allocation in liver transplantation waiting lists, replacing Child-Turcotte-Pugh score. However, there is debate as whether it is better in other settings of cirrhosis. To review studies comparing the accuracy of model for end-stage liver disease score vs. Child-Turcotte-Pugh score in non-transplant settings. Transjugular intrahepatic portosystemic shunt studies (with 1360 cirrhotics) only one of five, showed model for end-stage liver disease to be superior to Child-Turcotte-Pugh to predict 3-month mortality, but not for 12-month mortality. Prognosis of cirrhosis studies (with 2569 patients) none of four showed significant differences between the two scores for either short- or long-term prognosis whereas no differences for variceal bleeding studies (with 411 cirrhotics). Modified Child-Turcotte-Pugh score, by adding creatinine, performed similarly to model for end-stage liver disease score. Hepatic encephalopathy and hyponatraemia (as an index of ascites), both components of Child-Turcotte-Pugh score, add to the prognostic performance of model for end-stage liver disease score. Based on current literature, model for end-stage liver disease score does not perform better than Child-Turcotte-Pugh score in non-transplant settings. Modified Child-Turcotte-Pugh and model for end-stage liver disease scores need further evaluation.

  8. Correlation between anthropometrics measurements, prealbumin level and transferin serum with Child-Pugh classification in evaluating nutritional status of liver cirrhosis patient.

    PubMed

    Yovita, H; Djumhana, Ali; Abdurachman, S A; Saketi, Juke Roslia

    2004-01-01

    to evaluate nutritional status by using anthropometrics and biochemistry examination and to determine the correlation between albumin, prealbumin and transferin serum level with anthropometrics measures in liver cirrhosis patient according to Child-Pugh classification. study was conducted on 30 patients with liver cirrhosis Child-Pugh A, B and C. There were 8 patient of Child-Pugh A, 18 Child-Pugh B and 4 Child-Pugh C. Every patient underwent anthropometrics and biochemistry examination including ideal body weight (IBW), body mass index (BMI), triceps skin-fold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), albumin, prealbumin and transferin serum. We used statistical analysis Spearman and Pearson correlation test. by IBW and BMI measurement, most of liver cirrhosis patients indicated normal results. By MAMC measurement, there was no liver cirrhosis patient with good nutritional status. Most of them have slight and moderate malnutrition. There was no significant correlation between anthropometrics measurement with Child-Pugh score, with [p > 0.01]. And also, there was no significant relationship between albumin, prealbumin and serum transferin with anthropometrics measures, but there was significant correlation between prealbumin and transferin level with Child-Pugh score, with [p < 0.01]. the conclusion of this study is prealbumin and transferin level may be used to evaluate nutritional status of liver cirrhosis patient, and on the contrary with anthropometrics measures. There was no correlation between anthropometrics measures with albumin, prealbumin and transferin level.

  9. Laparoscopic splenectomy for patients with liver cirrhosis: Improvement of liver function in patients with Child-Pugh class B.

    PubMed

    Yamamoto, Naoki; Okano, Keiichi; Oshima, Minoru; Akamoto, Shitaro; Fujiwara, Masao; Tani, Joji; Miyoshi, Hisaaki; Yoneyama, Hirohito; Masaki, Tsutomu; Suzuki, Yasuyuki

    2015-12-01

    We aimed to assess the short-term outcomes of laparoscopic splenectomy (LS) and liver function at 1 year after splenectomy in the patients with liver cirrhosis. Forty-five patients with liver cirrhosis and hypersplenism underwent LS. We reviewed electronic medical records regarding the liver functional reserve, the etiology of liver cirrhosis, and the presence of hepatocellular carcinoma and esophago-gastric varices. Prospectively collected data of perioperative variables, postoperative complications, and long-term liver function were analyzed. Forty-five patients had a chronic liver disease classified into Child-Pugh classes (A/B/C: 23/20/2). The etiologies of disease were hepatitis C virus infection in 34 patients, hepatitis B virus infection in 4, and others in 7. Fourteen patients underwent procedures in addition to LS, including hepatectomy (n = 7) and devascularization for esophagogastric varices (n = 8). Postoperative complications occurred in 11 patients (24%). Neither postoperative liver failure nor in-hospital mortality occurred. White blood cell and platelet counts determined 7 days, 1 month, and 1 year after LS doubled or increased more than twice compared with the preoperative values (P < .001). One year after LS, patients who had been classified preoperatively into Child-Pugh class B had decreased total serum bilirubin levels (P = .03), and increased prothrombin activity (P = 003) and decreased Child-Pugh scores (P = .001). The Child-Pugh classifications improved in 14 of 18 patients (78%) who had Child-Pugh class B preoperatively. LS is a safe and feasible procedure for hypersplenism in patients with liver cirrhosis. In addition, LS most likely ameliorates liver function at 1 year after LS in patients with Child-Pugh class B liver cirrhosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Safety of the 2D/3D direct-acting antiviral regimen in HCV-induced Child-Pugh A cirrhosis - A pooled analysis.

    PubMed

    Poordad, Fred; Nelson, David R; Feld, Jordan J; Fried, Michael W; Wedemeyer, Heiner; Larsen, Lois; Cohen, Daniel E; Cohen, Eric; Mobashery, Niloufar; Tatsch, Fernando; Foster, Graham R

    2017-10-01

    Chronic hepatitis C virus (HCV)-infected patients with cirrhosis are a high-priority population for treatment. To help inform the benefit-risk profile of the all-oral direct-acting antiviral (DAA) combination regimen of ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir (OBV/PTV/r±DSV) in patients with Child-Pugh A cirrhosis, we undertook a comprehensive review of AbbVie-sponsored clinical trials enrolling patients with Child-Pugh A cirrhosis. Twelve phase II or III clinical trials of the 2-DAA regimen of OBV/PTV/r±ribavirin (RBV) or the 3-DAA regimen of OBV/PTV/r+DSV±RBV that included patients with Child-Pugh A cirrhosis were reviewed; patients who completed treatment by November 16, 2015 were included in a pooled, post hoc safety assessment. The number and percentage of patients with treatment-emergent adverse events (TEAEs), serious TEAEs, and TEAEs consistent with hepatic decompensation were reported. In 1,066 patients with Child-Pugh A cirrhosis, rates of serious TEAEs and TEAEs leading to study drug discontinuation were 5.3% (95% confidence interval [CI]: 4.1-6.8) and 2.2% (95% CI: 1.4-3.2), respectively. Thirteen patients (1.2%; 95% CI: 0.7-2.1) had a TEAE that was consistent with hepatic decompensation. The most frequent TEAEs consistent with hepatic decompensation were ascites (n=8), esophageal variceal hemorrhage (n=4), and hepatic encephalopathy (n=2). This pooled analysis in 1,066 HCV-infected patients with Child-Pugh A cirrhosis confirms the safety of OBV/PTV/r±DSV±RBV in this population. These results support the use of OBV/PTV/r±DSV±RBV in this high-priority population. Lay summary: This pooled safety analysis in 1,066 HCV-infected patients with compensated cirrhosis, receiving treatment with ombitasvir, paritaprevir, and ritonavir with or without dasabuvir, with or without ribavirin, shows that the rate of hepatic decompensation events was similar to previously reported rates in untreated patients. Copyright © 2017 European

  11. Better prognostic marker in ICU - APACHE II, SOFA or SAP II!

    PubMed

    Naqvi, Iftikhar Haider; Mahmood, Khalid; Ziaullaha, Syed; Kashif, Syed Mohammad; Sharif, Asim

    2016-01-01

    This study was designed to determine the comparative efficacy of different scoring system in assessing the prognosis of critically ill patients. This was a retrospective study conducted in medical intensive care unit (MICU) and high dependency unit (HDU) Medical Unit III, Civil Hospital, from April 2012 to August 2012. All patients over age 16 years old who have fulfilled the criteria for MICU admission were included. Predictive mortality of APACHE II, SAP II and SOFA were calculated. Calibration and discrimination were used for validity of each scoring model. A total of 96 patients with equal gender distribution were enrolled. The average APACHE II score in non-survivors (27.97+8.53) was higher than survivors (15.82+8.79) with statistically significant p value (<0.001). The average SOFA score in non-survivors (9.68+4.88) was higher than survivors (5.63+3.63) with statistically significant p value (<0.001). SAP II average score in non-survivors (53.71+19.05) was higher than survivors (30.18+16.24) with statistically significant p value (<0.001). All three tested scoring models (APACHE II, SAP II and SOFA) would be accurate enough for a general description of our ICU patients. APACHE II has showed better calibration and discrimination power than SAP II and SOFA.

  12. Upper gastrointestinal bleeding in patients with hepatic cirrhosis: clinical course and mortality prediction.

    PubMed

    Afessa, B; Kubilis, P S

    2000-02-01

    We conducted this study to describe the complications and validate the accuracy of previously reported prognostic indices in predicting the mortality of cirrhotic patients hospitalized for upper GI bleeding. This prospective, observational study included 111 consecutive hospitalizations of 85 cirrhotic patients admitted for GI bleeding. Data obtained included intensive care unit (ICU) admission status, Child-Pugh score, the development of systemic inflammatory response syndrome (SIRS), organ failure, and inhospital mortality. The performances of Garden's, Gatta's, and Acute Physiology and Chronic Health Evaluation (APACHE) II prognostic systems in predicting mortality were assessed. Patients' mean age was 48.7 yr, and the median APACHE II and Child-Pugh scores were 17 and 9, respectively. Their ICU admission rate was 71%. Organ failure developed in 57%, and SIRS in 46% of the patients. Nine patients had acute respiratory distress syndrome, and three patients had hepatorenal syndrome. The inhospital mortality was 21%. The APACHE II, Garden's, and Gatta' s predicted mortality rates were 39%, 24%, and 20%, respectively, and their areas under the receiver operating characteristic curve (AUC) were 0.78, 0.70, and 0.71, respectively. The AUC for Child-Pugh score was 0.76. SIRS and organ failure develop in many patients with hepatic cirrhosis hospitalized for upper GI bleeding, and are associated with increased mortality. Although the APACHE II prognostic system overestimated the mortality of these patients, the receiver operating characteristic curves did not show significant differences between the various prognostic systems.

  13. Use of APACHE II and SAPS II to predict mortality for hemorrhagic and ischemic stroke patients.

    PubMed

    Moon, Byeong Hoo; Park, Sang Kyu; Jang, Dong Kyu; Jang, Kyoung Sool; Kim, Jong Tae; Han, Yong Min

    2015-01-01

    We studied the applicability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in patients admitted to the intensive care unit (ICU) with acute stroke and compared the results with the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). We also conducted a comparative study of accuracy for predicting hemorrhagic and ischemic stroke mortality. Between January 2011 and December 2012, ischemic or hemorrhagic stroke patients admitted to the ICU were included in the study. APACHE II and SAPS II-predicted mortalities were compared using a calibration curve, the Hosmer-Lemeshow goodness-of-fit test, and the receiver operating characteristic (ROC) curve, and the results were compared with the GCS and NIHSS. Overall 498 patients were included in this study. The observed mortality was 26.3%, whereas APACHE II and SAPS II-predicted mortalities were 35.12% and 35.34%, respectively. The mean GCS and NIHSS scores were 9.43 and 21.63, respectively. The calibration curve was close to the line of perfect prediction. The ROC curve showed a slightly better prediction of mortality for APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients. The GCS and NIHSS were inferior in predicting mortality in both patient groups. Although both the APACHE II and SAPS II systems can be used to measure performance in the neurosurgical ICU setting, the accuracy of APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients was superior. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Risk of Bacterial Infection in Patients With Cirrhosis and Acute Variceal Hemorrhage, Based on Child-Pugh Class, and Effects of Antibiotics.

    PubMed

    Tandon, Puneeta; Abraldes, Juan G; Keough, Adam; Bastiampillai, Ravin; Jayakumar, Saumya; Carbonneau, Michelle; Wong, Eric; Kao, Dina; Bain, Vince G; Ma, Mang

    2015-06-01

    Antibiotics frequently are overused and are associated with serious adverse events in patients with cirrhosis. However, these drugs are recommended for all patients presenting with acute variceal hemorrhage (AVH). We investigated whether patients should be stratified for antibiotic prophylaxis based on Child-Pugh scores, to estimate risks of bacterial infection, rebleeding, and mortality, and whether antibiotics have equal effects on patients of all Child-Pugh classes. We performed a sensitivity analysis using model for end-stage liver disease (MELD) scores. In a retrospective study, we analyzed data from 381 adult patients with cirrhosis and AVH (70% men; mean age, 56 y), admitted from 2000 through 2009 to 2 tertiary care hospitals in Edmonton, Alberta, Canada. We excluded patients with bacterial infection on the day of AVH. The association between antibiotic prophylaxis and outcomes was adjusted by liver disease severity and by a propensity score. The patients included in the study had mean MELD scores of 16, and 54% received antibiotic prophylaxis. Overall, antibiotic therapy was associated with lower risks of infection (adjusted odds ratio, 0.37; 95% confidence interval, 0.91-0.74) and mortality (adjusted odds ratio, 0.63; 95% confidence interval, 0.31-1.29). Among patients categorized as Child-Pugh class A given antibiotics, only 2% developed infections and the mortality rate was 0.4%. Among patients categorized as Child-Pugh class B given antibiotics, 6% developed infections, compared with 14% of patients who did not receive antibiotics; antibiotics did not affect mortality. Administration of antibiotics to patients categorized as Child-Pugh class C reduced infections and mortality by approximately 50%, compared with patients who did not receive antibiotics. MELD scores were not as useful as Child-Pugh class in identifying patients at risk for infection. Based on a retrospective analysis of patients with cirrhosis and AVH, those categorized as Child-Pugh

  15. Effect of high-dose stereotactic body radiation therapy on liver function in the treatment of primary and metastatic liver malignancies using the Child-Pugh score classification system.

    PubMed

    Dyk, Pawel; Weiner, Ashley; Badiyan, Shahed; Myerson, Robert; Parikh, Parag; Olsen, Jeffrey

    2015-01-01

    The purpose of this study was to evaluate liver function after high-dose liver stereotactic body radiation therapy (SBRT) in the treatment of metastatic and primary malignancies of the liver using the Child-Pugh score classification system. This was a retrospective analysis of 46 patients treated with SBRT for metastatic and primary malignancies of the liver. Patient, disease, prior treatment, and SBRT dosimetric factors were analyzed to correlate with decline in Child-Pugh class after liver SBRT. Median follow-up was 11.0 months for patients alive at last follow-up. Twenty-three patients (50%) had primary liver malignancies. Median delivered dose was 55 Gy in 5 fractions (range, 36-60 Gy in 3-6 fractions) to 1 lesion (range, 1-4 lesions) measuring 4.0 cm (range, 1.3-12.4 cm). Forty-one patients (89%) received ≥50 Gy in 3 to 6 fractions. Child-Pugh score classification was A in 42 patients (91%). Seven patients (15%) received adjuvant chemotherapy or targeted therapy. Twenty-nine patients (63%) experienced an intrahepatic recurrence after treatment. Ten patients (22%) experienced a decline in Child-Pugh class at a median of 1.6 months (range, 0.2-6 months). Eighty percent experienced a one-category decline. Only the V20, V25, V30, and V50 were correlated with decline in Child-Pugh class on univariate analysis, with V25 being most significant (P = .027). A V25 >32% was associated with a 42% incidence of Child-Pugh class decline compared with 9% for V25 ≤32 (P = .029). For primary liver malignancies, a V25 >36% was associated with a 4-fold increase in the incidence of Child-Pugh class decline (60% vs 15%, P = .021). Approximately one-quarter of patients experience a decline in Child-Pugh class after high-dose liver SBRT. The V25 may be an important dosimetric parameter predicting decline in liver function after treatment. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  16. The model for the end-stage liver disease and Child-Pugh score in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding.

    PubMed

    Benedeto-Stojanov, Daniela; Nagorni, Aleksandar; Bjelaković, Goran; Stojanov, Dragan; Mladenović, Bojan; Djenić, Nebojsa

    2009-09-01

    Esophageal variceal bleeding is one of the most frequent and gravest complications of liver cirrhosis, directly life-threatening. By monitoring certain clinical and laboratory hepatocellular insufficiency parameters (Child-Pugh score), it is possible to determine prognosis in patients who are bleeding and evaluate further therapy. Recently, the Model for the End-Stage Liver Disease (MELD) has been proposed as a tool to predict mortality risk in cirrhotic patients. The aim of the study was to evaluate survival prognosis of cirrhotic patients by the MELD and Child-Pugh scores and to analyze the MELD score prognostic value in patients with both liver cirrhosis and variceal bleeding. We retrospectively evaluated the survival rate of a group of 100 cirrhotic patients of a median age of 57 years. The Child-Pugh score was calculated and the MELD score was computed according to the original formula for each patient. We also analysed clinical and laboratory hepatocellular insufficiency parameters in order to examine their connection with a 15-month survival. The MELD values were correlated with the Child-Pugh scores. The Student's t-test was used for statistical analysis. Twenty-two patients died within 15-months followup. Age and gender did not affect survival rate. The Child-Pugh and MELD scores, as well as ascites and encephalopathy significantly differed between the patients who survived and those who died (p < 0.0001). The International Normalized Ratio (INR) values, serum creatinine and bilirubin were significantly higher, and albumin significantly lower in the patients who died (p < 0.0001). The MELD score was significantly higher in the group of patients who died due to esophageal variceal bleeding (p < 0.0001). In cirrhotic patients the MELD score is an excellent survival predictor at least as well as the Child-Pugh score. Increase in the MELD score is associated with decrease in residual liver function. In the group of patients with liver cirrhosis and esophageal

  17. The White Mountain Apache Child Protection Service Training Curriculum. Nohwii Chaghashe Baa da gontzaa (Protect Our Apache Children).

    ERIC Educational Resources Information Center

    Gonzalez-Santin, Edwin, Comp.

    This curriculum manual provides 8 days of training for child protective services (CPS) personnel (social workers and administrators) working in the White Mountain Apache tribal community. Each of the first seven units in the manual contains a brief description of contents, course objectives, time required, key concepts, possible discussion topics,…

  18. Increasing reliability of APACHE II scores in a medical-surgical intensive care unit: a quality improvement study.

    PubMed

    Donahoe, Laura; McDonald, Ellen; Kho, Michelle E; Maclennan, Margaret; Stratford, Paul W; Cook, Deborah J

    2009-01-01

    Given their clinical, research, and administrative purposes, scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II should be reliable, whether calculated by health care personnel or a clinical information system. To determine reliability of APACHE II scores calculated by a clinical information system and by health care personnel before and after a multifaceted quality improvement intervention. APACHE II scores of 37 consecutive patients admitted to a closed, 15-bed, university-affiliated intensive care unit were collected by a research coordinator, a database clerk, and a clinical information system. After a quality improvement intervention focused on health care personnel and the clinical information system, the same methods were used to collect data on 32 consecutive patients. The research coordinator and the clerk did not know each other's scores or the information system's score. The data analyst did not know the source of the scores until analysis was complete. APACHE II scores obtained by the clerk and the research coordinator were highly reliable (intraclass correlation coefficient, 0.88 before vs 0.80 after intervention; P = .25). No significant changes were detected after the intervention; however, compared with scores of the research coordinator, the overall reliability of APACHE II scores calculated by the clinical information system improved (intraclass correlation coefficient, 0.24 before intervention vs 0.91 after intervention, P < .001). After completion of a quality improvement intervention, health care personnel and a computerized clinical information system calculated sufficiently reliable APACHE II scores for clinical, research, and administrative purposes.

  19. Predictive value of the APACHE II, SAPS II, SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis.

    PubMed

    Pietraszek-Grzywaczewska, Iwona; Bernas, Szymon; Łojko, Piotr; Piechota, Anna; Piechota, Mariusz

    2016-01-01

    Scoring systems in critical care patients are essential for predicting of the patient outcome and evaluating the therapy. In this study, we determined the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale (GCS) scoring systems in the prediction of mortality in adult patients admitted to the intensive care unit (ICU) with severe purulent bacterial meningitis. We retrospectively analysed data from 98 adult patients with severe purulent bacterial meningitis who were admitted to the single ICU between March 2006 and September 2015. Univariate logistic regression identified the following risk factors of death in patients with severe purulent bacterial meningitis: APACHE II, SAPS II, SOFA, and GCS scores, and the lengths of ICU stay and hospital stay. The independent risk factors of patient death in multivariate analysis were the SAPS II score, the length of ICU stay and the length of hospital stay. In the prediction of mortality according to the area under the curve, the SAPS II score had the highest accuracy followed by the APACHE II, GCS and SOFA scores. For the prediction of mortality in a patient with severe purulent bacterial meningitis, SAPS II had the highest accuracy.

  20. Mortality in Code Blue; can APACHE II and PRISM scores be used as markers for prognostication?

    PubMed

    Bakan, Nurten; Karaören, Gülşah; Tomruk, Şenay Göksu; Keskin Kayalar, Sinem

    2018-03-01

    Code blue (CB) is an emergency call system developed to respond to cardiac and respiratory arrest in hospitals. However, in literature, no scoring system has been reported that can predict mortality in CB procedures. In this study, we aimed to investigate the effectiveness of estimated APACHE II and PRISM scores in the prediction of mortality in patients assessed using CB to retrospectively analyze CB calls. We retrospectively examined 1195 patients who were evaluated by the CB team at our hospital between 2009 and 2013. The demographic data of the patients, diagnosis and relevant de-partments, reasons for CB, cardiopulmonary resuscitation duration, mortality calculated from the APACHE II and PRISM scores, and the actual mortality rates were retrospectively record-ed from CB notification forms and the hospital database. In all age groups, there was a significant difference between actual mortality rate and the expected mortality rate as estimated using APACHE II and PRISM scores in CB calls (p<0.05). The actual mortality rate was significantly lower than the expected mortality. APACHE and PRISM scores with the available parameters will not help predict mortality in CB procedures. Therefore, novels scoring systems using different parameters are needed.

  1. The customization of APACHE II for patients receiving orthotopic liver transplants

    PubMed Central

    Moreno, Rui

    2002-01-01

    General outcome prediction models developed for use with large, multicenter databases of critically ill patients may not correctly estimate mortality if applied to a particular group of patients that was under-represented in the original database. The development of new diagnostic weights has been proposed as a method of adapting the general model – the Acute Physiology and Chronic Health Evaluation (APACHE) II in this case – to a new group of patients. Such customization must be empirically tested, because the original model cannot contain an appropriate set of predictive variables for the particular group. In this issue of Critical Care, Arabi and co-workers present the results of the validation of a modified model of the APACHE II system for patients receiving orthotopic liver transplants. The use of a highly heterogeneous database for which not all important variables were taken into account and of a sample too small to use the Hosmer–Lemeshow goodness-of-fit test appropriately makes their conclusions uncertain. PMID:12133174

  2. Use of the APACHE II score to assess impact of therapeutic plasma exchange for critically ill patients with hypertriglyceride-induced pancreatitis.

    PubMed

    Nakhoda, Shazia; Zimrin, Ann B; Baer, Maria R; Law, Jennie Y

    2017-04-01

    Hypertriglyceridemic (HTG) pancreatitis carries significant morbidity and mortality and often requires intensive care unit (ICU) admission. Therapeutic plasma exchange (TPE) rapidly lowers serum triglyceride (TG) levels. However, evidence supporting TPE for HTG pancreatitis is lacking. Ten patients admitted to the ICU for HTG pancreatitis underwent TPE at our institution from 2005-2015. We retrospectively calculated the Acute Physiology and Chronic Health Examination II (APACHE II) score at the time of initial TPE and again after the final TPE session to assess the impact of triglyceride apheresis on morbidity and mortality associated with HTG pancreatitis. All 10 patients had rapid reduction in TG level after TPE, but only 5 had improvement in their APACHE II score. The median APACHE II score decreased from 19% to 17% after TPE, correlating with an 8% and 9% decrease in median predicted non-operative and post-operative mortality, respectively. The APACHE II score did not differ statistically before and after TPE implementation in our patient group (p=0.39). TPE is a clinically useful tool to rapidly lower TG levels, but its impact on mortality of HTG pancreatitis as assessed by the APACHE II score remains uncertain. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Accuracy and Predictability of PANC-3 Scoring System over APACHE II in Acute Pancreatitis: A Prospective Study.

    PubMed

    Rathnakar, Surag Kajoor; Vishnu, Vikram Hubbanageri; Muniyappa, Shridhar; Prasath, Arun

    2017-02-01

    Acute Pancreatitis (AP) is one of the common conditions encountered in the emergency room. The course of the disease ranges from mild form to severe acute form. Most of these episodes are mild and spontaneously subsiding within 3 to 5 days. In contrast, Severe Acute Pancreatitis (SAP) occurring in around 15-20% of all cases, mortality can range between 10 to 85% across various centres and countries. In such a situation we need an indicator which can predict the outcome of an attack, as severe or mild, as early as possible and such an indicator should be sensitive and specific enough to trust upon. PANC-3 scoring is such a scoring system in predicting the outcome of an attack of AP. To assess the accuracy and predictability of PANC-3 scoring system over APACHE II in predicting severity in an attack of AP. This prospective study was conducted on 82 patients admitted with the diagnosis of pancreatitis. Investigations to evaluate PANC-3 and APACHE II were done on all the patients and the PANC-3 and APACHE II score was calculated. PANC-3 score has a sensitivity of 82.6% and specificity of 77.9%, the test had a Positive Predictive Value (PPV) of 0.59 and Negative Predictive Value (NPV) of 0.92. Sensitivity of APACHE II in predicting SAP was 91.3% and specificity was 96.6% with PPV of 0.91, NPV was 0.96. Our study shows that PANC-3 can be used to predict the severity of pancreatitis as efficiently as APACHE II. The interpretation of PANC-3 does not need expertise and can be applied at the time of admission which is an advantage when compared to classical scoring systems.

  4. Prognostic scales ISS-RTS-TRISS, PRISM, APACHE II and PTS in decision support of treatment children with severe mechanical trauma.

    PubMed

    Vasilyeva, I V; Shvirev, S L; Arseniev, S B; Zarubina, T V

    2013-01-01

    The aim of the present study is to assess a possibility and validity of prognostic scales ISS-RTS-TRISS, PRISM, APACHE II and PTS to be used for the automated calculation in decision support when treating children with severe mechanical traumas. The mentioned scales are used in the Hospital Information System (HIS) MEDIALOG. The retrospective study was conducted using clinical and physiological data collected at the admission and during the first 24 hours of hospitalization in 166 patients. Scales PRISM, APACHE II, ISS-RTS-TRISS were used for calculating the severity of injury and for prognosis in death outcomes. Scale PTS was used for evaluating the severity index only. Our research has shown that ISS-RTS-TRISS has excellent discrimination ability, PRISM and APACHE II prognostic scales have acceptable discrimination ability; moreover, they all have significant calibration ability. PTS scale has acceptable discrimination ability. It has been showed that automated calculation scales ISS-RTS-TRISS, PRISM, APACHE II and PTS are useful for assessing outcomes in children with severe mechanical trauma.

  5. APACHE II score in massive upper gastrointestinal haemorrhage from peptic ulcer: prognostic value and potential clinical applications.

    PubMed

    Schein, M; Gecelter, G

    1989-07-01

    This study examined the prognostic value of the APACHE II scoring system in patients undergoing emergency operations for bleeding peptic ulcer. There were 96 operations for gastric ulcers and 58 for duodenal ulcers. The mean scores in survivors and in patients who died were 10.8 and 17.5 respectively. None of the 66 patients with an APACHE II score less than 11 died, while the mortality rate in those scored greater than 10 was 22 per cent. In patients scored greater than 10 non-resective procedures carried less risk of mortality than gastrectomy. The APACHE II score is useful when measuring the severity of the acute disease and predicting the outcome in these patients. If used in daily practice it may assist the surgeon in stratifying patients into a low-risk group (score less than 11) in which major operations are well tolerated and outcome is favourable and a high-risk group (score greater than 10) in which the risk of mortality is high and the performance of procedures of lesser magnitude is probably more likely to improve survival.

  6. Dr Pugh: a poisoner?

    PubMed

    Paull, J D; Morris, G M

    2012-07-01

    On 16 February 1845 the Reverend W. H. Browne, rector of St John's Church in Launceston, Van Diemen's Land, wrote in his journal, "My dear Wife died very suddenly almost immediately after and in consequence of taking a preparation of Hyd. Cyan. Acid prepared & supplied by Dr Pugh". This journal entry raises a number of questions. Was Dr Pugh treating a condition which he thought merited that treatment or was it a ghastly mistake? Was Caroline Browne suffering from pulmonary tuberculosis? Was hydrocyanic acid an accepted treatment at that time? Did Mrs Browne take the wrong dose? Was an incorrect concentration of the drug prepared by Dr Pugh? Did he use the wrong pharmacopoeia in preparing the hydrocyanic acid? Why was there no inquest? Only some of these questions can be answered.

  7. Severity and prognosis of acute organophosphorus pesticide poisoning are indicated by C-reactive protein and copeptin levels and APACHE II score

    PubMed Central

    WU, XINKUAN; XIE, WEI; CHENG, YUELEI; GUAN, QINGLONG

    2016-01-01

    The aim of the present study was to investigate the plasma levels of C-reactive protein (CRP) and copeptin, in addition to the acute physiology and chronic health evaluation II (APACHE II) scores, in patients with acute organophosphorus pesticide poisoning (AOPP). A total of 100 patients with AOPP were included and divided into mild, moderate and severe groups according to AOPP diagnosis and classification standards. Blood samples were collected from all patients on days 1, 3 and 7 following AOPP. The concentrations of CRP and copeptin in the plasma were determined using enzyme-linked immunosorbent assay. All AOPP patients underwent APACHE II scoring and the diagnostic value of these scores was analyzed using receiver operating characteristic curves (ROCs). On days 1, 3 and 7 after AOPP, the levels of CRP and copeptin were increased in correlation with the increase in AOPP severity, and were significantly higher compared with the control groups. Furthermore, elevated CRP and copeptin plasma levels were detected in patients with severe AOPP on day 7, whereas these levels were reduced in patients with mild or moderate AOPP. APACHE II scores, blood lactate level, acetylcholine esterase level, twitch disappearance time, reactivating agent dose and inability to raise the head were the high-risk factors that affected the prognosis of AOPP. Patients with plasma CRP and copeptin levels higher than median values had worse prognoses. The areas under curve for ROCs were 0.89, 0.75 and 0.72 for CRP levels, copeptin levels and APACHE II scores, respectively. In addition, the plasma contents of CRP and copeptin are increased according to the severity of AOPP. Therefore, the results of the present study suggest that CRP and copeptin levels and APACHE II scores may be used for the determination of AOPP severity and the prediction of AOPP prognosis. PMID:26997996

  8. Severity and prognosis of acute organophosphorus pesticide poisoning are indicated by C-reactive protein and copeptin levels and APACHE II score.

    PubMed

    Wu, Xinkuan; Xie, Wei; Cheng, Yuelei; Guan, Qinglong

    2016-03-01

    The aim of the present study was to investigate the plasma levels of C-reactive protein (CRP) and copeptin, in addition to the acute physiology and chronic health evaluation II (APACHE II) scores, in patients with acute organophosphorus pesticide poisoning (AOPP). A total of 100 patients with AOPP were included and divided into mild, moderate and severe groups according to AOPP diagnosis and classification standards. Blood samples were collected from all patients on days 1, 3 and 7 following AOPP. The concentrations of CRP and copeptin in the plasma were determined using enzyme-linked immunosorbent assay. All AOPP patients underwent APACHE II scoring and the diagnostic value of these scores was analyzed using receiver operating characteristic curves (ROCs). On days 1, 3 and 7 after AOPP, the levels of CRP and copeptin were increased in correlation with the increase in AOPP severity, and were significantly higher compared with the control groups. Furthermore, elevated CRP and copeptin plasma levels were detected in patients with severe AOPP on day 7, whereas these levels were reduced in patients with mild or moderate AOPP. APACHE II scores, blood lactate level, acetylcholine esterase level, twitch disappearance time, reactivating agent dose and inability to raise the head were the high-risk factors that affected the prognosis of AOPP. Patients with plasma CRP and copeptin levels higher than median values had worse prognoses. The areas under curve for ROCs were 0.89, 0.75 and 0.72 for CRP levels, copeptin levels and APACHE II scores, respectively. In addition, the plasma contents of CRP and copeptin are increased according to the severity of AOPP. Therefore, the results of the present study suggest that CRP and copeptin levels and APACHE II scores may be used for the determination of AOPP severity and the prediction of AOPP prognosis.

  9. Predictive ability of the ISS, NISS, and APACHE II score for SIRS and sepsis in polytrauma patients.

    PubMed

    Mica, L; Furrer, E; Keel, M; Trentz, O

    2012-12-01

    Systemic inflammatory response syndrome (SIRS) and sepsis as causes of multiple organ dysfunction syndrome (MODS) remain challenging to treat in polytrauma patients. In this study, the focus was set on widely used scoring systems to assess their diagnostic quality. A total of 512 patients (mean age: 39.2 ± 16.2, range: 16-88 years) who had an Injury Severity Score (ISS) ≥17 were included in this retrospective study. The patients were subdivided into four groups: no SIRS, slight SIRS, severe SIRS, and sepsis. The ISS, New Injury Severity Score (NISS), Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and prothrombin time were collected at admission. The Kruskal-Wallis test and χ(2)-test, multinomial regression analysis, and kernel density estimates were performed. Receiver operating characteristic (ROC) analysis is reported as the area under the curve (AUC). Data were considered as significant if p < 0.05. All variables were significantly different in all groups (p < 0.001). The odds ratio increased with increasing SIRS severity for NISS (slight vs. no SIRS, 1.06, p = 0.07; severe vs. no SIRS, 1.07, p = 0.04; and sepsis vs. no SIRS, 1.11, p = 0.0028) and APACHE II score (slight vs. no SIRS, 0.97, p = 0.44; severe vs. no SIRS, 1.08, p = 0.02; and sepsis vs. no SIRS, 1.12, p = 0.0028). ROC analysis revealed that the NISS (slight vs. no SIRS, AUC 0.61; severe vs. no SIRS, AUC 0.67; and sepsis vs. no SIRS, AUC 0.77) and APACHE II score (slight vs. no SIRS, AUC 0.60; severe vs. no SIRS, AUC 0.74; and sepsis vs. no SIRS, AUC 0.82) had the best predictive ability for SIRS and sepsis. Quick assessment with the NISS or APACHE II score could preselect possible candidates for sepsis following polytrauma and provide guidance in trauma surgeons' decision-making.

  10. Validation of the LOD score compared with APACHE II score in prediction of the hospital outcome in critically ill patients.

    PubMed

    Khwannimit, Bodin

    2008-01-01

    The Logistic Organ Dysfunction score (LOD) is an organ dysfunction score that can predict hospital mortality. The aim of this study was to validate the performance of the LOD score compared with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in a mixed intensive care unit (ICU) at a tertiary referral university hospital in Thailand. The data were collected prospectively on consecutive ICU admissions over a 24 month period from July1, 2004 until June 30, 2006. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUROC). The calibration was assessed by the Hosmer-Lemeshow goodness-of-fit H statistic. The overall fit of the model was evaluated by the Brier's score. Overall, 1,429 patients were enrolled during the study period. The mortality in the ICU was 20.9% and in the hospital was 27.9%. The median ICU and hospital lengths of stay were 3 and 18 days, respectively, for all patients. Both models showed excellent discrimination. The AUROC for the LOD and APACHE II were 0.860 [95% confidence interval (CI) = 0.838-0.882] and 0.898 (95% Cl = 0.879-0.917), respectively. The LOD score had perfect calibration with the Hosmer-Lemeshow goodness-of-fit H chi-2 = 10 (p = 0.44). However, the APACHE II had poor calibration with the Hosmer-Lemeshow goodness-of-fit H chi-2 = 75.69 (p < 0.001). Brier's score showed the overall fit for both models were 0.123 (95%Cl = 0.107-0.141) and 0.114 (0.098-0.132) for the LOD and APACHE II, respectively. Thus, the LOD score was found to be accurate for predicting hospital mortality for general critically ill patients in Thailand.

  11. Validation of APACHE II scoring system at 24 hours after admission as a prognostic tool in urosepsis: A prospective observational study.

    PubMed

    VijayGanapathy, Sundaramoorthy; Karthikeyan, VIlvapathy Senguttuvan; Sreenivas, Jayaram; Mallya, Ashwin; Keshavamurthy, Ramaiah

    2017-11-01

    Urosepsis implies clinically evident severe infection of urinary tract with features of systemic inflammatory response syndrome (SIRS). We validate the role of a single Acute Physiology and Chronic Health Evaluation II (APACHE II) score at 24 hours after admission in predicting mortality in urosepsis. A prospective observational study was done in 178 patients admitted with urosepsis in the Department of Urology, in a tertiary care institute from January 2015 to August 2016. Patients >18 years diagnosed as urosepsis using SIRS criteria with positive urine or blood culture for bacteria were included. At 24 hours after admission to intensive care unit, APACHE II score was calculated using 12 physiological variables, age and chronic health. Mean±standard deviation (SD) APACHE II score was 26.03±7.03. It was 24.31±6.48 in survivors and 32.39±5.09 in those expired (p<0.001). Among patients undergoing surgery, mean±SD score was higher (30.74±4.85) than among survivors (24.30±6.54) (p<0.001). Receiver operating characteristic (ROC) analysis revealed area under curve (AUC) of 0.825 with cutoff 25.5 being 94.7% sensitive and 56.4% specific to predict mortality. Mean±SD score in those undergoing surgery was 25.22±6.70 and was lesser than those who did not undergo surgery (28.44±7.49) (p=0.007). ROC analysis revealed AUC of 0.760 with cutoff 25.5 being 94.7% sensitive and 45.6% specific to predict mortality even after surgery. A single APACHE II score assessed at 24 hours after admission was able to predict morbidity, mortality, need for surgical intervention, length of hospitalization, treatment success and outcome in urosepsis patients.

  12. The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE II values and prothrombin time.

    PubMed

    Mica, Ladislav; Rufibach, Kaspar; Keel, Marius; Trentz, Otmar

    2013-01-01

    The early hemodynamic normalization of polytrauma patients may lead to better survival outcomes. The aim of this study was to assess the diagnostic quality of trauma and physiological scores from widely used scoring systems in polytrauma patients. In total, 770 patients with ISS > 16 who were admitted to a trauma center within the first 24 hours after injury were included in this retrospective study. The patients were subdivided into three groups: those who died on the day of admission, those who died within the first three days, and those who survived for longer than three days. ISS, NISS, APACHE II score, and prothrombin time were recorded at admission. The descriptive statistics for early death in polytrauma patients who died on the day of admission, 1-3 days after admission, and > 3 days after admission were: ISS of 41.0, 34.0, and 29.0, respectively; NISS of 50.0, 50.0, and 41.0, respectively; APACHE II score of 30.0, 25.0, and 15.0, respectively; and prothrombin time of 37.0%, 56.0%, and 84%, respectively. These data indicate that prothrombin time (AUC: 0.89) and APACHE II (AUC: 0.88) have the greatest prognostic utility for early death. The estimated densities of the scores may suggest a direction for resuscitative procedures in polytrauma patients. "Retrospektive Analysen in der Chirurgischen Intensivmedizin"StV01-2008.

  13. Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit.

    PubMed

    Freire, Paulo; Romãozinho, José M; Amaro, Pedro; Ferreira, Manuela; Sofia, Carlos

    2011-04-01

    prognostic scores have been validated in cirrhotic patients admitted to general Intensive Care Units. No assessment of these scores was performed in cirrhotics admitted to specialized Gastroenterology Intensive Care Units (GICUs). to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients. the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5,18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5,respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686,0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APA-CHE II, SAPS II, SOFA, MELD and CPT scores, respectively. in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction.

  14. Mortality of adult intensive care units in Turkey using the APACHE II and SOFA systems (outcome assessment in Turkish intensive care units).

    PubMed

    Kaymak, Cetin; Sencan, Irfan; Izdes, Seval; Sari, Aydin; Yagmurdur, Hatice; Karadas, Derya; Oztuna, Derya

    2018-04-01

    The aim of this study was to evaluate intensive care unit (ICU) performance using risk-adjusted ICU mortality rates nationally, assessing patients who died or had been discharged from the ICU. For this purpose, this study analyzed the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) databases, containing detailed clinical and physiological information and mortality of mixed critically ill patients in a medical ICU at secondary and tertiary referral ICUs in Turkey. A total of 690 adult intensive care units in Turkey were included in the study. Among 690 ICUs evaluated, 39.7% were secondary and 60.3% were tertiary ICUs. A total of 4188 patients were enrolled in this study. Intensive care units of ministry, university, and private hospitals were evaluated all over Turkey. During the study period, clinical data that were collected concurrently for each patient contained demographic details and the diagnostic category leading to ICU admission. APACHE II and SOFA scores following ICU admission were calculated and recorded. Patients were followed up for outcome data until death or ICU discharge. The mean age of patients was 68.8 ±19 and 54% of them were male. The mean APACHE II score was 20 ±8.7. The ICUs' mortality rate was 46.3%, and mean predicted mortality was 37.2% for APACHE II. The standardized mortality ratio was 1.28 (95% confidence interval: 1.21-1.31). There was a wide difference in outcome for patients admitted to different ICUs and severity of illness using risk adjustment methods. The high mortality rate in patients could be related to comorbid diseases, high mechanical ventilation rates and older ages.

  15. Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement

    PubMed Central

    Wagner, Douglas P.; Draper, Elizabeth A.

    1984-01-01

    This article describes the potential for the acute physiology score (APS) of acute physiology and chronic health evaluation (APACHE) II, to be used as a severity adjustment to diagnosis-related groups (DRG's) or other diagnostic classifications. The APS is defined by a relative value scale applied to 12 objective physiologic variables routinely measured on most hospitalized patients shortly after hospital admission. For intensive care patients, APS at admission is strongly related to subsequent resource costs of intensive care for 5,790 consecutive admissions to 13 large hospitals, across and within diagnoses. The APS could also be used to evaluate quality of care, medical technology, and the response to changing financial incentives. PMID:10311080

  16. A Photographic Essay of Apache Children in Early Times, Volume 2-Part C.

    ERIC Educational Resources Information Center

    Thompson, Doris; Jacobs, Ben

    As part of a series of guides designed for instruction of American Indian children and youth, this resource guide constitutes a pictorial essay on life of the Apache child from 1880 to the early 20th century. Each of the 12 photographs is accompanied by an historical narrative which describes one or more cultural aspects of Apache childhood.…

  17. Measurement of hepatic functional mass by means of 13C-methacetin and 13C-phenylalanine breath tests in chronic liver disease: Comparison with Child-Pugh score and serum bile acid levels

    PubMed Central

    Festi, D.; Capodicasa, S.; Sandri, L.; Colaiocco-Ferrante, L.; Staniscia, T.; Vitacolonna, E.; Vestito, A.; Simoni, P.; Mazzella, G.; Portincasa, P.; Roda, E.; Colecchia, A.

    2005-01-01

    AIM: To evaluate and compare the clinical usefulness of 13C-phenylalanine and 13C-methacetin breath tests in quantitating functional hepatic mass in patients with chronic liver disease and to further compare these results with those of conventional tests, Child-Pugh score and serum bile acid levels. METHODS: One hundred and forty patients (50 HCV- related chronic hepatitis, 90 liver cirrhosis patients) and 40 matched healthy controls were studied. Both breath test and routine liver test, serum levels of cholic and chenodeoxycholic acid conjugates were evaluated. RESULTS: Methacetin breath test, expressed as 60 min cumulative percent of oxidation, discriminated the hepatic functional capacity not only between controls and liver disease patients, but also between different categories of chronic liver disease patients. Methacetin breath test was correlated with liver function tests and serum bile acids. Furthermore, methacetin breath test, as well as serum bile acids, were highly predictive of Child-Pugh scores. The diagnostic power of phenylalanine breath test was always less than that of methacetin breath test. CONCLUSION: Methacetin breath test represents a safe and accurate diagnostic tool in the evaluation of hepatic functional mass in chronic liver disease patients. PMID:15609414

  18. Safety and Efficacy of Sorafenib in Patients with Hepatocellular Carcinoma (HCC) and Child-Pugh A versus B Cirrhosis

    PubMed Central

    Amadori, Dino; Santoro, Armando; Figer, Arie; De Greve, Jacques; Lathia, Chetan; Voliotis, Dimitris; Anderson, Sibyl; Moscovici, Marius; Ricci, Sergio

    2011-01-01

    ABSTRACT Background: We performed a retrospective analysis of data from a phase II study evaluating sorafenib in patients with advanced hepatocellular carcinoma (HCC) to assess differences in safety and efficacy based on Child-Pugh (CP) status (A/B). Methods: Patients received sorafenib 400 mg PO bid. We analyzed safety, pharmacokinetic (PK), and efficacy data in the two CP groups. Results: Ninety-eight patients were CP A; 38 were CP B, with a median duration of therapy of 4 and 1.8 months, respectively. Grade 3/4 adverse events in the CP A and B groups, respectively, included hyperbilirubinemia (14% and 53%), ascites (3% and 5%), and encephalopathy (3% and 13%). Median overall survival (OS) in the CP A group was 9.5 months, compared with 3.2 months in the CP B population. Responses were limited in both groups. AUC and Cmax values were comparable between the two groups. Conclusions: Due to the lack of randomization against placebo or no therapy in this study, it is unclear if the more frequent worsening of liver cirrhosis and outcome of CP B patients are drug related or due to disease progression, or both. As expected, outcome was poorer in patients with CP B than in those with CP A cirrhosis. The hyperbilirubinemia seen in both groups may be at least partly related to inhibition of UGT1A1 by sorafenib. PK profiles were similar in the two groups. More data are needed to confirm and more fully understand the safety and efficacy of sorafenib in patients with advanced HCC and CP B cirrhosis. PMID:21673874

  19. D-dimer as marker for microcirculatory failure: correlation with LOD and APACHE II scores.

    PubMed

    Angstwurm, Matthias W A; Reininger, Armin J; Spannagl, Michael

    2004-01-01

    The relevance of plasma d-dimer levels as marker for morbidity and organ dysfunction in severely ill patients is largely unknown. In a prospective study we determined d-dimer plasma levels of 800 unselected patients at admission to our intensive care unit. In 91% of the patients' samples d-dimer levels were elevated, in some patients up to several hundredfold as compared to normal values. The highest mean d-dimer values were present in the patient group with thromboembolic diseases, and particularly in non-survivors of pulmonary embolism. In patients with circulatory impairment (r=0.794) and in patients with infections (r=0.487) a statistically significant correlation was present between d-dimer levels and the APACHE II score (P<0.001). The logistic organ dysfunction score (LOD, P<0.001) correlated with d-dimer levels only in patients with circulatory impairment (r=0.474). On the contrary, patients without circulatory impairment demonstrated no correlation of d-dimer levels to the APACHE II or LOD score. Taking all patients together, no correlations of d-dimer levels with single organ failure or with indicators of infection could be detected. In conclusion, d-dimer plasma levels strongly correlated with the severity of the disease and organ dysfunction in patients with circulatory impairment or infections suggesting that elevated d-dimer levels may reflect the extent of microcirculatory failure. Thus, a therapeutic strategy to improve the microcirculation in such patients may be monitored using d-dimer plasma levels.

  20. ALBI versus Child-Pugh grading systems for liver function in patients with hepatocellular carcinoma.

    PubMed

    Na, Seong K; Yim, Sun Y; Suh, Sang J; Jung, Young K; Kim, Ji H; Seo, Yeon S; Yim, Hyung J; Yeon, Jong E; Byun, Kwan S; Um, Soon H

    2018-04-01

    The prognostic performance of the albumin-bilirubin (ALBI) grade in hepatocellular carcinoma (HCC) as an objective method of assessing liver function was investigated. Data from 2099 patients with HCC in Korea were collected and analyzed retrospectively. The discriminative performance of ALBI grade was compared with Child-Pugh (C-P) grade for different stages or treatments. The median follow up duration was 16.2 months (range: 1.0-124.9). The median survival times were 49.7 months for C-P grade A (65.8%), 12.4 months for C-P grade B (25.5%), and 4.2 months for C-P grade C (8.6%) (P < 0.001). The median survival times were 84.2 months for ALBI grade 1 (32.8%), 25.5 months for ALBI grade 2 (53.5%), and 7.7 months for ALBI grade 3 (13.7%) (P < 0.001). In early UICC stages, ALBI grade showed better discriminative performance than C-P grade. In curative treatments, ALBI grade also showed better discriminative performance than C-P grade (Harrell's C: 0.624 (C-P grade) vs 0.667 [ALBI grade]). ALBI grade provided better prognostic performance in survival analysis and better distribution of the grades than C-P grade in HCC, suggesting that ALBI grade could be a good alternative grading system for liver function in patients with HCC. © 2018 Wiley Periodicals, Inc.

  1. Renal dysfunction in liver cirrhosis and its correlation with Child-Pugh score and MELD score

    NASA Astrophysics Data System (ADS)

    Siregar, G. A.; Gurning, M.

    2018-03-01

    Renal dysfunction (RD) is a serious and common complication in a patient with liver cirrhosis. It provides a poor prognosis. The aim of our study was to evaluate the renal function in liver cirrhosis, also to determine the correlation with the graduation of liver disease assessed by Child-Pugh Score (CPS) and MELD score. This was a cross-sectional study included patients with liver cirrhosis admitted to Adam Malik Hospital Medan in June - August 2016. We divided them into two groups as not having renal dysfunction (serum creatinine < 1.5 mg/dL) and having renal dysfunction (serum creatinine ≤ 1.5 mg/dL). For the processing of data, SPSS 22.0 was used. Statistical methods used: Chi-square, Fisher exact, one way ANOVA, Kruskal Wallis test and Pearson coefficient of correlation. The level of significance was p<0.05. 55 patients with presented with renal dysfunction were 16 (29.1 %). There was statistically significant inverse correlation between GFR and CPS (r = -0.308), GFR and MELD score (r = -0.278). There was a statistically significant correlation between creatinine and MELD score (r = 0.359), creatinine and CPS (r = 0.382). The increase of the degree of liver damage is related to the increase of renal dysfunction.

  2. Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning.

    PubMed

    Sam, Kishore Gnana; Kondabolu, Krishnakanth; Pati, Dipanwita; Kamath, Asha; Pradeep Kumar, G; Rao, Padma G M

    2009-07-01

    Self-poisoning with organophosphorus (OP) compounds is a major cause of morbidity and mortality across South Asian countries. To develop uniform and effective management guidelines, the severity of acute OP poisoning should be assessed through scientific methods and a clinical database should be maintained. A prospective descriptive survey was carried out to assess the utility of severity scales in predicting the outcome of 71 organophosphate (OP) and carbamate poisoning patients admitted during a one year period at the Kasturba Hospital, Manipal, India. The Glasgow coma scale (GCS) scores, acute physiology and chronic health evaluation II (APACHE II) scores, predicted mortality rate (PMR) and Poisoning severity score (PSS) were estimated within 24h of admission. Significant correlation (P<0.05) between PSS and GCS and APACHE II and PMR scores were observed with the PSS scores predicting mortality significantly (P< or =0.001). A total of 84.5% patients improved after treatment while 8.5% of the patients were discharged with severe morbidity. The mortality rate was 7.0%. Suicidal poisoning was observed to be the major cause (80.2%), while other reasons attributed were occupational (9.1%), accidental (6.6%), homicidal (1.6%) and unknown (2.5%) reasons. This study highlights the application of clinical indices like GCS, APACHE, PMR and severity scores in predicting mortality and may be considered for planning standard treatment guidelines.

  3. [Prediction of mortality in patients with acute hepatic failure].

    PubMed

    Eremeeva, L F; Berdnikov, A P; Musaeva, T S; Zabolotskikh, I B

    2013-01-01

    The article deals with a study of 243 patients (from 18 to 65 years old) with acute hepatic failure. Purpose of the study was to evaluate the predictive capability of severity scales APACHE III, SOFA, MODS, Child-Pugh and to identify mortality predictors in patients with acute hepatic failure. Results; The best predictive ability in patients with acute hepatic failure and multiple organ failure had APACHE III and SOFA scales. The strongest mortality predictors were: serum creatinine > 132 mmol/L, fibrinogen < 1.4 g/L, Na < 129 mmol/L.

  4. Child–Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis

    PubMed Central

    Peng, Ying; Qi, Xingshun; Guo, Xiaozhong

    2016-01-01

    Abstract Child–Pugh and MELD scores have been widely used for the assessment of prognosis in liver cirrhosis. A systematic review and meta-analysis aimed to compare the discriminative ability of Child–Pugh versus MELD score to assess the prognosis of cirrhotic patients. PubMed and EMBASE databases were searched. The statistical results were summarized from every individual study. The summary areas under receiver operating characteristic curves, sensitivities, specificities, positive and negative likelihood ratios, and diagnostic odds ratios were also calculated. Of the 1095 papers initially identified, 119 were eligible for the systematic review. Study population was heterogeneous among studies. They included 269 comparisons, of which 44 favored MELD score, 16 favored Child–Pugh score, 99 did not find any significant difference between them, and 110 did not report the statistical significance. Forty-two papers were further included in the meta-analysis. In patients with acute-on-chronic liver failure, Child–Pugh score had a higher sensitivity and a lower specificity than MELD score. In patients admitted to ICU, MELD score had a smaller negative likelihood ratio and a higher sensitivity than Child–Pugh score. In patients undergoing surgery, Child–Pugh score had a higher specificity than MELD score. In other subgroup analyses, Child–Pugh and MELD scores had statistically similar discriminative abilities or could not be compared due to the presence of significant diagnostic threshold effects. Although Child–Pugh and MELD scores had similar prognostic values in most of cases, their benefits might be heterogeneous in some specific conditions. The indications for Child–Pugh and MELD scores should be further identified. PMID:26937922

  5. Rapid measurement of indocyanine green retention by pulse spectrophotometry: a validation study in 70 patients with Child-Pugh A cirrhosis before hepatectomy for hepatocellular carcinoma.

    PubMed

    Cheung, Tan To; Chan, See Ching; Chok, Kenneth S H; Chan, Albert C Y; Yu, Wan Ching; Poon, Ronnie T P; Lo, Chung Mau; Fan, Sheung Tat

    2012-06-01

    The indocyanine green (ICG) retention test is the most popular liver function test for selecting patients for major hepatectomy. Traditionally, it is done using spectrophotometry with serial blood sampling. The newly-developed pulse spectrophotometry is a faster alternative, but its accuracy on Child-Pugh A cirrhotic patients undergoing hepatectomy for hepatocellular carcinoma has not been well documented. This study aimed to assess the accuracy of the LiMON(®), one of the pulse spectrophotometry systems, in measuring preoperative ICG retention in these patients and to devise an easy formula for conversion of the results so that they can be compared with classical literature records where ICG retention was measured by the traditional method. We measured the liver function of 70 Child-Pugh A cirrhotic patients before hepatectomy for hepatocellular carcinoma from September 2008 to January 2009. ICG retention at 15 minutes measured by traditional spectrophotometry (ICGR15) was compared with ICG retention at 15 minutes measured by the LiMON (ICGR15(L)). The median ICGR15 was 14.7% (5.6%-32%) and the median ICGR15(L) was 10.4% (1.2%-28%). The mean difference between them was -4.3606. There was a strong correlation between ICGR15 and ICGR15(L) (correlation coefficient, 0.844; 95% confidence interval, 0.762-0.899). The following formula was devised: ICGR15=1.16XICGR15(L)+2.73. The LiMON provides a fast and repeatable way to measure ICG retention at 15 minutes, but with constant underestimation of the real value. Therefore, when comparing results obtained by traditional spectrophotometry and the LiMON, adjustment of results from the latter is necessary, and this can be done with a simple mathematical calculation using the above formula.

  6. Creatinine-modified Child-Turcotte-Pugh score is a good predictor of a short-term survival in patients with bleeding from esophageal varices.

    PubMed

    Radisavljević, Mirjana; Bjelaković, Goran; Jović, Jasna; Radovanović-Dinić, Biljana; Benedoto-Stojanov, Danijela; Brzački, Vesna; Marković-Živković, Bojana

    2017-01-01

    Bleeding from esophageal varices is a significant factor in mortality of patients with terminal liver cirrhosis. This complication is a major health problem for recipients on the list for liver transplant. In that regard, studying predictors of variceal bleeding episode is very important. Also, it is important to find the best survival predictor among prognostic scores. The aim of the study was to compare validity of prognostic scores in assessment of survival in hospital-treated patients after bleeding from esophageal varices, and to compare validity of baseline Child-Turcotte-Pugh (CTP) and Modul for End-stage Liver Disease (MELD) scores with CTP creatinine modified (CTP-crea) I and II scores in assessment of survival in patients within a long-term follow-up period after the episode of bleeding from esophageal varices. The study included a total of 126 patients suffering from terminal liver cirrhosis submited to testing CTP score score I and II, MELD score, MELD Na score, integrated MELD score, MELD sodium (MESO) index, United Kingdom Model for End-Stage Liver Disease (UKELD) score and updated MELD score. Patients with bleeding from esophageal varices most often had CTP score rank C (46,9%). CTP score rank B had 37.5% patients, while the smallest percentage of patients had CTP rank A, 15.6% of them. Patients who have values of CTP score higher than 10.50 and bleeding from esophagus, have 3.2 times higher chance for death outcome compared to other patients. Patients who have values of CTP-crea I score higher than 10.50 and bleeding from esophagus, have 3.1 times higher chance for death out-come than other patients. Patients who have values of CTP-crea II score higher than 11.50 and bleeding from esophagus, have 3,7 times higher chance for death outcome compared to other patients. Survival of patients with bleeding from esophageal varices in the short-term follow up can be predicted by following CTP score and creatinine modified CTP scores. Patients with bleeding

  7. Apache Open Climate Workbench: Building Open Source Climate Science Tools and Community at the Apache Software Foundation

    NASA Astrophysics Data System (ADS)

    Joyce, M.; Ramirez, P.; Boustani, M.; Mattmann, C. A.; Khudikyan, S.; McGibbney, L. J.; Whitehall, K. D.

    2014-12-01

    Apache Open Climate Workbench (OCW; https://climate.apache.org/) is a Top-Level Project at the Apache Software Foundation that aims to provide a suite of tools for performing climate science evaluations using model outputs from a multitude of different sources (ESGF, CORDEX, U.S. NCA, NARCCAP) with remote sensing data from NASA, NOAA, and other agencies. Apache OCW is the second NASA project to become a Top-Level Project at the Apache Software Foundation. It grew out of the Jet Propulsion Laboratory's (JPL) Regional Climate Model Evaluation System (RCMES) project, a collaboration between JPL and the University of California, Los Angeles' Joint Institute for Regional Earth System Science and Engineering (JIFRESSE). Apache OCW provides scientists and developers with tools for data manipulation, metrics for dataset comparisons, and a visualization suite. In addition to a powerful low-level API, Apache OCW also supports a web application for quick, browser-controlled evaluations, a command line application for local evaluations, and a virtual machine for isolated experimentation with minimal setup. This talk will look at the difficulties and successes of moving a closed community research project out into the wild world of open source. We'll explore the growing pains Apache OCW went through to become a Top-Level Project at the Apache Software Foundation as well as the benefits gained by opening up development to the broader climate and computer science communities.

  8. Review article: scoring systems for assessing prognosis in critically ill adult cirrhotics.

    PubMed

    Cholongitas, E; Senzolo, M; Patch, D; Shaw, S; Hui, C; Burroughs, A K

    2006-08-01

    Cirrhotic patients admitted to intensive care units (ICU) still have poor outcomes. Some current ICU prognostic models [Acute Physiology and Chronic Health Evaluation (APACHE), Organ System Failure (OSF) and Sequential Organ Failure Assessment (SOFA)] were used to stratify cirrhotics into risk categories, but few cirrhotics were included in the original model development. Liver-specific scores [Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD)] could be useful in this setting. To evaluate whether ICU prognostic models perform better compared with liver-disease specific ones in cirrhotics admitted to ICU. We performed a structured literature review identifying clinical studies focusing on prognosis and risk factors for mortality in adult cirrhotics admitted to ICU. We found 21 studies (five solely dealing with gastrointestinal bleeding) published during the last 20 years (54-420 patients in each). APACHE II and III, SOFA and OSF had better discrimination for correctly predicting death compared with the CTP score. The MELD score was evaluated only in one study and had good predictive accuracy [receiver operator characteristic (ROC) curve: 0.81). Organ dysfunction models (OSF, SOFA) were superior compared with APACHE II and III (ROC curve: range 0.83-0.94 vs. 0.66-0.88 respectively). Cardiovascular, liver and renal system dysfunction were more frequently independently associated with mortality. General-ICU models had better performance in cirrhotic populations compared with CTP score; OSF and SOFA had the best predictive ability. Further prospective and validation studies are needed.

  9. Curriculum Program for the Apache Language.

    ERIC Educational Resources Information Center

    Whiteriver Public Schools, AZ.

    These curriculum materials from the Whiteriver (Arizona) Elementary School consist of--(1) an English-Apache word list of some of the most commonly used words in Apache, 29p.; (2) a list of enclitics with approximate or suggested meanings and illustrations of usage, 5 p.; (3) an illustrated chart of Apache vowels and consonants, various written…

  10. Colour blindness does not preclude fame as an artist: celebrated Australian artist Clifton Pugh was a protanope.

    PubMed

    Cole, Barry L; Harris, Ross W

    2009-09-01

    The aim was to make a posthumous diagnosis of the abnormal colour vision of the acclaimed artist Clifton Pugh and to analyse his use of colours to discern the strategies he used to overcome his limited colour perception. A pedigree of Pugh's family was constructed by searching public records. Pugh had no daughters but he had two older brothers, one of whom was still living. We tested the colour vision of this brother and one of his daughters and one of his grandsons. Three children of the other brother were questioned about the colour vision of their father and one daughter was tested for heterozygosity with the Medmont C100. Four observers with normal colour vision categorised the colours used by Pugh in a sample of 59 of his paintings. Protanopic transformations of some of these paintings were made using the Vischeck algorithms to gain an appreciation of how Pugh saw his own paintings. The validity of the transformations was tested by asking a protanope to report if the transformations looked the same as the normal colour images of 10 of Pugh's paintings. Pugh's brother was a severe protan. His daughter showed Schmidt's sign and was a carrier of the protan gene and her son was a protanope. The oldest brother was reported as having normal colour vision. Therefore, it is almost certain that Clifton Pugh was a protanope. Pugh used all colours in his paintings but preferred to structure them on brown, black and blue or, for high key paintings, on cream or flesh colours. He used greens and purples sparingly. The protanopic Vischeck transformations did not always look the same as the normal colour image for the protanope observer. A severe colour vision deficiency does not preclude success as a painter. It is a handicap but there are strategies artists can use to overcome it.

  11. The Jicarilla Apaches. A Study in Survival.

    ERIC Educational Resources Information Center

    Gunnerson, Dolores A.

    Focusing on the ultimate fate of the Cuartelejo and/or Paloma Apaches known in archaeological terms as the Dismal River people of the Central Plains, this book is divided into 2 parts. The early Apache (1525-1700) and the Jicarilla Apache (1700-1800) tribes are studied in terms of their: persistent cultural survival, social/political adaptability,…

  12. The Apache OODT Project: An Introduction

    NASA Astrophysics Data System (ADS)

    Mattmann, C. A.; Crichton, D. J.; Hughes, J. S.; Ramirez, P.; Goodale, C. E.; Hart, A. F.

    2012-12-01

    Apache OODT is a science data system framework, borne over the past decade, with 100s of FTEs of investment, tens of sponsoring agencies (NASA, NIH/NCI, DoD, NSF, universities, etc.), and hundreds of projects and science missions that it powers everyday to their success. At its core, Apache OODT carries with it two fundamental classes of software services and components: those that deal with information integration from existing science data repositories and archives, that themselves have already-in-use business processes and models for populating those archives. Information integration allows search, retrieval, and dissemination across these heterogeneous systems, and ultimately rapid, interactive data access, and retrieval. The other suite of services and components within Apache OODT handle population and processing of those data repositories and archives. Workflows, resource management, crawling, remote data retrieval, curation and ingestion, along with science data algorithm integration all are part of these Apache OODT software elements. In this talk, I will provide an overview of the use of Apache OODT to unlock and populate information from science data repositories and archives. We'll cover the basics, along with some advanced use cases and success stories.

  13. Comparison of APACHE III, APACHE IV, SAPS 3, and MPM0III and Influence of Resuscitation Status on Model Performance

    PubMed Central

    Gajic, Ognjen; Afessa, Bekele

    2012-01-01

    Background: There are few comparisons among the most recent versions of the major adult ICU prognostic systems (APACHE [Acute Physiology and Chronic Health Evaluation] IV, Simplified Acute Physiology Score [SAPS] 3, Mortality Probability Model [MPM]0III). Only MPM0III includes resuscitation status as a predictor. Methods: We assessed the discrimination, calibration, and overall performance of the models in 2,596 patients in three ICUs at our tertiary referral center in 2006. For APACHE and SAPS, the analyses were repeated with and without inclusion of resuscitation status as a predictor variable. Results: Of the 2,596 patients studied, 283 (10.9%) died before hospital discharge. The areas under the curve (95% CI) of the models for prediction of hospital mortality were 0.868 (0.854-0.880), 0.861 (0.847-0.874), 0.801 (0.785-0.816), and 0.721 (0.704-0.738) for APACHE III, APACHE IV, SAPS 3, and MPM0III, respectively. The Hosmer-Lemeshow statistics for the models were 33.7, 31.0, 36.6, and 21.8 for APACHE III, APACHE IV, SAPS 3, and MPM0III, respectively. Each of the Hosmer-Lemeshow statistics generated P values < .05, indicating poor calibration. Brier scores for the models were 0.0771, 0.0749, 0.0890, and 0.0932, respectively. There were no significant differences between the discriminative ability or the calibration of APACHE or SAPS with and without “do not resuscitate” status. Conclusions: APACHE III and IV had similar discriminatory capability and both were better than SAPS 3, which was better than MPM0III. The calibrations of the models studied were poor. Overall, models with more predictor variables performed better than those with fewer. The addition of resuscitation status did not improve APACHE III or IV or SAPS 3 prediction. PMID:22499827

  14. The Western Apache home: landscape management and failing ecosystems

    Treesearch

    Seth Pilsk; Jeanette C. Cassa

    2005-01-01

    The traditional Western Apache home lies largely within the Madrean Archipelago. The natural resources of the region make up the basis of the Apache home and culture. Profound landscape changes in the region have occurred over the past 150 years. A survey of traditional Western Apache place names documents many of these changes. An analysis of the history and Apache...

  15. Falsely Elevated Serum Vitamin B12 Levels Were Associated with the Severity and Prognosis of Chronic Viral Liver Disease

    PubMed Central

    Sugihara, Takaaki; Koda, Masahiko; Okamoto, Toshiaki; Miyoshi, Kenichi; Matono, Tomomitsu; Oyama, Kenji; Hosho, Keiko; Okano, Jun-ichi; Isomoto, Hajime; Murawaki, Yoshikazu

    2017-01-01

    Background Vitamin B12 is stored primarily in the liver, and highly elevated serum vitamin B12 levels occur in acute hepatitis and severe alcoholic liver disease. We evaluated the relationship between vitamin B12 levels and liver disease severity and long term prognosis in patients with chronic viral hepatitis and cirrhosis. Methods We enrolled 90 patients (57 men, 33 women) with chronic viral hepatitis and cirrhosis who admitted to our hospital as a prospective cohort study. Overall, 37 patients had chronic hepatitis and 53 had cirrhosis (Child-Pugh A 33, B 13, and C 7); 57 patients had primary liver cancer. Serum vitamin B12 concentration and holotranscobalamin (holoTC) II (active form of vitamin B12) were determined and followed prospectively for at least 5 years. Results Mean total serum vitamin B12 concentration was significantly higher in Child-Pugh C (1308 ± 599 pg/mL) compared to those with chronic hepatitis (655 ± 551 pg/mL), Child-Pugh A (784 ± 559 pg/mL), and Child-Pugh B (660 ± 464 pg/mL) (P = 0.036) Presence of primary liver cancer also influenced serum vitamin B12 levels [657 (167–2956) vs. 432 (189–2956); P = 0.015]. Patients were divided into quartiles by vitamin B12 level. Patients without primary liver cancer in quartile 4 (≥ 880 pg/mL) demonstrated significantly poorer prognosis than those in quartiles 1–3 (< 880 pg/mL) (P = 0.023). The percentage of holohaptocorrin (holoHC) [(total vitamin B12 – holoTC II) × 100] was significantly higher in Child-Pugh B and C 86 (80–87)% than chronic hepatitis and Child-Pugh A 77 (31–89)% (P = 0.006) Multivariate analysis indicated serum vitamin B12 levels (HR = 1.001, P = 0.029) as a prognostic factor. Conclusion Falsely elevated serum vitamin B12 levels mainly composed of increased holoHC were associated with severity (Child-Pugh C and primary liver cancer) and prognosis in chronic viral liver disease. PMID:28331419

  16. Pro-atrial natriuretic peptide is a prognostic marker in sepsis, similar to the APACHE II score: an observational study.

    PubMed

    Morgenthaler, Nils G; Struck, Joachim; Christ-Crain, Mirjam; Bergmann, Andreas; Müller, Beat

    2005-02-01

    Additional biomarkers in sepsis are needed to tackle the challenges of determining prognosis and optimizing selection of high-risk patients for application of therapy. In the present study, conducted in a cohort of medical intensive care unit patients, our aim was to compare the prognostic value of mid-regional pro-atrial natriuretic peptide (ANP) levels with those of other biomarkers and physiological scores. Blood samples obtained in a prospective observational study conducted in 101 consecutive critically ill patients admitted to the intensive care unit were analyzed. The prognostic value of pro-ANP levels was compared with that of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and with those of various biomarkers (i.e. C-reactive protein, IL-6 and procalcitonin). Mid-regional pro-ANP was detected in EDTA plasma from all patients using a new sandwich immunoassay. On admission, 53 patients had sepsis, severe sepsis, or septic shock, and 68 had systemic inflammatory response syndrome. The median pro-ANP value in the survivors was 194 pmol/l (range 20-2000 pmol/l), which was significantly lower than in the nonsurvivors (median 853.0 pmol/l, range 100-2000 pmol/l; P < 0.001). On the day of admission, pro-ANP levels, but not levels of other biomarkers, were significantly higher in non-surviving [corrected] than in surviving [corrected] sepsis patients (P = 0.001). In a receiver operating characteristic curve analysis for the survival of patients with sepsis, the area under the curve (AUC) for pro-ANP was 0.88, which was significantly greater than the AUCs for procalcitonin and C-reactive protein, and similar to the AUC for the APACHE II score. Pro-ANP appears to be a valuable tool for individual risk assessment in sepsis patients and for stratification of high-risk patients in future intervention trials. Further studies are needed to validate our results.

  17. Escape from Albuquerque: An Apache Memorate.

    ERIC Educational Resources Information Center

    Greenfeld, Philip J.

    2001-01-01

    Clarence Hawkins, a White Mountain Apache, escaped from the Albuquerque Indian School around 1920. His 300-mile trip home, made with two other boys, exemplifies the reaction of many Indian youths to the American government's plans for cultural assimilation. The tale is told in the form of traditional Apache narrative. (TD)

  18. Determination of habitat requirements for Apache Trout

    USGS Publications Warehouse

    Petre, Sally J.; Bonar, Scott A.

    2017-01-01

    The Apache Trout Oncorhynchus apache, a salmonid endemic to east-central Arizona, is currently listed as threatened under the U.S. Endangered Species Act. Establishing and maintaining recovery streams for Apache Trout and other endemic species requires determination of their specific habitat requirements. We built upon previous studies of Apache Trout habitat by defining both stream-specific and generalized optimal and suitable ranges of habitat criteria in three streams located in the White Mountains of Arizona. Habitat criteria were measured at the time thought to be most limiting to juvenile and adult life stages, the summer base flow period. Based on the combined results from three streams, we found that Apache Trout use relatively deep (optimal range = 0.15–0.32 m; suitable range = 0.032–0.470 m) pools with slow stream velocities (suitable range = 0.00–0.22 m/s), gravel or smaller substrate (suitable range = 0.13–2.0 [Wentworth scale]), overhead cover (suitable range = 26–88%), and instream cover (large woody debris and undercut banks were occupied at higher rates than other instream cover types). Fish were captured at cool to moderate temperatures (suitable range = 10.4–21.1°C) in streams with relatively low maximum seasonal temperatures (optimal range = 20.1–22.9°C; suitable range = 17.1–25.9°C). Multiple logistic regression generally confirmed the importance of these variables for predicting the presence of Apache Trout. All measured variables except mean velocity were significant predictors in our model. Understanding habitat needs is necessary in managing for persistence, recolonization, and recruitment of Apache Trout. Management strategies such as fencing areas to restrict ungulate use and grazing and planting native riparian vegetation might favor Apache Trout persistence and recolonization by providing overhead cover and large woody debris to form pools and instream cover, shading streams and lowering temperatures.

  19. KinderApache Song and Dance Project.

    ERIC Educational Resources Information Center

    Shanklin, M. Trevor; Paciotto, Carla; Prater, Greg

    This paper describes activities and evaluation of the KinderApache Song and Dance Project, piloted in a kindergarten class in Cedar Creek (Arizona) on the White Mountain Apache Reservation. Introducing Native-language song and dance in kindergarten could help foster a sense of community and cultural pride and greater awareness of traditional…

  20. Module modified acute physiology and chronic health evaluation II: predicting the mortality of neuro-critical disease.

    PubMed

    Su, Yingying; Wang, Miao; Liu, Yifei; Ye, Hong; Gao, Daiquan; Chen, Weibi; Zhang, Yunzhou; Zhang, Yan

    2014-12-01

    This study aimed to conduct and assess a module modified acute physiology and chronic health evaluation (MM-APACHE) II model, based on disease categories modified-acute physiology and chronic health evaluation (DCM-APACHE) II model, in predicting mortality more accurately in neuro-intensive care units (N-ICUs). In total, 1686 patients entered into this prospective study. Acute physiology and chronic health evaluation (APACHE) II scores of all patients on admission and worst 24-, 48-, 72-hour scores were obtained. Neurological diagnosis on admission was classified into five categories: cerebral infarction, intracranial hemorrhage, neurological infection, spinal neuromuscular (SNM) disease, and other neurological diseases. The APACHE II scores of cerebral infarction, intracranial hemorrhage, and neurological infection patients were used for building the MM-APACHE II model. There were 1386 cases for cerebral infarction disease, intracranial hemorrhage disease, and neurological infection disease. The logistic linear regression showed that 72-hour APACHE II score (Wals  =  173.04, P < 0.001) and disease classification (Wals  =  12.51, P  =  0.02) were of importance in forecasting hospital mortality. Module modified acute physiology and chronic health evaluation II model, built on the variables of the 72-hour APACHE II score and disease category, had good discrimination (area under the receiver operating characteristic curve (AU-ROC  =  0.830)) and calibration (χ2  =  12.518, P  =  0.20), and was better than the Knaus APACHE II model (AU-ROC  =  0.778). The APACHE II severity of disease classification system cannot provide accurate prognosis for all kinds of the diseases. A MM-APACHE II model can accurately predict hospital mortality for cerebral infarction, intracranial hemorrhage, and neurologic infection patients in N-ICU.

  1. 40 CFR 52.150 - Yavapai-Apache Reservation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Yavapai-Apache Reservation. 52.150 Section 52.150 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arizona § 52.150 Yavapai-Apache Reservation. (a...

  2. 40 CFR 52.150 - Yavapai-Apache Reservation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 3 2013-07-01 2013-07-01 false Yavapai-Apache Reservation. 52.150 Section 52.150 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arizona § 52.150 Yavapai-Apache Reservation. (a...

  3. 40 CFR 52.150 - Yavapai-Apache Reservation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 3 2014-07-01 2014-07-01 false Yavapai-Apache Reservation. 52.150 Section 52.150 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arizona § 52.150 Yavapai-Apache Reservation. (a...

  4. 40 CFR 52.150 - Yavapai-Apache Reservation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 3 2011-07-01 2011-07-01 false Yavapai-Apache Reservation. 52.150 Section 52.150 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arizona § 52.150 Yavapai-Apache Reservation. (a...

  5. 40 CFR 52.150 - Yavapai-Apache Reservation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 3 2012-07-01 2012-07-01 false Yavapai-Apache Reservation. 52.150 Section 52.150 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arizona § 52.150 Yavapai-Apache Reservation. (a...

  6. FIB-4 index for assessing the prognosis of hepatocellular carcinoma in patients with Child-Pugh class A liver function.

    PubMed

    Ito, Takanori; Kumada, Takashi; Toyoda, Hidenori; Tada, Toshifumi

    2015-07-01

    We evaluated the prognosis of hepatocellular carcinoma (HCC) patients with Child-Pugh (C-P) class A based on FIB-4 index, which is a liver fibrosis marker. A total of 915 HCC patients with C-P class A were investigated. We assessed the prognosis using FIB-4 index, and factors associated with survival rates were analyzed in these patients. When patients were categorized according to FIB-4 index as <2.0 (n = 93), ≥ 2.0 and <4.0 (n = 311), and ≥ 4.0 (n = 511), survival rates at 5 years were 70.5% [95% confidence interval (CI) 59.0-79.9], 56.4% (95% CI 50.1-62.5), and 47.1% (95% CI 42.2-52.1), respectively. Patients with FIB-4 index <2.0 had a higher survival rate than the other groups (≥ 4.0 vs ≥ 2.0 and <4.0, p = 0.010; ≥ 2.0 and <4.0 vs <2.0, p = 0.028). We were able to predict prognosis in patients with C-P score 5 by FIB-4 index, but survival rate did not significantly differ in patients with C-P score 6. Multivariate analysis identified C-P score, FIB-4 index [≥ 2.0 and <4.0; hazard ratios (HRs) 1.638 (95% CI 1.084-2.474); p = 0.019/≥ 4.0; HR 1.828 (95% CI 1.217-2.744); p = 0.004], Lens culinaris agglutinin-reactive α-fetoprotein, tumor size, number, vascular invasion, antiviral therapy, and hepatectomy as independent predictive factors for survival. The FIB-4 index is useful for assessing prognosis in HCC patients with C-P class A, especially those with C-P score 5.

  7. Go-Gii-Ya [A Jicarilla Apache Religious Celebration].

    ERIC Educational Resources Information Center

    Pesata, Levi; And Others

    Developed by utilizing only Jicarilla Apache people as resources to preserve the authenticity of the material and information, this booklet presents information on the Jicarilla Apache celebration of "Go-gii-ya". "Go-gii-ya" is a religious feast and ceremony held annually over a three-day period which climaxes on the fifteenth…

  8. Mortality Prediction Using Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation IV Scoring Systems: Is There a Difference?

    PubMed

    Venkataraman, Ramesh; Gopichandran, Vijayaprasad; Ranganathan, Lakshmi; Rajagopal, Senthilkumar; Abraham, Babu K; Ramakrishnan, Nagarajan

    2018-05-01

    Mortality prediction in the Intensive Care Unit (ICU) setting is complex, and there are several scoring systems utilized for this process. The Acute Physiology and Chronic Health Evaluation (APACHE) II has been the most widely used scoring system; although, the more recent APACHE IV is considered an updated and advanced prediction model. However, these two systems may not give similar mortality predictions. The aim of this study is to compare the mortality prediction ability of APACHE II and APACHE IV scoring systems among patients admitted to a tertiary care ICU. In this prospective longitudinal observational study, APACHE II and APACHE IV scores of ICU patients were computed using an online calculator. The outcome of the ICU admissions for all the patients was collected as discharged or deceased. The data were analyzed to compare the discrimination and calibration of the mortality prediction ability of the two scores. Out of the 1670 patients' data analyzed, the area under the receiver operating characteristic of APACHE II score was 0.906 (95% confidence interval [CI] - 0.890-0.992), and APACHE IV score was 0.881 (95% CI - 0.862-0.890). The mean predicted mortality rate of the study population as given by the APACHE II scoring system was 44.8 ± 26.7 and as given by APACHE IV scoring system was 29.1 ± 28.5. The observed mortality rate was 22.4%. The APACHE II and IV scoring systems have comparable discrimination ability, but the calibration of APACHE IV seems to be better than that of APACHE II. There is a need to recalibrate the scales with weights derived from the Indian population.

  9. Mortality Prediction Using Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation IV Scoring Systems: Is There a Difference?

    PubMed Central

    Venkataraman, Ramesh; Gopichandran, Vijayaprasad; Ranganathan, Lakshmi; Rajagopal, Senthilkumar; Abraham, Babu K; Ramakrishnan, Nagarajan

    2018-01-01

    Background: Mortality prediction in the Intensive Care Unit (ICU) setting is complex, and there are several scoring systems utilized for this process. The Acute Physiology and Chronic Health Evaluation (APACHE) II has been the most widely used scoring system; although, the more recent APACHE IV is considered an updated and advanced prediction model. However, these two systems may not give similar mortality predictions. Objectives: The aim of this study is to compare the mortality prediction ability of APACHE II and APACHE IV scoring systems among patients admitted to a tertiary care ICU. Methods: In this prospective longitudinal observational study, APACHE II and APACHE IV scores of ICU patients were computed using an online calculator. The outcome of the ICU admissions for all the patients was collected as discharged or deceased. The data were analyzed to compare the discrimination and calibration of the mortality prediction ability of the two scores. Results: Out of the 1670 patients' data analyzed, the area under the receiver operating characteristic of APACHE II score was 0.906 (95% confidence interval [CI] – 0.890–0.992), and APACHE IV score was 0.881 (95% CI – 0.862–0.890). The mean predicted mortality rate of the study population as given by the APACHE II scoring system was 44.8 ± 26.7 and as given by APACHE IV scoring system was 29.1 ± 28.5. The observed mortality rate was 22.4%. Conclusions: The APACHE II and IV scoring systems have comparable discrimination ability, but the calibration of APACHE IV seems to be better than that of APACHE II. There is a need to recalibrate the scales with weights derived from the Indian population. PMID:29910542

  10. Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus: 2016 edition.

    PubMed

    Cheng, Shuqun; Chen, Minshan; Cai, Jianqiang

    2017-01-31

    Hepatocellular carcinoma is the fourth leading cause of cancer-related morbidity and mortality in China. Portal vein tumor thrombus (PVTT) is common and it worsens prognosis of hepatocellular carcinoma (HCC). There is no internationally accepted consensus or guideline for diagnosis and treatment of HCC with PVTT. Based on existing evidences and common current practices, Chinese Experts on Multidisciplinary Diagnosis and Treatment of HCC with portal vein tumor thrombus met to develop a national consensus on diagnosis and treatment of HCC with PVTT. The meeting concluded with the First Edition (version 2016) of consensus statements with grades of evidence given as grades Ia, Ib, IIa, IIb, III and IV, and ranking as Classes A, B, C, D and I for quality of evidence and strength of recommendation by the United State Preventive Service Task Force, respectively. The consensus suggests recommended treatment to be based on patients' PVTT type and ECOG functional status; surgery being the preferred treatment for Child-Pugh A, PVTT type I/II, and ECOG PS 0-1; transcatheter arterial chemoembolization (TACE) for non-resectable PVTT I/II and Child-Pugh A; and radiotherapy for non-resectable PVTT I/II/III and Child-Pugh A. Symptomatic treatment is recommended for Child-Pugh C, with massive ascites or gastrointestinal bleeding. By updating clinicians with treatment options for HCC with PVTT, the consensus statement aimed to prolong overall survival and to improve quality of life of patients with minimal treatment complication. Future treatment strategies for HCC with PVTT in China would depend on new evidences from more future clinical trials, especially studies defining the role of traditional Chinese medicine and clarifying molecular aspects of HCC.

  11. Evidence of sexually dimorphic introgression in Pinaleno Mountain Apache trout

    USGS Publications Warehouse

    Porath, M.T.; Nielsen, J.L.

    2003-01-01

    The high-elevation headwater streams of the Pinaleno Mountains support small populations of threatened Apache trout Oncorhynchus apache that were stocked following the chemical removal of nonnative salmonids in the 1960s. A fisheries survey to assess population composition, growth, and size structure confirmed angler reports of infrequent occurrences of Oncorhynchus spp. exhibiting the external morphological characteristics of both Apache trout and rainbow trout O. mykiss. Nonlethal tissue samples were collected from 50 individuals in the headwaters of each stream. Mitochondrial DNA (mtDNA) sequencing and amplification of nuclear microsatellite loci were used to determine the levels of genetic introgression by rainbow trout in Apache trout populations at these locations. Sexually dimorphic introgression from the spawning of male rainbow trout with female Apache trout was detected using mtDNA and microsatellites. Estimates of the degree of hybridization based on three microsatellite loci were 10-88%. The use of nonlethal DNA genetic analyses can supplement information obtained from standard survey methods and be useful in assessing the relative importance of small and sensitive populations with a history of nonnative introductions.

  12. Apache sharply expands western Egypt acreage position

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    NONE

    1997-02-10

    Apache Corp. became Egypt`s second largest acreage holder with acquisition of Mobil Corp.`s nonoperating interests in three western desert exploration concessions covering a combined 7.7 million gross acres. Apache assumed a 50% contractor interest in the Repsol SA operated East Bahariya concession, a 33% contractor interest in the Repsol operated West Mediterranean Block 1 concession, and a 24% contractor interest in the Royal Dutch/Shell operated Northeast Abu Gharadig concession. The concessions carry a total drilling obligation of 11 wells the next 3 years.

  13. Beneficial Effect of Maintaining Hepatic Reserve during Chemotherapy on the Outcomes of Patients with Hepatocellular Carcinoma

    PubMed Central

    Terashima, Takeshi; Yamashita, Tatsuya; Arai, Kuniaki; Kawaguchi, Kazunori; Kitamura, Kazuya; Yamashita, Taro; Sakai, Yoshio; Mizukoshi, Eishiro; Honda, Masao; Kaneko, Shuichi

    2017-01-01

    Hepatocellular carcinoma (HCC) usually develops in chronically damaged liver. We investigated hepatic reserves during chemotherapy of patients with advanced HCC and compensated liver function to evaluate the effect on patients' outcomes of maintaining hepatic reserve after chemotherapy. We retrospectively reviewed the medical records of 190 patients with Child-Pugh A with advanced HCC who were treated with sorafenib or hepatic arterial infusion chemotherapy (HAIC). We investigated the Child-Pugh score and albumin-bilirubin grade for hepatic reserve, and evaluated the effect of the change in Child-Pugh scores on patients' outcomes. Subjects were treated with sorafenib (n = 59) or HAIC (n = 131). Of patients with Child-Pugh data, 66.7% maintained or improved their Child-Pugh score after 4 weeks. Treatment with HAIC was the only factor that significantly contributed to maintaining Child-Pugh scores after 4 weeks. The overall survival of patients with a higher Child-Pugh score after 4 weeks was shorter than that of patients whose Child-Pugh classification was unchanged. Multivariate analysis demonstrated that an increased Child-Pugh score after 4 weeks was one of the independent unfavorable prognostic factors. The change of hepatic reserve as a function of albumin-bilirubin grade did not significantly correlate with patients' outcomes. Maintaining the Child-Pugh score during chemotherapy benefits the outcomes of patients with advanced HCC, even those with sufficient hepatic reserve. PMID:28626734

  14. Geologic influences on Apache trout habitat in the White Mountains of Arizona

    Treesearch

    Jonathan W. Long; Alvin L. Medina

    2006-01-01

    Geologic variation has important influences on habitat quality for species of concern, but it can be difficult to evaluate due to subtle variations, complex terminology, and inadequate maps. To better understand habitat of the Apache trout (Onchorhynchus apache or O. gilae apache Miller), a threatened endemic species of the White...

  15. 20 CFR 228.50 - Tier II annuity component widow(er), child, or parent.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... annuity component widow(er), child, or parent. (a) General. The tier II annuity component is an additional amount payable to a widow(er), disabled widow(er), child, or parent, but not to a surviving divorced... annuity component, the parent tier II annuity component is zero. (3) Child. The amount of each child's...

  16. 20 CFR 228.50 - Tier II annuity component widow(er), child, or parent.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... annuity component widow(er), child, or parent. (a) General. The tier II annuity component is an additional amount payable to a widow(er), disabled widow(er), child, or parent, but not to a surviving divorced... annuity component, the parent tier II annuity component is zero. (3) Child. The amount of each child's...

  17. 20 CFR 228.50 - Tier II annuity component widow(er), child, or parent.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... annuity component widow(er), child, or parent. (a) General. The tier II annuity component is an additional amount payable to a widow(er), disabled widow(er), child, or parent, but not to a surviving divorced... annuity component, the parent tier II annuity component is zero. (3) Child. The amount of each child's...

  18. 20 CFR 228.50 - Tier II annuity component widow(er), child, or parent.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... annuity component widow(er), child, or parent. (a) General. The tier II annuity component is an additional amount payable to a widow(er), disabled widow(er), child, or parent, but not to a surviving divorced... annuity component, the parent tier II annuity component is zero. (3) Child. The amount of each child's...

  19. Comparing Child-Pugh, MELD, and FIB-4 to Predict Clinical Outcomes in Hepatitis C Virus-Infected Persons: Results From ERCHIVES.

    PubMed

    Butt, Adeel A; Ren, Yanjie; Lo Re, Vincent; Taddei, Tamar H; Kaplan, David E

    2017-07-01

    Identifying hepatitis C virus (HCV)-positive persons at high risk of early complications can help prioritize treatment decisions. We conducted this study to compare Child-Turcotte-Pugh (CP), MELD, and FIB-4 scores for predicting clinical outcomes and to identify those at low risk of complications. Within electronically retrieved cohort of HCV-infected veterans, we identified HCV-positive persons and excluded those with human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), prevalent hepatic decompensation (HD), hepatocellular carcinoma (HCC), and those treated for HCV. We calculated incidence rates for HD, HCC, and all-cause mortality at 1, 3, and 5 years after HCV diagnosis. Using receiver operating characteristic (ROC) curves, we determined the optimal cut-off values for each score for these outcomes. Among 21 116 persons evaluated, 89.7% were CP Class-A, 79.9% had MELD<9, and 43.4% had FIB-4<1.45. AUROC for HD at 1, 3, and 5 years was higher for FIB-4 (0.84-0.86) compared with MELD (0.70-0.76) (P < .001). AUROC for HCC at 1, 3, and 5 years was 0.81-0.82 for FIB-4 but 0.61-0.68 for CP and MELD scores. (P < .001) AUROC for all-cause mortality at 3 and 5 years was 0.65-0.68. The optimal cut-off scores to identify persons at low risk of complications were as follows: CP <5; MELD <8; FIB-4 <3 for HD and HCC, and <2 for all-cause mortality, below which <1.5% developed HD and HCC and ≤2.5% died at 3 years. FIB-4 score is a better predictor of HD and HCC in HCV-positive persons. A score of <3 is associated with a low risk of HD and HCC 1 and 3 years after HCV diagnosis. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com

  20. [Comparison of predictive factors related to the mortality and rebleeding caused by variceal bleeding: Child-Pugh score, MELD score, and Rockall score].

    PubMed

    Lee, Ja Young; Lee, Jin Heon; Kim, Soo Jin; Choi, Dae Rho; Kim, Kyung Ho; Kim, Yong Bum; Kim, Hak Yang; Yoo, Jae Young

    2002-12-01

    The first episode of variceal bleeding is one of the most frequent causes of death in patients with liver cirrhosis. The Child-Pugh(CP) scoring system has been widely accepted for prognostic assessment. Recently, MELD has been known to be better than the CP scoring system for predicting mortality in patients with end-stage liver diseases. The Rockall risk scoring system was developed to predict the outcome of upper GI bleeding including variceal bleeding. The aim of this study was to investigate the mortality rate of first variceal bleeding and the predictability of each scoring system. We evaluated the 6-week mortality rate, rebleeding rate, and 1-year mortality rate of all the 136 patients with acute variceal bleeding without previous episode of hemorrhage between January 1, 1998 and December 31, 2000. The CP score, MELD score, and Rockall score were estimated and analyzed. Among 136 patients, 35 patients with hepatoma and 8 patients with follow-up loss were excluded. Six-week mortality rate, 1-year mortality rate, and rebleeding rate of first variceal bleeding were 24.7%, 35.5%, and 12.9%, respectively. The c-statistics of CP, MELD, and Rockall score for predicting 6-week mortality rate were 0.809 (p<0.001, 95% CI, 0.720-0.898), 0.804 (p<0.001, 95% CI, 0.696-0.911), 0.787 (p<0.001, 95% CI, 0.683-0.890), respectively. For 1-year mortality rate, c-statistics were 0.765 (p<0.005, 95% CI, 0.665-0.865), 0.780 (p<0.005, 95% CI, 0.676-0.883), 0.730 (p<0.01, 95% CI, 0.627-0.834), respectively. The CP, MELD, and Rockall scores were reliable measures of mortality risk in patients with first variceal bleeding. The CP classification is useful in its easy applicability.

  1. Mortality Probability Model III and Simplified Acute Physiology Score II

    PubMed Central

    Vasilevskis, Eduard E.; Kuzniewicz, Michael W.; Cason, Brian A.; Lane, Rondall K.; Dean, Mitzi L.; Clay, Ted; Rennie, Deborah J.; Vittinghoff, Eric; Dudley, R. Adams

    2009-01-01

    Background: To develop and compare ICU length-of-stay (LOS) risk-adjustment models using three commonly used mortality or LOS prediction models. Methods: Between 2001 and 2004, we performed a retrospective, observational study of 11,295 ICU patients from 35 hospitals in the California Intensive Care Outcomes Project. We compared the accuracy of the following three LOS models: a recalibrated acute physiology and chronic health evaluation (APACHE) IV-LOS model; and models developed using risk factors in the mortality probability model III at zero hours (MPM0) and the simplified acute physiology score (SAPS) II mortality prediction model. We evaluated models by calculating the following: (1) grouped coefficients of determination; (2) differences between observed and predicted LOS across subgroups; and (3) intraclass correlations of observed/expected LOS ratios between models. Results: The grouped coefficients of determination were APACHE IV with coefficients recalibrated to the LOS values of the study cohort (APACHE IVrecal) [R2 = 0.422], mortality probability model III at zero hours (MPM0 III) [R2 = 0.279], and simplified acute physiology score (SAPS II) [R2 = 0.008]. For each decile of predicted ICU LOS, the mean predicted LOS vs the observed LOS was significantly different (p ≤ 0.05) for three, two, and six deciles using APACHE IVrecal, MPM0 III, and SAPS II, respectively. Plots of the predicted vs the observed LOS ratios of the hospitals revealed a threefold variation in LOS among hospitals with high model correlations. Conclusions: APACHE IV and MPM0 III were more accurate than SAPS II for the prediction of ICU LOS. APACHE IV is the most accurate and best calibrated model. Although it is less accurate, MPM0 III may be a reasonable option if the data collection burden or the treatment effect bias is a consideration. PMID:19363210

  2. Relationships between blood levels of fat soluble vitamins and disease etiology and severity in adults awaiting liver transplantation.

    PubMed

    Abbott-Johnson, Winsome; Kerlin, Paul; Clague, Alan; Johnson, Helen; Cuneo, Ross

    2011-09-01

    Although malnutrition is common in liver disease, there are limited data on fat soluble vitamins in various diseases. The aims of this study were to: (i) determine fat soluble vitamin levels in patients assessed for liver transplantation; (ii) compare levels between different disease etiologies (hepatocellular and cholestatic) and between subgroups of hepatocellular disease; and (iii) assess the multivariate contribution to vitamin levels of etiology and various indicators of disease severity. This was a cross-sectional study of 107 inpatients awaiting liver transplantation, mean age 47 years. Biochemical parameters included plasma retinol, 25-hydroxycholecalciferol, and vitamin E. Biochemical (albumin, bilirubin and zinc) and clinical indicators (Child-Pugh and Model of End Stage Liver Disease [MELD] scores) of disease severity were determined. Deficiencies of retinol (< 1.0 µmol/L), 25-hydroxycholecalciferol (< 50 nmol/L) and vitamin E (< 11 µmol/L) were present in 75%, 66% and 3%, respectively, of patients. Concentrations of retinol and vitamin E were lower in hepatocellular than cholestatic disease but 25-hydroxycholecalciferol concentrations were similar. Child-Pugh score was higher in hepatocellular than cholestatic disease. Concentrations of retinol were lower in alcoholic liver disease (ALD) than hepatitis and Child-Pugh score was higher in ALD. For the whole group, levels of retinol, 25-hydroxycholecalciferol and vitamin E were negatively related to Child-Pugh score, MELD score and bilirubin, and positively related to albumin. When Child-Pugh scores were controlled for, retinol was lower in the hepatocellular group. There was a high prevalence of fat soluble vitamin deficiencies with vitamin levels being related to disease severity. Retinol was lower in the hepatocellular group. © 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.

  3. Biology and distribution of Lutzomyia apache as it relates to VSV

    USDA-ARS?s Scientific Manuscript database

    Phlebotomine sand flies are vectors of bacteria, parasites, and viruses. Lutzomyia apache was incriminated as a vector of vesicular stomatitis viruses(VSV)due to overlapping ranges of the sand fly and outbreaks of VSV. I report on newly discovered populations of L. apache in Wyoming from Albany and ...

  4. Prediction of radiation-induced liver disease by Lyman normal-tissue complication probability model in three-dimensional conformal radiation therapy for primary liver carcinoma

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Xu ZhiYong; Department of Oncology, Shanghai Medical School, Fudan University, Shanghai; Liang Shixiong

    Purpose: To describe the probability of RILD by application of the Lyman-Kutcher-Burman normal-tissue complication (NTCP) model for primary liver carcinoma (PLC) treated with hypofractionated three-dimensional conformal radiotherapy (3D-CRT). Methods and Materials: A total of 109 PLC patients treated by 3D-CRT were followed for RILD. Of these patients, 93 were in liver cirrhosis of Child-Pugh Grade A, and 16 were in Child-Pugh Grade B. The Michigan NTCP model was used to predict the probability of RILD, and then the modified Lyman NTCP model was generated for Child-Pugh A and Child-Pugh B patients by maximum-likelihood analysis. Results: Of all patients, 17 developedmore » RILD in which 8 were of Child-Pugh Grade A, and 9 were of Child-Pugh Grade B. The prediction of RILD by the Michigan model was underestimated for PLC patients. The modified n, m, TD{sub 5} (1) were 1.1, 0.28, and 40.5 Gy and 0.7, 0.43, and 23 Gy for patients with Child-Pugh A and B, respectively, which yielded better estimations of RILD probability. The hepatic tolerable doses (TD{sub 5}) would be MDTNL of 21 Gy and 6 Gy, respectively, for Child-Pugh A and B patients. Conclusions: The Michigan model was probably not fit to predict RILD in PLC patients. A modified Lyman NTCP model for RILD was recommended.« less

  5. 77 FR 51475 - Safety Zone; Apache Pier Labor Day Fireworks; Myrtle Beach, SC

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-24

    ...-AA00 Safety Zone; Apache Pier Labor Day Fireworks; Myrtle Beach, SC AGENCY: Coast Guard, DHS. ACTION... Atlantic Ocean in the vicinity of Apache Pier in Myrtle Beach, SC, during the Labor Day fireworks... [[Page 51476

  6. Observations of the larval stages of Diceroprocta apache Davis (Homoptera: Tibicinidae)

    USGS Publications Warehouse

    Ellingson, A.R.; Andersen, D.C.; Kondratieff, B.C.

    2002-01-01

    Diceroprocta apache Davis is a locally abundant cicada in the riparian woodlands of the southwestern United States. While its ecological importance has often been hypothesized, very little is known of its specific life history. This paper presents preliminary information on life history of D. apache from larvae collected in the field at seasonal intervals as well as a smaller number of reared specimens. Morphological development of the fore-femoral comb closely parallels growth through distinct size classes. The data indicate the presence of five larval instars in D. apache. Development times from greenhouse-reared specimens suggest a 3-4 year life span and overlapping broods were present in the field. Sex ratios among pre-emergent larvae suggest the asynchronous emergence of sexes.

  7. Growth and survival of Apache Trout under static and fluctuating temperature regimes

    USGS Publications Warehouse

    Recsetar, Matthew S.; Bonar, Scott A.; Feuerbacher, Olin

    2014-01-01

    Increasing stream temperatures have important implications for arid-region fishes. Little is known about effects of high water temperatures that fluctuate over extended periods on Apache Trout Oncorhynchus gilae apache, a federally threatened species of southwestern USA streams. We compared survival and growth of juvenile Apache Trout held for 30 d in static temperatures (16, 19, 22, 25, and 28°C) and fluctuating diel temperatures (±3°C from 16, 19, 22 and 25°C midpoints and ±6°C from 19°C and 22°C midpoints). Lethal temperature for 50% (LT50) of the Apache Trout under static temperatures (mean [SD] = 22.8 [0.6]°C) was similar to that of ±3°C diel temperature fluctuations (23.1 [0.1]°C). Mean LT50 for the midpoint of the ±6°C fluctuations could not be calculated because survival in the two treatments (19 ± 6°C and 22 ± 6°C) was not below 50%; however, it probably was also between 22°C and 25°C because the upper limb of a ±6°C fluctuation on a 25°C midpoint is above critical thermal maximum for Apache Trout (28.5–30.4°C). Growth decreased as temperatures approached the LT50. Apache Trout can survive short-term exposure to water temperatures with daily maxima that remain below 25°C and midpoint diel temperatures below 22°C. However, median summer stream temperatures must remain below 19°C for best growth and even lower if daily fluctuations are high (≥12°C).

  8. Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II.

    PubMed

    González-Castro, A; Ortiz-Lasa, M; Leizaola, O; Salgado, E; Irriguible, T; Sánchez-Satorra, M; Lomas-Fernández, C; Barral-Segade, P; Cordero-Vallejo, M; Rodrigo-Calabia, E; Dierssen-Sotos, T

    2017-05-01

    To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients' admission to ICU. Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Analysis of the liver functional reserve of patients with advanced hepatocellular carcinoma undergoing sorafenib treatment: Prospects for regorafenib therapy.

    PubMed

    Terashima, Takeshi; Yamashita, Tatsuya; Sunagozaka, Hajime; Arai, Kuniaki; Kawaguchi, Kazunori; Kitamura, Kazuya; Yamashita, Taro; Sakai, Yoshio; Mizukoshi, Eishiro; Honda, Masao; Kaneko, Shuichi

    2018-05-29

    This study aimed to investigate liver functional reserves during sorafenib treatment for advanced hepatocellular carcinoma (HCC), to identify predictive factors for maintaining them, and to analyze the proportion of candidates for regorafenib, which has been proven to improve patients' outcomes in the RESORCE trial. We retrospectively investigated Child-Pugh scores during and after sorafenib treatment and evaluated their effects on second-line treatment and outcomes of 125 patients with advanced HCC. Pretreatment Child-Pugh A was maintained in 59/90 (65.6%) patients and pretreatment Child-Pugh B was improved to Child-Pugh A in 10/35 (28.6%) patients when sorafenib ceased. A Child-Pugh score = 5 and aspartate amino transferase <40 IU/L before treatment were contributing factors; vascular invasion and cessation of sorafenib due to gastrointestinal or liver-related adverse effects were reverse predictive factors for Child-Pugh A when sorafenib treatment ceased. Significantly more patients with Child-Pugh A when sorafenib treatment ceased received subsequent therapy and achieved better outcomes compared with patients with Child-Pugh B. When sorafenib treatment failed, 45/125 patients (36.0%) fulfilled key inclusion criteria of the RESORCE trial as follows: Child-Pugh A, Eastern Cooperative Oncology Group performance status 0 or 1, tumor progression revealed by imaging, and treatment with ≥400 mg sorafenib for at least 20 of the last 28 days before treatment failure in 56.8%, 84.8%, 73.6%, and 68.0% of patients, respectively. A comprehensive understanding and management of dynamic changes in liver functional reserve during sorafenib treatment contributed to the efficacy of subsequent therapy (e.g. regorafenib) and to better outcomes for patients with advanced HCC. © 2018 The Japan Society of Hepatology.

  10. Utilizing findings from the APACHE III research to develop operational information system for the ICU--the APACHE III ICU Management System.

    PubMed Central

    Knaus, W. A.; Draper, E. A.; Wagner, D. P.

    1991-01-01

    The APACHE III data base reflects the disease, physiologic status, and outcome data from 17,400 ICU patients at 40 hospitals, 26 of which were randomly selected from representative geographic regions, bed size, and teaching status. This provides a nationally representative standard for measuring several important aspects of ICU performance. Results from the study have now been used to develop an automated information system to provide real time information about expected ICU patient outcome, length of stay, production cost, and ICU performance. The information system provides several new capabilities to ICU clinicians, clinic, and hospital administrators. Among the system's capabilities are: the ability to compare local ICU performance against predetermined criteria; the ability to forecast nursing requirements; and, the ability to make both individual and group patient outcome predictions. The system also provides improved administrative support by tracking ICU charges at the point of origin and reduces staff workload eliminating the requirement for several manually maintained logs and patient lists. APACHE III has the capability to electronically interface with and utilize data already captured in existing hospital information systems, automated laboratory information systems, and patient monitoring systems. APACHE III will also be completely integrated with several CIS vendors' products. PMID:1807779

  11. A Photographic Essay of Apache Chiefs and Warriors, Volume 2-Part B.

    ERIC Educational Resources Information Center

    Barkan, Gerald; Jacobs, Ben

    As part of a series designed for instruction of American Indian children and youth, this resource guide constitutes a pictorial essay describing forts, Indian agents, and Apache chiefs, warriors, and scouts of the 19th century. Accompanying each picture is a brief historical-biographical narrative. Focus is on Apache resistance to the reservation.…

  12. Solar Feasibility Study May 2013 - San Carlos Apache Tribe

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rapp, Jim; Duncan, Ken; Albert, Steve

    2013-05-01

    The San Carlos Apache Tribe (Tribe) in the interests of strengthening tribal sovereignty, becoming more energy self-sufficient, and providing improved services and economic opportunities to tribal members and San Carlos Apache Reservation (Reservation) residents and businesses, has explored a variety of options for renewable energy development. The development of renewable energy technologies and generation is consistent with the Tribe’s 2011 Strategic Plan. This Study assessed the possibilities for both commercial-scale and community-scale solar development within the southwestern portions of the Reservation around the communities of San Carlos, Peridot, and Cutter, and in the southeastern Reservation around the community of Bylas.more » Based on the lack of any commercial-scale electric power transmission between the Reservation and the regional transmission grid, Phase 2 of this Study greatly expanded consideration of community-scale options. Three smaller sites (Point of Pines, Dudleyville/Winkleman, and Seneca Lake) were also evaluated for community-scale solar potential. Three building complexes were identified within the Reservation where the development of site-specific facility-scale solar power would be the most beneficial and cost-effective: Apache Gold Casino/Resort, Tribal College/Skill Center, and the Dudleyville (Winkleman) Casino.« less

  13. Satellite Imagery Production and Processing Using Apache Hadoop

    NASA Astrophysics Data System (ADS)

    Hill, D. V.; Werpy, J.

    2011-12-01

    The United States Geological Survey's (USGS) Earth Resources Observation and Science (EROS) Center Land Science Research and Development (LSRD) project has devised a method to fulfill its processing needs for Essential Climate Variable (ECV) production from the Landsat archive using Apache Hadoop. Apache Hadoop is the distributed processing technology at the heart of many large-scale, processing solutions implemented at well-known companies such as Yahoo, Amazon, and Facebook. It is a proven framework and can be used to process petabytes of data on thousands of processors concurrently. It is a natural fit for producing satellite imagery and requires only a few simple modifications to serve the needs of science data processing. This presentation provides an invaluable learning opportunity and should be heard by anyone doing large scale image processing today. The session will cover a description of the problem space, evaluation of alternatives, feature set overview, configuration of Hadoop for satellite image processing, real-world performance results, tuning recommendations and finally challenges and ongoing activities. It will also present how the LSRD project built a 102 core processing cluster with no financial hardware investment and achieved ten times the initial daily throughput requirements with a full time staff of only one engineer. Satellite Imagery Production and Processing Using Apache Hadoop is presented by David V. Hill, Principal Software Architect for USGS LSRD.

  14. Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization

    PubMed Central

    Markgraf, Rainer; Deutschinoff, Gerd; Pientka, Ludger; Scholten, Theo; Lorenz, Cristoph

    2001-01-01

    Background: Mortality predictions calculated using scoring scales are often not accurate in populations other than those in which the scales were developed because of differences in case-mix. The present study investigates the effect of first-level customization, using a logistic regression technique, on discrimination and calibration of the Acute Physiology and Chronic Health Evaluation (APACHE) II and III scales. Method: Probabilities of hospital death for patients were estimated by applying APACHE II and III and comparing these with observed outcomes. Using the split sample technique, a customized model to predict outcome was developed by logistic regression. The overall goodness-of-fit of the original and the customized models was assessed. Results: Of 3383 consecutive intensive care unit (ICU) admissions over 3 years, 2795 patients could be analyzed, and were split randomly into development and validation samples. The discriminative powers of APACHE II and III were unchanged by customization (areas under the receiver operating characteristic [ROC] curve 0.82 and 0.85, respectively). Hosmer-Lemeshow goodness-of-fit tests showed good calibration for APACHE II, but insufficient calibration for APACHE III. Customization improved calibration for both models, with a good fit for APACHE III as well. However, fit was different for various subgroups. Conclusions: The overall goodness-of-fit of APACHE III mortality prediction was improved significantly by customization, but uniformity of fit in different subgroups was not achieved. Therefore, application of the customized model provides no advantage, because differences in case-mix still limit comparisons of quality of care. PMID:11178223

  15. Optimizing CMS build infrastructure via Apache Mesos

    DOE PAGES

    Abdurachmanov, David; Degano, Alessandro; Elmer, Peter; ...

    2015-12-23

    The Offline Software of the CMS Experiment at the Large Hadron Collider (LHC) at CERN consists of 6M lines of in-house code, developed over a decade by nearly 1000 physicists, as well as a comparable amount of general use open-source code. A critical ingredient to the success of the construction and early operation of the WLCG was the convergence, around the year 2000, on the use of a homogeneous environment of commodity x86-64 processors and Linux.Apache Mesos is a cluster manager that provides efficient resource isolation and sharing across distributed applications, or frameworks. It can run Hadoop, Jenkins, Spark, Aurora,more » and other applications on a dynamically shared pool of nodes. Lastly, we present how we migrated our continuous integration system to schedule jobs on a relatively small Apache Mesos enabled cluster and how this resulted in better resource usage, higher peak performance and lower latency thanks to the dynamic scheduling capabilities of Mesos.« less

  16. Optimizing CMS build infrastructure via Apache Mesos

    NASA Astrophysics Data System (ADS)

    Abdurachmanov, David; Degano, Alessandro; Elmer, Peter; Eulisse, Giulio; Mendez, David; Muzaffar, Shahzad

    2015-12-01

    The Offline Software of the CMS Experiment at the Large Hadron Collider (LHC) at CERN consists of 6M lines of in-house code, developed over a decade by nearly 1000 physicists, as well as a comparable amount of general use open-source code. A critical ingredient to the success of the construction and early operation of the WLCG was the convergence, around the year 2000, on the use of a homogeneous environment of commodity x86-64 processors and Linux. Apache Mesos is a cluster manager that provides efficient resource isolation and sharing across distributed applications, or frameworks. It can run Hadoop, Jenkins, Spark, Aurora, and other applications on a dynamically shared pool of nodes. We present how we migrated our continuous integration system to schedule jobs on a relatively small Apache Mesos enabled cluster and how this resulted in better resource usage, higher peak performance and lower latency thanks to the dynamic scheduling capabilities of Mesos.

  17. Optimizing CMS build infrastructure via Apache Mesos

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Abdurachmanov, David; Degano, Alessandro; Elmer, Peter

    The Offline Software of the CMS Experiment at the Large Hadron Collider (LHC) at CERN consists of 6M lines of in-house code, developed over a decade by nearly 1000 physicists, as well as a comparable amount of general use open-source code. A critical ingredient to the success of the construction and early operation of the WLCG was the convergence, around the year 2000, on the use of a homogeneous environment of commodity x86-64 processors and Linux.Apache Mesos is a cluster manager that provides efficient resource isolation and sharing across distributed applications, or frameworks. It can run Hadoop, Jenkins, Spark, Aurora,more » and other applications on a dynamically shared pool of nodes. Lastly, we present how we migrated our continuous integration system to schedule jobs on a relatively small Apache Mesos enabled cluster and how this resulted in better resource usage, higher peak performance and lower latency thanks to the dynamic scheduling capabilities of Mesos.« less

  18. The Apache Campaigns. Values in Conflict

    DTIC Science & Technology

    1985-06-01

    cultural aspects as land use, property ownership, criminal justice, re- ligious faith, and family and group loyalty differed sharply. Conceptual...and emphasized the primary importance of family and group loyalties. Initially, the Apache and Frontier Army co-habited the Southwest peacefully. Then...guidance during my research and writing this year. For intellectual stim- ulation and timely encouragement, I particularly thank my Committee Chairman

  19. 75 FR 68607 - BP Canada Energy Marketing Corp. Apache Corporation; Notice for Temporary Waivers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-08

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. RP11-1479-000] BP Canada Energy Marketing Corp. Apache Corporation; Notice for Temporary Waivers November 1, 2010. Take notice that on October 29, 2010, BP Canada Energy Marketing Corp. and Apache Corporation filed with the...

  20. Prediction of heart disease using apache spark analysing decision trees and gradient boosting algorithm

    NASA Astrophysics Data System (ADS)

    Chugh, Saryu; Arivu Selvan, K.; Nadesh, RK

    2017-11-01

    Numerous destructive things influence the working arrangement of human body as hypertension, smoking, obesity, inappropriate medication taking which causes many contrasting diseases as diabetes, thyroid, strokes and coronary diseases. The impermanence and horribleness of the environment situation is also the reason for the coronary disease. The structure of Apache start relies on the evolution which requires gathering of the data. To break down the significance of use programming focused on data structure the Apache stop ought to be utilized and it gives various central focuses as it is fast in light as it uses memory worked in preparing. Apache Spark continues running on dispersed environment and chops down the data in bunches giving a high profitability rate. Utilizing mining procedure as a part of the determination of coronary disease has been exhaustively examined indicating worthy levels of precision. Decision trees, Neural Network, Gradient Boosting Algorithm are the various apache spark proficiencies which help in collecting the information.

  1. A Phase II Study of Cixutumumab (IMC-A12, NSC742460) in Advanced Hepatocellular Carcinoma

    PubMed Central

    Abou-Alfa, Ghassan K.; Capanu, Marinela; O’Reilly, Eileen M.; Ma, Jennifer; Chou, Joanne F.; Gansukh, Bolorsukh; Shia, Jinru; Kalin, Marcia; Katz, Seth; Abad, Leslie; Reidy-Lagunes, Diane L.; Kelsen, David P.; Chen, Helen X.; Saltz, Leonard B.

    2014-01-01

    Background and Aims IGF-IR is implicated in hepatic carcinogenesis. This and preliminary evidence of biological activity of anti-IGF-1R monoclonal antibody cixutumumab in phase I trials prompted this phase II study. Methods Patients with advanced HCC, Child-Pugh A-B8, received cixutumumab 6 mg/kg weekly, in a Simon two-stage design study, with the primary endpoints being 4-month PFS and RECIST-defined response rate. Tissue and circulating markers plus different HCC scoring systems were evaluated for correlation with PFS and OS. Results As a result of pre-specified futility criteria, only stage 1 was accrued: N= 24: median age 67.5 years (range 49–83), KPS 80% (70–90%), 20 males (83%), 9 stage III (37%)/15 stage IV (63%), 18 Child-Pugh A (75%), 11 HBV (46%) /10 HCV (42%)/11 alcoholic cirrhosis (46%)/2 NASH (8%), 11 (46%) diabetic. Median number of doses: 7 (range 1–140). Grade 3/4 toxicities > 10% included: diabetes, elevated liver function tests, hyponatremia, and lymphopenia. Four-month PFS was 30% (95% CI 13–48), and there were no objective responses. Median overall survival was 8 months (95%CI 5.8– 14). IGF-R1 staining did not correlate with outcome. Elevated IGFBP-1 correlated with improved PFS (1.2 [95%CI 1–1.4]; p 0.009) and OS (1.2 [95%CI 1.1–1.4]; p 0.003). Conclusions Cixutumumab monotherapy did not have clinically meaningful activity in this unselected HCC population. Grade 3–4 hyperglycemia occurred in 46% of patients. Elevated IGFBP-1 correlated with improved PFS and OS. PMID:24045151

  2. Conservation priorities in the Apache Highlands ecoregion

    Treesearch

    Dale Turner; Rob Marshall; Carolyn A. F. Enquist; Anne Gondor; David F. Gori; Eduardo Lopez; Gonzalo Luna; Rafaela Paredes Aguilar; Chris Watts; Sabra Schwartz

    2005-01-01

    The Apache Highlands ecoregion incorporates the entire Madrean Archipelago/Sky Island region. We analyzed the current distribution of 223 target species and 26 terrestrial ecological systems there, and compared them with constraints on ecosystem integrity (e.g., road density) to determine the most efficient set of areas needed to maintain current biodiversity. The...

  3. Stereotactic Body Radiation Therapy and Transarterial Chemoembolization in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery

    ClinicalTrials.gov

    2018-03-01

    Child-Pugh Class A; Child-Pugh Class B; Stage IIIA Hepatocellular Carcinoma; Stage IIIB Hepatocellular Carcinoma; Stage IIIC Hepatocellular Carcinoma; Stage IVA Hepatocellular Carcinoma; Stage IVB Hepatocellular Carcinoma

  4. William Russ Pugh's remarkable life: natural scientist, innovative anaesthetist and founding member of the Royal Society of Tasmania.

    PubMed

    Paull, J D

    2011-07-01

    While well known in anaesthetic circles for being the first to provide ether anaesthesia for a surgical procedure in June 1847 in Launceston, Tasmania, William Russ Pugh's achievements in the field of natural history are less well known. He personally assisted Count Peter de Strzelecki in the chemical analysis of Australian coal and mineral samples and provided the laboratory space and equipment. His analytic skills were utilised by coroners in cases of poisoning. He was consulted about a ship's cargo which threatened to spontaneously combust in Launceston's port. He was a founding member of the Tasmanian Society and subsequently of the Royal Society of Tasmania. He made many presentations on geology, zoology, botany, mineralogy and meteorology to meetings of both Societies. These scientific interests may have provided the knowledge and motivation which encouraged Pugh to proceed so confidently with the introduction of ether anaesthesia.

  5. Safety and efficacy of endoscopic retrograde cholangiopancreatography for common bile duct stones in liver cirrhotic patients.

    PubMed

    Li, De-min; Zhao, Jie; Zhao, Qiu; Qin, Hua; Wang, Bo; Li, Rong-xiang; Zhang, Min; Hu, Ji-fen; Yang, Min

    2014-08-01

    In order to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatograpy (ERCP) in liver cirrhosis patients with common bile duct stones, we retrospectively analyzed data of 46 common bile duct stones patients with liver cirrhosis who underwent ERCP between 2000 and 2008. There were 12 cases of Child-Pugh A, 26 cases of Child-Pugh B, and 8 cases of Child-Pugh C. 100 common bile duct stones patients without liver cirrhosis were randomly selected. All the patients were subjected to ERCP for biliary stones extraction. The rates of bile duct clearance and complications were compared between cirrhotic and non-cirrhotic patients. The success rate of selective biliary cannulation was 95.6% in liver cirrhotic patients versus 97% in non-cirrhotic patients (P>0.05). The bile duct clearance rate was 87% in cirrhotic patients versus 96% in non-cirrhotic patients, but the difference was not statistically significant. Two liver cirrhotic patients (4.35%, 2/46) who were scored Child-Pugh C had hematemesis and melena 24 h after ERCP. The hemorrhage rate after ERCP in non-cirrhotic patients was 3%. The hemorrhage rate associated with ERCP in Child-Pugh C patients was significantly higher (25%, 2/8) than that (3%, 3/100) in non-cirrhotic patients (P<0.01%). There was no significant difference between these two groups in the rate of post-ERCP pancreatitis (PEP) and cholangitis. ERCP is safe and effective for Child-Pugh A and B cirrhotic patients with common bile duct stones. Hemorrhage risk in ERCP is higher in Child-Pugh C patients.

  6. An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit.

    PubMed

    Wong, Rowena S Y; Ismail, Noor Azina; Tan, Cheng Cheng

    2015-04-01

    Intensive care unit (ICU) prognostic models are predominantly used in more developed nations such as the United States, Europe and Australia. These are not that popular in Southeast Asian countries due to costs and technology considerations. The purpose of this study is to evaluate the suitability of the acute physiology and chronic health evaluation (APACHE) IV model in a single centre Malaysian ICU. A prospective study was conducted at the single centre ICU in Hospital Sultanah Aminah (HSA) Malaysia. External validation of APACHE IV involved a cohort of 916 patients who were admitted in 2009. Model performance was assessed through its calibration and discrimination abilities. A first-level customisation using logistic regression approach was also applied to improve model calibration. APACHE IV exhibited good discrimination, with an area under receiver operating characteristic (ROC) curve of 0.78. However, the model's overall fit was observed to be poor, as indicated by the Hosmer-Lemeshow goodness-of-fit test (Ĉ = 113, P <0.001). Predicted in-ICU mortality rate (28.1%) was significantly higher than the actual in-ICU mortality rate (18.8%). Model calibration was improved after applying first-level customisation (Ĉ = 6.39, P = 0.78) although discrimination was not affected. APACHE IV is not suitable for application in HSA ICU, without further customisation. The model's lack of fit in the Malaysian study is attributed to differences in the baseline characteristics between HSA ICU and APACHE IV datasets. Other possible factors could be due to differences in clinical practice, quality and services of health care systems between Malaysia and the United States.

  7. Quantitative evaluation of liver cirrhosis using T1 relaxation time with 3 tesla MRI before and after oxygen inhalation.

    PubMed

    Kim, Kyung Ah; Park, Mi-Suk; Kim, In-Seong; Kiefer, Berthold; Chung, Woo-Suk; Kim, Myeong-Jin; Kim, Ki Whang

    2012-08-01

    To quantify liver T1 relaxation times before and after oxygen inhalation in patients with and without liver cirrhosis using a 3 Tesla (T) MRI. Institutional Review Board approval and written informed consent were obtained. Ninety-two noncirrhotic patients and 87 patients with hepatitis B viral liver cirrhosis (72 Child-Pugh class A and 15 Child-Pugh class B or C) underwent MRI with a 3.0T system before and after the supply of 100% oxygen at a rate of 15 L/min by means of a nonrebreather ventilation mask for 3 min. T1 maps were acquired using three-dimensional spoiled gradient echo sequences with two different flip angles (2° and 14°) and a fixed TR/TE (2.54 ms/0.95 ms). Liver T1 values were obtained using a T1 processing tool (MapIT software). The mean baseline T1 values of three groups (control, Child-Pugh class A, and Child-Pugh class B/C) were compared using an analysis of variance test. Liver T1 value before and after oxygenation was compared using a paired t-test for each group. The baseline liver T1 value was significantly higher in the control group (941 ± 136 ms) than in Child-Pugh A (858 ± 143 ms) and Child-Pugh B/C (783 ± 164 ms) group (P < 0.001 and P < 0.0001). The reduction in the liver T1 value after oxygen inhalation was significant in the control group (P = 0.012) but not significant in Child-Pugh class A (P = 0.079) and Child-Pugh class B/C (P = 0.752). The baseline liver T1 relaxation time was significantly different between the patients with and without liver cirrhosis. The shortening effect of oxygen on the liver T1 value was significant in the control group but not in the cirrhotic patients. Copyright © 2012 Wiley Periodicals, Inc.

  8. 78 FR 11677 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Apache-Sitgreaves...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-19

    ... DEPARTMENT OF THE INTERIOR National Park Service [NPS-WASO-NAGPRA-12186; 2200-1100-665] Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Apache-Sitgreaves National Forests.... ACTION: Notice. SUMMARY: The U.S. Department of Agriculture (USDA), Forest Service, Apache-Sitgreaves...

  9. 20 CFR 228.50 - Tier II annuity component widow(er), child, or parent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., or parent. 228.50 Section 228.50 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE... annuity component widow(er), child, or parent. (a) General. The tier II annuity component is an additional amount payable to a widow(er), disabled widow(er), child, or parent, but not to a surviving divorced...

  10. Survival of Apache Trout eggs and alevins under static and fluctuating temperature regimes

    USGS Publications Warehouse

    Recsetar, Matthew S.; Bonar, Scott A.

    2013-01-01

    Increased stream temperatures due to global climate change, livestock grazing, removal of riparian cover, reduction of stream flow, and urbanization will have important implications for fishes worldwide. Information exists that describes the effects of elevated water temperatures on fish eggs, but less information is available on the effects of fluctuating water temperatures on egg survival, especially those of threatened and endangered species. We tested the posthatch survival of eyed eggs and alevins of Apache Trout Oncorhynchus gilae apache, a threatened salmonid, in static temperatures of 15, 18, 21, 24, and 27°C, and also in treatments with diel fluctuations of ±3°C around those temperatures. The LT50 for posthatch survival of Apache Trout eyed eggs and alevins was 17.1°C for static temperatures treatments and 17.9°C for the midpoints of ±3°C fluctuating temperature treatments. There was no significant difference in survival between static temperatures and fluctuating temperatures that shared the same mean temperature, yet there was a slight difference in LT50s. Upper thermal tolerance of Apache Trout eyed eggs and alevins is much lower than that of fry to adult life stages (22–23°C). Information on thermal tolerance of early life stages (eyed egg and alevin) will be valuable to those restoring streams or investigating thermal tolerances of imperiled fishes.

  11. The Apache Point Observatory Lunar Laser-ranging Operation: Instrument Description and First Detections

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Murphy, TW; Adelberger, Eric G.; Battat, J.

    2008-01-01

    A next-generation lunar laser ranging apparatus using the 3.5 m telescope at the Apache Point Observatory in southern New Mexico has begun science operation. APOLLO (the Apache Point Observatory Lunar Laser-ranging Operation) has achieved one-millimeter range precision to the moon which should lead to aproximately one-orderof-magnitude improvements in the precision of several tests of fundamental properties of gravity. We briefly motivate the scientific goals, and then give a detailed discussion of the APOLLO instrumentation.

  12. A Tour of Big Data, Open Source Data Management Technologies from the Apache Software Foundation

    NASA Astrophysics Data System (ADS)

    Mattmann, C. A.

    2012-12-01

    The Apache Software Foundation, a non-profit foundation charged with dissemination of open source software for the public good, provides a suite of data management technologies for distributed archiving, data ingestion, data dissemination, processing, triage and a host of other functionalities that are becoming critical in the Big Data regime. Apache is the world's largest open source software organization, boasting over 3000 developers from around the world all contributing to some of the most pervasive technologies in use today, from the HTTPD web server that powers a majority of Internet web sites to the Hadoop technology that is now projected at over a $1B dollar industry. Apache data management technologies are emerging as de facto off-the-shelf components for searching, distributing, processing and archiving key science data sets both geophysical, space and planetary based, all the way to biomedicine. In this talk, I will give a virtual tour of the Apache Software Foundation, its meritocracy and governance structure, and also its key big data technologies that organizations can take advantage of today and use to save cost, schedule, and resources in implementing their Big Data needs. I'll illustrate the Apache technologies in the context of several national priority projects, including the U.S. National Climate Assessment (NCA), and in the International Square Kilometre Array (SKA) project that are stretching the boundaries of volume, velocity, complexity, and other key Big Data dimensions.

  13. PDS4: Harnessing the Power of Generate and Apache Velocity

    NASA Astrophysics Data System (ADS)

    Padams, J.; Cayanan, M.; Hardman, S.

    2018-04-01

    The PDS4 Generate Tool is a Java-based command-line tool developed by the Cartography and Imaging Sciences Nodes (PDSIMG) for generating PDS4 XML labels, from Apache Velocity templates and input metadata.

  14. Nutrition Survey of White Mountain Apache Preschool Children.

    ERIC Educational Resources Information Center

    Owen, George M.; And Others

    As part of a national study of the nutrition of preschool children, data were collected on 201 Apache children, 1 to 6 years of age, living on an Indian reservation in Arizona. This report reviews procedures and clinical findings, and gives an analysis of growth data including skeletal maturation, nutrient intakes and clinical biochemical data. In…

  15. Assessment of prognostic performance of Albumin-Bilirubin, Child-Pugh, and Model for End-stage Liver Disease scores in patients with liver cirrhosis complicated with acute upper gastrointestinal bleeding.

    PubMed

    Xavier, Sofia A; Vilas-Boas, Ricardo; Boal Carvalho, Pedro; Magalhães, Joana T; Marinho, Carla M; Cotter, José B

    2018-06-01

    The Albumin-Bilirubin (ALBI) score was developed recently to assess the severity of liver dysfunction. We aimed to assess its prognostic performance in patients with liver cirrhosis complicated with upper gastrointestinal bleeding (UGIB) while comparing it with Child-Pugh (CP) and Model for End-stage Liver Disease (MELD) scores. This was a retrospective unicentric study, including consecutive adult patients with cirrhosis admitted for UGIB between January 2011 and November 2015. Clinical, analytical, and endoscopic variables were assessed and ALBI, CP, and MELD scores at admission were calculated. This study included 111 patients. During the first 30 days of follow-up, 12 (10.8%) patients died, and during the first year of follow-up, another 10 patients died (first-year mortality of 19.8%).On comparing the three scores, for in-stay and 30-day mortality, only the ALBI score showed statistically significant results, with an area under the curve (AUC) of 0.80 (P<0.01) for both outcomes. For first-year mortality, AUC for ALBI, CP, and MELD scores were 0.71 (P<0.01), 0.64 (P<0.05), and 0.66 (P=0.02), respectively, whereas for global mortality, AUC were 0.75 (P<0.01), 0.72 (P<0.01), and 0.72 (P<0.01), respectively. On comparing the AUC of the three scores, no significant differences were found in first-year mortality and global mortality. In our series, the ALBI score accurately predicted both in-stay and 30-day mortality, whereas CP and MELD scores could not predict these outcomes. All scores showed a fair prognostic prediction performance for first-year and global mortality. These results suggest that the ALBI score is particularly useful in the assessment of short-term outcomes, with a better performance than the most commonly used scores.

  16. 4. APACHE INDIAN LABORER WITH TEAM AND SCRAPER WORKING ON ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. APACHE INDIAN LABORER WITH TEAM AND SCRAPER WORKING ON THE POWER CANAL LINE FOUR MILES ABOVE LIVINGSTONE, ARIZONA Photographer: Walter J. Lubken, June 14, 1906 - Roosevelt Power Canal & Diversion Dam, Parallels Salt River, Roosevelt, Gila County, AZ

  17. Impact of chronic liver disease in intensive care unit acquired pneumonia: a prospective study.

    PubMed

    Di Pasquale, Marta; Esperatti, Mariano; Crisafulli, Ernesto; Ferrer, Miquel; Bassi, Gianluigi Li; Rinaudo, Mariano; Escorsell, Angels; Fernandez, Javier; Mas, Antoni; Blasi, Francesco; Torres, Antoni

    2013-10-01

    To assess the impact of chronic liver disease (CLD) on ICU-acquired pneumonia. This was a prospective, observational study of the characteristics, microbiology, and outcomes of 343 consecutive patients with ICU-acquired pneumonia clustered according to the presence of CLD. Sixty-seven (20%) patients had CLD (67% had liver cirrhosis, LC), MELD score 26 ± 9, 20% Child-Pugh class C). They presented higher severity scores than patients without CLD both on admission to the ICU (APACHE II, LC 19 ± 6 vs. other CLD 18 ± 6 vs. no CLD 16 ± 6; p < 0.001; SOFA, 10 ± 3 vs. 8 ± 4 vs. 7 ± 3; p < 0.001) and at onset of pneumonia (APACHE II, 19 ± 6 vs. 17 ± 6 vs. 16 ± 5; p = 0.001; SOFA, 11 ± 4 vs. 9 ± 4 vs. 7 ± 3; p < 0.001). Levels of CRP were lower in patients with LC than in the other two groups (day 1, 6.5 [2.5-11.5] vs. 13 [6-23] vs. 15.5 [8-24], p < 0.001, day 3, 6 [3-12] vs. 16 [9-21] vs. 11 [5-20], p = 0.001); all the other biomarkers were higher in LC and other CLD patients. LC patients had higher 28- and 90-day mortality (63 vs. 28%, p < 0.001; 72 vs. 38%, p < 0.001, respectively) than non-CLD patients. Presence of LC was independently associated with decreased 28- and 90-day survival (95% confidence interval [CI], 1.982-17.250; p = 0.001; 95% confidence interval [CI], 2.915-20.699, p = 0.001, respectively). In critically ill patients with ICU-acquired pneumonia, CLD is associated with a more severe clinical presentation and poor clinical outcomes. Moreover, LC is independently associated with 28- and 90-day mortality. The results of this study are important for future trials focused on mortality.

  18. Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: A retrospective study.

    PubMed

    Zou, Deli; Qi, Xingshun; Zhu, Cuihong; Ning, Zheng; Hou, Feifei; Zhao, Jiancheng; Peng, Ying; Li, Jing; Deng, Han; Guo, Xiaozhong

    2016-03-01

    The albumin-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction. In the present study, we aimed to retrospectively compare the performance of ALBI with Child-Pugh and the model for end-stage liver disease (MELD) scores for predicting the in-hospital mortality of acute gastrointestinal bleeding (AUGIB) in liver cirrhosis. All cirrhotic patients with AUGIB were eligible, provided they had the data needed to determine the ALBI score. Areas under the receiving-operator characteristics curve (AUC) are reported. Overall, 631 patients were included. In all the included patients, the AUC of the ALBI, Child-Pugh, and MELD scores were 0.808, 0.785 (p=0.5831), and 0.787 (p=0.7033), respectively. In patients with only hepatitis B virus-related liver cirrhosis, the AUC of the ALBI, Child-Pugh, and MELD scores were 0.865, 0.836 (p=0.6064), and 0.818 (p=0.6399), respectively. In patients with only alcohol-related liver cirrhosis, the AUC of the ALBI, Child-Pugh, and MELD scores were 0.869, 0.860 (p=0.9003), and 0.801 (p=0.5548), respectively. In patients treated with endoscopic therapy for AUGIB, the AUC of the ALBI, Child-Pugh, and MELD scores were 0.873, 0.884 (p=0.7898), and 0.834 (p=0.5531), respectively. The prognostic performance of the ALBI score was comparable with that of the Child-Pugh and MELD scores for predicting the in-hospital mortality of AUGIB in liver cirrhosis.

  19. Preliminary Assessment of Apache Hopefulness: Relationships with Hopelessness and with Collective as well as Personal Self-Esteem

    ERIC Educational Resources Information Center

    Hammond, Vanessa Lea; Watson, P. J.; O'Leary, Brian J.; Cothran, D. Lisa

    2009-01-01

    Hopelessness is central to prominent mental health problems within American Indian (AI) communities. Apaches living on a reservation in Arizona responded to diverse expressions of hope along with Hopelessness, Personal Self-Esteem, and Collective Self-Esteem scales. An Apache Hopefulness Scale expressed five themes of hope and correlated…

  20. Large-scale virtual screening on public cloud resources with Apache Spark.

    PubMed

    Capuccini, Marco; Ahmed, Laeeq; Schaal, Wesley; Laure, Erwin; Spjuth, Ola

    2017-01-01

    Structure-based virtual screening is an in-silico method to screen a target receptor against a virtual molecular library. Applying docking-based screening to large molecular libraries can be computationally expensive, however it constitutes a trivially parallelizable task. Most of the available parallel implementations are based on message passing interface, relying on low failure rate hardware and fast network connection. Google's MapReduce revolutionized large-scale analysis, enabling the processing of massive datasets on commodity hardware and cloud resources, providing transparent scalability and fault tolerance at the software level. Open source implementations of MapReduce include Apache Hadoop and the more recent Apache Spark. We developed a method to run existing docking-based screening software on distributed cloud resources, utilizing the MapReduce approach. We benchmarked our method, which is implemented in Apache Spark, docking a publicly available target receptor against [Formula: see text]2.2 M compounds. The performance experiments show a good parallel efficiency (87%) when running in a public cloud environment. Our method enables parallel Structure-based virtual screening on public cloud resources or commodity computer clusters. The degree of scalability that we achieve allows for trying out our method on relatively small libraries first and then to scale to larger libraries. Our implementation is named Spark-VS and it is freely available as open source from GitHub (https://github.com/mcapuccini/spark-vs).Graphical abstract.

  1. Vegetative response to water availability on the San Carlos Apache Reservation

    USGS Publications Warehouse

    Petrakis, Roy; Wu, Zhuoting; McVay, Jason; Middleton, Barry R.; Dye, Dennis G.; Vogel, John M.

    2016-01-01

    On the San Carlos Apache Reservation in east-central Arizona, U.S.A., vegetation types such as ponderosa pine forests, pinyon-juniper woodlands, and grasslands have significant ecological, cultural, and economic value for the Tribe. This value extends beyond the tribal lands and across the Western United States. Vegetation across the Southwestern United States is susceptible to drought conditions and fluctuating water availability. Remotely sensed vegetation indices can be used to measure and monitor spatial and temporal vegetative response to fluctuating water availability conditions. We used the Moderate Resolution Imaging Spectroradiometer (MODIS)-derived Modified Soil Adjusted Vegetation Index II (MSAVI2) to measure the condition of three dominant vegetation types (ponderosa pine forest, woodland, and grassland) in response to two fluctuating environmental variables: precipitation and the Standardized Precipitation Evapotranspiration Index (SPEI). The study period covered 2002 through 2014 and focused on a region within the San Carlos Apache Reservation. We determined that grassland and woodland had a similar moderate to strong, year-round, positive relationship with precipitation as well as with summer SPEI. This suggests that these vegetation types respond negatively to drought conditions and are more susceptible to initial precipitation deficits. Ponderosa pine forest had a comparatively weaker relationship with monthly precipitation and summer SPEI, indicating that it is more buffered against short-term drought conditions. This research highlights the response of multiple, dominant vegetation types to seasonal and inter-annual water availability. This research demonstrates that multi-temporal remote sensing imagery can be an effective tool for the large scale detection of vegetation response to adverse impacts from climate change and support potential management practices such as increased monitoring and management of drought-affected areas. Different

  2. Prognostic Value of Metabolic Liver Function Tests: a Study on 711 Cirrhotic Patients.

    PubMed

    Lebossé, Fanny; Guillaud, Olivier; Forestier, Julien; Ecochard, Marie; Boillot, Olivier; Roman, Sabine; Mion, François; Dumortier, Jérôme

    2016-09-01

    The prognosis of cirrhotic patients is usually assessed by Child-Pugh and MELD scores. Metabolic liver function tests such as aminopyrine breath test (ABT) and indocyanine green clearance (IGC) have been shown to reveal hepatocellular dysfunction. The aim of this retrospective study was to compare the prognostic value of the MELD score, Child-Pugh score, ABT and IGC in a large cohort of cirrhotic patients. Between January 1996 and June 2008, 711 cirrhotic patients were included and the primary endpoint was survival without LT. The ROC curves with c-statistics, correlation coefficient and survival were calculated. Metabolic function tests and scores were strongly correlated. At the time of evaluation, 111 patients had died and 520 had received a transplant. Prognostic ability (estimated by the AUROC curve) to predict survival without LT at 6 months was 0.662, 0.691, 0.738 and 0.715 for ABT, IGC, Child-Pugh score and MELD score, respectively. Similarly, at 1 year, AUROC was 0.738 for Child-Pugh score, 0.716 for MELD score, 0.693 for IGC clearance and 0.651 for ABT. Our results strongly confirm that IGC and ABT have a high prognostic value in cirrhotic patients, similar to Child-Pugh and MELD scores. They could be developed to routinely evaluate the prognosis of patients in addition to clinical and biochemical data.

  3. Fallugia paradoxa (D. Don) Endl. ex Torr.: Apache-plume

    Treesearch

    Susan E. Meyer

    2008-01-01

    The genus Fallugia contains a single species - Apache-plume, F. paradoxa (D. Don) Endl. ex Torr. - found throughout the southwestern United States and northern Mexico. It occurs mostly on coarse soils on benches and especially along washes and canyons in both warm and cool desert shrub communities and up into the pinyon-juniper vegetation type. It is a sprawling, much-...

  4. Nonsuicidal Self-Injury in an American Indian Reservation Community: Results from the White Mountain Apache Surveillance System, 2007-2008

    ERIC Educational Resources Information Center

    Cwik, Mary F.; Barlow, Allison; Tingey, Lauren; Larzelere-Hinton, Francene; Goklish, Novalene; Walkup, John T.

    2011-01-01

    Objective: To describe characteristics and correlates of nonsuicidal self-injury (NSSI) among the White Mountain Apache Tribe. NSSI has not been studied before in American Indian samples despite associated risks for suicide, which disproportionately affect American Indian youth. Method: Apache case managers collected data through a tribally…

  5. Are cicadas (Diceroprocta apache) both a "keystone" and a "critical-link" species in lower Colorado River riparian communities?

    USGS Publications Warehouse

    Andersen, Douglas C.

    1994-01-01

    Apache cicada (Homoptera: Cicadidae: Diceroprocta apache Davis) densities were estimated to be 10 individuals/m2 within a closed-canopy stand of Fremont cottonwood (Populus fremontii) and Goodding willow (Salix gooddingii) in a revegetated site adjacent to the Colorado River near Parker, Arizona. Coupled with data drawn from the literature, I estimate that up to 1.3 cm (13 1/m2) of water may be added to the upper soil layers annually through the feeding activities of cicada nymphs. This is equivalent to 12% of the annual precipitation received in the study area. Apache cicadas may have significant effects on ecosystem functioning via effects on water transport and thus act as a critical-link species in this southwest desert riverine ecosystem. Cicadas emerged later within the cottonwood-willow stand than in relatively open saltcedar-mesquite stands; this difference in temporal dynamics would affect their availability to several insectivorous bird species and may help explain the birds' recent declines. Resource managers in this region should be sensitive to the multiple and strong effects that Apache cicadas may have on ecosystem structure and functioning.

  6. Variceal bleeding in cirrhotic patients: What is the best prognostic score?

    PubMed

    Mohammad, Asmaa N; Morsy, Khairy H; Ali, Moustafa A

    2016-09-01

    To find the most accurate, suitable, and applicable scoring system for the prediction of outcome in cirrhotic patients with bleeding varices. A prospective study was conducted comprising 120 cirrhotic patients with acute variceal bleeding who were admitted to Tropical Medicine and Gastroenterology Department in Sohag University Hospital, over a 1-year period (1/2015 to 1/2016). The clinical, laboratory, and endoscopic parameters were studied. Child-Turcotte-Pugh (CTP) classification score, Model for end-stage liver disease (MELD) score, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, and AIMS65 score were calculated for all patients. Univariate and multivariate analyses were performed for all the measured parameters and scores. Of the 120 patients (92 male) admitted during the study period, eight patients (6.67%) died in the hospital. Advanced age, the presence of encephalopathy, rebleeding, and higher serum bilirubin were independent factors associated with higher hospital mortality. The largest area under the receiver operator curve (AUROC) was obtained for the AIMS65 score and SOFA score, followed by the MELD score and APACHEII score, then CTP score, all of which achieved very good performance (AUROC>0.8). AIMS65 score showed the best sensitivity, specificity, and negative and positive predictive values. Although the AIMS65 score was not significantly different from the MELD, SOFA, and APACHEII scores, it was the optimum among them in terms of the prediction of mortality. AIMS65 score is the best simple and applicable scoring system for independently predicting mortality in cirrhotic patients with acute variceal bleeding.

  7. Sorafenib for the Treatment of Advanced Hepatocellular Cancer - a UK Audit.

    PubMed

    King, J; Palmer, D H; Johnson, P; Ross, P; Hubner, R A; Sumpter, K; Darby, S; Braconi, C; Iwuji, C; Swinson, D; Collins, P; Patel, K; Nobes, J; Muazzam, I; Blesing, C; Kirkwood, A; Nash, S; Meyer, T

    2017-04-01

    Sorafenib is the current standard treatment for advanced hepatocellular carcinoma. We carried out a national audit of UK patients treated with sorafenib as standard-of-care and those treated with systemic therapy in first-line trials. Sorafenib-treated and trial-treated patients were identified via the Cancer Drugs Fund and local databases. Data were collected retrospectively from medical records according to a standard case report form. The primary outcome measure was overall survival, estimated by the Kaplan-Meier method. Data were obtained for 448 sorafenib-treated patients from 15 hospitals. The median age was 68 years (range 17-89) and 75% had performance status ≤ 1. At baseline, 77% were Child-Pugh A and 16.1% Child-Pugh B; 38% were albumin-bilirubin grade 1 (ALBI-1) and 48% ALBI-2; 23% were Barcelona Clinic Liver Classification B (BCLC-B) and 72% BCLC-C. The median time on sorafenib was 3.6 months, with a mean daily dose of 590 mg. The median overall survival for 448 evaluable sorafenib-treated patients was 8.5 months. There were significant differences in overall survival comparing Child-Pugh A versus Child-Pugh B (9.5 versus 4.6 months), ALBI-1 versus ALBI-2 (12.9 versus 5.9 months) and BCLC-B versus BCLC-C (13.0 versus 8.3 months). For trial-treated patients (n=109), the median overall survival was 8.1 months and this was not significantly different from the sorafenib-treated patients. For Child-Pugh A patients with good performance status, survival outcomes were similar to those reported in global randomised controlled trials. Patients with ALBI grade > 1, Child-Pugh B or poor performance status seem to derive limited benefit from sorafenib treatment. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  8. High incidence of zinc deficiency among Filipino children with compensated and decompensated liver disease.

    PubMed

    Umusig-Quitain, Perlina; Gregorio, Germana V

    2010-02-01

    The role of zinc in the nutrition and growth of children with chronic liver disease is poorly defined. The present study determined the serum zinc levels of children with compensated liver disease (CLD) and decompensated liver disease (DLD) and compared this with healthy children. Zinc levels were also correlated with the severity of liver disease as measured by Child-Pugh scores. The study comprised of 60 children 0-10 years of age with chronic liver disease, defined as CLD (n = 30) if the Child-Pugh score was < 6, and DLD (n = 30) if the Child-Pugh score was > or = 6. Thirty healthy children 0-10 years served as controls. Serum zinc levels were measured by atomic absorption spectrometry. The 90 patients included 30 with CLD (mean age: 4.54 years: 21 boys; mean Child-Pugh score: 5.83), 30 with DLD (mean age: 1.39 years; 17 boys; mean Child-Pugh score: 9.53) and 30 healthy children (mean age: 4.6; 16 boys). Zinc levels of patients with CLD were significantly lower compared with the healthy controls (Mean [standard deviation]: 68.07 [31.55]vs 89.9 [25.9]microg/dL, P = 0.000), but significantly higher compared to the patients with DLD (48.8 [26.8]microg/dL). Correlation studies showed that the higher the Child-Pugh score, the lower the zinc levels (r = -0.460) Children with chronic liver disease, whether in a compensated or decompensated state, had lower serum zinc levels compared with the healthy controls. As the severity of liver disease worsened, the zinc levels decreased. The study suggests that zinc supplementation should constitute part of the micronutrient intake of children with chronic liver disease.

  9. Lutzomyia (Helcocyrtomyia) Apache Young and Perkins (Diptera: Psychodidae) feeds on reptiles

    USDA-ARS?s Scientific Manuscript database

    Phlebotomine sand flies are vectors of bacteria, parasites, and viruses. In the western USA a sand fly, Lutzomyia apache Young and Perkins, was initially associated with epizootics of vesicular stomatitis virus (VSV), because sand flies were trapped at sites of an outbreak. Additional studies indica...

  10. The Roles of Literacy and Collaboration in Documenting Native American Languages: A Report from the Jicarilla Apache Dictionary Project.

    ERIC Educational Resources Information Center

    Axelrod, Melissa; de Garcia, Jule Gomez; Lachler, Jordan

    2003-01-01

    Reports on the progress of a project to produce a dictionary of the Jicarilla Apache language. Jicarilla, an Eastern Apachean language is spoken on the Jicarilla Apache reservation in Northern New Mexico. The project has revealed much about the role of literacy in language standardization and in speaker empowerment. Suggests that many parallels…

  11. The Mescalero Apaches. The Civilization of the American Indian Series.

    ERIC Educational Resources Information Center

    Sonnichsen, C. L.

    The history of the Eastern Apache tribe called the Mescaleros is one of hardship and oppression altering with wars of revenge. They were friendly to the Spaniard until victimized by them. They were also friendly to the white man until they were betrayed again. For three hundred years they fought the Spaniards and Mexicans. For forty more they…

  12. The evaluation of acute physiology and chronic health evaluation II score, poisoning severity score, sequential organ failure assessment score combine with lactate to assess the prognosis of the patients with acute organophosphate pesticide poisoning.

    PubMed

    Yuan, Shaoxin; Gao, Yusong; Ji, Wenqing; Song, Junshuai; Mei, Xue

    2018-05-01

    The aim of this study was to assess the ability of acute physiology and chronic health evaluation II (APACHE II) score, poisoning severity score (PSS) as well as sequential organ failure assessment (SOFA) score combining with lactate (Lac) to predict mortality in the Emergency Department (ED) patients who were poisoned with organophosphate.A retrospective review of 59 stands-compliant patients was carried out. Receiver operating characteristic (ROC) curves were constructed based on the APACHE II score, PSS, SOFA score with or without Lac, respectively, and the areas under the ROC curve (AUCs) were determined to assess predictive value. According to SOFA-Lac (a combination of SOFA and Lac) classification standard, acute organophosphate pesticide poisoning (AOPP) patients were divided into low-risk and high-risk groups. Then mortality rates were compared between risk levels.Between survivors and non-survivors, there were significant differences in the APACHE II score, PSS, SOFA score, and Lac (all P < .05). The AUCs of the APACHE II score, PSS, and SOFA score were 0.876, 0.811, and 0.837, respectively. However, after combining with Lac, the AUCs were 0.922, 0.878, and 0.956, respectively. According to SOFA-Lac, the mortality of high-risk group was significantly higher than low-risk group (P < .05) and the patients of the non-survival group were all at high risk.These data suggest the APACHE II score, PSS, SOFA score can all predict the prognosis of AOPP patients. For its simplicity and objectivity, the SOFA score is a superior predictor. Lac significantly improved the predictive abilities of the 3 scoring systems, especially for the SOFA score. The SOFA-Lac system effectively distinguished the high-risk group from the low-risk group. Therefore, the SOFA-Lac system is significantly better at predicting mortality in AOPP patients.

  13. Natural history of major complications in hepatitis C virus-related cirrhosis evaluated by per-rectal portal scintigraphy

    PubMed Central

    Kawamura, Etsushi; Habu, Daiki; Hayashi, Takehiro; Oe, Ai; Kotani, Jin; Ishizu, Hirotaka; Torii, Kenji; Kawabe, Joji; Fukushima, Wakaba; Tanaka, Takashi; Nishiguchi, Shuhei; Shiomi, Susumu

    2005-01-01

    AIM: To examine the correlation between the porto-systemic hypertension evaluated by portal shunt index (PSI) and life-threatening complications, including hepatocellular carcinoma (HCC), liver failure (Child-Pugh stage progression), and esophagogastric varices. METHODS: Two hundred and twelve consecutive subjects with HCV-related cirrhosis (LC-C) underwent per-rectal portal scintigraphy. They were allocated into three groups according to their PSI: group I, PSI ≤ 10%; group II, 10%Child-Pugh stage A (Child A) subjects were included in analysis (a mean follow-up period of 5.9 ± 5.4 years, range 6 mo-21 years). RESULTS: No significant correlation between PSI and cumulative probability of HCC incidence was observed. Cumulative probability of Child A to B progression was tended to be higher in group III than in group I, and significantly higher in group III than in group II (62% vs 34%, 62% vs 37%; P = 0.060, <0.01; respectively). Cumulative probability of varices tended to be higher in group III than in group I (31% vs 12%, P = 0.090). On multivariate analyses, significant correlation between PSI and Child A to B progression was observed, and no significant correlation between PSI and HCC incidence or varices progression was observed. CONCLUSION: Patients with LC-C of Child A will progress to Child B rapidly after their PSI reaches 30% or higher. PSI can be used to predict occult progressive porto-systemic shunting and liver failure non-invasively. It indicates that PSI may play an important role in follow-up of the porto-systemic hypertension gradient for outpatients with LC unlike hepatic venous catheterization. PMID:15991287

  14. VizieR Online Data Catalog: Radial velocities of δ Sagittae (Pugh+, 2015)

    NASA Astrophysics Data System (ADS)

    Pugh, T.; Gray, D. F.; Griffin, R. F.

    2018-01-01

    28 spectra were obtained by Gray and Pugh between 2008 July and 2010 October (MJD 2454674-2455479) with the high-resolution (R~100000) coude spectrograph of the Elginfield Observatory of Western University (Gray 2009ApJ...697.1032G). The signal-to-noise ratios in the continuum, estimated from the photon counts, ranged from 152 to 314 with a mean of 220. The spectrograph has a dispersion of ~0.013 Å/mm and can reach a radial-velocity precision of 25 m/s by reference to water vapour lines inside the spectrograph (Gray & Brown 2006PASP..118.1112G). In the current case our measurement errors (based on exposures taken within a few nights of one another) range from 27 to 160 m/s, with a mean value of 90 m/s. The radial velocities were determined by measuring the positions of the spectral lines at 85 per cent of the line depth for 15 neutral metal lines in the λ6250-Å region. (1 data file).

  15. Geologic map and digital database of the Apache Canyon 7.5' quadrangle, Ventura and Kern counties, California

    USGS Publications Warehouse

    Stone, Paul; Cossette, P.M.

    2000-01-01

    The Apache Canyon 7.5-minute quadrangle is located in southwestern California about 55 km northeast of Santa Barbara and 65 km southwest of Bakersfield. This report presents the results of a geologic mapping investigation of the Apache Canyon quadrangle that was carried out in 1997-1999 as part of the U.S. Geological Survey's Southern California Areal Mapping Project. This quadrangle was chosen for study because it is in an area of complex, incompletely understood Cenozoic stratigraphy and structure of potential importance for regional tectonic interpretations, particularly those involving the San Andreas fault located just northwest of the quadrangle and the Big Pine fault about 10 km to the south. In addition, the quadrangle is notable for its well-exposed sequences of folded Neogene nonmarine strata including the Caliente Formation of Miocene age from which previous workers have collected and described several biostratigraphically significant land-mammal fossil assemblages. During the present study, these strata were mapped in detail throughout the quadrangle to provide an improved framework for possible future paleontologic investigations. The Apache Canyon quadrangle is in the eastern part of the Cuyama 30-minute by 60-minute quadrangle and is largely part of an erosionally dissected terrain known as the Cuyama badlands at the east end of Cuyama Valley. Most of the Apache Canyon quadrangle consists of public lands in the Los Padres National Forest.

  16. Combination of Acute Physiology and Chronic Health Evaluation II score, early lactate area, and N-terminal prohormone of brain natriuretic peptide levels as a predictor of mortality in geriatric patients with septic shock.

    PubMed

    Wang, Hao; Li, Zhong; Yin, Mei; Chen, Xiao-Mei; Ding, Shi-Fang; Li, Chen; Zhai, Qian; Li, Yuan; Liu, Han; Wu, Da-Wei

    2015-04-01

    Given the high mortality rates in elderly patients with septic shock, the early recognition of patients at greatest risk of death is crucial for the implementation of early intervention strategies. Serum lactate and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels are often elevated in elderly patients with septic shock and are therefore important biomarkers of metabolic and cardiac dysfunction. We hypothesized that a risk stratification system that incorporates the Acute Physiology and Chronic Health Evaluation (APACHE) II score and lactate and NT-proBNP biomarkers would better predict mortality in geriatric patients with septic shock than the APACHE II score alone. A single-center prospective study was conducted from January 2012 to December 2013 in a 30-bed intensive care unit of a triservice hospital. The lactate area score was defined as the sum of the area under the curve of serial lactate levels measured during the 24 hours following admission divided by 24. The NT-proBNP score was assigned based on NT-proBNP levels measured at admission. The combined score was calculated by adding the lactate area and NT-proBNP scores to the APACHE II score. Multivariate logistic regression analyses and receiver operating characteristic curves were used to evaluate which variables and scoring systems served as the best predictors of mortality in elderly septic patients. A total of 115 patients with septic shock were included in the study. The overall 28-day mortality rate was 67.0%. When compared to survivors, nonsurvivors had significantly higher lactate area scores, NT-proBNP scores, APACHE II scores, and combined scores. In the multivariate regression model, the combined score, lactate area score, and mechanical ventilation were independent risk factors associated with death. Receiver operating characteristic curves indicated that the combined score had significantly greater predictive power when compared to the APACHE II score or the NT-proBNP score

  17. A low muscle mass increases mortality in compensated cirrhotic patients with sepsis.

    PubMed

    Lucidi, Cristina; Lattanzi, Barbara; Di Gregorio, Vincenza; Incicco, Simone; D'Ambrosio, Daria; Venditti, Mario; Riggio, Oliviero; Merli, Manuela

    2018-05-01

    Severe infections and muscle wasting are both associated to poor outcome in cirrhosis. A possible synergic effect of these two entities in cirrhotic patients has not been previously investigated. We aimed at analysing if a low muscle mass may deteriorate the outcome of cirrhotic patients with sepsis. Consecutive cirrhotic patients hospitalized for sepsis were enrolled in the study. Patients were classified for the severity of liver impairment (Child-Pugh class) and for the presence of "low muscle mass" (mid-arm muscle circumference<5th percentile). The development of complication during hospitalization and survival was analysed. There were 74 consecutive cirrhotics with sepsis. Forty-three of these patients showed low muscle mass. In patients with and without low muscle mass, severity of liver disease and characteristics of infections were similar. Mortality tended to be higher in patients with low muscle mass (47% vs 26%, P = .06). A multivariate analysis selected low muscle mass (P < .01, HR: 3.2, IC: 1.4-4.8) and Child-Pugh C (P < .01, HR: 3.3, 95% IC: 1.5-4.9) as independent predictors of in-hospital mortality. In Child-Pugh A-B patients, mortality was higher in patients with low muscle mass compared with those without (50% vs 16%; P = .01). The mortality rate and the incidence of complications in malnourished patients classified in Child-Pugh A-B were similar to those Child-Pugh C. Low muscle mass worsen prognosis in cirrhotic patients with severe infections. This is particularly evident in patients with Child A-B cirrhosis in whom the coexistence of low muscle mass and sepsis caused a negative impact on mortality similar to that observable in all Child C patients with sepsis. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Predictive factors in patients with hepatocellular carcinoma receiving sorafenib therapy using time-dependent receiver operating characteristic analysis.

    PubMed

    Nishikawa, Hiroki; Nishijima, Norihiro; Enomoto, Hirayuki; Sakamoto, Azusa; Nasu, Akihiro; Komekado, Hideyuki; Nishimura, Takashi; Kita, Ryuichi; Kimura, Toru; Iijima, Hiroko; Nishiguchi, Shuhei; Osaki, Yukio

    2017-01-01

    To investigate variables before sorafenib therapy on the clinical outcomes in hepatocellular carcinoma (HCC) patients receiving sorafenib and to further assess and compare the predictive performance of continuous parameters using time-dependent receiver operating characteristics (ROC) analysis. A total of 225 HCC patients were analyzed. We retrospectively examined factors related to overall survival (OS) and progression free survival (PFS) using univariate and multivariate analyses. Subsequently, we performed time-dependent ROC analysis of continuous parameters which were significant in the multivariate analysis in terms of OS and PFS. Total sum of area under the ROC in all time points (defined as TAAT score) in each case was calculated. Our cohort included 175 male and 50 female patients (median age, 72 years) and included 158 Child-Pugh A and 67 Child-Pugh B patients. The median OS time was 0.68 years, while the median PFS time was 0.24 years. On multivariate analysis, gender, body mass index (BMI), Child-Pugh classification, extrahepatic metastases, tumor burden, aspartate aminotransferase (AST) and alpha-fetoprotein (AFP) were identified as significant predictors of OS and ECOG-performance status, Child-Pugh classification and extrahepatic metastases were identified as significant predictors of PFS. Among three continuous variables (i.e., BMI, AST and AFP), AFP had the highest TAAT score for the entire cohort. In subgroup analyses, AFP had the highest TAAT score except for Child-Pugh B and female among three continuous variables. In continuous variables, AFP could have higher predictive accuracy for survival in HCC patients undergoing sorafenib therapy.

  19. Restoration of Soldier Spring: an isolated habitat for native Apache trout

    Treesearch

    Jonathan W. Long; B. Mae Burnette; Alvin L. Medina; Joshua L. Parker

    2004-01-01

    Degradation of streams is a threat to the recovery of the Apache trout, an endemic fish of the White Mountains of Arizona. Historic efforts to improve trout habitat in the Southwest relied heavily on placement of in-stream log structures. However, the effects of structural interventions on trout habitat and populations have not been adequately evaluated. We treated an...

  20. Forest resources of the Forest resources of the Apache-Sitgreaves National Forest

    Treesearch

    Paul Rogers

    2008-01-01

    The Interior West Forest Inventory and Analysis (IWFIA) program of the USDA Forest Service, Rocky Mountain Research Station, as part of its national Forest Inventory and Analysis (FIA) duties, conducted forest resource inventories of the Southwestern Region (Region 3) National Forests. This report presents highlights of the Apache-Sitgreaves National Forest...

  1. Geronimo's Kids: A Teacher's Lessons on the Apache Reservation. Elma Dill Russell Spencer Series in the West and Southwest, No. 16.

    ERIC Educational Resources Information Center

    Ove, Robert S.; Stockel, H. Henrietta

    In 1948, a young and naive Robert Ove arrived at Whitetail, on the Mescalero Apache Reservation, to teach at the Bureau of Indian Affairs day school. Living there were the Chiricahua Apaches--descendants of Geronimo and the survivors of nearly 30 years of incarceration by the U.S. government. With help from Indian historian H. Henrietta Stockel,…

  2. Single-Center Evaluation of the Pharmacokinetics and Safety of the Angiotensin II Receptor Antagonist Azilsartan Medoxomil in Mild to Moderate Hepatic Impairment.

    PubMed

    Dudkowski, Caroline; Karim, Aziz; Zhao, Zhen; Alonso, Alberto B; Garg, Dyal; Preston, Richard A

    2018-01-01

    Azilsartan medoxomil (AZL-M) is a potent angiotensin II receptor blocker that decreases blood pressure in a dose-dependent manner. It is a prodrug that is not detected in blood after its oral administration because of its rapid hydrolysis to the active moiety, azilsartan (AZL). AZL undergoes further metabolism to the major metabolite, M-II, and minor metabolites. The objective of this study was to determine the effect of mild to moderate hepatic impairment on the pharmacokinetics of AZL and its major metabolite. This was a single-center, open-label, phase 1 parallel-group study that examined the single-dose (day 1) and multiple-dose (days 4-8) - 40 mg - pharmacokinetics of AZL and M-II in 16 subjects with mild and moderate hepatic impairment by Child-Pugh classification (n = 8 per group) and subjects (n = 16) matched based on age, sex, race, weight, and smoking status. Mild or moderate hepatic impairment did not cause clinically meaningful increases in exposure to AZL and M-II. Mild or moderate hepatic impairment had no clinically meaningful effect on the plasma protein binding of AZL and M-II. Single and multiple doses of AZL-M 40 mg were well tolerated in all subject groups. Based on the pharmacokinetic and tolerability findings, no dose adjustment of AZL-M is required for subjects with mild and moderate hepatic impairment. © 2017, The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

  3. mod_bio: Apache modules for Next-Generation sequencing data.

    PubMed

    Lindenbaum, Pierre; Redon, Richard

    2015-01-01

    We describe mod_bio, a set of modules for the Apache HTTP server that allows the users to access and query fastq, tabix, fasta and bam files through a Web browser. Those data are made available in plain text, HTML, XML, JSON and JSON-P. A javascript-based genome browser using the JSON-P communication technique is provided as an example of cross-domain Web service. https://github.com/lindenb/mod_bio. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  4. San Carlos Apache Tribe - Energy Organizational Analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rapp, James; Albert, Steve

    2012-04-01

    The San Carlos Apache Tribe (SCAT) was awarded $164,000 in late-2011 by the U.S. Department of Energy (U.S. DOE) Tribal Energy Program's "First Steps Toward Developing Renewable Energy and Energy Efficiency on Tribal Lands" Grant Program. This grant funded:  The analysis and selection of preferred form(s) of tribal energy organization (this Energy Organization Analysis, hereinafter referred to as "EOA").  Start-up staffing and other costs associated with the Phase 1 SCAT energy organization.  An intern program.  Staff training.  Tribal outreach and workshops regarding the new organization and SCAT energy programs and projects, including two annual tribalmore » energy summits (2011 and 2012). This report documents the analysis and selection of preferred form(s) of a tribal energy organization.« less

  5. CMS Analysis and Data Reduction with Apache Spark

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gutsche, Oliver; Canali, Luca; Cremer, Illia

    Experimental Particle Physics has been at the forefront of analyzing the world's largest datasets for decades. The HEP community was among the first to develop suitable software and computing tools for this task. In recent times, new toolkits and systems for distributed data processing, collectively called "Big Data" technologies have emerged from industry and open source projects to support the analysis of Petabyte and Exabyte datasets in industry. While the principles of data analysis in HEP have not changed (filtering and transforming experiment-specific data formats), these new technologies use different approaches and tools, promising a fresh look at analysis ofmore » very large datasets that could potentially reduce the time-to-physics with increased interactivity. Moreover these new tools are typically actively developed by large communities, often profiting of industry resources, and under open source licensing. These factors result in a boost for adoption and maturity of the tools and for the communities supporting them, at the same time helping in reducing the cost of ownership for the end-users. In this talk, we are presenting studies of using Apache Spark for end user data analysis. We are studying the HEP analysis workflow separated into two thrusts: the reduction of centrally produced experiment datasets and the end-analysis up to the publication plot. Studying the first thrust, CMS is working together with CERN openlab and Intel on the CMS Big Data Reduction Facility. The goal is to reduce 1 PB of official CMS data to 1 TB of ntuple output for analysis. We are presenting the progress of this 2-year project with first results of scaling up Spark-based HEP analysis. Studying the second thrust, we are presenting studies on using Apache Spark for a CMS Dark Matter physics search, comparing Spark's feasibility, usability and performance to the ROOT-based analysis.« less

  6. Are total prostate-specific antigen serum levels in cirrhotic men different from those in normal men?

    PubMed

    Vicentini, Fabio C; Botelho, Luiz A A; Hisano, Marcelo; Ebaid, Gustavo X; Lucon, Marcos; Lucon, Antonio M; Srougi, Miguel

    2009-05-01

    To determine the serum total prostate-specific antigen (tPSA) levels in cirrhotic men and compare them with those in noncirrhotic men. We prospectively evaluated 113 cirrhotic patients listed for liver transplantation using the serum tPSA, total testosterone level, and Child-Pugh liver function score according to age and severity of liver disease. The tPSA levels were compared with those of 661 healthy men. The Mann-Whitney U test was used for statistical analysis, with a significance level of .05. The median age of the cirrhotic and noncirrhotic patients was 55 years (range 28-70) and 58 years (range 46-70), respectively (P < .01). However, when stratified by age group (<49, 50-59, and >60 years), this difference was not significant. The median serum tPSA level was 0.3 ng/mL (range 0.04-9.9) and 1.3 ng/mL (range 0.04-65.8) in the cirrhotic and noncirrhotic group, respectively (P < .0001). Stratifying both groups according to age, the cirrhotic patients had significantly lower tPSA levels than did the noncirrhotic patients. According to the Child-Pugh score (A, B, and C), Child-Pugh class C patients had significantly lower tPSA levels than did Child-Pugh class A patients and also had lower testosterone levels than did Child-Pugh class A and B patients. The tPSA levels correlated significantly with the testosterone levels in the cirrhotic patients (P = .028). The results of our study have shown that cirrhotic patients have approximately 4 times lower serum tPSA levels than noncirrhotic men. Patients with more severe liver disease have lower tPSA and testosterone levels than patients less affected. The tPSA levels in cirrhotic men are affected by the total testosterone levels.

  7. [Non-invasive fibrosis indexes in predicting acute liver function deterioration after transcatheter arterial chemoembolization].

    PubMed

    Song, Y P; Zhao, Q Y; Li, S; Wang, H; Wu, P H

    2016-03-08

    To investigate the ability of two non-invasive fibrosis indexes-APRI, i. e. aspartate transaminase (AST) to platelet (PLT) ratio index, and fibrosis index based on the 4 factors (FIB-4)score in predicting ALFD in patients with unresectable primary HCC and underwent TACE. Clinical data of those patients treated with TACE in Department of Interventional Radiology of the Center from Jan 2010 to Aug 2014 were investigated retrospectively. A total of 366 cases were enrolled after randomized selection, 62 (18.5%) of which developed ALFD after TACE. Child-Pugh score, APRI and FIB-4 score in every case were calculated, receiver operating characteristic (ROC) curve of each model were performed and the predictive abilities of them were assessed by area under the curve (AUC), positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity. The AUC of Child-Pugh score, APRI and FIB-4 score were 0.783, 0.752 and 0.758 respectively, while the difference had no significance in statistics, indicating that predictive accuracies of them were similar. APRI≤1.15 and FIB-4≤3.08 had better NPV (90.6% and 93.6%) and sensitivity (65.6% and 80.0%) than Child-Pugh score>6 (NPV=85.8%, sensitivity=27.4%), PPV and specificity of them are 35.7%, 32.9%, 89.5% and 73.7%, 64.2%, 99.3% respectively. Comparing to Child-Pugh score, APRI and FIB-4 score have similar accuracy but better NPV and sensitivity in predicting post-TACE ALFD. Thereafter they are good for selection of low-risk patients for TACE treatment. Candidates with an APRI≤1.15 or a FIB-4≤3.08 or in Child-Pugh a stage are unlikely to develop ALFD thus could receive TACE safely.

  8. [Prognostic parameters in liver cirrhosis, varicose bleeding and sclerosing therapy. Prospective comparison of a prognostic system with the Child classification obtained by discriminant analysis].

    PubMed

    Sauerbruch, T; Ansari, H; Wotzka, R; Soehendra, N; Köpcke, W

    1988-01-08

    Prospective prognosis systems for predicting half-year death-rate after bleeding from oesophageal varices and sclerotherapy were tested on 129 patients. The receiver-operating-characteristic curves of three discriminant scores were compared with the Child-Pugh classification. It was found that the latter is still the best for prognosticating the course of the disease. A simplified discriminant score which contains as its only factors bilirubin and the Quick value does, however, give nearly as good information.

  9. HLA Class II Antigens and Their Interactive Effect on Perinatal Mother-To-Child HIV-1 Transmission

    PubMed Central

    Luo, Ma; Embree, Joanne; Ramdahin, Suzie; Bielawny, Thomas; Laycock, Tyler; Tuff, Jeffrey; Haber, Darren; Plummer, Mariel; Plummer, Francis A.

    2015-01-01

    HLA class II antigens are central in initiating antigen-specific CD4+ T cell responses to HIV-1. Specific alleles have been associated with differential responses to HIV-1 infection and disease among adults. This study aims to determine the influence of HLA class II genes and their interactive effect on mother-child perinatal transmission in a drug naïve, Mother-Child HIV transmission cohort established in Kenya, Africa in 1986. Our study showed that DRB concordance between mother and child increased risk of perinatal HIV transmission by three fold (P = 0.00035/Pc = 0.0014, OR: 3.09, 95%CI, 1.64-5.83). Whereas, DPA1, DPB1 and DQB1 concordance between mother and child had no significant influence on perinatal HIV transmission. In addition, stratified analysis showed that DRB1*15:03+ phenotype (mother or child) significantly increases the risk of perinatal HIV-1 transmission. Without DRB1*15:03, DRB1 discordance between mother and child provided 5 fold protection (P = 0.00008, OR: 0.186, 95%CI: 0.081-0.427). However, the protective effect of DRB discordance was diminished if either the mother or the child was DRB1*15:03+ phenotype (P = 0.49-0.98, OR: 0.7-0.99, 95%CI: 0.246-2.956). DRB3+ children were less likely to be infected perinatally (P = 0.0006, Pc = 0.014; OR:0.343, 95%CI:0.183-0.642). However, there is a 4 fold increase in risk of being infected at birth if DRB3+ children were born to DRB1*15:03+ mother compared to those with DRB1*15:03- mother. Our study showed that DRB concordance/discordance, DRB1*15:03, children’s DRB3 phenotype and their interactions play an important role in perinatal HIV transmission. Identification of genetic factors associated with protection or increased risk in perinatal transmission will help develop alternative prevention and treatment methods in the event of increases in drug resistance of ARV. PMID:25945792

  10. Spatial correlations of Diceroprocta apache and its host plants: Evidence for a negative impact from Tamarix invasion

    USGS Publications Warehouse

    Ellingson, A.R.; Andersen, D.C.

    2002-01-01

    1. The hypothesis that the habitat-scale spatial distribution of the, Apache cicada Diceroprocta apache Davis is unaffected by the presence of the invasive exotic saltcedar Tamarix ramosissima was tested using data from 205 1-m2 quadrats placed within the flood-plain of the Bill Williams River, Arizona, U.S.A. Spatial dependencies within and between cicada density and habitat variables were estimated using Moran's I and its bivariate analogue to discern patterns and associations at spatial scales from 1 to 30 m. 2. Apache cicadas were spatially aggregated in high-density clusters averaging 3m in diameter. A positive association between cicada density, estimated by exuvial density, and the per cent canopy cover of a native tree, Goodding's willow Salix gooddingii, was detected in a non-spatial correlation analysis. No non-spatial association between cicada density and saltcedar canopy cover was detected. 3. Tests for spatial cross-correlation using the bivariate IYZ indicated the presence of a broad-scale negative association between cicada density and saltcedar canopy cover. This result suggests that large continuous stands of saltcedar are associated with reduced cicada density. In contrast, positive associations detected at spatial scales larger than individual quadrats suggested a spill-over of high cicada density from areas featuring Goodding's willow canopy into surrounding saltcedar monoculture. 4. Taken together and considered in light of the Apache cicada's polyphagous habits, the observed spatial patterns suggest that broad-scale factors such as canopy heterogeneity affect cicada habitat use more than host plant selection. This has implications for management of lower Colorado River riparian woodlands to promote cicada presence and density through maintenance or creation of stands of native trees as well as manipulation of the characteristically dense and homogeneous saltcedar canopies.

  11. Spatial correlations of Diceroprocta apache and its host plants: Evidence for a negative impact from Tamarix invasion

    USGS Publications Warehouse

    Ellingson, A.R.; Andersen, D.C.

    2002-01-01

    1. The hypothesis that the habitat-scale spatial distribution of the Apache cicada Diceroprocta apache Davis is unaffected by the presence of the invasive exotic saltcedar Tamarix ramosissima was tested using data from 205 1-m2 quadrats placed within the flood-plain of the Bill Williams River, Arizona, U.S.A. Spatial dependencies within and between cicada density and habitat variables were estimated using Moran's I and its bivariate analogue to discern patterns and associations at spatial scales from 1 to 30 m.2. Apache cicadas were spatially aggregated in high-density clusters averaging 3 m in diameter. A positive association between cicada density, estimated by exuvial density, and the per cent canopy cover of a native tree, Goodding's willow Salix gooddingii, was detected in a non-spatial correlation analysis. No non-spatial association between cicada density and saltcedar canopy cover was detected.3. Tests for spatial cross-correlation using the bivariate IYZ indicated the presence of a broad-scale negative association between cicada density and saltcedar canopy cover. This result suggests that large continuous stands of saltcedar are associated with reduced cicada density. In contrast, positive associations detected at spatial scales larger than individual quadrats suggested a spill-over of high cicada density from areas featuring Goodding's willow canopy into surrounding saltcedar monoculture.4. Taken together and considered in light of the Apache cicada's polyphagous habits, the observed spatial patterns suggest that broad-scale factors such as canopy heterogeneity affect cicada habitat use more than host plant selection. This has implications for management of lower Colorado River riparian woodlands to promote cicada presence and density through maintenance or creation of stands of native trees as well as manipulation of the characteristically dense and homogeneous saltcedar canopies.

  12. A Photographic Essay of the San Carlos Apache Indians, Volume 2-Part A.

    ERIC Educational Resources Information Center

    Soto, Ed; And Others

    As part of a series of guides designed for instruction of American Indian children and youth, this resource guide constitutes a pictorial essay on the San Carlos Apache Reservation founded in the late 1800's and located in Arizona's Gila County. An historical narrative and discussion questions accompany each of the 12 photographs. Photographic…

  13. Efficient Streaming Mass Spatio-Temporal Vehicle Data Access in Urban Sensor Networks Based on Apache Storm

    PubMed Central

    Zhou, Lianjie; Chen, Nengcheng; Chen, Zeqiang

    2017-01-01

    The efficient data access of streaming vehicle data is the foundation of analyzing, using and mining vehicle data in smart cities, which is an approach to understand traffic environments. However, the number of vehicles in urban cities has grown rapidly, reaching hundreds of thousands in number. Accessing the mass streaming data of vehicles is hard and takes a long time due to limited computation capability and backward modes. We propose an efficient streaming spatio-temporal data access based on Apache Storm (ESDAS) to achieve real-time streaming data access and data cleaning. As a popular streaming data processing tool, Apache Storm can be applied to streaming mass data access and real time data cleaning. By designing the Spout/bolt workflow of topology in ESDAS and by developing the speeding bolt and other bolts, Apache Storm can achieve the prospective aim. In our experiments, Taiyuan BeiDou bus location data is selected as the mass spatio-temporal data source. In the experiments, the data access results with different bolts are shown in map form, and the filtered buses’ aggregation forms are different. In terms of performance evaluation, the consumption time in ESDAS for ten thousand records per second for a speeding bolt is approximately 300 milliseconds, and that for MongoDB is approximately 1300 milliseconds. The efficiency of ESDAS is approximately three times higher than that of MongoDB. PMID:28394287

  14. Efficient Streaming Mass Spatio-Temporal Vehicle Data Access in Urban Sensor Networks Based on Apache Storm.

    PubMed

    Zhou, Lianjie; Chen, Nengcheng; Chen, Zeqiang

    2017-04-10

    The efficient data access of streaming vehicle data is the foundation of analyzing, using and mining vehicle data in smart cities, which is an approach to understand traffic environments. However, the number of vehicles in urban cities has grown rapidly, reaching hundreds of thousands in number. Accessing the mass streaming data of vehicles is hard and takes a long time due to limited computation capability and backward modes. We propose an efficient streaming spatio-temporal data access based on Apache Storm (ESDAS) to achieve real-time streaming data access and data cleaning. As a popular streaming data processing tool, Apache Storm can be applied to streaming mass data access and real time data cleaning. By designing the Spout/bolt workflow of topology in ESDAS and by developing the speeding bolt and other bolts, Apache Storm can achieve the prospective aim. In our experiments, Taiyuan BeiDou bus location data is selected as the mass spatio-temporal data source. In the experiments, the data access results with different bolts are shown in map form, and the filtered buses' aggregation forms are different. In terms of performance evaluation, the consumption time in ESDAS for ten thousand records per second for a speeding bolt is approximately 300 milliseconds, and that for MongoDB is approximately 1300 milliseconds. The efficiency of ESDAS is approximately three times higher than that of MongoDB.

  15. Evaluation of Apache Hadoop for parallel data analysis with ROOT

    NASA Astrophysics Data System (ADS)

    Lehrack, S.; Duckeck, G.; Ebke, J.

    2014-06-01

    The Apache Hadoop software is a Java based framework for distributed processing of large data sets across clusters of computers, using the Hadoop file system (HDFS) for data storage and backup and MapReduce as a processing platform. Hadoop is primarily designed for processing large textual data sets which can be processed in arbitrary chunks, and must be adapted to the use case of processing binary data files which cannot be split automatically. However, Hadoop offers attractive features in terms of fault tolerance, task supervision and control, multi-user functionality and job management. For this reason, we evaluated Apache Hadoop as an alternative approach to PROOF for ROOT data analysis. Two alternatives in distributing analysis data were discussed: either the data was stored in HDFS and processed with MapReduce, or the data was accessed via a standard Grid storage system (dCache Tier-2) and MapReduce was used only as execution back-end. The focus in the measurements were on the one hand to safely store analysis data on HDFS with reasonable data rates and on the other hand to process data fast and reliably with MapReduce. In the evaluation of the HDFS, read/write data rates from local Hadoop cluster have been measured and compared to standard data rates from the local NFS installation. In the evaluation of MapReduce, realistic ROOT analyses have been used and event rates have been compared to PROOF.

  16. Branched-chain amino acids to tyrosine ratio (BTR) predicts intrahepatic distant recurrence and survival for early hepatocellular carcinoma.

    PubMed

    Ishikawa, Toru; Kubota, Tomoyuki; Horigome, Ryoko; Kimura, Naruhiro; Honda, Hiroki; Iwanaga, Akito; Seki, Keiichi; Honma, Terasu; Yoshida, Toshiaki

    2013-01-01

    The Child-Pugh classification system is the most widely used system for assessing hepatic functional reserve in HCC treatment. In the Child-Pugh classification system, serum albumin levels are used to accurately assess the status of protein metabolism and nutrition. To date, a lack of attention has been given to amino acid metabolism. In the present study, we investigated whether the branched-chain amino acids to tyrosine ratio (BTR) as an indicator of amino acid metabolism can serve as both a prognostic factor for early HCC and a predictive factor for recurrence. We conducted a cohort study of 50 patients with stage I/II HCC enrolled between May 2002 and December 2010. It was investigated whether BTR can serve as both a prognostic factor and a predictive factor for HCC recurrence. Overall survival rates were significantly higher in patients with high baseline BTR than in those with low BTR. Multivariate analysis showed that both BTR and serum albumin were prognostic factors, and that BTR was the best predictive factor for recurrence. BTR was a prognostic factor for early HCC and the most predictive factor for intrahepatic distant recurrence and contributing factors for survival.

  17. Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System, 2001-2012.

    PubMed

    Cwik, Mary F; Tingey, Lauren; Maschino, Alexandra; Goklish, Novalene; Larzelere-Hinton, Francene; Walkup, John; Barlow, Allison

    2016-12-01

    We evaluated the impact of a comprehensive, multitiered youth suicide prevention program among the White Mountain Apache of Arizona since its implementation in 2006. Using data from the tribally mandated Celebrating Life surveillance system, we compared the rates, numbers, and characteristics of suicide deaths and attempts from 2007 to 2012 with those from 2001 to 2006. The overall Apache suicide death rates dropped from 40.0 to 24.7 per 100 000 (38.3% decrease), and the rate among those aged 15 to 24 years dropped from 128.5 to 99.0 per 100 000 (23.0% decrease). The annual number of attempts also dropped from 75 (in 2007) to 35 individuals (in 2012). National rates remained relatively stable during this time, at 10 to 13 per 100 000. Although national rates remained stable or increased slightly, the overall Apache suicide death rates dropped following the suicide prevention program. The community surveillance system served a critical role in providing a foundation for prevention programming and evaluation.

  18. Feasibility analysis for biomass cogeneration at the Fort Apache Timber Company

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Whittier, J.; Hasse, S.; Tomberlin, G.

    1996-12-31

    The Fort Apache Timber Company (FATCO) is a wholly-owned tribal enterprise of the White Mountain Apache Tribe (WMAT). WMAT officials are concerned about fuel buildup on the forest floor and the potential for catastrophic forests fires. Cogeneration is viewed as one means to effectively utilize biomass from the forest to reduce the chance of forest fires. FATCO presently spends approximately $1.6 million per year for electricity service from Navopache Electric Cooperative, Inc. for three sites. Peak demand is approximately 3.9 MW and the annual load factor is slightly under 50 percent. The blended cost of electricity is approximately $0.089 /more » kWh at the main mill. Biomass resources for fuel purposes may be obtained both from mill operations and from the forest operations. For many years FATCO has burned its wood residues to supply steam for dry kilns. It is estimated that a total of 125,778 bone dry tons (bdt) per year are available for fuel. A twenty year economic analysis model was used to evaluate the cogeneration potential. The model performs annual cash flow calculations to arrive at three measures of economic vitality: (1) Net Present Value (NPV), (2) levelized cost per kWh, and (3) Year 2 Return on Investment (ROI). Results of the analysis are positive for several scenarios.« less

  19. The Effect of a Monocular Helmet-Mounted Display on Aircrew Health: A Cohort Study of Apache AH Mk 1 Pilots Four-Year Review

    DTIC Science & Technology

    2009-12-01

    forward-looking infrared FOV field-of-view HDU helmet display unit HMD helmet-mounted display IHADSS Integrated Helmet and Display...monocular Integrated Helmet and Display Sighting System (IHADSS) helmet-mounted display ( HMD ) in the British Army’s Apache AH Mk 1 attack helicopter has any...Integrated Helmet and Display Sighting System, IHADSS, Helmet-mounted display, HMD , Apache helicopter, Visual performance UNCLAS UNCLAS UNCLAS SAR 96

  20. Ultrasonic diagnosis of patients with clonorchiasis and preliminary study of pathogenic mechanism.

    PubMed

    Fan, Mei; Lu, Lin; Su, Chun; Xue, Mei; Dou, Ji-Mei; Li, Pei; Feng, Han-Qi; Fan, Yan-Bing

    2016-07-01

    To discuss the liver function damage mechanism of patients with clonorchiasis by analyzing the ultrasound characteristics, liver function, change of the serum inflammatory factors and cell apoptosis factors. Color Doppler ultrasound technique was adopted to detect the portal vein and blood flow change of patients with clonorchiasis; ELISA was used to determine the level of different serum inflammatory factors. The levels of serum total bilirubin, serum albumin and glutamic-pyruvic transaminase were detected by automatic biochemical analyzer. Western blot was used to determine the expression of proteins relevant to apoptosis. Compared with the health control group, the trunk diameter of portal vein and the thickness of spleen, as well as the hepatic artery pulsation index of clonorchiasis patients increased obviously, the mean blood flow velocity of portal vein (P < 0.05 or P < 0.01) decreased. The content of total bilirubin and transaminase in plasma increased significantly, but albumin decreased (P < 0.05). Levels of TNF-α, IL-6 and IFN-γ increased remarkably, and the level of every factor was significantly different among patients with Child-Pugh , Child-Pugh II and Child-Pugh III classification of liver function (P < 0.05 or P < 0.01). With the exacerbation of liver dysfunction, levels of TNF-α, IL-6 and IFN-γ gradually increased (P < 0.05). Compared with the healthy control group, the expression quantity of apoptosis protein Fas, FasL, Bax and Caspase-3 increased significantly (P < 0.05 or P < 0.01), but Bcl-2 decreased (P < 0.05). Changes of ultrasonic characteristics and liver dysfunction, caused by liver fluke infection, may be related to that both inflammatory response and apoptosis response have participated in the pathogenic process and liver damage course of clonorchiasis. Copyright © 2016 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.

  1. 75 FR 14419 - Camp Tatiyee Land Exchange on the Lakeside Ranger District of the Apache-Sitgreaves National...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-25

    ... Ranger, Lakeside Ranger District, Apache-Sitgreaves National Forests, c/o TEC Inc., 514 Via de la Valle... to other papers serving areas affected by this proposal: Tucson Citizen, Sierra Vista Herald, Nogales...

  2. Serum proinflammatory cytokines and nutritional status in pediatric chronic liver disease.

    PubMed

    Santetti, Daniele; de Albuquerque Wilasco, Maria Inês; Dornelles, Cristina Toscani Leal; Werlang, Isabel Cristina Ribas; Fontella, Fernanda Urruth; Kieling, Carlos Oscar; Dos Santos, Jorge Luiz; Vieira, Sandra Maria Gonçalves; Goldani, Helena Ayako Sueno

    2015-08-07

    To evaluate the nutritional status and its association with proinflammatory cytokines in children with chronic liver disease. We performed a cross-sectional study with 43 children and adolescents, aged 0 to 17 years, diagnosed with chronic liver disease. All patients regularly attended the Pediatric Hepatology Unit and were under nutritional follow up. The exclusion criteria were fever from any etiology at the time of enrollment, inborn errors of the metabolism and any chronic illness. The severity of liver disease was assessed by Child-Pugh, Model for End-stage Liver Disease (MELD) and Pediatric End Stage Liver Disease (PELD) scores. Anthropometric parameters were height/age, body mass index/age and triceps skinfold/age according to World Health Organization standards. The cutoff points for nutritional status were risk of malnutrition (Z-score < -1.00) and malnutrition (Z-score < -2.00). Interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α levels were assessed by commercial ELISA kits. For multivariate analysis, linear regression was applied to assess the association between cytokine levels, disease severity and nutritional status. The median (25(th)-75(th) centile) age of the study population was 60 (17-116)-mo-old, and 53.5% were female. Biliary atresia was the main cause of chronic liver disease (72%). With respect to Child-Pugh score, cirrhotic patients were distributed as follows: 57.1% Child-Pugh A, a mild presentation of the disease, 34.3% Child-Pugh B, a moderate stage of cirrhosis and 8.6% Child-Pugh C, were considered severe cases. PELD and MELD scores were only above the cutoff point in 5 cases. IL-6 values ​​were increased in patients at nutritional risk (34.9%) compared with those who were well-nourished [7.12 (0.58-34.23) pg/mL vs 1.63 (0.53-3.43) pg/mL; P = 0.02], correlating inversely with triceps skinfold-for-age z-score (rs = -0.61; P < 0.001). IL-6 levels were associated with liver disease severity assessed by Child-Pugh score (P = 0

  3. Serum proinflammatory cytokines and nutritional status in pediatric chronic liver disease

    PubMed Central

    Santetti, Daniele; de Albuquerque Wilasco, Maria Inês; Dornelles, Cristina Toscani Leal; Werlang, Isabel Cristina Ribas; Fontella, Fernanda Urruth; Kieling, Carlos Oscar; dos Santos, Jorge Luiz; Vieira, Sandra Maria Gonçalves; Goldani, Helena Ayako Sueno

    2015-01-01

    AIM: To evaluate the nutritional status and its association with proinflammatory cytokines in children with chronic liver disease. METHODS: We performed a cross-sectional study with 43 children and adolescents, aged 0 to 17 years, diagnosed with chronic liver disease. All patients regularly attended the Pediatric Hepatology Unit and were under nutritional follow up. The exclusion criteria were fever from any etiology at the time of enrollment, inborn errors of the metabolism and any chronic illness. The severity of liver disease was assessed by Child-Pugh, Model for End-stage Liver Disease (MELD) and Pediatric End Stage Liver Disease (PELD) scores. Anthropometric parameters were height/age, body mass index/age and triceps skinfold/age according to World Health Organization standards. The cutoff points for nutritional status were risk of malnutrition (Z-score < -1.00) and malnutrition (Z-score < -2.00). Interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α levels were assessed by commercial ELISA kits. For multivariate analysis, linear regression was applied to assess the association between cytokine levels, disease severity and nutritional status. RESULTS: The median (25th-75th centile) age of the study population was 60 (17-116)-mo-old, and 53.5% were female. Biliary atresia was the main cause of chronic liver disease (72%). With respect to Child-Pugh score, cirrhotic patients were distributed as follows: 57.1% Child-Pugh A, a mild presentation of the disease, 34.3% Child-Pugh B, a moderate stage of cirrhosis and 8.6% Child-Pugh C, were considered severe cases. PELD and MELD scores were only above the cutoff point in 5 cases. IL-6 values ​​were increased in patients at nutritional risk (34.9%) compared with those who were well-nourished [7.12 (0.58-34.23) pg/mL vs 1.63 (0.53-3.43) pg/mL; P = 0.02], correlating inversely with triceps skinfold-for-age z-score (rs = -0.61; P < 0.001). IL-6 levels were associated with liver disease severity assessed by Child-Pugh

  4. Apache Trail, Tonto National Forest : Observations, Considerations, and Recommendations from the Interagency Transportation Assistance Group (TAG)

    DOT National Transportation Integrated Search

    2016-03-03

    This report summarizes the observations and findings of an interagency transportation assistance group (TAG) convened to discuss the long-term future of Arizona State Route 88, also known as the Apache Trail, a historic road on the Tonto Nation...

  5. A Photographic Essay of Apache Clothing, War Charms, and Weapons, Volume 2-Part D.

    ERIC Educational Resources Information Center

    Thompson, Doris; Jacobs, Ben

    As part of a series of guides designed for instruction of American Indian children and youth, this resource guide constitutes a pictorial essay on Apache clothing, war charms, and weaponry. A brief historical introduction is followed by 21 question suggestions for classroom use. Each of the 12 photographic topics is accompanied by a descriptive…

  6. Retrospective evaluation of prognostic score performances in cirrhotic patients admitted to an intermediate care unit.

    PubMed

    Dupont, Benoît; Delvincourt, Maxime; Koné, Mamadou; du Cheyron, Damien; Ollivier-Hourmand, Isabelle; Piquet, Marie-Astrid; Terzi, Nicolas; Dao, Thông

    2015-08-01

    The prognosis of cirrhotic patients in the Intensive Care Unit requires the development of predictive tools for mortality. We aimed to evaluate the ability of different prognostic scores to predict hospital mortality in these patients. A single-centre retrospective analysis was conducted of 281 hospital stays of cirrhotic patients at an Intermediate Care Unit between June 2009 and December 2010. The performance of the Simplified Acute Physiology Score (SOFA), the Simplified Acute Physiology Score (SAPS) II or III, Child-Pugh, Model for End-Stage Liver Disease (MELD), MELD-Na and the Chronic Liver Failure-Consortium Acute-on-Chronic Liver Failure score (CLIF-C ACLF) in predicting hospital mortality were compared. Mean age was 58.2±12.1 years; 77% were male. The main cause of admission was acute gastrointestinal bleeding (47%). The in-hospital mortality rate was 25.3%. Receiver operating characteristic curve analyses demonstrated that SOFA (0.82) MELD-Na (0.82) or MELD (0.81) scores at admission predicted in-hospital mortality better than Child-Pugh (0.76), SAPS II (0.77), SAPS III (0.75) or CLIF-C ACLF (0.75). We then developed the cirrhosis prognostic score (Ci-Pro), which performed better (0.89) than SOFA. SOFA, MELD and especially the Ci-Pro score show the best performance in predicting hospital mortality of cirrhotic patients admitted to an Intermediate Care Unit. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  7. Negative pressure wound treatment improves Acute Physiology and Chronic Health Evaluation II score in mediastinitis allowing a successful elective pectoralis muscle flap closure: six-year experience of a single protocol.

    PubMed

    Salica, Andrea; Weltert, Luca; Scaffa, Raffaele; Guerrieri Wolf, Lorenzo; Nardella, Saverio; Bellisario, Alessandro; De Paulis, Ruggero

    2014-11-01

    Optimal management of poststernotomy mediastinitis is controversial. Negative pressure wound treatment improves wound environment and sternal stability with low surgical invasiveness. Our protocol was based on negative pressure followed by delayed surgical closure. The aim of this study was to provide the results at early follow-up and to identify the risk factors for adverse outcome. In 5400 cardiac procedures, 44 consecutive patients with mediastinitis were enrolled in the study. Mediastinitis treatment was based on urgent debridement and negative pressure as the first-line approach. After wound sterilization, chest closure was achieved by elective pectoralis muscle advancement flap. Each patient's hospital data were collected prospectively. Variables included patient demographics and clinical and biological data. Acute Physiology and Chronic Health Evaluation (APACHE) II score was calculated at the time of diagnosis and 48 hours after debridement. Focus outcome measures were mediastinitis-related death and need for reintervention after pectoralis muscle closure. El Oakley type I and type IIIA mediastinitis were the most frequent types (63.6%). Methicillin-resistant Staphylococcus aureus was present in 25 patients (56.8%). Mean APACHE II score was 19.4±4 at the time of diagnosis, and 30 patients (68.2%) required intensive care unit transfer before surgical debridement. APACHE II score improved 48 hours after wound debridement and negative pressure application (mean value, 19.4±4 vs 7.2±2; P=.005) independently of any other variables included in the study. One patient in septic shock at the time of diagnosis died (2.2%). Negative pressure promotes a significant improvement in clinical status according to APACHE II score and allows a successful elective surgical closure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  8. Ground-water exploration in the Bosque del Apache Grant, Socorro County, New Mexico

    USGS Publications Warehouse

    Cooper, James B.

    1968-01-01

    Test drilling along the Rio Grande in the Bosque del Apache Grant in Socorro County, New Mexico has shown that the area is hydrologically complex and that the quality of the ground water varies from saline to fresh within short distances both laterally and vertically. Nearly all of the riverside land in the Grant is occupied by the migratory waterfowl refuge of the Bosque del Apache National Wildlife Refuge. Potable and near-potable water is obtained from 12 wells in this area that tap sand and gravel, and the wells are capable of yielding 1,000 gallons per minute or more. Stallion Range Center, a military installation on the White Sands Missile Range, about 15 miles east of =he waterfowl refuge, needs about 100,000 gallons per day of potable water. Potable water in large quantities is not known to be available at a location closer to the Center than the refuge area. The Fish and Wildlife Service, which operates the waterfowl refuge, gave permission to White Sands Missile Range to test drill and to develop a supply well in certain areas along the Rio Grande outside the managed lands of the refuge. The U.S. Geological Survey was then asked by White Sands Missile Range to choose locations for test drilling and to monitor drilling and testing of the wells. Between 1963 and 1967 test wells were drilled and a suitable location for a supply well as found. The well would be about 250 feet deep and would tap a body of potable water that is about 100 feet in thickness and is thought to underlie an area of at least 5 square miles. This report contains diagrammatic sections that show the lateral and vertical relation of waters of different quality along the Rio Grande in a part of the Bosque del Apache Grant. Basic data are given in tables; they include records of 7 test wells and 12 high-yield supply wells, and 52 chemical analyses of ground water from the wells.

  9. Field of genes: using Apache Kafka as a bioinformatic data repository

    PubMed Central

    Lynch, Richard; Walsh, Paul

    2018-01-01

    Abstract Background Bioinformatic research is increasingly dependent on large-scale datasets, accessed either from private or public repositories. An example of a public repository is National Center for Biotechnology Information's (NCBI’s) Reference Sequence (RefSeq). These repositories must decide in what form to make their data available. Unstructured data can be put to almost any use but are limited in how access to them can be scaled. Highly structured data offer improved performance for specific algorithms but limit the wider usefulness of the data. We present an alternative: lightly structured data stored in Apache Kafka in a way that is amenable to parallel access and streamed processing, including subsequent transformations into more highly structured representations. We contend that this approach could provide a flexible and powerful nexus of bioinformatic data, bridging the gap between low structure on one hand, and high performance and scale on the other. To demonstrate this, we present a proof-of-concept version of NCBI’s RefSeq database using this technology. We measure the performance and scalability characteristics of this alternative with respect to flat files. Results The proof of concept scales almost linearly as more compute nodes are added, outperforming the standard approach using files. Conclusions Apache Kafka merits consideration as a fast and more scalable but general-purpose way to store and retrieve bioinformatic data, for public, centralized reference datasets such as RefSeq and for private clinical and experimental data. PMID:29635394

  10. Field of genes: using Apache Kafka as a bioinformatic data repository.

    PubMed

    Lawlor, Brendan; Lynch, Richard; Mac Aogáin, Micheál; Walsh, Paul

    2018-04-01

    Bioinformatic research is increasingly dependent on large-scale datasets, accessed either from private or public repositories. An example of a public repository is National Center for Biotechnology Information's (NCBI's) Reference Sequence (RefSeq). These repositories must decide in what form to make their data available. Unstructured data can be put to almost any use but are limited in how access to them can be scaled. Highly structured data offer improved performance for specific algorithms but limit the wider usefulness of the data. We present an alternative: lightly structured data stored in Apache Kafka in a way that is amenable to parallel access and streamed processing, including subsequent transformations into more highly structured representations. We contend that this approach could provide a flexible and powerful nexus of bioinformatic data, bridging the gap between low structure on one hand, and high performance and scale on the other. To demonstrate this, we present a proof-of-concept version of NCBI's RefSeq database using this technology. We measure the performance and scalability characteristics of this alternative with respect to flat files. The proof of concept scales almost linearly as more compute nodes are added, outperforming the standard approach using files. Apache Kafka merits consideration as a fast and more scalable but general-purpose way to store and retrieve bioinformatic data, for public, centralized reference datasets such as RefSeq and for private clinical and experimental data.

  11. Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines

    PubMed Central

    Manzini, Giulia; Henne-Bruns, Doris; Porzsolt, Franz; Kremer, Michael

    2017-01-01

    Background and aims Liver resection (LR) and transplantation are the most reliable treatments for hepatocellular carcinoma (HCC). Aim was to compare different guidelines regarding indication for resection and transplantation because of HCC with and without underlying cirrhosis. Methods We compared the following guidelines published after 1 January 2010: American (American Association for the Study of Liver Diseases (AASLD)), Spanish (Sociedad Espanola de Oncologia Medica (SEOM)), European (European Association for the study of liver-European Organization for Research and Treatment of Cancer (EASL-EORTC) and European Society for Medical Oncology-European Society of Digestive Oncology (ESMO-ESDO)), Asian (Asian Pacific Association for the Study of Liver (APASL)), Japanese (Japan Society of Hepatology (JSH)), Italian (Associazione Italiana Oncologia Medica (AIOM)) and German (S3) guidelines. Results All guidelines recommend resection as therapy of choice in healthy liver. Guidelines based on the Barcelona Clinic Liver Cancer staging system recommend resection for single HCC<2 cm and Child-Pugh A cirrhosis and for HCC≤5 cm with normal bilirubin and portal pressure, whereas transplantation is recommended for multiple tumours between Milan criteria and for single tumours ≤5 cm and advanced liver dysfunction. Patients with HCC and Child-Pugh C cirrhosis are not candidates for transplantation. JSH guidelines recommend LR for patients with Child-Pugh A/B with HCC without tumour size restriction; APASL guidelines in general exclude patients with Child-Pugh A from transplantation. In patients with Child-Pugh B, transplantation is the second-line therapy, if resection is not possible for patients within Milan criteria. German and Italian guidelines recommend transplantation for all patients within Milan criteria. Conclusions Whereas resection is the standard therapy of HCC in healthy liver, a standard regarding the indication for LR and transplantation for HCC in

  12. Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines.

    PubMed

    Manzini, Giulia; Henne-Bruns, Doris; Porzsolt, Franz; Kremer, Michael

    2017-01-01

    Liver resection (LR) and transplantation are the most reliable treatments for hepatocellular carcinoma (HCC). Aim was to compare different guidelines regarding indication for resection and transplantation because of HCC with and without underlying cirrhosis. We compared the following guidelines published after 1 January 2010: American (American Association for the Study of Liver Diseases (AASLD)), Spanish (Sociedad Espanola de Oncologia Medica (SEOM)), European (European Association for the study of liver-European Organization for Research and Treatment of Cancer (EASL-EORTC) and European Society for Medical Oncology-European Society of Digestive Oncology (ESMO-ESDO)), Asian (Asian Pacific Association for the Study of Liver (APASL)), Japanese (Japan Society of Hepatology (JSH)), Italian (Associazione Italiana Oncologia Medica (AIOM)) and German (S3) guidelines. All guidelines recommend resection as therapy of choice in healthy liver. Guidelines based on the Barcelona Clinic Liver Cancer staging system recommend resection for single HCC<2 cm and Child-Pugh A cirrhosis and for HCC≤5 cm with normal bilirubin and portal pressure, whereas transplantation is recommended for multiple tumours between Milan criteria and for single tumours ≤5 cm and advanced liver dysfunction. Patients with HCC and Child-Pugh C cirrhosis are not candidates for transplantation. JSH guidelines recommend LR for patients with Child-Pugh A/B with HCC without tumour size restriction; APASL guidelines in general exclude patients with Child-Pugh A from transplantation. In patients with Child-Pugh B, transplantation is the second-line therapy, if resection is not possible for patients within Milan criteria. German and Italian guidelines recommend transplantation for all patients within Milan criteria. Whereas resection is the standard therapy of HCC in healthy liver, a standard regarding the indication for LR and transplantation for HCC in cirrhotic liver does not exist, although nearly all

  13. Pro-Brain Natriuretic Peptide and Troponin T-Hypersensitivity Levels Correlate With the Severity of Liver Dysfunction in Liver Cirrhosis.

    PubMed

    Zhao, Jiancheng; Li, Sai; Ren, Linan; Guo, Xiaozhong; Qi, Xingshun

    2017-08-01

    Increased pro-brain natriuretic peptide (pro-BNP) or troponin T-hypersensitivity (TnT-HSST) levels are common in liver cirrhosis. We conducted a retrospective observational study aimed to evaluate the correlation of pro-BNP and TnT-HSST levels with the clinical characteristics, laboratory data and in-hospital outcomes of patients with liver cirrhosis. We selected cirrhotic patients admitted to our hospital between January 2011 and June 2014. All eligible patients had pro-BNP or TnT-HSST data, or both. The pro-BNP and TnT-HSST data were further divided according to the presence of cardiac diseases. The prevalence of pro-BNP level >900pg/mL was 41.72% (63 of 151 patients). The prevalence of TnT-HSST level >0.05ng/mL was 11.22% (45 of 401 patients). In the overall analysis, pro-BNP level significantly correlated with red blood cell (RBC), platelet, ascites, blood urea nitrogen (BUN), creatinine (Cr), Child-Pugh score, model for end-stage liver disease (MELD) score and in-hospital death; TnT-HSST level significantly correlated with white blood cell, ascites, albumin (ALB), BUN, Cr, Child-Pugh score, MELD score and in-hospital death. In patients with cardiac diseases, pro-BNP level significantly correlated with RBC, ascites, BUN, Cr, Child-Pugh score and MELD score; TnT-HSST level significantly correlated with sex, ascites, white blood cell, ALB, BUN, Cr, Child-Pugh score, MELD score and in-hospital death. In patients without cardiac diseases, pro-BNP level significantly correlated with ascites, RBC, platelet, BUN, Cr, MELD score and in-hospital death; TnT-HSST level significantly correlated with age, ascites, RBC, ALB, BUN, Cr, Child-Pugh score, MELD score and in-hospital death. Pro-BNP and TnT-HSST levels significantly correlated with the severity of liver dysfunction and in-hospital mortality in cirrhosis. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  14. Exceptional Child I: Building Understanding [and] Exceptional Child II: Focusing on Nurturing & Learning. The Developing Child. [Videotapes].

    ERIC Educational Resources Information Center

    Magna Systems, Inc., Crystal Lake, IL.

    These two videotape recordings and accompanying workbook provide information on the developmental stages of childhood, influences on child development, and identifying children with disabilities. The videos, "Exceptional Child 1: Building Understanding," (27 minutes) and "Exceptional Child 2: Focusing on Nurturing & Learning," (28 minutes) address…

  15. An assessment of the spatial extent and condition of grasslands in the Apache Highlands ecoregion

    Treesearch

    Carolyn A. F. Enquist; David F. Gori

    2005-01-01

    Grasslands in the Apache Highlands ecoregion have experienced dramatic changes. To assess and identify remaining native grasslands for conservation planning and management, we used a combination of expert consultation and field verification. Over two-thirds of native grasslands have experienced shrub encroachment. More than 30% of these may be restorable with...

  16. Validation of the Sepsis Severity Score Compared with Updated Severity Scores in Predicting Hospital Mortality in Sepsis Patients.

    PubMed

    Khwannimit, Bodin; Bhurayanontachai, Rungsun; Vattanavanit, Veerapong

    2017-06-01

    Recently, the Sepsis Severity Score (SSS) was constructed to predict mortality in sepsis patients. The aim of this study was to compare performance of the SSS with the Acute Physiology and Chronic Health Evaluation (APACHE) II-IV, Simplified Acute Physiology Score (SAPS) II, and SAPS 3 scores in predicting hospital outcome in sepsis patients. A retroprospective analysis was conducted in the medical intensive care unit of a tertiary university hospital. A total of 913 patients were enrolled; 476 of these patients (52.1%) had septic shock. The median SSS was 80 (range 20-137). The SSS presented good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.892. However, the AUC of the SSS did not differ significantly from that of APACHE II (P = 0.07), SAPS II (P = 0.06), and SAPS 3 (P = 0.11). The APACHE IV score showed the best discrimination with an AUC of 0.948 and the overall performance by a Brier score of 0.096. The AUC of the APACHE IV score was statistically greater than the SSS, APACHE II, SAPS II, and SAPS 3 (P <0.0001 for all) and APACHE III (P = 0.0002). The calibration of all scores was poor with the Hosmer-Lemeshow goodness-of-fit H test <0.05. The SSS provided as good discrimination as the APACHE II, SAPS II, and SAPS 3 scores. However, the APACHE IV score had the best discrimination and overall performance in our sepsis patients. The SSS needs to be adapted and modified with new parameters to improve its performance.

  17. Use of saltcedar vegetation by landbirds migrating through the Bosque Del Apache National Wildlife Refuge

    Treesearch

    Jeffrey F. Kelly; Deborah M. Finch

    1999-01-01

    We compared diversity, abundance and energetic condition of migrant landbirds captured in four different vegetation types in the Bosque del Apache National Wildlife Refuge. We found lower species diversity among migrants caught in exotic saltcedar vegetation than in native willow or cottonwood. In general, Migrants were most abundant in agricultural edge and least...

  18. Serum level of IL-6 in liver cirrhosis patients

    NASA Astrophysics Data System (ADS)

    Rey, I.; Effendi-YS, R.; Dairi, L. B.; Siregar, G. A.; Zain, L. H.

    2018-03-01

    Cytokines are polypeptides that have a wide spectrum of inflammatory, metabolic, hematopoietic and immunologic regulatory properties. The liver represents an important site of synthesis and clearance organ for several cytokines. This study aimed to evaluate serum IL-6 in liver cirrhosis with the type of underlying disease, child pugh group and various clinical and laboratory parameter. This cross-sectional study was at Adam Malik General Hospital and Pirngadi General Hospital from July - December 2016. We examine 75 patients with liver cirrhosis. The exclusion criteria were hepatoma, sepsis and renal impairment. There were 28 (37.3%), 8 (10.6%) and 39 (52%) for HBV-positive; HCV-positive and HBV- HCV negative liver cirrhosis patients, respectively were 14 (18.7 %), 15 (20 %) and 46 (61.3%) for Child- Pugh A, B and C respectively. There was no significant difference value of IL-6 between HBV positive, HCV positive, and HBV-HCV negative group (7.7/6.1/10.9). There was no significant difference value of IL-6 between child pugh A, B, and C group (4.2/11.0/7.9).

  19. Sideloading - Ingestion of Large Point Clouds Into the Apache Spark Big Data Engine

    NASA Astrophysics Data System (ADS)

    Boehm, J.; Liu, K.; Alis, C.

    2016-06-01

    In the geospatial domain we have now reached the point where data volumes we handle have clearly grown beyond the capacity of most desktop computers. This is particularly true in the area of point cloud processing. It is therefore naturally lucrative to explore established big data frameworks for big geospatial data. The very first hurdle is the import of geospatial data into big data frameworks, commonly referred to as data ingestion. Geospatial data is typically encoded in specialised binary file formats, which are not naturally supported by the existing big data frameworks. Instead such file formats are supported by software libraries that are restricted to single CPU execution. We present an approach that allows the use of existing point cloud file format libraries on the Apache Spark big data framework. We demonstrate the ingestion of large volumes of point cloud data into a compute cluster. The approach uses a map function to distribute the data ingestion across the nodes of a cluster. We test the capabilities of the proposed method to load billions of points into a commodity hardware compute cluster and we discuss the implications on scalability and performance. The performance is benchmarked against an existing native Apache Spark data import implementation.

  20. [Umbilical and inguinal hernioplasty in cirrhotic patients].

    PubMed

    Zepeda, R; Herrera, M F; Mercado, M A

    1994-01-01

    The overall results of surgical treatment of abdominal wall hernias in patients with hepatic cirrhosis were assessed by a retrospective study in 41 cirrhotic patients. They underwent 22 umbilical and 22 inguinal herniorrhapies between 1982 and 1992. Sixteen patients were classified as Child-Pugh A, 16 as B and 9 as C. Clinical evidence of ascitis was documented in 19 patients. The operative mortality was 5% (two Child-Pugh C cases). Postoperative complications occurred in 10 patients, most of them related to the surgical wound. We recommend herniorraphy in symptomatic cirrhotic patients but with fairly good hepatic function.

  1. National Trends: Enhancing Education through Technology--No Child Left Behind Title II D--Year One in Review

    ERIC Educational Resources Information Center

    Lemke, Cheryl; Vandersall, Kirk; Ravden, Daran

    2004-01-01

    In the fall of 2003, the State Educational Technology Directors Association (SETDA) commissioned the Metiri Group to conduct a national survey on the first year of implementation of the No Child Left Behind, Title II, Part D, Enhancing Education through Technology program. The findings in this report represent 46 states and the District of…

  2. Is a specific oncological scoring system better at predicting the prognosis of cancer patients admitted for an acute medical complication in an intensive care unit than general gravity scores?

    PubMed

    Berghmans, T; Paesmans, M; Sculier, J P

    2004-04-01

    To evaluate the effectiveness of a specific oncologic scoring system-the ICU Cancer Mortality model (ICM)-in predicting hospital mortality in comparison to two general severity scores-the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Simplified Acute Physiology Score (SAPS II). All 247 patients admitted for a medical acute complication over an 18-month period in an oncological medical intensive care unit were prospectively registered. Their data, including type of complication, vital status at discharge and cancer characteristics as well as other variables necessary to calculate the three scoring systems were retrospectively assessed. Observed in-hospital mortality was 34%. The predicted in-hospital mortality rate for APACHE II was 32%; SAPS II, 24%; and ICM, 28%. The goodness of fit was inadequate except for the ICM score. Comparison of the area under the ROC curves revealed a better fit for ICM (area 0.79). The maximum correct classification rate was 72% for APACHE II, 74% for SAPS II and 77% for ICM. APACHE II and SAPS II were better at predicting outcome for survivors to hospital discharge, although ICM was better for non-survivors. Two variables were independently predicting the risk of death during hospitalisation: ICM (OR=2.31) and SAPS II (OR=1.05). Gravity scores were the single independent predictors for hospital mortality, and ICM was equivalent to APACHE II and SAPS II.

  3. Mid-infrared spectroscopy of serum, a promising non-invasive method to assess prognosis in patients with ascites and cirrhosis

    PubMed Central

    Le Corvec, Maëna; Jezequel, Caroline; Monbet, Valérie; Fatih, Nadia; Charpentier, Frédéric; Tariel, Hugues; Boussard-Plédel, Catherine; Bureau, Bruno; Loréal, Olivier; Sire, Olivier

    2017-01-01

    Background & aims Prognostic tests are critical in the management of patients with cirrhosis and ascites. Biological tests or scores perform poorly in that situation. Mid-infrared fibre evanescent wave spectroscopy (MIR-FEWS) which allows for global serum metabolic profiling may provide more relevant information by measuring a wider range of metabolic parameters in serum. Here we present the accuracy of a MIR-FEWS based predictive model for the prognosis of 6 months survival in patients with ascites and cirrhosis. Methods Patients with ascites were prospectively included and followed up for 6 months. MIR-FEWS spectra were measured in serum samples. The most informative spectral variables obtained by MIR-FEWS were selected by FADA algorithm and then used to build the MIR model. Accuracy of this model was assessed by ROC curves and 90%/10% Monte Carlo cross-validation. MIR model accuracy for 6 months survival was compared to that of the Child-Pugh and MELD scores. Results 119 patients were included. The mean age was 57.36±13.70, the MELD score was 16.32±6.26, and the Child-Pugh score was 9.5±1.83. During follow-up, 23 patients died (20%). The MIR model had an AUROC for 6 months mortality of 0.90 (CI95: 0.88–0.91), the MELD 0.77 (CI95: 0.66–0.89) and Child-Pugh 0.76 (CI95: 0.66–0.88). MELD and Child-Pugh AUROCs were significantly lower than that of the MIR model (p = 0.02 and p = 0.02 respectively). Multivariate logistic regression analysis showed that MELD (p<0.05, OR:0.86;CI95:0.76–0.97), Beta blockers (p = 0.036;OR:0.20;CI95:0.04–0.90), and the MIR model (p<0.001; OR:0.50; CI95:0.37–0.66), were significantly associated with 6 months mortality. Conclusions In this pilot study MIR-FEWS more accurately assess the 6-month prognosis of patients with ascites and cirrhosis than the MELD or Child-Pugh scores. These promising results, if confirmed by a larger study, suggest that mid infrared spectroscopy could be helpful in the management of these patients

  4. Assessment of performance and utility of mortality prediction models in a single Indian mixed tertiary intensive care unit.

    PubMed

    Sathe, Prachee M; Bapat, Sharda N

    2014-01-01

    To assess the performance and utility of two mortality prediction models viz. Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in a single Indian mixed tertiary intensive care unit (ICU). Secondary objectives were bench-marking and setting a base line for research. In this observational cohort, data needed for calculation of both scores were prospectively collected for all consecutive admissions to 28-bedded ICU in the year 2011. After excluding readmissions, discharges within 24 h and age <18 years, the records of 1543 patients were analyzed using appropriate statistical methods. Both models overpredicted mortality in this cohort [standardized mortality ratio (SMR) 0.88 ± 0.05 and 0.95 ± 0.06 using APACHE II and SAPS II respectively]. Patterns of predicted mortality had strong association with true mortality (R (2) = 0.98 for APACHE II and R (2) = 0.99 for SAPS II). Both models performed poorly in formal Hosmer-Lemeshow goodness-of-fit testing (Chi-square = 12.8 (P = 0.03) for APACHE II, Chi-square = 26.6 (P = 0.001) for SAPS II) but showed good discrimination (area under receiver operating characteristic curve 0.86 ± 0.013 SE (P < 0.001) and 0.83 ± 0.013 SE (P < 0.001) for APACHE II and SAPS II, respectively). There were wide variations in SMRs calculated for subgroups based on International Classification of Disease, 10(th) edition (standard deviation ± 0.27 for APACHE II and 0.30 for SAPS II). Lack of fit of data to the models and wide variation in SMRs in subgroups put a limitation on utility of these models as tools for assessing quality of care and comparing performances of different units without customization. Considering comparable performance and simplicity of use, efforts should be made to adapt SAPS II.

  5. Parent-child relationship disorders. Part II. The vulnerable child syndrome and its relation to parental overprotection.

    PubMed

    Thomasgard, M; Shonkoff, J P; Metz, W P; Edelbrock, C

    1995-08-01

    Parents who are excessively concerned about their child's health are often characterized as being overprotective. We hypothesized that parental overprotection is independent of parental perception of child vulnerability to illness or injury despite their presumed interchangeability. A community-based sample of 892 parents (92% white, 84% married, 88% middle-upper socioeconomic status, 90% mothers) completed a three-part protocol (clinical background data, the Child Vulnerability Scale, and the Parent Protection Scale). Correlates of high parental perception of child vulnerability included a medical condition in the child, a history of life-threatening illness or injury, and the child being seen for a sick visit. Correlates of high parental overprotection included younger age of child and parent. Only 20% of those parents who considered their child vulnerable were also considered overprotective.

  6. Evaluation of the relationship between hepatocellular carcinoma location and transarterial chemoembolization efficacy.

    PubMed

    Miki, Izumi; Murata, Satoru; Uchiyama, Fumio; Yasui, Daisuke; Ueda, Tatsuo; Sugihara, Fumie; Saito, Hidemasa; Yamaguchi, Hidenori; Murakami, Ryusuke; Kawamoto, Chiaki; Uchida, Eiji; Kumita, Shin-Ichiro

    2017-09-21

    To evaluate the relationship between the location of hepatocellular carcinoma (HCC) and the efficacy of transarterial chemoembolization (TACE). We evaluated 115 patients (127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to mRECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center (mm)/liver diameter (mm) on multiplanar reconstruction images rendered (MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response (CR) and non-CR groups in Child-Pugh grade A and B patients. The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients (0.82 vs 0.62, P < 0.001; 0.71 vs 0.59, P < 0.01; 0.81 vs 0.49, P < 0.05, respectively). However, there was no significant difference in the median location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups (0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups. Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients.

  7. [Liver stiffness measured by acoustic radiation force impulse imaging in assessing hepatic functional reserve in patients with space-occupying lesions in the liver].

    PubMed

    Yan, Hui-tong; Luo, Yu-kun; Tang, Wen-bo; Jiao, Zi-yu; Yao, Chun-xiao; Lv, Fa-qin; Tang, Jie

    2013-04-01

    To investigate the value of liver stiffness measured by acoustic radiation force impulse imaging(ARFI) in assessing hepatic functional reserve in patients with space-occupying lesions in the liver. Sixty-three patients with space-occupying lesions in the liver were enrolled. Liver stiffness (LS) measurements with ARFI and indocyanine green(ICG) retention test were performed in the same day, and plasma clearance rate of indocyanine green(ICG-K), ICG retention at 15 minutes(ICGR15) as well as 10 effective values of LS were recorded. The correlation between Child-Pugh score, ICGR15, ICG-K, and LS were evaluated. The LS measurements with ARFI failed in one patient. A strong correlation between LS and ICGR15(r=0.789, P<0.01) and an inverse correlation between LS and ICG-K(r=-0.738, P<0.01) were observed. Besides, there was a significant correlation between LS measurements and Child-Pugh score(r=0.929, P<0.01) . The LS significantly differed among patients with Child-Pugh class A, B, and C(P<0.01) . ARFI is a simple, feasible and non-invasive method for assessing hepatic functional reserve in patients with space-occupying lesions in the liver.

  8. 76 FR 72969 - Proclaiming Certain Lands as Reservation for the Fort Sill Apache Indian Tribe

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ... the Fort Sill Apache Tribe of Indians. FOR FURTHER INFORMATION CONTACT: Ben Burshia, Bureau of Indian... from a tangent which bears N. 89[deg]56'18'' W., having a radius of 789.30 feet, a delta angle of 32... radius of 1096.00 feet, a delta angle of 39[deg]58'50'', a chord which bears S. 77[deg]15'43'' W., 749.36...

  9. Admission Cell Free DNA Levels Predict 28-Day Mortality in Patients with Severe Sepsis in Intensive Care

    PubMed Central

    Almog, Yaniv; Perl, Yael; Novack, Victor; Galante, Ori; Klein, Moti; Pencina, Michael J.; Douvdevani, Amos

    2014-01-01

    Aim The aim of the current study is to assess the mortality prediction accuracy of circulating cell-free DNA (CFD) level at admission measured by a new simplified method. Materials and Methods CFD levels were measured by a direct fluorescence assay in severe sepsis patients on intensive care unit (ICU) admission. In-hospital and/or twenty eight day all-cause mortality was the primary outcome. Results Out of 108 patients with median APACHE II of 20, 32.4% have died in hospital/or at 28-day. CFD levels were higher in decedents: median 3469.0 vs. 1659 ng/ml, p<0.001. In multivariable model APACHE II score and CFD (quartiles) were significantly associated with the mortality: odds ratio of 1.05, p = 0.049 and 2.57, p<0.001 per quartile respectively. C-statistics for the models was 0.79 for CFD and 0.68 for APACHE II. Integrated discrimination improvement (IDI) analyses showed that CFD and CFD+APACHE II score models had better discriminatory ability than APACHE II score alone. Conclusions CFD level assessed by a new, simple fluorometric-assay is an accurate predictor of acute mortality among ICU patients with severe sepsis. Comparison of CFD to APACHE II score and Procalcitonin (PCT), suggests that CFD has the potential to improve clinical decision making. PMID:24955978

  10. Predictive comparisons of procalcitonin (PCT) level, arterial ketone body ratio (AKBR), APACHE III score and multiple organ dysfunction score (MODS) in systemic inflammatory response syndrome (SIRS).

    PubMed

    Lee, Young-Joo; Park, Chan-Hee; Yun, Jang-Woon; Lee, Young-Suk

    2004-02-29

    Procalcitonin (PCT) is a newly introduced marker of systemic inflammation and bacterial infection. A marked increase in circulating PCT level in critically ill patients has been related with the severity of illness and poor survival. The goal of this study was to compare the prognostic power of PCT and three other parameters, the arterial ketone body ratio (AKBR), the acute physiology, age, chronic health evaluation (APACHE) III score and the multiple organ dysfunction score (MODS), in the differentiation between survivors and nonsurvivors of systemic inflammatory response syndrome (SIRS). The study was performed in 95 patients over 16 years of age who met the criteria of SIRS. PCT and AKBR were assayed in arterial blood samples. The APACHE III score and MODS were recorded after the first 24 hours of surgical ICU (SICU) admission and then daily for two weeks or until either discharge or death. The patients were divided into two groups, survivors (n=71) and nonsurvivors (n=24), in accordance with the ICU outcome. They were also divided into three groups according to the trend of PCT level: declining, increasing or no change. Significant differences between survivors and nonsurvivors were found in APACHE III score and MODS throughout the study period, but in PCT value only up to the 7th day and in AKBR only up to the 3rd day. PCT values of the three groups were not significantly different on the first day between survivors and nonsurvivors. Receiver operating characteristic (ROC) curves for prediction of mortality by PCT, AKBR, APACHE III score and MODS were 0.690, 0.320, 0.915 and 0.913, respectively, on the admission day. In conclusion, PCT could have some use as a mortality predictor in SIRS patients but was less reliable than APACHE III score or MODS.

  11. Reliability of intensive care unit admitting and comorbid diagnoses, race, elements of Acute Physiology and Chronic Health Evaluation II score, and predicted probability of mortality in an electronic intensive care unit database.

    PubMed

    Wenner, Joshua B; Norena, Monica; Khan, Nadia; Palepu, Anita; Ayas, Najib T; Wong, Hubert; Dodek, Peter M

    2009-09-01

    Although reliability of severity of illness and predicted probability of hospital mortality have been assessed, interrater reliability of the abstraction of primary and other intensive care unit (ICU) admitting diagnoses and underlying comorbidities has not been studied. Patient data from one ICU were originally abstracted and entered into an electronic database by an ICU nurse. A research assistant reabstracted patient demographics, ICU admitting diagnoses and underlying comorbidities, and elements of Acute Physiology and Chronic Health Evaluation II (APACHE II) score from 100 random patients of 474 admitted during 2005 using an identical electronic database. Chamberlain's percent positive agreement was used to compare diagnoses and comorbidities between the 2 data abstractors. A kappa statistic was calculated for demographic variables, Glasgow Coma Score, APACHE II chronic health points, and HIV status. Intraclass correlation was calculated for acute physiology points and predicted probability of hospital mortality. Percent positive agreement for ICU primary and other admitting diagnoses ranged from 0% (primary brain injury) to 71% (sepsis), and for underlying comorbidities, from 40% (coronary artery bypass graft) to 100% (HIV). Agreement as measured by kappa statistic was strong for race (0.81) and age points (0.95), moderate for chronic health points (0.50) and HIV (0.66), and poor for Glasgow Coma Score (0.36). Intraclass correlation showed a moderate-high agreement for acute physiology points (0.88) and predicted probability of hospital mortality (0.71). Reliability for ICU diagnoses and elements of the APACHE II score is related to the objectivity of primary data in the medical charts.

  12. A Nonrandomized, Phase II Study of Sequential Irinotecan and Flavopiridol in Patients With Advanced Hepatocellular Carcinoma

    PubMed Central

    Ang, Celina; O'Reilly, Eileen M.; Carvajal, Richard D.; Capanu, Marinela; Gonen, Mithat; Doyle, Laurence; Ghossein, Ronald; Schwartz, Lawrence; Jacobs, Gria; Ma, Jennifer; Schwartz, Gary K.

    2012-01-01

    ABSTRACT BACKGROUND: Flavopiridol, a Cdk inhibitor, potentiates irinotecan-induced apoptosis. In a phase I trial of sequential irinotecan and flavopiridol, 2 patients with advanced hepatocellular carcinoma (HCC) had stable disease (SD) for ≥14 months. We thus studied the sequential combination of irinotecan and flavopiridol in patients with HCC. METHODS: Patients with advanced HCC naïve to systemic therapy, Child-Pugh ≤B8, and Karnofsky performance score (KPS) ≥70% received 100 mg/m2 irinotecan followed 7 hours later by flavopiridol 60 mg/m2 weekly for 4 of 6 weeks. The primary end point was an improvement in progression-free survival at 4 months (PFS-4) from 33% to 54%, using a Simon's two-stage design. Tumors were stained for p53. RESULTS: Only 16 patients in the first stage were enrolled: median age, 64 years; median KPS, 80%; Child-Pugh A, 87.5%; and stage III/IV, 25%/75%. The primary end point was not met; PFS-4 was 20%, leading to early termination of the study. Ten patients were evaluable for response: 1 had SD >1 year and 9 had disease progression. Grade 3 fatigue, dehydration, diarrhea, neutropenia with or without fever, lymphopenia, anemia, hyperbilirubinemia, and transaminitis occurred in ≥10% of the patients. Of the 9 patients who progressed, 5 had mutant p53 and 4 had wild-type p53. The patient with stable disease had wild-type p53. CONCLUSION: Sequential irinotecan and flavopiridol are ineffective and poorly tolerated in patients with advanced HCC. Despite our limited assessments, it is possible that the presence of wild-type p53 is necessary but not sufficient to predict response in HCC. PMID:23293699

  13. 34 CFR 303.321 - Evaluation of the child and assessment of the child and family.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES Child Find, Evaluations and Assessments, and... (a)(3)(i) of this section; and (ii) If the child is determined eligible as an infant or toddler with... needs of that infant or toddler. The assessments of the child and family are described in paragraph (c...

  14. 34 CFR 303.321 - Evaluation of the child and assessment of the child and family.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES Child Find, Evaluations and Assessments, and... (a)(3)(i) of this section; and (ii) If the child is determined eligible as an infant or toddler with... needs of that infant or toddler. The assessments of the child and family are described in paragraph (c...

  15. 34 CFR 303.321 - Evaluation of the child and assessment of the child and family.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES Child Find, Evaluations and Assessments, and... (a)(3)(i) of this section; and (ii) If the child is determined eligible as an infant or toddler with... needs of that infant or toddler. The assessments of the child and family are described in paragraph (c...

  16. Delayed child-bearing.

    PubMed

    Johnson, Jo-Ann; Tough, Suzanne

    2012-01-01

    compensate for age-related decline in fertility. (II-2A) 2. A fertility evaluation should be initiated after 6 months of unprotected intercourse without conception in women 35 to 37 years of age, and earlier in women > 37 years of age. (II-2A) 3. Prospective parents should be informed that semen quality and male fertility deteriorate with advancing age and that the risk of genetic disorders in offspring increases. (II-2A) 4. Women ≥ 35 years of age should be offered screening for fetal aneuploidy and undergo a detailed second trimester ultrasound examination to look for significant fetal birth defects (particularly cardiac defects). (II-1A) 5. Delayed child-bearing is associated with increased obstetrical and perinatal complications. Care providers need to be aware of these complications and adjust obstetrical management protocols to ensure optimal maternal and perinatal outcomes. (II-2A) 6. All adults of reproductive age should be aware of the obstetrical and perinatal risks of advanced maternal age so they can make informed decisions about the timing of child-bearing. (II-2A) 7. Strategies to improve informed decision-making by prospective parents should be designed, implemented, and evaluated. These strategies should provide opportunity for adults to understand the potential medical, social, and economic consequences of child-bearing throughout the reproductive years. (III-B) 8. Barriers to healthy reproduction, including workplace policies, should be reviewed to optimize the likelihood of healthy pregnancies. (III-C).

  17. Fungal Peritonitis: Underestimated Disease in Critically Ill Patients with Liver Cirrhosis and Spontaneous Peritonitis.

    PubMed

    Lahmer, Tobias; Brandl, Andreas; Rasch, Sebastian; Schmid, Roland M; Huber, Wolfgang

    2016-01-01

    Spontaneous peritonitis, especially spontaneous fungal peritonitis (SFP), is an important and potentially fatal complication in patients with endstage liver disaese. We evaluated potential risk factors, microbiological findings, and outcome of patients with SFP compared to spontaneous bacterial peritonitis (SBP) in critically ill patients. Retrospective analyses of critically ill patients with suspected spontaneous peritonitis. Out of 205 patients, 20 (10%) had SFP, 28 (14%) had SBP, 48 (24%) had peritonitis without microbiological findings (SP) and 109 (52%) had no-peritonitis (NP). APACHE II and SOFA score were significantly higher in patients with SFP (26; 22-28; p<0.004 and 16; 14-18; p<0.002), SBP (26; 22-28; p<0.004 and 16; 14-18; p<0.002) and SP (24; 18-30; p<0.045 and 14; 10-18; p<0.044) as compared to NP (22; 16-24 and 12; 10-14). CHILD Pugh classification was mainly CHILD C and MELD Score was in patients with SFP (34; 18-40; p<0.001), SBP (32;12-40 p<0.002) and SP (29; 14-40 p<0.003) significantly higher as compared to NP (25;8-40). Nosocomial peritonitis could be significantly more often found in patients with SFP (65%; p<0.023) and SBP (62%, p<0.030) as compared to SP (51 p = 0.243) and NP (45%). Antibiotic pretreatment last 3 month prior peritonitis was significantly more often in patients with SFP (85%; p<0.002), SBP (71%, p<0.033), and SP (56; p<0.040) as compared to NP (33%). Candida albicans (60%; 12/20) was the most common isolated fungus, followed by Candida glabrata (13%) and Candida krusei (13%). Mortality rate was significantly higher in patients with SFP (90%, p<0.001), followed by SBP (75%; p<0.001) and SP (69%; p<0.001) as compared to NP (45%). SFP is not a rare complication in end stage liver disease which is associated with increased mortality. Physicians should be aware of SFP in patients with CHILD C liver cirrhosis, elevated MELD score, antibiotic pretreatment and nosocomial peritonitis.

  18. Major clinical events, signs and severity assessment scores related to actual survival in patients who died from primary biliary cirrhosis. A long-term historical cohort study.

    PubMed

    van Dam, G M; Gips, C H; Reisman, Y; Maas, K W; Purmer, I M; Huizenga, J R; Verbaan, B W

    1999-01-01

    One of the prognostic methods for survival in primary biliary cirrhosis (PBC) is the Mayo model, with a time-scale limited to 7 years. The aim of our study was to assess how major clinical events, signs, several severity assessment methods and Mayo survival probabilities fit in with actual patient survival, by using yearly observations until 0.5 years before patient death from PBC. Data of 32 patients dying from PBC were collected prior to death at -0.5, -1, -2 etc. years (median: -5 years, range: -16 to -0.5 years). Major events registered were: first occurrence of ascites, upper gastrointestinal bleeding or manifest hepatic encephalopathy and signs, first observation of spider naevi or purpura. Severity assessment methods applied (all with scores and classes) were: Mayo (M), Child-Campbell (C), Pugh-Child (P), Pugh-Child-PBC (PP), 'Child-Pugh' (CP), and Ascites Nutritional State-Child (ANS). Fifty percent survival estimates were calculated from Mayo scores. Severity assessment method variables were: ascites (C, P, PP, CP, ANS), encephalopathy (C, P, PP, CP), nutritional state (C, ANS), edema (M), age (M), serum albumin (M, C, P, PP, CP), bilirubin (C, M, P, PP, CP), and prothrombin time (M, P, PP, CP). In 27 out of 32 patients a major event occurred, always between -6 and -0.5 years (median: -1 year) and, never between -16 and -7 years (p < 0.0001). A sign was first observed in 30/32 between -14 and -0.5 years (median: -2 years). Compared to the total population, a sign, and even more so, an event indicated a shorter survival (p = 0.004 and p = 0.0002, respectively). The median 50% estimated survival (predicted by the Mayo model) fitted the actual survival from -6 to -0.5 years (r = -0.7, p < 0.0001), but not from -16 to -7 years (r = -0.1, p = 0.4). All -6 to -0.5-year severity scores correlated (p < 0.0001) both with actual survival (M, C, P, PP, and CP r = 0.7; ANS r = 0.5) and with estimated M 50% survival (C, P, PP, CP r = -0.9; ANS r = -0.6; M score: -0

  19. Clinical Pharmacology of Delafloxacin in Patients With Hepatic Impairment.

    PubMed

    Hoover, Randall; Marbury, Thomas C; Preston, Richard A; Quintas, Megan; Lawrence, Laura E; Paulson, Susan K; Luke, David R; Cammarata, Sue K

    2017-03-01

    Delafloxacin is a novel anionic fluoroquinolone with robust activity against Gram-positive, Gram-negative, atypical, and anaerobic bacteria, including methicillin-resistant S aureus. Delafloxacin is currently being studied for the treatment of acute bacterial skin and skin structure infections and community-acquired pneumonia. This was a phase 1, open-label pharmacokinetic and safety study of a single intravenous dose of 300 mg delafloxacin in subjects with mild, moderate, and severe hepatic impairment (Child-Pugh class A, B, and C, respectively) compared with matched healthy controls. The effects of hepatic impairment were assessed by ANOVA of log-transformed values for AUC 0-∞ , C max , and systemic clearance, with hepatic group as a fixed effect. Mean AUC 0-∞ and C max in each impairment group were not significantly different from those of the pooled healthy subjects (P > 0.05). The 90% confidence interval (CI) of the percentage ratios of least-squares means of AUC 0-∞ did not indicate significant differences between the impairment groups and pooled healthy controls: Child-Pugh class A (mild) 114.4 (CI: 95.6, 137.0), Child-Pugh class B (moderate) 114.8 (CI: 95.9, 137.4), and Child-Pugh class C (severe) 115.1 (CI: 96.1, 137.8). A single IV infusion of delafloxacin was generally well tolerated in all treatment groups. The exposure and clearance of delafloxacin in subjects with mild, moderate, or severe hepatic impairment did not significantly differ from those of pooled, matched healthy subjects. Based on these pharmacokinetic data, dose adjustment of delafloxacin in the presence of hepatic impairment is not needed. © 2016, The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

  20. HATT: a phase IV, single-arm, open-label study of sorafenib in Taiwanese patients with advanced hepatocellular carcinoma.

    PubMed

    Lin, Shi-Ming; Lu, Sheng-Nan; Chen, Ping-Tsung; Jeng, Long-Bin; Chen, Shinn-Cherng; Hu, Chi-Tan; Yang, Sien-Sing; Le Berre, Marie-Aude; Liu, Xuan; Mitchell, David Y; Prins, Klaas; Grevel, Joachim; Peña, Carol A E; Meinhardt, Gerold

    2017-03-01

    Sorafenib significantly improves survival in patients with advanced hepatocellular carcinoma (HCC). This phase IV study assessed sorafenib efficacy/safety in Taiwanese patients with advanced HCC and Child-Pugh A status. All patients received 400 mg sorafenib BID. Safety, efficacy, sorafenib pharmacokinetics, and Child-Pugh progression were evaluated. A hand-foot skin reaction (HFSR) prevention substudy assessed HFSR incidence and grade/severity and time to HFSR in 29 and 34 patients randomized to corticosteroid and noncorticosteroid ointments, respectively, and in 88 nonrandomized patients. The 151 patients included 120 (80%) male patients and 81 (54%) with stage IV disease. Mean sorafenib dose was 626 mg/day, and median treatment duration was 4.2 months. Median overall survival (OS), progression-free survival, and time to progression (TTP) were 8.6, 2.7, and 3.8 months, respectively. Disease control and response rates (partial responses only) were 48 and 6.6%, respectively. Median TTP from Child-Pugh A to B/C was 88 days. Drug-related adverse events (AEs) occurred in 89.4% of patients; none were new or unexpected. The most frequent grade ≥3 drug-related, treatment-emergent AEs were HFSR (13.2%), diarrhea (11.9%), and hypertension (6.6%). Corticosteroid ointment tended to reduce the severity and incidence of all HFSR-associated parameters. Pharmacokinetic exposure was unaltered by Child-Pugh progression. The final pharmacokinetic model predicted 13.1 and 33.8% reductions in sorafenib exposure over 6 and 12 months, respectively. There was a trend of longer OS and TTP in Taiwanese patients with advanced HCC compared with patients with advanced HCC in the Asia-Pacific trial. Sorafenib exposure did not correlate with liver function. Reduced pharmacokinetic exposure over time was unrelated to reduced or interrupted dosing.

  1. Evaluation of Liver Function After Proton Beam Therapy for Hepatocellular Carcinoma

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mizumoto, Masashi; Okumura, Toshiyuki; Hashimoto, Takayuki

    Purpose: Our previous results for treatment of hepatocellular carcinoma with proton beam therapy (PBT) revealed excellent local control. In this study, we focused on the impact of PBT on normal liver function. Methods and Materials: The subjects were 259 patients treated with PBT at University of Tsukuba between January 2001 and December 2007. We evaluated the Child-Pugh score pretreatment, on the final day of PBT, and 6, 12, and 24 months after treatment with PBT. Patients who had disease progression or who died with tumor progression at each evaluation point were excluded from the analysis to rule out an effectmore » of tumor progression. An increase in the Child-Pugh score of 1 or more was defined as an adverse event. Results: Of the 259 patients, 241 had no disease progression on the final day of PBT, and 91 had no progression within 12 months after PBT. In univariate analysis, the percentage volumes of normal liver receiving at least 0, 10, 20, and 30 GyE in PBT (V0, 10, 20, and 30) were significantly associated with an increase of Child-Pugh score at 12 months after PBT. Of the 91 patients evaluated at 12 months, 66 had no increase of Child-Pugh score, 15 had a 1-point increase, and 10 had an increase of {>=}2 points. For the Youden index, the optimal cut-offs for V0, V10, V20, and V30 were 30%, 20%, 26%, and 18%, respectively. Conclusion: Our findings indicate that liver function after PBT is significantly related to the percentage volume of normal liver that is not irradiated. This suggests that further study of the relationship between liver function and PBT is required.« less

  2. "International Criminalisation and Child Welfare Protection": The Optional Protocol to the Convention on the Rights of the Child

    ERIC Educational Resources Information Center

    Buck, Trevor

    2008-01-01

    The Optional Protocol to the Convention on the Rights of the Child (CRC) on the Sale of Children, Child Prostitution and Child Pornography has two overall aims: (i) to strengthen international criminalisation and (ii) to provide welfare protection for child victims. This article reviews the context of the Protocol including the work of the Special…

  3. [Prevalence of protein-energy undernutrition evaluated by the measurement of triceps skinfold thickness and mid-arm muscle circumference of 103 adults with cirrhosis of the liver hospitalized in the department of hepatology and gastroenterology of the Lomé Campus University Hospital (Togo)].

    PubMed

    Kouassi, K; Bagny, A; Kaaga, L; Bouglouga, O; Lawson Anani-Soh, L; Lamboni, C; Redah, D

    2014-01-01

    To evaluate by a reliable method the protein-energy nutritional status of adults hospitalized in the hepatology and gastroenterology department of the Lomé Campus University Hospital. This cross-sectional prospective study conducted from March 1 to September 15, 2012, included 103 inpatients aged at least 16 years. The variables evaluated were: triceps skinfold thickness (TST), mid-arm muscle circumference (MAMC), serum albumin, CRP, and orosomucoid. The Child-Pugh classification was used to evaluate the clinical severity of liver disease. Within this population of patients with cirrhosis, 40 were alcohol-dependent (39.0%) and 85 had anorexia (82.5%); 49 were in group B of the Child-Pugh classification, and 37 in group C. We found a non-significant (p = 0.324) difference in TST measurement between the three Child-Pugh groups: A (8.4 ± 4.5); B (6.1 ± 3.7); and C (6.4 ± 7.2). The prevalence of protein-energy malnutrition ranged from 52.0% to 82.5%, when evaluated by MAMC or TST. Our results confirm the need to pay additional attention to the protein-energy nutritional status of inpatients in this department, by adding reliable tools, such as the TST and MAMC, to the biochemistry analysis to characterize undernutrition.

  4. LHCbDIRAC as Apache Mesos microservices

    NASA Astrophysics Data System (ADS)

    Haen, Christophe; Couturier, Benjamin

    2017-10-01

    The LHCb experiment relies on LHCbDIRAC, an extension of DIRAC, to drive its offline computing. This middleware provides a development framework and a complete set of components for building distributed computing systems. These components are currently installed and run on virtual machines (VM) or bare metal hardware. Due to the increased workload, high availability is becoming more and more important for the LHCbDIRAC services, and the current installation model is showing its limitations. Apache Mesos is a cluster manager which aims at abstracting heterogeneous physical resources on which various tasks can be distributed thanks to so called “frameworks” The Marathon framework is suitable for long running tasks such as the DIRAC services, while the Chronos framework meets the needs of cron-like tasks like the DIRAC agents. A combination of the service discovery tool Consul together with HAProxy allows to expose the running containers to the outside world while hiding their dynamic placements. Such an architecture brings a greater flexibility in the deployment of LHCbDirac services, allowing for easier deployment maintenance and scaling of services on demand (e..g LHCbDirac relies on 138 services and 116 agents). Higher reliability is also easier, as clustering is part of the toolset, which allows constraints on the location of the services. This paper describes the investigations carried out to package the LHCbDIRAC and DIRAC components into Docker containers and orchestrate them using the previously described set of tools.

  5. Developer Initiation and Social Interactions in OSS: A Case Study of the Apache Software Foundation

    DTIC Science & Technology

    2014-08-01

    public interaction with the Apache Pluto community is on the mailing list in August 2006: Hello all, I’am John from the University [...], we are...developing the Prototype for the JSR 286. I hope that we can discuss the code [...] we have made and then develop new code for Pluto together [...], referring...to his and some of his fellow student’s intentions to contribute to Pluto . John gets the attention of Pluto committers and is immediately welcomed as

  6. Constructing Flexible, Configurable, ETL Pipelines for the Analysis of "Big Data" with Apache OODT

    NASA Astrophysics Data System (ADS)

    Hart, A. F.; Mattmann, C. A.; Ramirez, P.; Verma, R.; Zimdars, P. A.; Park, S.; Estrada, A.; Sumarlidason, A.; Gil, Y.; Ratnakar, V.; Krum, D.; Phan, T.; Meena, A.

    2013-12-01

    A plethora of open source technologies for manipulating, transforming, querying, and visualizing 'big data' have blossomed and matured in the last few years, driven in large part by recognition of the tremendous value that can be derived by leveraging data mining and visualization techniques on large data sets. One facet of many of these tools is that input data must often be prepared into a particular format (e.g.: JSON, CSV), or loaded into a particular storage technology (e.g.: HDFS) before analysis can take place. This process, commonly known as Extract-Transform-Load, or ETL, often involves multiple well-defined steps that must be executed in a particular order, and the approach taken for a particular data set is generally sensitive to the quantity and quality of the input data, as well as the structure and complexity of the desired output. When working with very large, heterogeneous, unstructured or semi-structured data sets, automating the ETL process and monitoring its progress becomes increasingly important. Apache Object Oriented Data Technology (OODT) provides a suite of complementary data management components called the Process Control System (PCS) that can be connected together to form flexible ETL pipelines as well as browser-based user interfaces for monitoring and control of ongoing operations. The lightweight, metadata driven middleware layer can be wrapped around custom ETL workflow steps, which themselves can be implemented in any language. Once configured, it facilitates communication between workflow steps and supports execution of ETL pipelines across a distributed cluster of compute resources. As participants in a DARPA-funded effort to develop open source tools for large-scale data analysis, we utilized Apache OODT to rapidly construct custom ETL pipelines for a variety of very large data sets to prepare them for analysis and visualization applications. We feel that OODT, which is free and open source software available through the Apache

  7. An international, multicenter phase II trial of bortezomib in patients with hepatocellular carcinoma.

    PubMed

    Kim, George P; Mahoney, Michelle R; Szydlo, Daniel; Mok, Tony S K; Marshke, Robert; Holen, Kyle; Picus, Joel; Boyer, Michael; Pitot, Henry C; Rubin, Joseph; Philip, Philip A; Nowak, Anna; Wright, John J; Erlichman, Charles

    2012-02-01

    Bortezomib (PS-341, VELCADE®) is a selective inhibitor of the 26S proteasome, an integral component of the ubiquitin-proteasome pathway. This phase II study evaluated the activity and tolerability of bortezomib in unresectable hepatocellular carcinoma (HCC) patients. The primary endpoint was confirmed tumor response rate (RR) with secondary endpoints including duration of response, time to disease progression, survival and toxicity. Treatment consisted of bortezomib, 1.3 mg/m2 IV bolus on days 1, 4, 8, and 11 of each 21-day treatment cycle. Eligibility included: no prior systemic chemotherapy, ECOG PS 0-2, Child-Pugh A or B, preserved hematologic, hepatic and neurologic function; prior liver-directed therapy was permitted. Thirty-five patients enrolled and received a median of 2 cycles of treatment (range 1-12). Overall, 24 and 4 patients had a maximum severity of grade 3 and 4 adverse events (AEs), respectively. No treatment related deaths occurred. Only thrombocytopenia (11%) was seen in greater than 10% of patients. One patient achieved a partial response, lasting 13 weeks during treatment and progressed 11.6 months later; two patients received treatment for greater than 6 months. Median time-to-progression was 1.6 months and median survival was 6.0 months. This international, multicenter trial evaluated bortezomib as monotherapy in unresectable HCC patients. And, despite the lack of significant activity, this report serves as a baseline clinical experience for the development of future dual biologic approaches including bortezomib.

  8. VizieR Online Data Catalog: SNe type II from CSP-I, SDSS-II, and SNLS (de Jaeger+, 2017)

    NASA Astrophysics Data System (ADS)

    de Jaeger, T.; Gonzalez-Gaitan, S.; Hamuy, M.; Galbany, L.; Anderson, J. P.; Phillips, M. M.; Stritzinger, M. D.; Carlberg, R. G.; Sullivan, M.; Gutierrez, C. P.; Hook, I. M.; Howell, D. A.; Hsiao, E. Y.; Kuncarayakti, H.; Ruhlmann-Kleider, V.; Folatelli, G.; Pritchet, C.; Basa, S.

    2017-10-01

    The CSP-I (Carnegie Supernova Project-I) had guaranteed access to ~300 nights per year between 2004 and 2009 on the Swope 1m and du Pont 2.5m telescopes at the Las Campanas Observatory (LCO). This observation time allowed the CSP-I to obtain optical-band light curves for 67 SNe II. From the CSP-I sample, we remove six outliers. The SDSS-II SN Survey operated for three years, from 2005 September to 2007 November. Using the 2.5m telescope at the Apache Point Observatory in New Mexico. This survey observed about 80 spectroscopically confirmed core-collapse SNe but the main driver of this project was the study of SNe Ia, involving the acquisition of only one or two spectra per SNe II. The total SDSS-II SN sample is composed of 16 spectroscopically confirmed SNe II. The SNLS (Supernova Legacy Survey) was designed to discover SNe and to obtain photometric follow-up using the MegaCam imager on the 3.6m Canada-France-Hawaii Telescope. The observation strategy consisted of obtaining images of the same field every four nights over five years (between 2003 and 2008); thus, in total more than 470 nights were allocated to this project. The total SNLS sample is composed of 28 SNeII. See section 2 for further explanations on the data sample. (1 data file).

  9. Stromatolites of the Mescal Limestone (Apache Group, middle Proterozoic, central Arizona): taxonomy, biostratigraphy, and paleoenvironments

    NASA Technical Reports Server (NTRS)

    Bertrand-Sarfati, J.; Awramik, S. M.

    1992-01-01

    The 25- to 30-m-thick Algal Member of the Mescal Limestone (middle Proterozoic Apache Group) contains two distinct stromatolitic units: at the base, a 2- to 3-m-thick unit composed of columnar stromatolites and above, a thicker unit of stratiform and pseudocolumnar stromatolites. Columnar forms from the first unit belong to the Group Tungussia, and two new Forms are described: T. mescalita and T. chrysotila. Among the pseudocolumnar stromatolites of the thicker unit, one distinctive new taxon, Apachina henryi, is described. Because of the low stromatolite diversity, the biostratigraphic value of this assemblage is limited. The presence of Tungussia is consistent with the generally accepted isotopic age for the Apache Group of 1200 to 1100 Ma. The Mescal stromatolites do not closely resemble any other known Proterozoic stromatolites in the southwestern United States or northwestern Mexico. Analyses of sedimentary features and stromatolite growth forms suggest deposition on a stable, flat, shallow, subtidal protected platform during phases of Tungussia growth. Current action probably influenced the development of columns, pseudocolumns, and elongate stromatolitic ridges; these conditions alternated with phases of relatively quiet water characterized by nonoriented stromatolitic domes and stratiform stromatolites. Stable conditions favorable for development of the Mescal stromatolites were short-lived and did not permit the development of thick, stromatolite-bearing units such as those characteristic of many Proterozoic sequences elsewhere.

  10. Cloud Computing: A model Construct of Real-Time Monitoring for Big Dataset Analytics Using Apache Spark

    NASA Astrophysics Data System (ADS)

    Alkasem, Ameen; Liu, Hongwei; Zuo, Decheng; Algarash, Basheer

    2018-01-01

    The volume of data being collected, analyzed, and stored has exploded in recent years, in particular in relation to the activity on the cloud computing. While large-scale data processing, analysis, storage, and platform model such as cloud computing were previously and currently are increasingly. Today, the major challenge is it address how to monitor and control these massive amounts of data and perform analysis in real-time at scale. The traditional methods and model systems are unable to cope with these quantities of data in real-time. Here we present a new methodology for constructing a model for optimizing the performance of real-time monitoring of big datasets, which includes a machine learning algorithms and Apache Spark Streaming to accomplish fine-grained fault diagnosis and repair of big dataset. As a case study, we use the failure of Virtual Machines (VMs) to start-up. The methodology proposition ensures that the most sensible action is carried out during the procedure of fine-grained monitoring and generates the highest efficacy and cost-saving fault repair through three construction control steps: (I) data collection; (II) analysis engine and (III) decision engine. We found that running this novel methodology can save a considerate amount of time compared to the Hadoop model, without sacrificing the classification accuracy or optimization of performance. The accuracy of the proposed method (92.13%) is an improvement on traditional approaches.

  11. Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation.

    PubMed

    Gaba, Ron C; Couture, Patrick M; Bui, James T; Knuttinen, M Grace; Walzer, Natasha M; Kallwitz, Eric R; Berkes, Jamie L; Cotler, Scott J

    2013-03-01

    To compare the performance of various liver disease scoring systems in predicting early mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. In this single-institution retrospective study, eight scoring systems were used to grade liver disease in 211 patients (male-to-female ratio = 131:80; mean age, 54 y) before TIPS creation from 1999-2011. Scoring systems included bilirubin level, Child-Pugh (CP) score, Model for End-Stage Liver Disease (MELD) and Model for End-Stage Liver Disease sodium (MELD-Na) score, Emory score, prognostic index (PI), Acute Physiology and Chronic Health Evaluation (APACHE) 2 score, and Bonn TIPS early mortality (BOTEM) score. Medical record review was used to identify 30-day and 90-day clinical outcomes. The relationship of scoring parameters with mortality outcomes was assessed with multivariate analysis, and the relative ability of systems to predict mortality after TIPS creation was evaluated by comparing area under receiver operating characteristic (AUROC) curves. TIPS were successfully created for variceal hemorrhage (n = 121), ascites (n = 72), hepatic hydrothorax (n = 15), and portal vein thrombosis (n = 3). All scoring systems had a significant association with 30-day and 90-day mortality (P<.050 in each case) on multivariate analysis. Based on 30-day and 90-day AUROC, MELD (0.878, 0.816) and MELD-Na (0.863, 0.823) scores had the best capability to predict early mortality compared with bilirubin (0.786, 0.749), CP (0.822, 0.771), Emory (0.786, 0.681), PI (0.854, 0.760), APACHE 2 (0.836, 0.735), and BOTEM (0.798, 0.698), with statistical superiority over bilirubin, Emory, and BOTEM scores. Several liver disease scoring systems have prognostic value for early mortality after TIPS creation. MELD and MELD-Na scores most effectively predict survival after TIPS creation. Copyright © 2013. Published by Elsevier Inc.

  12. Precise Gravity Measurements for Lunar Laser Ranging at Apache Point Observatory

    NASA Astrophysics Data System (ADS)

    Crossley, D. J.; Murphy, T.; Boy, J.; De Linage, C.; Wheeler, R. D.; Krauterbluth, K.

    2012-12-01

    Lunar Laser Ranging (LLR) at Apache Point Observatory began in 2006 under the APOLLO project using a 3.5 m telescope on a 2780 m summit in New Mexico. Recent improvements in the technical operations are producing uncertainties at the few-mm level in the 1.5 x 10^13 cm separation of the solar orbits of the Earth and Moon. This level of sensitivity permits a number of important aspects of gravitational theory to be tested. Among these is the Equivalence Principle that determines the universality of free fall, tests of the time variation of the Gravitational Constant G, deviations from the inverse square law, and preferred frame effects. In 2009 APOLLO installed a superconducting gravimeter (SG) on the concrete pier under the main telescope to further constrain the deformation of the site as part of an initiative to improve all aspects of the modeling process. We have analyzed more than 3 years of high quality SG data that provides unmatched accuracy in determining the local tidal gravimetric factors for the solid Earth and ocean tide loading. With on-site gravity we have direct measurements of signals such as polar motion, and can compute global atmospheric and hydrological loading for the site using GLDAS and local hydrology models that are compared with the SG observations. We also compare the SG residuals with satellite estimates of seasonal ground gravity variations from the GRACE mission. Apache Point is visited regularly by a team from the National Geospatial-Intelligence Agency to provide absolute gravity values for the calibration of the SG and to determine secular gravity changes. Nearby GPS location P027 provides continuous position information from the Plate Boundary Observatory of Earthscope that is used to correlate gravity/height variations at the site. Unusual aspects of the data processing include corrections for the telescope azimuth that appear as small offsets at the 1 μGal level and can be removed by correlating the azimuth data with the SG

  13. Teacher-Child Relationships as Dynamic Systems

    ERIC Educational Resources Information Center

    O'Connor, Erin

    2010-01-01

    The purpose of the present study was to examine factors associated with the quality of the teacher-child relationship from first through fifth grade using data from phases I, II and III of the National Institutes of Child Health and Human Development Study of Early Child Care and Youth Development, a prospective study of 1364 children from birth…

  14. [The present level of post-traumatic stress symptoms in a sample of child survivors of World War II].

    PubMed

    Lis-Turlejska, Maja; Szumiał, Szymon; Okuniewska, Hanna

    2012-01-01

    The aim of the study was to estimate the prevalence of PTSD and level of symptoms more broadly considered as post-traumatic e.g. depression among Polish child survivors of World War II. Data were collected from 218 individuals aged 63-78. a list of questions regarding exposure to a range of war related traumas; PDS (Foa, 1995); IES (Horowitz et al., 1976) to measure PTSD symptoms and BDI (Beck et al., 1961) for depression symptoms. Exposure to potentially traumatic events related to the WWII varied from 1.83% to 47.25%. The prevalence of PTSD symptoms at a diagnostic level according to PDS was 29.4%. The mean values B, C and D-category symptoms were respectively: 2.08 (SD=1.74), 2.34 (SD=1.98) and 2.40 (SD=1.69). Greater age, parental loss and exposure to at least one traumatic war-related event (this variable was close to the level of statistical significance, however) were all predictors of a diagnostic level of PTSD symptoms. 60 years after WW II about one-third of respondents manifest a clinical level of PTSD symptoms. Taking into consideration the results of the research on the child survivors of the modern wars, psychosocial and cultural factors should also be examined as causes of this phenomenon.

  15. An Investigation of Multiple Unmanned Aircraft Systems Control from the Cockpit of an AH-64 Apache Helicopter

    DTIC Science & Technology

    2014-12-01

    An Investigation of Multiple Unmanned Aircraft Systems Control from the Cockpit of an AH-64 Apache Helicopter by Jamison S Hicks and David B...estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense , Washington...infantrymen, aircraft pilots, or dedicated UAS ground control station (GCS) operators. The purpose of the UAS is to allow for longer and more discrete

  16. [The correlation between procalcitonin, C-reactive protein and severity scores in patients with sepsis and their value in assessment of prognosis].

    PubMed

    Wang, Shengyun; Chen, Dechang

    2015-02-01

    To investigate the correlation between procalcitonin (PCT), C-reactive protein (CRP) and acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score, and to investigate the value in assessment of PCT and CRP in prognosis in patients with sepsis. Clinical data of patients admitted to intensive care unit (ICU) of Changzheng Hospital Affiliated to the Second Military Medical University from January 2011 to June 2014 were retrospectively analyzed. 201 sepsis patients who received PCT and CRP tests, and evaluation of APACHE II score and SOFA score were enrolled. The values of PCT, CRP, APACHE II score and SOFA score between survivals (n = 136) and non-survivals (n = 65) were compared. The values of PCT and CRP among groups with different APACHE II scores and SOFA scores were compared. The relationships between PCT, CRP and APACHE II score and SOFA score were analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was plotted to assess the prognostic value of PCT and CRP for prognosis of patients with sepsis. Compared with survival group, the values of PCT [μg/L: 11.03 (19.17) vs. 1.39 (2.61), Z = -4.572, P < 0.001], APACHE II score (19.16±5.32 vs. 10.01±3.88, t = -13.807, P < 0.001) and SOFA score (9.66±4.28 vs. 4.27±3.19, t = -9.993, P < 0.001) in non-survival group were significantly increased, but the value of CRP was not significantly different between non-survival group and survival group [mg/L: 75.22 (110.94) vs. 56.93 (100.75), Z = -0.731, P = 0.665]. The values of PCT were significantly correlated with APACHE II score and SOFA score (r1 = 0.373, r2 = 0.392, both P < 0.001), but the values of CRP were not significantly correlated with APACHE II score and SOFA score (r1 = -0.073, P1 = 0.411; r2 = -0.106, P2 = 0.282). The values of PCT rose significantly as the APACHE II score and SOFA score became higher, but the value of CRP was not significantly increased. When

  17. Restoration of Rio Grande cutthroat trout Oncorhynchus clarkii virginalis to the Mescalero Apache Reservation

    USGS Publications Warehouse

    Kalb, Bradley W.; Caldwell, Colleen A.

    2014-01-01

    Rio Grande Cutthroat trout Oncorhynchus clarkii virginalis (RGCT) represents the most southern subspecies of cutthroat trout, endemic to Rio Grande, Canadian, and Pecos basins of New Mexico and southern Colorado. The subspecies currently occupies less than 12% of its historic range. The Mescalero Apache Tribe has partnered with U.S. Geological Survey-New Mexico Cooperative Fish and Wildlife Research Unit, New Mexico State University, U.S. Fish and Wildlife Service, and New Mexico Department of Game and Fish to meet mutually shared goals of restoring and maintaining a Pecos strain of RGCT to Tribal lands. The goal of this project was to assess the suitability of the Rio Ruidoso within the Mescalero Apache Reservation to support a self-sustaining RGCT population by conducting a systematic and comprehensive survey. We conducted three surveys (fall 2010, spring 2011 and 2012) to characterize water quality, macroinvertebrate assemblages, fish communities, and physical habitat (stream size, channel gradient, channel substrate, habitat complexity, riparian vegetation cover and structure, migration barriers to movement).Seven-100 m reaches throughout three major tributaries of the Rio Ruidoso within the Tribal lands were sampled during baseflow conditions October 2010, May 2011, and June 2012. Despite the onset of severe drought in 2011, water quality, physical habitat, and fish populations revealed that the Rio Ruidoso and its three tributaries would most likely support a self-sustaining RGCT population. Pools were abundant (mean, 8.9 pools/100 m), instream woody debris was present (range, 3.8-45.6 pieces/100 m), and instream dataloggers revealed daily maximum stream temperatures rarely exceeded criteria established in New Mexico for coldwater fishes, however, presence of frazil and anchor ice may limit fish distribution in the winter. Aquatic macroinvertebrate samples revealed a community of benthic invertebrates reflective of high quality cool to cold water. Overall

  18. Vitamin D deficiency is a risk factor for infections in patients affected by HCV-related liver cirrhosis.

    PubMed

    Buonomo, Antonio Riccardo; Zappulo, Emanuela; Scotto, Riccardo; Pinchera, Biagio; Perruolo, Giuseppe; Formisano, Pietro; Borgia, Guglielmo; Gentile, Ivan

    2017-10-01

    To evaluate the prevalence of vitamin D deficiency and its impact on infections in HCV-related liver cirrhosis. We enrolled 291 patients affected by HCV-related liver cirrhosis. Serum vitamin D levels were dosed at enrolment. The presence of infection was assessed at baseline and during follow-up based on physical examination and laboratory analyses. Vitamin D deficiency (<20ng/mL) was diagnosed in 68.3% of patients, and a total of 102 infections were detected. Urinary tract infections were the most common infections diagnosed (41.2%). Vitamin D deficiency rates were higher in patients with decompensated cirrhosis (Child-Pugh B vs A p=0.008, and Child-Pugh C vs A p=0.024). Infection was significantly associated with vitamin D deficiency (p<0.001), MELD score >15 (p=0.003), Child-Pugh class B/C vs A (p<0.001), and active hepatocellular carcinoma (HCC) (p<0.001). At multivariate analysis, vitamin D deficiency (p<0.01), HCC (p<0.05), hospitalization (p<0.001) and exposure to immunosuppressant agents (p<0.05) were independent risk factors for infection at baseline. Vitamin D may play a role in the development of infections in patients affected by liver cirrhosis, and preventive strategies with vitamin D supplementation are to be evaluated in randomized controlled trials. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  19. Correlation of serum liver fibrosis markers with severity of liver dysfunction in liver cirrhosis: a retrospective cross-sectional study

    PubMed Central

    Zhu, Cuihong; Qi, Xingshun; Li, Hongyu; Peng, Ying; Dai, Junna; Chen, Jiang; Xia, Chunlian; Hou, Yue; Zhang, Wenwen; Guo, Xiaozhong

    2015-01-01

    Hyaluronic acid (HA), laminin (LN), amino-terminal pro-peptide of type III pro-collagen (PIIINP), and collagen IV (CIV) are four major serum markers of liver fibrosis. This retrospective cross-sectional study aimed to evaluate the correlations of the four serum markers with the severity of liver dysfunction in cirrhotic patients. Between January 2013 and June 2014, a total of 228 patients with a clinical diagnosis with liver cirrhosis and without malignancy underwent the tests of HA, LN, PIIINP, and CIV levels. Laboratory data were collected. Child-Pugh and model for the end-stage of liver diseases (MELD) scores were calculated. Of them, 32%, 40%, and 18% had Child-Pugh class A, B, and C, respectively. MELD score was 7.58±0.50. HA (coefficient r: 0.1612, P=0.0203), LN (coefficient r: 0.2445, P=0.0004), and CIV (coefficient r: 0.2361, P=0.0006) levels significantly correlated with Child-Pugh score, but not PIIINP level. Additionally, LN (coefficient r: 0.2588, P=0.0002) and CIV (coefficient r: 0.1795, P=0.0108) levels significantly correlated with MELD score, but not HA or PIIINP level. In conclusions, HA, LN, and CIV levels might be positively associated with the severity of liver dysfunction in cirrhotic patients. However, given a relatively weak correlation between them, our findings should be cautiously interpreted and further validated. PMID:26131195

  20. Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation.

    PubMed

    Vulcano, Daniela Salate Biagioni; Carvalhaes, Maria Antonieta de Barros Leite; Bakonyi Neto, Alexandre

    2013-10-01

    Malnutrition is prevalent in patients with advanced liver disease (LD) related to multifactorial causes. Fluid retention can underestimate the nutritional status based on anthropometric measures. We evaluated nutritional indicators and body composition (BC) in patients with liver cirrhosis and correlated them with LD severity. Forty three patients with LD enrolled for liver transplantation were evaluated by Anthropometric measures, subjective evaluation (Global Assessment of Nutritional Status - SGA) and biochemical indicators. Single-frequency electrical bioimpedance (SFE-BIA) was used to evaluate body composition (BC). It measured resistance (R), reactance (Xc) and the phase angle (PA). LD severity was estimated by Child-Pugh and Meld criteria (Model for End-Stage Liver Disease). Child-Pugh index between patients was 7.11 ± 1.70 and Meld was 12.23 ± 4.22. Arm Circumference, Arm Muscle Circumference and Arm Muscle Area, SGA, hemoglobin, hematocrit and albumin showed better correlation with disease severity. Xc and PA showed correlation both with Meld and Child-Pugh score when BC were evaluated. PA was depleted in 55.8% of the patients. Diagnosis of malnutrition varied according to the method. Global assessment of nutritional status showed better correlation with disease severity than with objective methods. Single-frequency electrical bioimpedance for body composition analysis in cirrhotic patients must be cautiously used; however, primary vectors seems to be valid and promising in clinical practice.

  1. Confluent hepatic fibrosis in liver cirrhosis: possible relation with middle hepatic venous drainage.

    PubMed

    Ozaki, Kumi; Matsui, Osamu; Gabata, Toshifumi; Kobayashi, Satoshi; Koda, Wataru; Minami, Tetsuya

    2013-08-01

    Our aim was to retrospectively analyze the location of confluent hepatic fibrosis in relation to the portal and hepatic venous anatomy using multidetector computed tomography (CT) and to clarify the influence of the hepatic venous drainage on confluent fibrosis. The study population consisted of 879 patients diagnosed with cirrhosis: 539 men and 340 women (65.9 ± 10.6 years) and 633 with Child-Pugh class A, 161 with class B, and 85 with class C. The cause of cirrhosis was hepatitis C (n = 528) and hepatitis B (n = 122) virus infection, alcoholism (n = 114), and others (n = 115). The confluent fibrosis was diagnosed using CT images according to previous reports and statistically analyzed (p < 0.05). Thirty-five confluent fibrosis lesions in 30 patients (3.4 %) were identified. The predictive factors were alcoholic cirrhosis [odds ratio (OR), 7.25; p < 0.0001], Child-Pugh class C (OR, 6.95; p < 0.0001), and Child-Pugh class B (OR, 2.91; p < 0.0023). Confluent fibrosis was most frequently seen in the middle hepatic venous drainage area (n = 21) or at the boundary between the medial and anterior segments (n = 17), and each distribution of the location of confluent fibrosis was significantly unequal (p < 0.0001). Confluent fibrosis was most commonly located in the middle hepatic venous drainage area.

  2. The value of grip test, lysophosphatidlycholines, glycerophosphocholine, ornithine, glucuronic acid decrement in assessment of nutritional and metabolic characteristics in hepatitis B cirrhosis

    PubMed Central

    Zhang, Lei; Xiao, Huijuan; Qi, Yumei; Liu, Shuye; Qian, Baoxin; Wang, Fengmei; Han, Tao

    2017-01-01

    The liver is essential for the regulation of energy, protein and amino acids, as well as in other aspects of metabolism. To identify efficient indexes for evaluation of nutritional status and metabolic characteristics during different Child-Pugh stages of hepatitis B cirrhosis, 83 patients and 35 healthy individuals were enrolled in our study. We found that grip strength, triceps skinfold thickness (TSF), body fat and skeletal muscle of the patients were reduced compared to the control group (P<0.05). Ultra-high-performance liquid chromatography data combined with mass spectrometry (UPLC-MS) showed that levels of a variety of metabolites, including lysophosphatidylcholines (LysoPCs), glycerophosphocholine, ornithine and glucuronic acid were reduced in the serum of patients with hepatitis B cirrhosis (P<0.001). However, glycerophosphoserine and taurocholic acid levels were higher than in the control group (P<0.001). Moreover, grip strength was correlated with the Child-Pugh score (P<0.05). Serum albumin, total cholesterol, LDL, LysoPCs, glycerophosphocholine, ornithine, glucuronic acid, glycerophosphoserine and taurocholic acid were correlated with the Child-Pugh score (P<0.01). These findings suggested that grip strength and the above small molecular substances might be considered as sensitive and important indexes for evaluating nutritional status and metabolic characteristics of patients with hepatitis B cirrhosis, which may help assess prognosis and adjust nutritional treatment. PMID:28384211

  3. Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers.

    PubMed

    Noda, Yoshifumi; Goshima, Satoshi; Kajita, Kimihiro; Kawada, Hiroshi; Kawai, Nobuyuki; Koyasu, Hiromi; Matsuo, Masayuki; Bae, Kyongtae T

    2016-11-01

    To evaluate the association between gadoxetic-acid-enhanced magnetic resonance (MR) imaging measurements and laboratory and clinical biomarkers of liver function and fibrosis. One hundred thirty nine consecutive patients with suspected liver disease or liver tumor underwent gadoxetic-acid-enhanced MR imaging. MR imaging measurements during the hepatobiliary phase included biliary tract structure-to-muscle signal intensity ratio (SIR). These measurements were compared with Child-Pugh classification, end-stage liver disease (MELD) score, and aspartate aminotransferase-to-platelet ratio index (APRI). The SIRs of cystic duct and common bile duct were significantly correlated with Child-Pugh classification (P=0.012 for cystic duct and P<0.0001 for common bile duct), MELD score (P=0.0016 and P=0.0033), and APRI (P=0.0022 and P=0.0015). The sensitivity, specificity, and area under the receiver-operating-characteristic curve were: (74%, 88%, 0.86) with the SIR of common bile duct for the detection of patients with Child-Pugh class B or C; (100%, 87%, 0.94) with the SIR of cystic duct for MELD score (>10); (65%, 76%, 0.70) with the SIR of common bile duct for APRI (>1.5). Gadoxetic-acid contrast enhancement of cystic duct and common bile duct could be used as biomarkers to assess liver function. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Correlation of nitric oxide and other free radicals with the severity of acute pancreatitis and complicated systemic inflammatory response syndrome.

    PubMed

    Que, Ri-sheng; Cao, Li-ping; Ding, Guo-ping; Hu, Jun-an; Mao, Ke-jie; Wang, Gui-feng

    2010-05-01

    To investigate the correlation of nitric oxide (NO) and other free radicals with the severity of acute pancreatitis (AP) and complicated systemic inflammatory response syndrome (SIRS). Fifty AP patients (24 simple AP patients and 26 patients with AP complicated by SIRS) were involved in the study. Fifty healthy volunteers were included as controls. Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were evaluated, and plasma NO, plasma lipid peroxides, plasma vitamin E, plasma beta-carotene, whole-blood glutathione (GSH), and the activity of plasma GSH peroxidase were measured. Compared with the control group, the APACHE II scores heightened in the AP group, and the SIRS group had the highest APACHE II scores (P < 0.005, P < 0.001, respectively). Plasma NO and plasma lipid peroxides increased with the heightening APACHE II scores, demonstrating a significant linear positive correlation (r = 0.618, r = 0.577, respectively; P < 0.001). Plasma vitamin E, plasma beta-carotene, whole-blood GSH, and the activity of plasma GSH peroxidase decreased with the heightening APACHE II scores, demonstrating a significant linear negative correlation (r = -0.600, r = -0.609, r = -0.559, r = -0.592, respectively; P < 0.001). Nitric oxide and other free radicals take part in the aggravation of oxidative stress and oxidative injury and may play important roles in the pathogenesis of AP and SIRS. It may be valuable to measure free radicals to predict the severity of AP.

  5. Small Bowel Transit and Altered Gut Microbiota in Patients With Liver Cirrhosis.

    PubMed

    Liu, Yang; Jin, Ye; Li, Jun; Zhao, Lei; Li, Zhengtian; Xu, Jun; Zhao, Fuya; Feng, Jing; Chen, Huinan; Fang, Chengyuan; Shilpakar, Rojina; Wei, Yunwei

    2018-01-01

    Disturbance of the gut microbiota is common in liver cirrhosis (LC) patients, the underlying mechanisms of which are yet to be unfolded. This study aims to explore the relationship between small bowel transit (SBT) and gut microbiota in LC patients. Cross-sectional design was applied with 36 LC patients and 20 healthy controls (HCs). The gut microbiota was characterized by 16S rRNA gene sequencing. The Firmicutes/Bacteroidetes (F/B) ratio and the Microbial Dysbiosis index (MDI) were used to evaluate the severity of microbiota dysbiosis. The scintigraphy method was performed in patients to describe the objective values of SBT. Patients were then subdivided according to the Child-Pugh score (threshold = 5) or SBT value (threshold = 0.6) for microbiota analysis. LC patients were characterized by an altered gut microbiota; F/B ratios and MDI were higher than HC in both Child_5 (14.00 ± 14.69 vs. 2.86 ± 0.99, p < 0.01; 0.49 ± 0.80 vs. -0.47 ± 0.69, p < 0.01) and Child_5+ (15.81 ± 15.11 vs. 2.86±0.99, p < 0.01; 1.11 ± 1.05 vs. -0.47 ± 0.69, p < 0.01) sub-groups in patients. Difference in the gut microbiota between Child_ 5 and Child_5+ patients was inappreciable, but the SBT was relatively slower in Child_5+ patients (43 ± 26% vs. 80 ± 15%, p < 0.05). Compared with the Child-Pugh score indicators, SBT showed stronger associations with bacterial genera. A clear difference in the gut microbiota was observed between SBT_0.6- and SBT_0.6+ patients [Pr(> F ) = 0.0068, pMANOVA], with higher F/B ratios and MDI in SBT_0.6- patients (19.71 ± 16.62 vs. 7.33 ± 6.65, p < 0.01; 1.02 ± 0.97 vs. 0.20 ± 0.58, p < 0.01). Similar results were observed between the SBT_0.6- and SBT_0.6+ sub-groups of patients with normal liver function and a Child-Pugh score of 5. SBT was negatively correlated with both the F/B ratio and MDI ( r = -0.34, p < 0.05; r = -0.38, p < 0.05). Interestingly, an increased capacity for the inferred pathway "bacterial invasion of epithelial cells" in

  6. Dual-sugar tests of small intestinal permeability are poor predictors of bacterial infections and mortality in cirrhosis: A prospective study.

    PubMed

    Vogt, Anika; Reuken, Philipp A; Stengel, Sven; Stallmach, Andreas; Bruns, Tony

    2016-03-21

    To prospectively analyze the impact of increased intestinal permeability (IP) on mortality and the occurrence of infections in patients with cirrhosis. IP was quantified using the lactulose/mannitol (L/M) test in 46 hospitalized patients with cirrhosis (25 Child-Pugh A/B, 21 Child-Pugh C) and in 16 healthy controls. Markers of inflammation [LPS-binding protein, Interleukin-6 (IL-6)] and enterocyte death [intestinal fatty-acid binding protein (I-FABP)] were determined in serum using enzyme-linked immunosorbent assays. Patients were followed for one year and assessed for survival, liver transplantation, the necessity of hospitalization and the occurrence of bacterial infections. The primary endpoint of the study was defined as differences in survival between patients with pathological and without pathological lactulose/mannitol test. Thirty-nine (85%) patients with cirrhosis had a pathologically increased IP index (L/M ratio > 0.07) compared to 4 (25%) healthy controls (P < 0.0001). The IP index correlated with the Child-Pugh score (r = 0.484, P = 0.001) and with serum IL-6 (r = 0.342, P = 0.02). Within one year, nineteen (41%) patients developed a total of 33 episodes of hospitalization with bacterial or fungal infections. Although patients who developed spontaneous bacterial peritonitis (SBP) (n = 7) had a higher IP index than patients who did not (0.27 vs 0.14, P = 0.018), the baseline IP index did not predict time to infection, infection-free survival or overall survival, neither when assessed as linear variable, as tertiles, nor dichotomized using an established cut-off. In contrast, model for end-stage liver disease score, Child-Pugh score, the presence of ascites, serum IL-6 and I-FABP were univariate predictors of infection-free survival. Although increased IP is a frequent phenomenon in advanced cirrhosis and may predispose to SBP, it failed to predict infection-free and overall survival in this prospective cohort study.

  7. Handbook of Child Language Acquisition.

    ERIC Educational Resources Information Center

    Ritchie, William C., Ed.; Bhatia, Tej K., Ed.

    This volume provides a comprehensive overview of the major areas of research in the field of child language acquisition. It is divided into seven parts and 19 chapters. Part I is an introduction and overview. Part II covers central issues in the study of child language acquisition, focusing on syntax, including those of innateness, maturation, and…

  8. Update on Astrometric Follow-Up at Apache Point Observatory by Adler Planetarium

    NASA Astrophysics Data System (ADS)

    Nault, Kristie A.; Brucker, Melissa; Hammergren, Mark

    2016-10-01

    We began our NEO astrometric follow-up and characterization program in 2014 Q4 using about 500 hours of observing time per year with the Astrophysical Research Consortium (ARC) 3.5m telescope at Apache Point Observatory (APO). Our observing is split into 2 hour blocks approximately every other night for astrometry (this poster) and several half-nights per month for spectroscopy (see poster by M. Hammergren et al.) and light curve studies.For astrometry, we use the ARC Telescope Imaging Camera (ARCTIC) with an SDSS r filter, in 2 hour observing blocks centered around midnight. ARCTIC has a magnitude limit of V~23 in 60s, and we target 20 NEOs per session. ARCTIC has a FOV 1.57 times larger and a readout time half as long as the previous imager, SPIcam, which we used from 2014 Q4 through 2015 Q3. Targets are selected primarily from the Minor Planet Center's (MPC) NEO Confirmation Page (NEOCP), and NEA Observation Planning Aid; we also refer to JPL's What's Observable page, the Spaceguard Priority List and Faint NEOs List, and requests from other observers. To quickly adapt to changing weather and seeing conditions, we create faint, midrange, and bright target lists. Detected NEOs are measured with Astrometrica and internal software, and the astrometry is reported to the MPC.As of June 19, 2016, we have targeted 2264 NEOs, 1955 with provisional designations, 1582 of which were detected. We began observing NEOCP asteroids on January 30, 2016, and have targeted 309, 207 of which were detected. In addition, we serendipitously observed 281 moving objects, 201 of which were identified as previously known objects.This work is based on observations obtained with the Apache Point Observatory 3.5m telescope, which is owned and operated by the Astrophysical Research Consortium. We gratefully acknowledge support from NASA NEOO award NNX14AL17G and thank the University of Chicago Department of Astronomy and Astrophysics for observing time in 2014.

  9. Child Care Is Good Business: An Agenda for Fort Wayne.

    ERIC Educational Resources Information Center

    Van Leuven, Patricia O'Brien

    Background information and recommendations related to the support of child care services in Fort Wayne, Indiana is presented in six chapters. Chapter I discusses the feminization of the workforce and demographic data bearing on the need for child care, the child care workforce, and child care arrangements. Chapter II reviews child care services in…

  10. Outcrop Analysis of the Cretaceous Mesaverde Group: Jicarilla Apache Reservation, New Mexico

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ridgley, Jennie; Dunbar, Robin Wright

    2001-04-24

    Field work for this project was conducted during July and April 1998, at which time fourteen measured sections were described and correlated on or adjacent to Jicarilla Apache Reservation lands. A fifteenth section, described east of the main field area, is included in this report, although its distant location precluded use in the correlations and cross sections presented herein. Ground-based photo mosaics were shot for much of the exposed Mesaverde outcrop belt and were used to assist in correlation. Outcrop gamma-ray surveys at six of the fifteen measured sections using a GAD-6 scintillometer was conducted. The raw gamma-ray data aremore » included in this report, however, analysis of those data is part of the ongoing Phase Two of this project.« less

  11. Significance of blood pressure variability in patients with sepsis.

    PubMed

    Pandey, Nishant Raj; Bian, Yu-Yao; Shou, Song-Tao

    2014-01-01

    This study was undertaken to observe the characteristics of blood pressure variability (BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis. Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis. In patients with APACHE II score>19, the values of systolic blood pressure (SBPV), diasystolic blood pressure (DBPV), non-dipper percentage, cortisol (COR), lactate (LAC), platelet count (PLT) and glucose (GLU) were significantly higher than in those with APACHE II score ≤19 (P<0.05), whereas the values of procalcitonin (PCT), white blood cell (WBC), creatinine (Cr), PaO2, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH) and tumor necrosis factor α (TNF-α) were not statistically significant (P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV (P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR (P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT (P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve (ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively. The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.

  12. An international, multicenter phase II trial of bortezomib in patients with hepatocellular carcinoma

    PubMed Central

    Kim, George P.; Mahoney, Michelle R.; Szydlo, Daniel; Mok, Tony S. K.; Marshke, Robert; Holen, Kyle; Picus, Joel; Boyer, Michael; Pitot, Henry C.; Rubin, Joseph; Philip, Philip A.; Nowak, Anna; Wright, John J.; Erlichman, Charles

    2013-01-01

    Summary Background and Rationale Bortezomib (PS-341, VELCADE®) is a selective inhibitor of the 26S proteasome, an integral component of the ubiquitinproteasome pathway. This phase II study evaluated the activity and tolerability of bortezomib in unresectable hepatocellular carcinoma (HCC) patients. Methods The primary endpoint was confirmed tumor response rate (RR) with secondary endpoints including duration of response, time to disease progression, survival and toxicity. Treatment consisted of bortezomib, 1.3 mg/m2 IV bolus on days 1, 4, 8, and 11 of each 21-day treatment cycle. Eligibility included: no prior systemic chemotherapy, ECOG PS 0-2, Child-Pugh A or B, preserved hematologic, hepatic and neurologic function; prior liver-directed therapy was permitted. Results Thirty-five patients enrolled and received a median of 2 cycles of treatment (range 1–12). Overall, 24 and 4 patients had a maximum severity of grade 3 and 4 adverse events (AEs), respectively. No treatment related deaths occurred. Only thrombocytopenia (11%) was seen in greater than 10% of patients. One patient achieved a partial response, lasting 13 weeks during treatment and progressed 11.6 months later; two patients received treatment for greater than 6 months. Median time-to-progression was 1.6 months and median survival was 6.0 months. Conclusions This international, multicenter trial evaluated bortezomib as monotherapy in unresectable HCC patients. And, despite the lack of significant activity, this report serves as a baseline clinical experience for the development of future dual biologic approaches including bortezomib. PMID:20839030

  13. Building Child Friendly Cities in the MENA Region

    ERIC Educational Resources Information Center

    Nour, Osman El Hassan N.

    2013-01-01

    The notion of Child Friendly Cities (CFCs) was first developed during the Second United Nations Conference on Human Settlements (HABITAT II), held in Istanbul in 1996. The concept is based on four general principles of the United Nations "Convention on the rights of the child": (1) fair treatment of every child, regardless of ethnicity,…

  14. Sorafenib Tosylate and Pembrolizumab in Treating Patients With Advanced or Metastatic Liver Cancer

    ClinicalTrials.gov

    2018-06-04

    Advanced Adult Hepatocellular Carcinoma; Child-Pugh Class A; Stage III Hepatocellular Carcinoma; Stage IIIA Hepatocellular Carcinoma; Stage IIIB Hepatocellular Carcinoma; Stage IIIC Hepatocellular Carcinoma; Stage IV Hepatocellular Carcinoma; Stage IVA Hepatocellular Carcinoma; Stage IVB Hepatocellular Carcinoma

  15. Next Generation Astronomical Data Processing using Big Data Technologies from the Apache Software Foundation

    NASA Astrophysics Data System (ADS)

    Mattmann, Chris

    2014-04-01

    In this era of exascale instruments for astronomy we must naturally develop next generation capabilities for the unprecedented data volume and velocity that will arrive due to the veracity of these ground-based sensor and observatories. Integrating scientific algorithms stewarded by scientific groups unobtrusively and rapidly; intelligently selecting data movement technologies; making use of cloud computing for storage and processing; and automatically extracting text and metadata and science from any type of file are all needed capabilities in this exciting time. Our group at NASA JPL has promoted the use of open source data management technologies available from the Apache Software Foundation (ASF) in pursuit of constructing next generation data management and processing systems for astronomical instruments including the Expanded Very Large Array (EVLA) in Socorro, NM and the Atacama Large Milimetre/Sub Milimetre Array (ALMA); as well as for the KAT-7 project led by SKA South Africa as a precursor to the full MeerKAT telescope. In addition we are funded currently by the National Science Foundation in the US to work with MIT Haystack Observatory and the University of Cambridge in the UK to construct a Radio Array of Portable Interferometric Devices (RAPID) that will undoubtedly draw from the rich technology advances underway. NASA JPL is investing in a strategic initiative for Big Data that is pulling in these capabilities and technologies for astronomical instruments and also for Earth science remote sensing. In this talk I will describe the above collaborative efforts underway and point to solutions in open source from the Apache Software Foundation that can be deployed and used today and that are already bringing our teams and projects benefits. I will describe how others can take advantage of our experience and point towards future application and contribution of these tools.

  16. Extraction of UMLS® Concepts Using Apache cTAKES™ for German Language.

    PubMed

    Becker, Matthias; Böckmann, Britta

    2016-01-01

    Automatic information extraction of medical concepts and classification with semantic standards from medical reports is useful for standardization and for clinical research. This paper presents an approach for an UMLS concept extraction with a customized natural language processing pipeline for German clinical notes using Apache cTAKES. The objectives are, to test the natural language processing tool for German language if it is suitable to identify UMLS concepts and map these with SNOMED-CT. The German UMLS database and German OpenNLP models extended the natural language processing pipeline, so the pipeline can normalize to domain ontologies such as SNOMED-CT using the German concepts. For testing, the ShARe/CLEF eHealth 2013 training dataset translated into German was used. The implemented algorithms are tested with a set of 199 German reports, obtaining a result of average 0.36 F1 measure without German stemming, pre- and post-processing of the reports.

  17. Thromboelastometry

    PubMed Central

    Dumitrescu, Gabriel; Januszkiewicz, Anna; Ågren, Anna; Magnusson, Maria; Wahlin, Staffan; Wernerman, Jan

    2017-01-01

    Abstract The severity of liver disease is assessed by scoring systems, which include the conventional coagulation test prothrombin time-the international normalized ratio (PT-INR). However, PT-INR is not predictive of bleeding in liver disease and thromboelastometry (ROTEM) has been suggested to give a better overview of the coagulation system in these patients. It has now been suggested that coagulation as reflected by tromboelastomety may also be used for prognostic purposes. The objective of our study was to investigate whether thrombelastometry may discriminate the degree of liver insufficiency according to the scoring systems Child Pugh and Model for End-stage Liver Disease (MELD). Forty patients with chronic liver disease of different etiologies and stages were included in this observational cross-sectional study. The severity of liver disease was evaluated using the Child-Pugh score and the MELD score, and blood samples for biochemistry, conventional coagulation tests, and ROTEM were collected at the time of the final assessment for liver transplantation. Statistical comparisons for the studied parameters with scores of severity were made using Spearman correlation test and receiver-operating characteristic (ROC) curves. Spearman correlation coefficients indicated that the thromboelastometric parameters did not correlate with Child-Pugh or MELD scores. The ROC curves of the thromboelastometric parameters could not differentiate advanced stages from early stages of liver cirrhosis. Standard ROTEM cannot discriminate the stage of chronic liver disease in patients with severe chronic liver disease. PMID:28591054

  18. Balloon-Occluded Antegrade Transvenous Sclerotherapy to Treat Rectal Varices: A Direct Puncture Approach to the Superior Rectal Vein Through the Greater Sciatic Foramen Under CT Fluoroscopy Guidance

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ono, Yasuyuki, E-mail: onoyasy@hirakata.kmu.ac.jp; Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp

    Rectal varices occur in 44.5 % of patients with ectopic varices caused by portal hypertension, and 48.6 % of these patients are untreated and followed by observation. However, bleeding occurs in 38 % and shock leading to death in 5 % of such patients. Two patients, an 80-year-old woman undergoing treatment for primary biliary cirrhosis (Child-Pugh class A) and a 63-year-old man with class C hepatic cirrhosis (Child-Pugh class A), in whom balloon-occluded antegrade transvenous sclerotherapy was performed to treat rectal varices are reported. A catheter was inserted by directly puncturing the rectal vein percutaneously through the greater sciatic foramen under computed tomographic fluoroscopymore » guidance. In both cases, the rectal varices were successfully treated without any significant complications, with no bleeding from rectal varices after embolization.« less

  19. Which maternal personality traits affect child behaviour during dental treatment.

    PubMed

    Arpaci, A H; Işik, B; Cura, N; Kaplan, B; Bozkurt, P

    2016-09-01

    Maternal personality traits affect child dental behaviour and have a potential link with dental treatment methods. This study aims to evaluate which maternal personality traits affect child dental behaviour. Research was carried out upon 60 children aged between 3-12 years, who had been admitted to our clinic for tooth extraction. All children were evaluated by means of the Frankl Behavior Scale (FBS): degrees I and II represent negative behaviours, while III and IV positive behaviour. Thirty children with FBS degree III and IV were assigned to Group I and 30 children with FBS degree I and II were assigned to Group II. Children in Group I underwent tooth extraction with local anaesthesia. Children in Group II underwent tooth extraction under deep sedation. During the first visit, the mothers were tested with the Minnesota Multiphasic Personality Inventory to evaluate personality traits. All mothers in Group I and half the mothers in Group II filled a complete and valid test. Group I and II mothers were compared according to the test results: scores of the Minnesota Multiphasic Personality Inventory (MMPI) test were significantly higher in Group II (p<0.05). We hypotetise that character features of mothers of children with negative dental behaviour and positive dental behaviour are different and affect child dental behaviour.

  20. [Diagnostic value of integral scoring systems in assessing the severity of acute pancreatitis and patient's condition].

    PubMed

    Vinnik, Y S; Dunaevskaya, S S; Antufrieva, D A

    2015-01-01

    The aim of the study was to evaluate the diagnostic value of specific and nonspecific scoring systems Tolstoy-Krasnogorov score, Ranson, BISAP, Glasgow, MODS 2, APACHE II and CTSI, which used at urgent pancreatology for estimation the severity of acute pancreatitis and status of patient. 1550 case reports of patients which had inpatient surgical treatment at Road clinical hospital at the station Krasnoyarsk from 2009 till 2013 were analyzed. Diagnosis of severe acute pancreatitis and its complications were determined based on anamnestic data, physical exami- nation, clinical indexes, ultrasonic examination and computed tomography angiography. Specific and nonspecific scores (scoring system of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow, BISAP, MODS 2, APACHE II, CTSI) were used for estimation the severity of acute pancreatitis and patient's general condition. Effectiveness of these scoring systems was determined based on some parameters: accuracy (Ac), sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Most valuables score for estimation of acute pancreatitis's severity is BISAP (Se--98.10%), for estimation of organ failure--MODS 2 (Sp--100%, PPV--100%) and APACHE II (Sp--100%, PPV--100%), for detection of pancreatonecrosis sings--CTSI (Sp--100%, NPV--100%), for estimation of need for intensive care--MODS 2 (Sp--100%, PPV--100%, NPV--96.29%) and APACHE II (Sp--100%, PPV--100%, NPV--97.21%), for prediction of lethality--MODS 2 (Se-- 100%, Sp--98.14%, NPV--100%) and APACHE II (Se--95.00%, NPV-.99.86%). Most effective scores for estimation of acute pancreatitis's severity are Score of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow and BISAP Scoring systems MODS 2, APACHE I high specificity and positive predictive value allow using it at clinical practice.

  1. The Psychohistory of Child Maltreatment Among Antebellum Slaveholders: Part II.

    PubMed

    Adams, Kenneth Alan

    2017-01-01

    In the psychohistory of the antebellum South, the extent of child abuse in slaveholder families is important for understanding how members of the southern elite were reared and the extent to which they were infected with the toxic residue of their elders’ passions and rages. It is argued that the Old South was a developing region, rather than an already developed one. Consequently, the rate of child abuse that is characteristic of contemporary postindustrial societies is not the proper paradigm for conceptualizing the abuse rate in slaveholder families. It is proposed instead that the rate of child abuse in contemporary developing societies is a better fit for estimating abuse in the antebellum South. Societal and familial variables impinging on the abuse of slaveholder children—corporal punishment, alcohol consumption, hyper-masculinity, a traumatogenic culture of violence, wife abuse, maternal ambivalence and neglect, miscegenation and incest are discussed, as is the likelihood of maltreatment by slaves. Using a study of child abuse across 28 nations, tentative rates of abuse are proposed.

  2. Controlled Antenatal Thyroid Screening II: effect of treating maternal sub-optimal thyroid function on child cognition.

    PubMed

    Hales, Charlotte; Taylor, Peter N; Channon, Sue; Paradice, Ruth; McEwan, Kirsten; Zhang, Lei; Gyedu, Michael; Bakhsh, Ameen; Okosieme, Onyebuchi; Muller, Ilaria; Draman, Mohd S; Gregory, John W; Dayan, Colin; Lazarus, John H; Rees, D Aled; Ludgate, Marian

    2018-01-15

    The Controlled Antenatal Thyroid Screening (CATS) study investigated treatment for suboptimal gestational thyroid function (SGTF) on childhood cognition and found no difference in IQ at 3 years between children of treated and untreated SGTF mothers. We have measured IQ in the same children at age 9.5-years and included children from normal-GTF mothers. One examiner, blinded to participant group, assessed children's IQ (WISC-IV), long-term memory and motor function (NEPSY-II) from children of 119 treated and 98 untreated SGTF mothers plus children of 232 mothers with normal-GTF. Logistic regression explored the odds and percentages of IQ<85 in the groups. There was no difference in IQ<85 between children of mothers with normal-GTF and combined SGTF i.e. treated and untreated (fully adjusted OR=1.15 (95% CI 0.52, 2.51) p=0.731). Furthermore, there was no significant effect of treatment (untreated OR=1.33 (95% CI 0.53, 3.34), treated OR=0.75 (95% CI 0.27, 2.06) p=0.576). IQ< 85 was 6.03% in normal-GTF, 7.56% in treated and 11.22% in untreated groups. Analyses accounting for treated-SGTF women with FT4 >97.5th centile of the entire CATS-I cohort revealed no significant effect on child's IQ<85 in CATS-II. IQ at age 3 predicted IQ at age 9.5 (p<0.0001) and accounted for 45% of the variation. Maternal thyroxine during pregnancy did not improve child cognition at age 9.5 years. Our findings confirmed CATS-I and suggest that the lack of treatment effect may be due to the similar proportion of IQ<85 in children of women with normal-GTF and SGTF. Copyright © 2018 Endocrine Society

  3. A phase II and biomarker study of ramucirumab, a human monoclonal antibody targeting the VEGF receptor-2, as first-line monotherapy in patients with advanced hepatocellular cancer.

    PubMed

    Zhu, Andrew X; Finn, Richard S; Mulcahy, Mary; Gurtler, Jayne; Sun, Weijing; Schwartz, Jonathan D; Dalal, Rita P; Joshi, Adarsh; Hozak, Rebecca R; Xu, Yihuan; Ancukiewicz, Marek; Jain, Rakesh K; Nugent, Francis W; Duda, Dan G; Stuart, Keith

    2013-12-01

    To assess the efficacy and safety of the anti-VEGF receptor-2 (VEGFR-2) antibody ramucirumab as first-line therapy in patients with advanced hepatocellular carcinoma and explore potential circulating biomarkers. Adults with advanced hepatocellular carcinoma and no prior systemic treatment received ramucirumab 8 mg/kg every two weeks until disease progression or limiting toxicity. The primary endpoint was progression-free survival (PFS); secondary endpoints included objective response rate (ORR) and overall survival (OS). Circulating biomarkers were evaluated before and after ramucirumab treatment in a subset of patients. Forty-two patients received ramucirumab. Median PFS was 4.0 months [95% confidence interval (CI), 2.6-5.7], ORR was 9.5% (95% CI, 2.7-22.6; 4/42 patients had a partial response), and median OS was 12.0 months (95% CI, 6.1-19.7). For patients with Barcelona Clinic Liver Cancer (BCLC) stage C disease, median OS was 4.4 months (95% CI, 0.5-9.0) for patients with Child-Pugh B cirrhosis versus 18.0 months (95% CI, 6.1-23.5) for patients with Child-Pugh A cirrhosis. Treatment-related grade ≥ 3 toxicities included hypertension (14%), gastrointestinal hemorrhage and infusion-related reactions (7% each), and fatigue (5%). There was one treatment-related death (gastrointestinal hemorrhage). After treatment with ramucirumab, there was an increase in serum VEGF and placental growth factor (PlGF) and a transient decrease in soluble VEGFR-2. Ramucirumab monotherapy may confer anticancer activity in advanced hepatocellular carcinoma with an acceptable safety profile. Exploratory biomarker studies showed changes in circulating VEGF, PlGF, and sVEGFR-2 that are consistent with those seen with other anti-VEGF agents. ©2013 AACR.

  4. Development and validation of a blade-element mathematical model for the AH-64A Apache helicopter

    NASA Technical Reports Server (NTRS)

    Mansur, M. Hossein

    1995-01-01

    A high-fidelity blade-element mathematical model for the AH-64A Apache Advanced Attack Helicopter has been developed by the Aeroflightdynamics Directorate of the U.S. Army's Aviation and Troop Command (ATCOM) at Ames Research Center. The model is based on the McDonnell Douglas Helicopter Systems' (MDHS) Fly Real Time (FLYRT) model of the AH-64A (acquired under contract) which was modified in-house and augmented with a blade-element-type main-rotor module. This report describes, in detail, the development of the rotor module, and presents some results of an extensive validation effort.

  5. Readings in Child Development: Causes of Behavior.

    ERIC Educational Resources Information Center

    Rosenblith, Judy F., Ed.; And Others

    This volume is intended for use in college courses that combine educational psychology with child and adolescent psychology or human development. Section I, an introductory chapter presents selective groups of readings in the field of child developmental theory. Sections II through X each deal with one of the explanations of behavior that have…

  6. Pediatric CLIF-SOFA score is the best predictor of 28-day mortality in children with decompensated chronic liver disease.

    PubMed

    Bolia, Rishi; Srivastava, Anshu; Yachha, Surender Kumar; Poddar, Ujjal

    2018-03-01

    Early identification of children with decompensated chronic liver disease (DCLD) at risk of short-term mortality helps improve outcome. We aimed to evaluate the predictors of outcome and role of Child-Pugh, pediatric end-stage liver disease (PELD) and pediatric chronic liver failure sequential organ failure assessment (pCLIF-SOFA) score for prognosticating 28-day mortality in children with DCLD. DCLD children were prospectively evaluated with a clinico-laboratory proforma and followed for 28 days to determine outcome. Child-Pugh, PELD and pCLIF-SOFA were calculated at admission. Univariate and multivariate analysis was performed to identify the best predictors of outcome. A total of 110 children (74 boys, 96 [4-204] months) were enrolled and 37 (33.6%) died at 28 days. Significant risk factors for mortality were a higher international normalized ratio (hazard ratio [HR] 1.17; 95% CI 1.04-1.31; p <0.001) and bilirubin (HR 1.04; 95% CI 1.01-1.08; p <0.001), lower albumin (HR 0.46; 95% CI 0.27-0.77; p = 0.03) and sodium (HR 0.93; 95% CI 0.89-0.98; p = 0.01), absence of treatable etiology (HR 2.00; 95% CI 1.40-2.87; p = 0.001) and presence of organ failure (HR 3.22; 95% CI 1.98-10.58; p <0.001). Organ failure and serum sodium were independent predictors of poor outcome on multivariate analysis. pCLIF-SOFA (16 [9-22] vs. 9 [5-15]), Child-Pugh (11 [9-15] vs. 10 [8-14]) and PELD (22.2 [7.5-45.3] vs. 15.3 [4.5-23.9]) scores were significantly higher in non-survivors. The area under the curve was 0.977 for pCLIF-SOFA, 0.815 for Child-Pugh score, and 0.741 for PELD score. A pCLIF-SOFA score of ≥11 identified 28-day mortality with a sensitivity and specificity of 94.9% and 91.5%, respectively. Thirty-four percent of children with DCLD have a poor short-term outcome. Organ failure and low serum sodium are independent predictors of outcome. pCLIF-SOFA performs better than Child-Pugh and PELD in prognostication of 28-day mortality. Our study supports the

  7. 76 FR 22921 - Child Labor, Forced Labor, and Forced or Indentured Child Labor in the Production of Goods in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-25

    ... Production of Goods in Foreign Countries and Efforts by Certain Countries to Eliminate the Worst Forms of... eliminate the worst forms of child labor.'' Title II of the TDA and the TDA Conference Report, Joint... ``[w]hether the country has implemented its commitments to eliminate the worst forms of child labor as...

  8. The Apache Point Observatory Galactic Evolution Experiment (APOGEE)

    NASA Astrophysics Data System (ADS)

    Majewski, Steven R.; Schiavon, Ricardo P.; Frinchaboy, Peter M.; Allende Prieto, Carlos; Barkhouser, Robert; Bizyaev, Dmitry; Blank, Basil; Brunner, Sophia; Burton, Adam; Carrera, Ricardo; Chojnowski, S. Drew; Cunha, Kátia; Epstein, Courtney; Fitzgerald, Greg; García Pérez, Ana E.; Hearty, Fred R.; Henderson, Chuck; Holtzman, Jon A.; Johnson, Jennifer A.; Lam, Charles R.; Lawler, James E.; Maseman, Paul; Mészáros, Szabolcs; Nelson, Matthew; Nguyen, Duy Coung; Nidever, David L.; Pinsonneault, Marc; Shetrone, Matthew; Smee, Stephen; Smith, Verne V.; Stolberg, Todd; Skrutskie, Michael F.; Walker, Eric; Wilson, John C.; Zasowski, Gail; Anders, Friedrich; Basu, Sarbani; Beland, Stephane; Blanton, Michael R.; Bovy, Jo; Brownstein, Joel R.; Carlberg, Joleen; Chaplin, William; Chiappini, Cristina; Eisenstein, Daniel J.; Elsworth, Yvonne; Feuillet, Diane; Fleming, Scott W.; Galbraith-Frew, Jessica; García, Rafael A.; García-Hernández, D. Aníbal; Gillespie, Bruce A.; Girardi, Léo; Gunn, James E.; Hasselquist, Sten; Hayden, Michael R.; Hekker, Saskia; Ivans, Inese; Kinemuchi, Karen; Klaene, Mark; Mahadevan, Suvrath; Mathur, Savita; Mosser, Benoît; Muna, Demitri; Munn, Jeffrey A.; Nichol, Robert C.; O'Connell, Robert W.; Parejko, John K.; Robin, A. C.; Rocha-Pinto, Helio; Schultheis, Matthias; Serenelli, Aldo M.; Shane, Neville; Silva Aguirre, Victor; Sobeck, Jennifer S.; Thompson, Benjamin; Troup, Nicholas W.; Weinberg, David H.; Zamora, Olga

    2017-09-01

    The Apache Point Observatory Galactic Evolution Experiment (APOGEE), one of the programs in the Sloan Digital Sky Survey III (SDSS-III), has now completed its systematic, homogeneous spectroscopic survey sampling all major populations of the Milky Way. After a three-year observing campaign on the Sloan 2.5 m Telescope, APOGEE has collected a half million high-resolution (R ˜ 22,500), high signal-to-noise ratio (>100), infrared (1.51-1.70 μm) spectra for 146,000 stars, with time series information via repeat visits to most of these stars. This paper describes the motivations for the survey and its overall design—hardware, field placement, target selection, operations—and gives an overview of these aspects as well as the data reduction, analysis, and products. An index is also given to the complement of technical papers that describe various critical survey components in detail. Finally, we discuss the achieved survey performance and illustrate the variety of potential uses of the data products by way of a number of science demonstrations, which span from time series analysis of stellar spectral variations and radial velocity variations from stellar companions, to spatial maps of kinematics, metallicity, and abundance patterns across the Galaxy and as a function of age, to new views of the interstellar medium, the chemistry of star clusters, and the discovery of rare stellar species. As part of SDSS-III Data Release 12 and later releases, all of the APOGEE data products are publicly available.

  9. Enabling Automated Graph-based Search for the Identification and Characterization of Mesoscale Convective Complexes in Satellite Datasets through Integration with the Apache Open Climate Workbench

    NASA Astrophysics Data System (ADS)

    McGibbney, L. J.; Whitehall, K. D.; Mattmann, C. A.; Goodale, C. E.; Joyce, M.; Ramirez, P.; Zimdars, P.

    2014-12-01

    We detail how Apache Open Climate Workbench (OCW) (recently open sourced by NASA JPL) was adapted to facilitate an ongoing study of Mesoscale Convective Complexes (MCCs) in West Africa and their contributions within the weather-climate continuum as it relates to climate variability. More than 400 MCCs occur annually over various locations on the globe. In West Africa, approximately one-fifth of that total occur during the summer months (June-November) alone and are estimated to contribute more than 50% of the seasonal rainfall amounts. Furthermore, in general the non-discriminatory socio-economic geospatial distribution of these features correlates with currently and projected densely populated locations. As such, the convective nature of MCCs raises questions regarding their seasonal variability and frequency in current and future climates, amongst others. However, in spite of the formal observation criteria of these features in 1980, these questions have remained comprehensively unanswered because of the untimely and subjective methods for identifying and characterizing MCCs due to limitations data-handling limitations. The main outcome of this work therefore documents how a graph-based search algorithm was implemented on top of the OCW stack with the ultimate goal of improving fully automated end-to-end identification and characterization of MCCs in high resolution observational datasets. Apache OCW as an open source project was demonstrated from inception and we display how it was again utilized to advance understanding and knowledge within the above domain. The project was born out of refactored code donated by NASA JPL from the Earth science community's Regional Climate Model Evaluation System (RCMES), a joint project between the Joint Institute for Regional Earth System Science and Engineering (JIFRESSE), and a scientific collaboration between the University of California at Los Angeles (UCLA) and NASA JPL. The Apache OCW project was then integrated back

  10. The Child Abusing Family: II. Child and Child-Rearing Variables, Environmental Factors and Typologies of Abusing Families.

    ERIC Educational Resources Information Center

    Berger, Audrey M.

    1980-01-01

    Characteristics such as prematurity, illegitimacy, handicaps, or behavior deviations have been found with high frequency in abused children. Aggressive/coercive behavior may be typical of child rearing techniques in abusing families who tend to be socially isolated and experience environmental stress. Investigators must interpret such factors with…

  11. Statement of Hubert Velarde, Jicarilla Apache Tribe to United States Commission on Civil Rights at Albuquerque Convention Center (Albuquerque, New Mexico, November 14, 1972).

    ERIC Educational Resources Information Center

    Velarde, Hubert

    The statement by the President of the Jicarilla Apache Tribe emphasizes reservation problems that need to be examined. Presented at a 1972 Civil Rights Commission hearing on Indian Concerns, Velarde's statement listed employment, education, the administration of justice, water rights, and medical services as areas for investigation. (KM)

  12. C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis.

    PubMed

    Huang, Si-Si; Xie, Dong-Mei; Cai, Yi-Jing; Wu, Jian-Min; Chen, Rui-Chong; Wang, Xiao-Dong; Song, Mei; Zheng, Ming-Hua; Wang, Yu-Qun; Lin, Zhuo; Shi, Ke-Qing

    2017-04-01

    Hepatitis B virus (HBV) infection remains a major health problem and HBV-related-decompensated cirrhosis (HBV-DC) usually leads to a poor prognosis. Our aim was to determine the utility of inflammatory biomarkers in predicting mortality of HBV-DC. A total of 329 HBV-DC patients were enrolled. Survival estimates for the entire study population were generated using the Kaplan-Meier method. The prognostic values for model for end-stage liver disease (MELD) score, Child-Pugh score, and inflammatory biomarkers neutrophil/lymphocyte ratio, C-reactive protein-to-albumin ratio (CAR), and lymphocyte-to-monocyte ratio (LMR) for HBV-DC were compared using time-dependent receiver operating characteristic curves and time-dependent decision curves. The survival time was 23.1±15.8 months. Multivariate analysis identified age, CAR, LMR, and platelet count as prognostic independent risk factors. Kaplan-Meier analysis indicated that CAR of at least 1.0 (hazard ratio, 7.19; 95% confidence interval, 4.69-11.03), and LMR less than 1.9 (hazard ratio, 2.40; 95% confidence interval, 1.69-3.41) were independently associated with mortality of HBV-DC. The time-dependent receiver operating characteristic indicated that CAR showed the best performance in predicting mortality of HBV-DC compared with LMR, MELD score, and Child-Pugh score. The results were also confirmed by time-dependent decision curves. CAR and LMR were associated with the prognosis of HBV-DC. CAR was superior to LMR, MELD score, and Child-Pugh score in HBV-DC mortality prediction.

  13. [Predicting very early rebleeding after acute variceal bleeding based in classification and regression tree analysis (CRTA).].

    PubMed

    Altamirano, J; Augustin, S; Muntaner, L; Zapata, L; González-Angulo, A; Martínez, B; Flores-Arroyo, A; Camargo, L; Genescá, J

    2010-01-01

    Variceal bleeding (VB) is the main cause of death among cirrhotic patients. About 30-50% of early rebleeding is encountered few days after the acute episode of VB. It is necessary to stratify patients with high risk of very early rebleeding (VER) for more aggressive therapies. However, there are few and incompletely understood prognostic models for this purpose. To determine the risk factors associated with VER after an acute VB. Assessment and comparison of a novel prognostic model generated by Classification and Regression Tree Analysis (CART) with classic-used models (MELD and Child-Pugh [CP]). Sixty consecutive cirrhotic patients with acute variceal bleeding. CART analysis, MELD and Child-Pugh scores were performed at admission. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of the models. Very early rebleeding rate was 13%. Variables associated with VER were: serum albumin (p = 0.027), creatinine (p = 0.021) and transfused blood units in the first 24 hrs (p = 0.05). The area under the ROC for MELD, CHILD-Pugh and CART were 0.46, 0.50 and 0.82, respectively. The value of cut analyzed by CART for the significant variables were: 1) Albumin 2.85 mg/dL, 2) Packed red cells 2 units and 3) Creatinine 1.65 mg/dL the ABC-ROC. Serum albumin, creatinine and number of transfused blood units were associated with VER. A simple CART algorithm combining these variables allows an accurate predictive assessment of VER after acute variceal bleeding. Key words: cirrhosis, variceal bleeding, esophageal varices, prognosis, portal hypertension.

  14. Factors associated with pulmonary dysfunction in patients undergoing coronary artery bypass graft surgery with use of intra-aortic balloon pump.

    PubMed

    Amaral Gonçalves Fusatto, Helena; Castilho de Figueiredo, Luciana; Ragonete Dos Anjos Agostini, Ana Paula; Sibinelli, Melissa; Dragosavac, Desanka

    2018-01-01

    The aim of this study was to identify pulmonary dysfunction and factors associated with prolonged mechanical ventilation, hospital stay, weaning failure and mortality in patients undergoing coronary artery bypass grafting with use of intra-aortic balloon pump (IABP). This observational study analyzed respiratory, surgical, clinical and demographic variables and related them to outcomes. We analyzed 39 patients with a mean age of 61.2 years. Pulmonary dysfunction, characterized by mildly impaired gas exchange, was present from the immediate postoperative period to the third postoperative day. Mechanical ventilation time was influenced by the use of IABP and PaO2/FiO2, female gender and smoking. Intensive care unit (ICU) stay was influenced by APACHE II score and use of IABP. Mortality was strongly influenced by APACHE II score, followed by weaning failure. Pulmonary dysfunction was present from the first to the third postoperative day. Mechanical ventilation time was influenced by female gender, smoking, duration of IABP use and PaO2/FiO2 on the first postoperative day. ICU stay was influenced by APACHE II score and duration of IABP. Mortality was influenced by APACHE II score, followed by weaning failure. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Triage of patients with acute gastrointestinal bleeding for intensive care unit admission based on risk factors for poor outcome.

    PubMed

    Afessa, B

    2000-04-01

    This study's aim was to determine the prognostic factors and to develop a triage system for intensive care unit (ICU) admission of patients with gastrointestinal bleeding (GIB). This prospective, observational study included 411 adults consecutively hospitalized for GIB. Each patient's selected clinical findings and laboratory values at presentation were obtained. The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated from the initial findings in the emergency department. Poor outcome was defined as recurrent GIB, emergency surgery, or death. The role of hepatic cirrhosis, APACHE II score, active GIB, end-organ dysfunction, and hypotension in predicting outcome was evaluated. Chi-square, Student's t, Mann-Whitney U, and logistic regression analysis tests were used for statistical comparisons. Poor outcome developed in 81 (20%) patients; 39 died, 23 underwent emergency surgery, and 47 rebled. End-organ dysfunction, active bleeding, hepatic cirrhosis, and high APACHE II scores were independent predictors of poor outcome with odds ratios of 3:1, 3:1, 2:3, and 1:1, respectively. The ICU admission rate was 37%. High APACHE II score, active bleeding, end-organ dysfunction, and hepatic cirrhosis are independent predictors of poor outcome in patients with GIB and can be used in the triage of these patients for ICU admission.

  16. The Apache Point Observatory Galactic Evolution Experiment (APOGEE)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Majewski, Steven R.; Brunner, Sophia; Burton, Adam

    2017-09-01

    The Apache Point Observatory Galactic Evolution Experiment (APOGEE), one of the programs in the Sloan Digital Sky Survey III (SDSS-III), has now completed its systematic, homogeneous spectroscopic survey sampling all major populations of the Milky Way. After a three-year observing campaign on the Sloan 2.5 m Telescope, APOGEE has collected a half million high-resolution ( R  ∼ 22,500), high signal-to-noise ratio (>100), infrared (1.51–1.70 μ m) spectra for 146,000 stars, with time series information via repeat visits to most of these stars. This paper describes the motivations for the survey and its overall design—hardware, field placement, target selection, operations—and gives anmore » overview of these aspects as well as the data reduction, analysis, and products. An index is also given to the complement of technical papers that describe various critical survey components in detail. Finally, we discuss the achieved survey performance and illustrate the variety of potential uses of the data products by way of a number of science demonstrations, which span from time series analysis of stellar spectral variations and radial velocity variations from stellar companions, to spatial maps of kinematics, metallicity, and abundance patterns across the Galaxy and as a function of age, to new views of the interstellar medium, the chemistry of star clusters, and the discovery of rare stellar species. As part of SDSS-III Data Release 12 and later releases, all of the APOGEE data products are publicly available.« less

  17. Building a Snow Data System on the Apache OODT Open Technology Stack

    NASA Astrophysics Data System (ADS)

    Goodale, C. E.; Painter, T. H.; Mattmann, C. A.; Hart, A. F.; Ramirez, P.; Zimdars, P.; Bryant, A. C.; Snow Data System Team

    2011-12-01

    Snow cover and its melt dominate regional climate and hydrology in many of the world's mountainous regions. One-sixth of Earth's population depends on snow- or glacier-melt for water resources. Operationally, seasonal forecasts of snowmelt-generated streamflow are leveraged through empirical relations based on past snowmelt periods. These historical data show that climate is changing, but the changes reduce the reliability of the empirical relations. Therefore optimal future management of snowmelt derived water resources will require explicit physical models driven by remotely sensed snow property data. Toward this goal, the Snow Optics Laboratory at the Jet Propulsion Laboratory has initiated a near real-time processing pipeline to generate and publish post-processed snow data products within a few hours of satellite acquisition. To solve this challenge, a Scientific Data Management and Processing System was required and the JPL Team leveraged an open-source project called Object Oriented Data Technology (OODT). OODT was developed within NASA's Jet Propulsion Laboratory across the last 10 years. OODT has supported various scientific data management and processing projects, providing solutions in the Earth, Planetary, and Medical science fields. It became apparent that the project needed to be opened to a larger audience to foster and promote growth and adoption. OODT was open-sourced at the Apache Software Foundation in November 2010 and has a growing community of users and committers that are constantly improving the software. Leveraging OODT, the JPL Snow Data System (SnowDS) Team was able to install and configure a core Data Management System (DMS) that would download MODIS raw data files and archive the products in a local repository for post processing. The team has since built an online data portal, and an algorithm-processing pipeline using the Apache OODT software as the foundation. We will present the working SnowDS system with its core remote sensing

  18. Inequalities in Open Source Software Development: Analysis of Contributor's Commits in Apache Software Foundation Projects.

    PubMed

    Chełkowski, Tadeusz; Gloor, Peter; Jemielniak, Dariusz

    2016-01-01

    While researchers are becoming increasingly interested in studying OSS phenomenon, there is still a small number of studies analyzing larger samples of projects investigating the structure of activities among OSS developers. The significant amount of information that has been gathered in the publicly available open-source software repositories and mailing-list archives offers an opportunity to analyze projects structures and participant involvement. In this article, using on commits data from 263 Apache projects repositories (nearly all), we show that although OSS development is often described as collaborative, but it in fact predominantly relies on radically solitary input and individual, non-collaborative contributions. We also show, in the first published study of this magnitude, that the engagement of contributors is based on a power-law distribution.

  19. Parents' Views about Child Sexual Abuse Prevention Education: A Systematic Review

    ERIC Educational Resources Information Center

    Hunt, Robyn; Walsh, Kerryann

    2011-01-01

    This paper presents the results of a systematic review of literature on the topic of parents' views about child sexual abuse prevention education. It describes: i) what parents know about child sexual abuse prevention education; ii) what child sexual abuse prevention messages parents provide to their children and what topics they discuss; iii)…

  20. Child Care Indicators, 1998. Part I: Preliminary Figures [and] Part II: County Aggregates, Working Poor Families, Child Care Workforce. Research Series.

    ERIC Educational Resources Information Center

    Fuller, Bruce; Kipnis, Fran; Siegel, Patricia

    Rising maternal employment, welfare reform, and increased preschool enrollment contribute to accelerating family demand for child care in California, and federal and state governments have responded by doubling support for child care and preschool programs between 1996 and 1999. However, there is little information available on how child care…

  1. Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

    PubMed Central

    2005-01-01

    Introduction Risk prediction scores usually overestimate mortality in obstetric populations because mortality rates in this group are considerably lower than in others. Studies examining this effect were generally small and did not distinguish between obstetric and nonobstetric pathologies. We evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II model in obstetric admissions to critical care units contributing to the ICNARC Case Mix Programme. Methods All obstetric admissions were extracted from the ICNARC Case Mix Programme Database of 219,468 admissions to UK critical care units from 1995 to 2003 inclusive. Cases were divided into direct obstetric pathologies and indirect or coincidental pathologies, and compared with a control cohort of all women aged 16–50 years not included in the obstetric categories. The predictive ability of APACHE II was evaluated in the three groups. A prognostic model was developed for direct obstetric admissions to predict the risk for hospital mortality. A log-linear model was developed to predict the length of stay in the critical care unit. Results A total of 1452 direct obstetric admissions were identified, the most common pathologies being haemorrhage and hypertensive disorders of pregnancy. There were 278 admissions identified as indirect or coincidental and 22,938 in the nonpregnant control cohort. Hospital mortality rates were 2.2%, 6.0% and 19.6% for the direct obstetric group, the indirect or coincidental group, and the control cohort, respectively. Cox regression calibration analysis showed a reasonable fit of the APACHE II model for the nonpregnant control cohort (slope = 1.1, intercept = -0.1). However, the APACHE II model vastly overestimated mortality for obstetric admissions (mortality ratio = 0.25). Risk prediction modelling demonstrated that the Glasgow Coma Scale score was the best discriminator between survival and death in obstetric admissions. Conclusion This study confirms

  2. Integrating the Apache Big Data Stack with HPC for Big Data

    NASA Astrophysics Data System (ADS)

    Fox, G. C.; Qiu, J.; Jha, S.

    2014-12-01

    There is perhaps a broad consensus as to important issues in practical parallel computing as applied to large scale simulations; this is reflected in supercomputer architectures, algorithms, libraries, languages, compilers and best practice for application development. However, the same is not so true for data intensive computing, even though commercially clouds devote much more resources to data analytics than supercomputers devote to simulations. We look at a sample of over 50 big data applications to identify characteristics of data intensive applications and to deduce needed runtime and architectures. We suggest a big data version of the famous Berkeley dwarfs and NAS parallel benchmarks and use these to identify a few key classes of hardware/software architectures. Our analysis builds on combining HPC and ABDS the Apache big data software stack that is well used in modern cloud computing. Initial results on clouds and HPC systems are encouraging. We propose the development of SPIDAL - Scalable Parallel Interoperable Data Analytics Library -- built on system aand data abstractions suggested by the HPC-ABDS architecture. We discuss how it can be used in several application areas including Polar Science.

  3. Tolerance of high-intensity focused ultrasound ablation in patients with hepatocellular carcinoma.

    PubMed

    Cheung, Tan To; Chu, Ferdinand S K; Jenkins, Caroline R; Tsang, Dickson S F; Chok, Kenneth S H; Chan, Albert C Y; Yau, Thomas C C; Chan, See Ching; Poon, Ronnie T P; Lo, Chung Mau; Fan, Sheung Tat

    2012-10-01

    High-intensity focused ultrasound (HIFU) ablation is a relatively new, noninvasive way of ablation for treating hepatocellular carcinoma (HCC). Emerging evidence has shown that it is effective for the treatment of HCC, even in patients with poor liver function. There is currently no data on the safety limit of HIFU ablation in patients with cirrhosis. However, this information is vital for the selection of appropriate patients for the procedure. We analyzed HCC patients who had undergone HIFU ablation and determined the lower limit of liver function and other patient factors with which HCC patients can tolerate this treatment modality. Preoperative variables of 100 patients who underwent HIFU ablation for HCC were analyzed to identify the risk factors in HIFU intolerance in terms of stress-induced complications. Factors that may contribute to postablation complications were compared. Thirteen (13 %) patients developed a total of 18 complications. Morbidity was mainly due to skin and subcutaneous tissue injuries (n = 9). Five patients had first-degree skin burn, one had second-degree skin burn, and three had third-degree skin burn. Four complications were grade 3a in the Clavien classification and 14 were below this grade. Univariate analysis showed that age (p = 0.022) was the only independent factor in HIFU intolerance. HIFU ablation is generally well tolerated in HCC patients with cirrhosis. It is safe for Child-Pugh A and B patients and selected Child-Pugh C patients. With this new modality, HCC patients who were deemed unsalvageable by other surgical means in the past because of simultaneous Child-Pugh B or C disease now have a new hope.

  4. Subclassification of Barcelona Clinic Liver Cancer B and C hepatocellular carcinoma: A cohort study of the multicenter registry database.

    PubMed

    Lee, Sangheun; Kim, Beom Kyung; Song, Kijun; Park, Jun Yong; Ahn, Sang Hoon; Kim, Seung Up; Han, Kwang-Hyub; Kim, Do Young

    2016-04-01

    We aimed to subclassify hepatocellular carcinoma (HCC) using Barcelona Clinic Liver Cancer intermediate and advanced stages, which include a highly heterogeneous population. From two registries ("random" and "voluntary" cohorts in the Korean Liver Cancer Study Group), patients who were newly diagnosed as HCC with intermediate or advanced stage between 2003 and 2005 were considered eligible. Overall survival (OS) was analyzed using Kaplan-Meier method with comparison by log-rank test. Patients with intermediate-stage HCC (n = 994) were subclassified according to tumor size and Child-Pugh class. Patients with tumor size < 5 cm (B1), those with tumor size ≥ 5 cm and Child-Pugh A (B2), and those with tumor size ≥ 5 cm and Child-Pugh B (B3) had median OS of 30.73, 20.60, and 9.23 months, respectively (P < 0.001 by log-rank test). Among patients with advanced stage HCC (n = 1746), patients were subclassified according to presence of significant portal vein invasion (sPVI; defined as portal vein invasion in lobar, main, or contralateral branch) and extrahepatic spread (EHS). Patients with neither sPVI nor EHS (C1), those with either sPVI or EHS (C2), and those with both sPVI and EHS (C3) had median OS of 8.43, 4.63, and 3.63 months, respectively (P < 0.001 by log-rank test). Subclassification of Barcelona Clinic Liver Cancer intermediate and advanced stages might be useful for determining patient prognosis and guiding treatment strategies for HCC. © 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  5. Predictive factors for long-term survival in patients with clinically significant portal hypertension following resection of hepatocellular carcinoma.

    PubMed

    Choi, Gi H; Park, Jun Y; Hwang, Ho K; Kim, Dong H; Kang, Chang M; Choi, Jin S; Park, Young N; Kim, Do Y; Ahn, Sang H; Han, Kwang-Hyub; Chon, Chae Y; Lee, Woo J

    2011-04-01

    Hepatic resection for hepatocellular carcinoma (HCC) is not currently recommended for patients with clinically significant portal hypertension (PHT); however, recent studies have shown similar post-operative outcomes between patients with and without clinically significant PHT. To clarify the post-operative prognostic relevance of clinically significant PHT in Child-Pugh A cirrhotic patients. A total of 100 Child-Pugh A cirrhotic patients who underwent curative resection of HCC were eligible for this analysis. Patients were divided into two groups: PHT group (n=47) and non-PHT group (n=53). Clinicopathological variables showed no significant differences except for prothrombine time. Liver-related complications were significantly higher in the PHT group (P=0.015), and the 5-year overall survival rate was significantly higher in the non-PHT group (78.7 vs. 37.9%, P<0.001). The proportion of patients who died because of complications of cirrhosis was significantly higher in the PHT group (P=0.001). Multivariate analysis indicated that the presence of clinically significant PHT was the most powerful adverse prognostic factor for overall survival. Multivariate analysis of the 47 patients with clinically significant PHT indicated that gross vascular invasion and non-single nodular type were poor prognostic factors. The 5-year survival rate of patients with single nodular type and without gross vascular invasion (n=17) was 78.4%. In Child-Pugh A cirrhotic patients, the presence of clinically significant PHT was significantly associated with post-operative hepatic decompensation and poor prognosis after resection of HCC. However, in patients with clinically significant PHT, those with single nodular tumours lacking gross vascular invasion may be good surgical candidates. © 2011 John Wiley & Sons A/S.

  6. Domestic violence and immigration status among Latina mothers in the child welfare system: findings from the National Survey of Child and Adolescent Well-being II (NSCAW II).

    PubMed

    Ogbonnaya, Ijeoma Nwabuzor; Finno-Velasquez, Megan; Kohl, Patricia L

    2015-01-01

    Many children involved with the child welfare system witness parental domestic violence. The association between children's domestic violence exposure and child welfare involvement may be influenced by certain socio-cultural factors; however, minimal research has examined this relationship. The current study compares domestic violence experiences and case outcomes among Latinas who are legal immigrants (n=39), unauthorized immigrants (n=77), naturalized citizens (n=30), and US-born citizen mothers (n=383) reported for child maltreatment. This analysis used data from the second round of the National Survey of Child and Adolescent Well-being. Mothers were asked about whether they experienced domestic violence during the past year. In addition, data were collected to assess if (a) domestic violence was the primary abuse type reported and, if so, (b) the maltreatment allegation was substantiated. Results show that naturalized citizens, legal residents, and unauthorized immigrants did not differ from US-born citizens in self-reports of domestic violence; approximately 33% of mothers reported experiences of domestic violence within the past year. Yet, unauthorized immigrants were 3.76 times more likely than US-born citizens to have cases with allegations of domestic violence as the primary abuse type. Despite higher rates of alleged domestic violence, unauthorized citizens were not more likely than US-born citizens to have these cases substantiated for domestic violence (F(2.26, 153.99)=0.709, p=.510). Findings highlight that domestic violence is not accurately accounted for in families with unauthorized immigrant mothers. We recommend child welfare workers are trained to properly assess and fulfill the needs of immigrant families, particularly as it relates to domestic violence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Visible Wavelength Reflectance Spectra and Taxonomies of Near-Earth Objects from Apache Point Observatory

    NASA Astrophysics Data System (ADS)

    Hammergren, Mark; Brucker, Melissa J.; Nault, Kristie A.; Gyuk, Geza; Solontoi, Michael R.

    2015-11-01

    Near-Earth Objects (NEOs) are interesting to scientists and the general public for diverse reasons: their impacts pose a threat to life and property; they present important albeit biased records of the formation and evolution of the Solar System; and their materials may provide in situ resources for future space exploration and habitation.In January 2015 we began a program of NEO astrometric follow-up and physical characterization using a 17% share of time on the Astrophysical Research Consortium (ARC) 3.5-meter telescope at Apache Point Observatory (APO). Our 500 hours of annual observing time are split into frequent, short astrometric runs (see poster by K. A. Nault et. al), and half-night runs devoted to physical characterization (see poster by M. J. Brucker et. al for preliminary rotational lightcurve results). NEO surface compositions are investigated with 0.36-1.0 μm reflectance spectroscopy using the Dual Imaging Spectrograph (DIS) instrument. As of August 25, 2015, including testing runs during fourth quarter 2014, we have obtained reflectance spectra of 68 unique NEOs, ranging in diameter from approximately 5m to 8km.In addition to investigating the compositions of individual NEOs to inform impact hazard and space resource evaluations, we may examine the distribution of taxonomic types and potential trends with other physical and orbital properties. For example, the Yarkovsky effect, which is dependent on asteroid shape, mass, rotation, and thermal characteristics, is believed to dominate other dynamical effects in driving the delivery of small NEOs from the main asteroid belt. Studies of the taxonomic distribution of a large sample of NEOs of a wide range of sizes will test this hypothesis.We present a preliminary analysis of the reflectance spectra obtained in our survey to date, including taxonomic classifications and potential trends with size.Acknowledgements: Based on observations obtained with the Apache Point Observatory 3.5-meter telescope, which

  8. Emricasan Improves Liver Function in Patients With Cirrhosis and High Model for End-stage Liver Disease Scores Compared With Placebo.

    PubMed

    Frenette, Catherine T; Morelli, Giuseppe; Shiffman, Mitchell L; Frederick, R Todd; Rubin, Raymond A; Fallon, Michael B; Cheng, Jason T; Cave, Matt; Khaderi, Saira A; Massoud, Omar; Pyrsopoulos, Nikolaos; Park, James S; Robinson, James M; Yamashita, Mason; Spada, Alfred P; Chan, Jean L; Hagerty, David T

    2018-06-15

    Caspase-mediated apoptosis and inflammation contribute to progression of liver disease. Emricasan is a pan-caspase inhibitor that reduced serum markers of apoptosis and liver inflammation in patients with hepatitis C and non-alcoholic steatohepatitis (NASH). We performed a multicenter study of 86 patients with cirrhosis (Child-Pugh class A or B; mean score, 6.9; 38% with alcohol-associated cirrhosis, 29% with HCV-associated cirrhosis, and 23% with NASH) and model for end-stage liver disease (MELD) scores of 11-18 (mean, 12.8). Patients were randomly assigned to groups given placebo (n=42) or emricasan (25 mg, n=44), twice daily for 3 months; subjects then received open-label emricasan (25 mg) twice-daily for 3 months. The primary endpoint was the change from baseline in serum levels of cleaved keratin 18 (CK-18) at month 3. Seventy-four patients completed the 3-month study period (40 given emricasan and 34 given placebo); 69 patients received open-label emricasan for 3 months afterward. At the 3-month timepoint, emricasan significantly reduced mean MELD (P=.003) and Child-Pugh (P=.003) scores in subjects with high MELD scores (15 or more), compared with placebo, with significant reductions in INR (95% CI, -0.2882 to -0.0866) and total bilirubin (95% CI, -1.5069 to -0.0823) vs placebo. There were no significant differences between emricasan and placebo groups in mean MELD (P=.466) or Child-Pugh (P=.124) scores overall at 3 months compared to placebo. Of patients with high MELD scores, 6/9 given emricasan (67%) had a reduction of 2 points or more at month 3, compared with 2/10 given placebo (20%). Serum levels of full-length CK-18 (P=.02) and caspase 3/7 (P<.001), but not cleaved CK-18 (P=.092), decreased significantly at 3 months in the emricasan vs placebo group. Emricasan was well tolerated, and adverse events were balanced between groups. Emricasan's effects were generally maintained or increased after 6 months of treatment. In a randomized trial of patients with

  9. Inequalities in Open Source Software Development: Analysis of Contributor’s Commits in Apache Software Foundation Projects

    PubMed Central

    2016-01-01

    While researchers are becoming increasingly interested in studying OSS phenomenon, there is still a small number of studies analyzing larger samples of projects investigating the structure of activities among OSS developers. The significant amount of information that has been gathered in the publicly available open-source software repositories and mailing-list archives offers an opportunity to analyze projects structures and participant involvement. In this article, using on commits data from 263 Apache projects repositories (nearly all), we show that although OSS development is often described as collaborative, but it in fact predominantly relies on radically solitary input and individual, non-collaborative contributions. We also show, in the first published study of this magnitude, that the engagement of contributors is based on a power-law distribution. PMID:27096157

  10. Child disaster mental health interventions, part II

    PubMed Central

    Pfefferbaum, Betty; Sweeton, Jennifer L.; Newman, Elana; Varma, Vandana; Noffsinger, Mary A.; Shaw, Jon A.; Chrisman, Allan K.; Nitiéma, Pascal

    2014-01-01

    This review summarizes current knowledge on the timing of child disaster mental health intervention delivery, the settings for intervention delivery, the expertise of providers, and therapeutic approaches. Studies have been conducted on interventions delivered during all phases of disaster management from pre event through many months post event. Many interventions were administered in schools which offer access to large numbers of children. Providers included mental health professionals and school personnel. Studies described individual and group interventions, some with parent involvement. The next generation of interventions and studies should be based on an empirical analysis of a number of key areas. PMID:26295009

  11. Comparison of Glasgow Coma Scale, Full Outline of Unresponsiveness and Acute Physiology and Chronic Health Evaluation in Prediction of Mortality Rate Among Patients With Traumatic Brain Injury Admitted to Intensive Care Unit

    PubMed Central

    Hosseini, Seyed Hossein; Ayyasi, Mitra; Akbari, Hooshang; Heidari Gorji, Mohammad Ali

    2016-01-01

    Background Traumatic brain injury (TBI) is a common cause of mortality and disability worldwide. Choosing an appropriate diagnostic tool is critical in early stage for appropriate decision about primary diagnosis, medical care and prognosis. Objectives This study aimed to compare the Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) and acute physiology and chronic health evaluation (APACHE II) with respect to prediction of the mortality rate of patients with TBI admitted to intensive care unit. Patients and Methods This diagnostic study was conducted on 80 patients with TBI in educational hospitals. The scores of APACHE II, GCS and FOUR were recorded during the first 24 hours of admission of patients. In this study, early mortality means the patient death before 14 days and delayed mortality means the patient death 15 days after admitting to hospital. The collected data were analyzed using descriptive and inductive statistics. Results The results showed that the mean age of the patients was 33.80 ± 12.60. From a total of 80 patients with TBI, 16 (20%) were females and 64 (80%) males. The mortality rate was 15 (18.7%). The results showed no significant difference among three tools. In prediction of early mortality, the areas under the curve (AUCs) were 0.92 (CI = 0.95. 0.81 - 0.97), 0.90 (CI = 0.95. 0.74 - 0.94), and 0.96 (CI = 0.95. 0.87 - 0.9) for FOUR, APACHE II and GCS, respectively. In delayed mortality, the AUCs were 0.89 (CI = 0.95. 0.81-0.94), 0.94 (CI = 0.95. 0.74 - 0.97) and 0.90 (CI = 0.95. 0.87 - 0.95) for FOUR, APACHE II and GCS, respectively. Conclusions Considering that GCS is easy to use and the FOUR can diagnose a locking syndrome along same values of subscales. These two subscales are superior to APACHI II in prediction of early mortality. Conversation APACHE II is more punctual in the prediction of delayed mortality. PMID:29696116

  12. Usefulness of Glycemic Gap to Predict ICU Mortality in Critically Ill Patients With Diabetes.

    PubMed

    Liao, Wen-I; Wang, Jen-Chun; Chang, Wei-Chou; Hsu, Chin-Wang; Chu, Chi-Ming; Tsai, Shih-Hung

    2015-09-01

    Stress-induced hyperglycemia (SIH) has been independently associated with an increased risk of mortality in critically ill patients without diabetes. However, it is also necessary to consider preexisting hyperglycemia when investigating the relationship between SIH and mortality in patients with diabetes. We therefore assessed whether the gap between admission glucose and A1C-derived average glucose (ADAG) levels could be a predictor of mortality in critically ill patients with diabetes.We retrospectively reviewed the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores and clinical outcomes of patients with diabetes admitted to our medical intensive care unit (ICU) between 2011 and 2014. The glycosylated hemoglobin (HbA1c) levels were converted to the ADAG by the equation, ADAG = [(28.7 × HbA1c) - 46.7]. We also used receiver operating characteristic (ROC) curves to determine the optimal cut-off value for the glycemic gap when predicting ICU mortality and used the net reclassification improvement (NRI) to measure the improvement in prediction performance gained by adding the glycemic gap to the APACHE-II score.We enrolled 518 patients, of which 87 (17.0%) died during their ICU stay. Nonsurvivors had significantly higher APACHE-II scores and glycemic gaps than survivors (P < 0.001). Critically ill patients with diabetes and a glycemic gap ≥80 mg/dL had significantly higher ICU mortality and adverse outcomes than those with a glycemic gap <80 mg/dL (P < 0.001). Incorporation of the glycemic gap into the APACHE-II score increased the discriminative performance for predicting ICU mortality by increasing the area under the ROC curve from 0.755 to 0.794 (NRI = 13.6%, P = 0.0013).The glycemic gap can be used to assess the severity and prognosis of critically ill patients with diabetes. The addition of the glycemic gap to the APACHE-II score significantly improved its ability to predict ICU mortality.

  13. Charters, Constitutions and By-Laws of the Indian Tribes of North America; Part III: The Southwest (Apache--Mohave). Occasional Publications in Anthropology Ethnology Series No. 4.

    ERIC Educational Resources Information Center

    Fay, George E., Comp.

    The Museum of Anthropology of the University of Northern Colorado (formerly known as Colorado State College) has assembled a large number of Indian tribal charters, constitutions, and by-laws to be reproduced as a series of publications. Included in this volume are the amended charter and constitution of the Jicarilla Apache Tribe, Dulce, New…

  14. Research priorities on ending child marriage and supporting married girls.

    PubMed

    Svanemyr, Joar; Chandra-Mouli, Venkatraman; Raj, Anita; Travers, Ellen; Sundaram, Lakshmi

    2015-09-03

    Over the past few years the issue of child marriage has received growing political and programmatic attention. In spite of some progress in a number of countries, global rates have not declined over the past decade. Knowledge gaps remain in understanding trends, drivers and approaches to ending child marriage, especially to understand what is needed to achieve results on a large scale. This commentary summarizes the outcomes of an Expert Group Meeting organized by World Health Organization to discuss research priorities on Ending Child Marriage and Supporting Married Girls. It presents research gaps and recommends priorities for research in five key areas; (i) prevalence and trends of child marriage; (ii) causes of child marriage (iii) consequences of child marriage; (iv) efforts to prevent child marriage; (v) efforts to support married girls.

  15. A Western apache writing system: the symbols of silas john.

    PubMed

    Basso, K H; Anderson, N

    1973-06-08

    At the outset of this article, it was observed that the adequacy of an etic typology of written symbols could be judged by its ability to describe all the emic distinctions in all the writing systems of the world. In conclusion, we should like to return to this point and briefly examine the extent to which currently available etic concepts can be used to describe the distinctions made by Western Apaches in relation to the writing system of Silas John. Every symbol in the Silas John script may be classified as a phonetic-semantic sign. Symbols of this type denote linguistic expressions that consist of one or more words and contrast as a class with phonetic-nonsemantic signs, which denote phonemes (or phoneme clusters), syllables (or syllable clusters), and various prosodic phenomena (2, pp. 2, 248). Phonetic semantic signs are commonly partitioned into two subclasses: alogographs (which denote single words) and phraseographs (which denote on or more words). Although every symbol in the Silas John script can be assigned to one or the other of these categories, such an exercise is without justification (21). We have no evidence to suggest that Western Apaches classify symbols according to the length or complexity of their linguistic referents, and therefore the imposition of distinctions based on these criteria would be inappropriate and misleading. A far more useful contrast, and one we have already employed, is presented in most etic typologies as an opposition between compound (composite) and noncompound (noncomposite) symbols. Used to break down the category of phonetic-semantic signs, these two concepts enable us to describe more or less exactly the distinction Apaches draw between "symbol elements put together" (ke?escin ledidilgoh) and "symbol elements standing alone" (ke?- escin doledidildaahi). The former may now be defined as consisting of compound phonetic-semantic signs, while the latter is composed of noncompound phonetic-semantic signs. Up to this point

  16. Efficacy of Various Scoring Systems for Predicting the 28-Day Survival Rate among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Emergency Intensive Care.

    PubMed

    Feng, Zhihong; Wang, Tao; Liu, Ping; Chen, Sipeng; Xiao, Han; Xia, Ning; Luo, Zhiming; Wei, Bing; Nie, Xiuhong

    2017-01-01

    We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients) and those who did not (survival group; 336 patients). Compared to the survival group, the death group had a significantly higher GCS score, frequency of comorbidities including hypertension and heart failure, and age ( P < 0.05 for all). With all four systems, scores of age, gender, renal inadequacy, hypertension, coronary heart disease, heart failure, arrhythmia, anemia, fracture leading to bedridden status, tumor, and the GCS were significantly higher in the death group than the survival group. The prediction efficacy of the APACHE II and SAPS II scores was 88.4%. The survival rates did not differ significantly between APACHE II and SAPS II ( P = 1.519). Our results may guide triage for early identification of critically ill patients with AECOPD in the emergency department.

  17. Analysis of Pathogen and Host Factors Related to Clinical Outcomes in Patients with Hospital-Acquired Pneumonia Due to Methicillin-Resistant Staphylococcus aureus

    PubMed Central

    Haque, Nadia Z.; Arshad, Samia; Peyrani, Paula; Ford, Kimbal D.; Perri, Mary B.; Jacobsen, Gordon; Reyes, Katherine; Scerpella, Ernesto G.; Ramirez, Julio A.

    2012-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial pneumonia. To characterize pathogen-derived and host-related factors in intensive care unit (ICU) patients with MRSA pneumonia, we evaluated the Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) database. We performed multivariate regression analyses of 28-day mortality and clinical response using univariate analysis variables at a P level of <0.25. In isolates from 251 patients, the most common molecular characteristics were USA100 (55.0%) and USA300 (23.9%), SCCmec types II (64.1%) and IV (33.1%), and agr I (36.7%) and II (61.8%). Panton-Valentine leukocidin (PVL) was present in 21.9%, and vancomycin heteroresistance was present in 15.9%. Mortality occurred in 37.1% of patients; factors in the univariate analysis were age, APACHE II score, AIDS, cardiac disease, vascular disease, diabetes, SCCmec type II, PVL negativity, and higher vancomycin MIC (all P values were <0.05). In multivariate analysis, independent predictors were APACHE II score (odds ratio [OR], 1.090; 95% confidence interval [CI], 1.041 to 1.141; P < 0.001) and age (OR, 1.024; 95% CI, 1.003 to 1.046; P = 0.02). Clinical failure occurred in 36.8% of 201 evaluable patients; the only independent predictor was APACHE II score (OR, 1.082; 95% CI, 1.031 to 1.136; P = 0.002). In summary, APACHE II score (mortality, clinical failure) and age (mortality) were the only independent predictors, which is consistent with severity of illness in ICU patients with MRSA pneumonia. Interestingly, our univariate findings suggest that both pathogen and host factors influence outcomes. As the epidemiology of MRSA pneumonia continues to evolve, both pathogen- and host-related factors should be considered when describing epidemiological trends and outcomes of therapeutic interventions. PMID:22337980

  18. The outcomes and prognostic factors of acute respiratory failure in the patients 90 years old and over

    PubMed Central

    Kung, Shu-Chen; Wang, Ching-Min; Lai, Chih-Cheng; Chao, Chien-Ming

    2018-01-01

    This retrospective cohort study investigated the outcomes and prognostic factors in nonagenarians (patients 90 years old or older) with acute respiratory failure. Between 2006 and 2016, all nonagenarians with acute respiratory failure requiring invasive mechanical ventilation (MV) were enrolled. Outcomes including in-hospital mortality and ventilator dependency were measured. A total of 173 nonagenarians with acute respiratory failure were admitted to the intensive care unit (ICU). A total of 56 patients died during the hospital stay and the rate of in-hospital mortality was 32.4%. Patients with higher APACHE (Acute Physiology and Chronic Health Evaluation) II scores (adjusted odds ratio [OR], 5.91; 95 % CI, 1.55-22.45; p = 0.009, APACHE II scores ≥ 25 vs APACHE II scores < 15), use of vasoactive agent (adjust OR, 2.67; 95% CI, 1.12-6.37; p = 0.03) and more organ dysfunction (adjusted OR, 11.13; 95% CI, 3.38-36.36, p < 0.001; ≥ 3 organ dysfunction vs ≤ 1 organ dysfunction) were more likely to die. Among the 117 survivors, 25 (21.4%) patients became dependent on MV. Female gender (adjusted OR, 3.53; 95% CI, 1.16-10.76, p = 0.027) and poor consciousness level (adjusted OR, 4.98; 95% CI, 1.41-17.58, p = 0.013) were associated with MV dependency. In conclusion, the mortality rate of nonagenarians with acute respiratory failure was high, especially for those with higher APACHE II scores or more organ dysfunction. PMID:29467961

  19. The outcomes and prognostic factors of acute respiratory failure in the patients 90 years old and over.

    PubMed

    Chen, Wan-Ling; Chen, Chin-Ming; Kung, Shu-Chen; Wang, Ching-Min; Lai, Chih-Cheng; Chao, Chien-Ming

    2018-01-23

    This retrospective cohort study investigated the outcomes and prognostic factors in nonagenarians (patients 90 years old or older) with acute respiratory failure. Between 2006 and 2016, all nonagenarians with acute respiratory failure requiring invasive mechanical ventilation (MV) were enrolled. Outcomes including in-hospital mortality and ventilator dependency were measured. A total of 173 nonagenarians with acute respiratory failure were admitted to the intensive care unit (ICU). A total of 56 patients died during the hospital stay and the rate of in-hospital mortality was 32.4%. Patients with higher APACHE (Acute Physiology and Chronic Health Evaluation) II scores (adjusted odds ratio [OR], 5.91; 95 % CI, 1.55-22.45; p = 0.009, APACHE II scores ≥ 25 vs APACHE II scores < 15), use of vasoactive agent (adjust OR, 2.67; 95% CI, 1.12-6.37; p = 0.03) and more organ dysfunction (adjusted OR, 11.13; 95% CI, 3.38-36.36, p < 0.001; ≥ 3 organ dysfunction vs ≤ 1 organ dysfunction) were more likely to die. Among the 117 survivors, 25 (21.4%) patients became dependent on MV. Female gender (adjusted OR, 3.53; 95% CI, 1.16-10.76, p = 0.027) and poor consciousness level (adjusted OR, 4.98; 95% CI, 1.41-17.58, p = 0.013) were associated with MV dependency. In conclusion, the mortality rate of nonagenarians with acute respiratory failure was high, especially for those with higher APACHE II scores or more organ dysfunction.

  20. Comparative randomized study on efficacy of losartan versus propranolol in lowering portal pressure in decompensated chronic liver disease.

    PubMed

    Agasti, Ananta Kumar; Mahajan, Ajay U; Phadke, Aniruddha Y; Nathani, Pratap J; Sawant, Prabha

    2013-05-01

    This study aimed to compare the efficacy of losartan, an angiotensin II receptor antagonist, with propranolol on portal hypertension in patients with decompensated chronic liver disease. In all, 30 patients with Child-Pugh B cirrhosis and large varices without any prior therapy for portal hypertension were randomized to either losartan (n = 15) or propranolol (n = 15). Clinical, biochemical and hemodynamic parameters including hepatic venous pressure gradient (HVPG), wedged hepatic venous pressure (WHVP), mean arterial blood pressure (MABP) and free hepatic venous pressure (FHVP) were measured at baseline and after 4-week therapy. Patients with HVPG < 12 mmHg were regarded as responders. An equal number of responders were seen in both groups (6/15, 40.0%). The reduction of WHVP and HVPG was greater in the losartan group than in the propranolol group, although no significant differences between them were found. Heart rate decreased more in the propranolol arm than in the losartan arm (P < 0.01); however, no correlation between the decrease of heart rate and the reduction of HVPG was observed. One patient in the losartan group, although a responder, had gastrointestinal bleeding 2 months after the drug administration, but the varices were small under endoscopy and did not require definitive therapy. The fall of MABP was greater with losartan, with no statistical difference between the two groups. The effect of losartan was comparable to propranolol in reducing portal pressure in decompensated Child-Pugh B chronic liver disease. © 2012 The Authors. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  1. Incidence of DAA failure and the clinical impact of retreatment in real-life patients treated in the advanced stage of liver disease: Interim evaluations from the PITER network

    PubMed Central

    Gaeta, Giovanni Battista; Brunetto, Maurizia Rossana; Di Leo, Alfredo; Iannone, Andrea; Santantonio, Teresa Antonia; Giammario, Adele; Raimondo, Giovanni; Filomia, Roberto; Coppola, Carmine; Amoruso, Daniela Caterina; Blanc, Pierluigi; Del Pin, Barbara; Chemello, Liliana; Cavalletto, Luisa; Morisco, Filomena; Donnarumma, Laura; Rumi, Maria Grazia; Gasbarrini, Antonio; Siciliano, Massimo; Massari, Marco; Corsini, Romina; Coco, Barbara; Madonia, Salvatore; Cannizzaro, Marco; Zignego, Anna Linda; Monti, Monica; Russo, Francesco Paolo; Zanetto, Alberto; Persico, Marcello; Masarone, Mario; Villa, Erica; Bernabucci, Veronica; Taliani, Gloria; Biliotti, Elisa; Chessa, Luchino; Pasetto, Maria Cristina; Andreone, Pietro; Margotti, Marzia; Brancaccio, Giuseppina; Ieluzzi, Donatella; Borgia, Guglielmo; Zappulo, Emanuela; Calvaruso, Vincenza; Petta, Salvatore; Falzano, Loredana; Quaranta, Maria Giovanna; Weimer, Liliana Elena; Rosato, Stefano; Vella, Stefano; Giannini, Edoardo Giovanni

    2017-01-01

    Background Few data are available on the virological and clinical outcomes of advanced liver disease patients retreated after first-line DAA failure. Aim To evaluate DAA failure incidence and the retreatment clinical impact in patients treated in the advanced liver disease stage. Methods Data on HCV genotype, liver disease severity, and first and second line DAA regimens were prospectively collected in consecutive patients who reached the 12-week post-treatment and retreatment evaluations from January 2015 to December 2016 in 23 of the PITER network centers. Results Among 3,830 patients with advanced fibrosis (F3) or cirrhosis, 139 (3.6%) failed to achieve SVR. Genotype 3, bilirubin levels >1.5mg/dl, platelet count <120,000/mm3 and the sofosbuvir+ribavirin regimen were independent predictors of failure by logistic regression analysis. The failure rate was 7.6% for patients treated with regimens that are no longer recommended or considered suboptimal (sofosbuvir+ribavirin or simeprevir+sofosbuvir±ribavirin), whereas 1.4% for regimens containing sofosbuvir combined with daclatasvir or ledipasvir or other DAAs. Of the patients who failed to achieve SVR, 72 (51.8%) were retreated with a second DAA regimen, specifically 38 (52.7%) with sofosbuvir+daclatasvir, 27 (37.5%) with sofosbuvir+ledipasvir, and 7 (9.7%) with other DAAs ±ribavirin. Among these, 69 (96%) patients achieved SVR12 and 3 (4%) failed. During a median time of 6 months (range: 5–14 months) between failure and the second DAA therapy, the Child-Pugh class worsened in 12 (16.7%) patients: from A to B in 10 patients (19.6%) and from B to C in 2 patients (10.5%), whereas it did not change in the remaining 60 patients. Following the retreatment SVR12 (median time of 6 months; range: 3–12 months), the Child-Pugh class improved in 17 (23.6%) patients: from B to A in 14 (19.4%) patients, from C to A in 1 patient (1.4%) and from C to B in 2 (2.9%) patients; it remained unchanged in 53 patients (73.6%) and

  2. Incidence of DAA failure and the clinical impact of retreatment in real-life patients treated in the advanced stage of liver disease: Interim evaluations from the PITER network.

    PubMed

    Kondili, Loreta A; Gaeta, Giovanni Battista; Brunetto, Maurizia Rossana; Di Leo, Alfredo; Iannone, Andrea; Santantonio, Teresa Antonia; Giammario, Adele; Raimondo, Giovanni; Filomia, Roberto; Coppola, Carmine; Amoruso, Daniela Caterina; Blanc, Pierluigi; Del Pin, Barbara; Chemello, Liliana; Cavalletto, Luisa; Morisco, Filomena; Donnarumma, Laura; Rumi, Maria Grazia; Gasbarrini, Antonio; Siciliano, Massimo; Massari, Marco; Corsini, Romina; Coco, Barbara; Madonia, Salvatore; Cannizzaro, Marco; Zignego, Anna Linda; Monti, Monica; Russo, Francesco Paolo; Zanetto, Alberto; Persico, Marcello; Masarone, Mario; Villa, Erica; Bernabucci, Veronica; Taliani, Gloria; Biliotti, Elisa; Chessa, Luchino; Pasetto, Maria Cristina; Andreone, Pietro; Margotti, Marzia; Brancaccio, Giuseppina; Ieluzzi, Donatella; Borgia, Guglielmo; Zappulo, Emanuela; Calvaruso, Vincenza; Petta, Salvatore; Falzano, Loredana; Quaranta, Maria Giovanna; Weimer, Liliana Elena; Rosato, Stefano; Vella, Stefano; Giannini, Edoardo Giovanni

    2017-01-01

    Few data are available on the virological and clinical outcomes of advanced liver disease patients retreated after first-line DAA failure. To evaluate DAA failure incidence and the retreatment clinical impact in patients treated in the advanced liver disease stage. Data on HCV genotype, liver disease severity, and first and second line DAA regimens were prospectively collected in consecutive patients who reached the 12-week post-treatment and retreatment evaluations from January 2015 to December 2016 in 23 of the PITER network centers. Among 3,830 patients with advanced fibrosis (F3) or cirrhosis, 139 (3.6%) failed to achieve SVR. Genotype 3, bilirubin levels >1.5mg/dl, platelet count <120,000/mm3 and the sofosbuvir+ribavirin regimen were independent predictors of failure by logistic regression analysis. The failure rate was 7.6% for patients treated with regimens that are no longer recommended or considered suboptimal (sofosbuvir+ribavirin or simeprevir+sofosbuvir±ribavirin), whereas 1.4% for regimens containing sofosbuvir combined with daclatasvir or ledipasvir or other DAAs. Of the patients who failed to achieve SVR, 72 (51.8%) were retreated with a second DAA regimen, specifically 38 (52.7%) with sofosbuvir+daclatasvir, 27 (37.5%) with sofosbuvir+ledipasvir, and 7 (9.7%) with other DAAs ±ribavirin. Among these, 69 (96%) patients achieved SVR12 and 3 (4%) failed. During a median time of 6 months (range: 5-14 months) between failure and the second DAA therapy, the Child-Pugh class worsened in 12 (16.7%) patients: from A to B in 10 patients (19.6%) and from B to C in 2 patients (10.5%), whereas it did not change in the remaining 60 patients. Following the retreatment SVR12 (median time of 6 months; range: 3-12 months), the Child-Pugh class improved in 17 (23.6%) patients: from B to A in 14 (19.4%) patients, from C to A in 1 patient (1.4%) and from C to B in 2 (2.9%) patients; it remained unchanged in 53 patients (73.6%) and worsened in 2 (2.8%) patients. Of

  3. Validation of Clinical Scoring Systems ART and ABCR after Transarterial Chemoembolization of Hepatocellular Carcinoma.

    PubMed

    Kloeckner, Roman; Pitton, Michael B; Dueber, Christoph; Schmidtmann, Irene; Galle, Peter R; Koch, Sandra; Wörns, Marcus A; Weinmann, Arndt

    2017-01-01

    To perform an external validation of the Assessment for Retreatment with Transarterial Chemoembolization (ART) and α-fetoprotein (AFP), Barcelona Clinic Liver Cancer (BCLC), Child-Pugh, and response (ABCR) scores and to compare them in terms of prognostic power. From 2000 to 2015, 871 patients with hepatocellular carcinoma underwent transarterial chemoembolization at a tertiary referral hospital, and 176 met all inclusion and exclusion criteria for both scores and were analyzed. Nineteen percent (n = 34) had BCLC stage A disease and 81% had stage B disease. Thirty-nine patients (22%) presented with elevated AFP levels. Overall survival was calculated. Scores were validated and compared with a Harrell C-index, integrated Brier score (IBS), and prediction error curves. Before the second chemoembolization procedure, 22 patients (12%) showed an increase of 1 point in Child-Pugh score and 51 patients (22%) had an increase of ≥ 2 points. Thirty-one patients (23%) showed a > 25% increase in aspartate aminotransferase level, and 114 (65%) showed a response to treatment. Consequently, 127 patients (72%) had a low ART score and 49 (28%) had a high ART score. One hundred fifty-eight patients (90%) had a low ABCR score, whereas 18 (10%) had a high ABCR score. Low and high ART score groups had median survival durations of 20.8 and 15.3 mo, respectively. Harrell C-indexes were 0.572 and 0.608, and IBSs were 0.135 and 0.128, for ART and ABCR, respectively. For both scores, an increase in Child-Pugh score ≥ 2 points and a radiologic response were significantly associated with survival. Both scores were of limited predictive value, and neither was sufficient to support clear-cut clinical decisions. Further effort is necessary to determine criteria for making valid clinical predictions. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  4. Prospective Randomized Study of Doxorubicin-Eluting-Bead Embolization in the Treatment of Hepatocellular Carcinoma: Results of the PRECISION V Study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lammer, Johannes, E-mail: johannes.lammer@meduniwien.ac.a; Malagari, Katarina; Vogl, Thomas

    2010-02-15

    Transcatheter arterial chemoembolization (TACE) offers a survival benefit to patients with intermediate hepatocellular carcinoma (HCC). A widely accepted TACE regimen includes administration of doxorubicin-oil emulsion followed by gelatine sponge-conventional TACE. Recently, a drug-eluting bead (DC Bead) has been developed to enhance tumor drug delivery and reduce systemic availability. This randomized trial compares conventional TACE (cTACE) with TACE with DC Bead for the treatment of cirrhotic patients with HCC. Two hundred twelve patients with Child-Pugh A/B cirrhosis and large and/or multinodular, unresectable, N0, M0 HCCs were randomized to receive TACE with DC Bead loaded with doxorubicin or cTACE with doxorubicin. Randomizationmore » was stratified according to Child-Pugh status (A/B), performance status (ECOG 0/1), bilobar disease (yes/no), and prior curative treatment (yes/no). The primary endpoint was tumor response (EASL) at 6 months following independent, blinded review of MRI studies. The drug-eluting bead group showed higher rates of complete response, objective response, and disease control compared with the cTACE group (27% vs. 22%, 52% vs. 44%, and 63% vs. 52%, respectively). The hypothesis of superiority was not met (one-sided P = 0.11). However, patients with Child-Pugh B, ECOG 1, bilobar disease, and recurrent disease showed a significant increase in objective response (P = 0.038) compared to cTACE. DC Bead was associated with improved tolerability, with a significant reduction in serious liver toxicity (P < 0.001) and a significantly lower rate of doxorubicin-related side effects (P = 0.0001). TACE with DC Bead and doxorubicin is safe and effective in the treatment of HCC and offers a benefit to patients with more advanced disease.« less

  5. Can oesophagectomy be performed for patients with oesophageal carcinoma and concomitant liver cirrhosis? A retrospective study based on a propensity-matched cohort.

    PubMed

    Wang, Zhi-Qiang; Deng, Han-Yu; Yang, Yu-Shang; Wang, Yun; Hu, Yang; Yuan, Yong; Wang, Wen-Ping; Chen, Long-Qi

    2017-09-01

    For patients with oesophageal carcinoma and concomitant liver cirrhosis, the safety profile and postoperative prognosis of oesophagectomy are not clearly established due to the lack of relevant studies with large sample sizes. Our objective was to explore the surgical indications and postoperative prognosis in patients with oesophageal carcinoma and liver cirrhosis. A total of 2226 patients with oesophageal carcinoma underwent curative oesophagectomy (37 with liver cirrhosis and 2189 without) in our department from April 2008 to September 2013. Overall, 37 patients with liver cirrhosis (30 Child-Pugh Grade A and 7 Child-Pugh Grade B) and a propensity-matched cohort of 74 patients without cirrhosis were analysed. We compared the rates of postoperative complications and 5-year survival in these 2 groups. In addition, we performed an analysis of any potential risk factors for death, including patient demographic information and of operation performed. A higher operative mortality rate was observed in patients with oesophageal carcinoma and liver cirrhosis compared to patients with oesophageal carcinoma but without cirrhosis (11 vs 1%, P = 0.042). Patients with cirrhosis included those with Child-Pugh Grade B (43%), preoperative moderate ascites (100%), a prothrombin time of ≥ 4 s (75%) and greater weight loss. Although the rates of surgical death and postoperative hydrothorax were significantly higher in patients with liver cirrhosis, the rates of other major complications and 5-year overall survival were not significantly different compared to patients without cirrhosis. Curative oesophagectomy is a feasible, beneficial treatment option for patients with oesophageal carcinoma and liver cirrhosis, with a higher perioperative risk but reasonable longer term survival compared to patients without cirrhosis. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. Soluble CD163, a marker of Kupffer cell activation, is related to portal hypertension in patients with liver cirrhosis.

    PubMed

    Grønbaek, H; Sandahl, T D; Mortensen, C; Vilstrup, H; Møller, H J; Møller, S

    2012-07-01

    Activation of Kupffer cells may be involved in the pathogenesis of portal hypertension by release of vasoconstrictive substances and fibrosis due to co-activation of hepatic stellate cells. To study soluble plasma (s) CD163, a specific marker of activated macrophages, as a biomarker for portal hypertension in patients with liver cirrhosis. We measured sCD163 concentration and the hepatic venous pressure gradient (HVPG) by liver vein catheterisation in 81 cirrhosis patients (Child-Pugh CP-A: n = 26, CP-B: n = 29, CP-C: n = 26) and 22 healthy subjects. We also measured their cardiac output (CO), cardiac index and systemic vascular resistance (SVR). Liver status was examined by Child-Pugh and MELD-score. In cirrhosis, sCD163 concentration was nearly three times higher than in controls (4.7 ± 2.5 vs. 1.6 ± 0.5 mg/L, P < 0.001). sCD163 was also higher, as measured in steps by CP-score (P < 0.001). The HVPG rose steeply to an asymptote of 22 mmHg with sCD163 up to about 5 mg/L and not to higher values with higher sCD163. In a multivariate analysis, sCD163 was the only independent predictor of the HVPG but did not predict any of the systemic circulatory findings. sCD163 > 3.95 mg/L (upper normal limit) predicted HVPG ≥ 10 mmHg with a positive predictive value of 0.99. Circulating sCD163 originating from activated Kupffer cells is increased in cirrhosis with increasing Child-Pugh score and with increasing HVPG, and it is an independent predictor for HVPG. These findings support a primary role of macrophage activation in portal hypertension, and may indicate a target for biological intervention. © 2012 Blackwell Publishing Ltd.

  7. Demonstration of the Military Ecological Risk Assessment Framework (MERAF): Apache Longbow - Hell Missile Test at Yuma Proving Ground

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Efroymson, R.A.

    2002-05-09

    This ecological risk assessment for a testing program at Yuma Proving Ground, Arizona, is a demonstration of the Military Ecological Risk Assessment Framework (MERAF; Suter et al. 2001). The demonstration is intended to illustrate how risk assessment guidance concerning-generic military training and testing activities and guidance concerning a specific type of activity (e.g., low-altitude aircraft overflights) may be implemented at a military installation. MERAF was developed with funding from the Strategic Research and Development Program (SERDP) of the Department of Defense. Novel aspects of MERAF include: (1) the assessment of risks from physical stressors using an ecological risk assessment framework,more » (2) the consideration of contingent or indirect effects of stressors (e.g., population-level effects that are derived from habitat or hydrological changes), (3) the integration of risks associated with different component activities or stressors, (4) the emphasis on quantitative risk estimates and estimates of uncertainty, and (5) the modularity of design, permitting components of the framework to be used in various military risk assessments that include similar activities. The particular subject of this report is the assessment of ecological risks associated with a testing program at Cibola Range of Yuma Proving Ground, Arizona. The program involves an Apache Longbow helicopter firing Hellfire missiles at moving targets, i.e., M60-A1 tanks. Thus, the three component activities of the Apache-Hellfire test were: (1) helicopter overflight, (2) missile firing, and (3) tracked vehicle movement. The demonstration was limited, to two ecological endpoint entities (i.e., potentially susceptible and valued populations or communities): woody desert wash communities and mule deer populations. The core assessment area is composed of about 126 km{sup 2} between the Chocolate and Middle Mountains. The core time of the program is a three-week period, including fourteen

  8. Single‐Center Evaluation of the Pharmacokinetics and Safety of the Angiotensin II Receptor Antagonist Azilsartan Medoxomil in Mild to Moderate Hepatic Impairment

    PubMed Central

    Karim, Aziz; Zhao, Zhen; Alonso, Alberto B.; Garg, Dyal; Preston, Richard A.

    2017-01-01

    Abstract Azilsartan medoxomil (AZL‐M) is a potent angiotensin II receptor blocker that decreases blood pressure in a dose‐dependent manner. It is a prodrug that is not detected in blood after its oral administration because of its rapid hydrolysis to the active moiety, azilsartan (AZL). AZL undergoes further metabolism to the major metabolite, M‐II, and minor metabolites. The objective of this study was to determine the effect of mild to moderate hepatic impairment on the pharmacokinetics of AZL and its major metabolite. This was a single‐center, open‐label, phase 1 parallel‐group study that examined the single‐dose (day 1) and multiple‐dose (days 4–8) — 40 mg — pharmacokinetics of AZL and M‐II in 16 subjects with mild and moderate hepatic impairment by Child‐Pugh classification (n = 8 per group) and subjects (n = 16) matched based on age, sex, race, weight, and smoking status. Mild or moderate hepatic impairment did not cause clinically meaningful increases in exposure to AZL and M‐II. Mild or moderate hepatic impairment had no clinically meaningful effect on the plasma protein binding of AZL and M‐II. Single and multiple doses of AZL‐M 40 mg were well tolerated in all subject groups. Based on the pharmacokinetic and tolerability findings, no dose adjustment of AZL‐M is required for subjects with mild and moderate hepatic impairment. PMID:28750149

  9. [Prevalence of severe sepsis in intensive care units. A national multicentric study].

    PubMed

    Dougnac, Alberto L; Mercado, Marcelo F; Cornejo, Rodrigo R; Cariaga, Mario V; Hernández, Glenn P; Andresen, Max H; Bugedo, Guillermo T; Castillo, Luis F

    2007-05-01

    Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU). To study the prevalence of SS in Chilean ICUs. An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004. General hospital and ICU data and the number of hospitalized patients in the hospital and in the ICU at the survey day, were recorded. Patients were followed for 28 days. Ninety four percent of ICUs participated in the survey. The ICU occupation index was 66%. Mean age of patients was 57.7+/-18 years and 59% were male, APACHE II score was 15+/-7.5 and SOFA score was 6+/-4. SS was the admission diagnosis of 94 of the 283 patients (33%) and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria (40%). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients. Global case-fatality ratio at 28 days was 15.9% (45/283). Case-fatality ratio in patients with or without SS at the moment of the survey was 26.7% (30/112) and 8.7% (17/171), respectively p <0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios for patients with SS from Santiago and the other cities were similar, but APACHE II score was significantly higher in patients from Santiago. In SS patients, the independent predictors of mortality were SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SS patients had a known sepsis focus (48% respiratory and 30% abdominal). Eighty five patients that presented SS after admission, had a respiratory focus. SS is highly prevalent in Chilean ICUs and represents the leading diagnosis at admission. SS as cause of hospitalization, APACHE II and SOFA scores were independent predictors of mortality.

  10. Phase II trial of bevacizumab and erlotinib as a second-line therapy for advanced hepatocellular carcinoma.

    PubMed

    Kaseb, Ahmed O; Morris, Jeffrey S; Iwasaki, Michiko; Al-Shamsi, Humaid O; Raghav, Kanwal Pratap Singh; Girard, Lauren; Cheung, Sheree; Nguyen, Van; Elsayes, Khaled M; Xiao, Lianchun; Abdel-Wahab, Reham; Shalaby, Ahmed S; Hassan, Manal; Hassabo, Hesham M; Wolff, Robert A; Yao, James C

    2016-01-01

    Clinicaltrials.gov #NCT01180959. Early clinical studies of bevacizumab and erlotinib in advanced hepatocellular carcinoma (HCC) have a tolerable toxicity and a promising clinical outcome. We evaluated the efficacy and tolerability of this combination as a second-line therapy for HCC refractory to sorafenib. For this single-arm, Phase II study, we recruited patients with Child-Pugh class A or B liver disease, Eastern Cooperative Oncology Group performance status 0-2, and advanced HCC that was not amenable to surgical or regional therapies and treatment with sorafenib had failed (disease progressed or patient could not tolerate sorafenib). Patients received 10 mg/kg intravenous bevacizumab every 14 days and 150 mg oral erlotinib daily for 28-day cycles until progression. Tumor response was evaluated every two cycles using Response Evaluation Criteria in Solid Tumors. The primary end point was the 16-week progression-free survival rate. Secondary end points included time to progression and overall survival. A total of 44 patients were enrolled and had a median follow-up time of 33.8 months (95% confidence interval [CI]: 23.5 months - not defined). The 16-week progression-free survival rate was 43% (95% CI: 28%-59%), median time to progression was 3.9 months (95% CI: 2.0-8.3 months), and median overall survival duration was 9.9 months (95% CI: 8.3-15.5 months). Grade 3-4 adverse events included fatigue (13%), acne (11%), diarrhea (9%), anemia (7%), and upper gastrointestinal hemorrhage (7%). Bevacizumab plus erlotinib was tolerable and showed a signal of survival benefit in the second-line setting for patients with advanced HCC. Because standard-of-care options are lacking in this setting, further studies to identify predictors of response to this regimen are warranted.

  11. Caregiver Substance Abuse and Children’s Exposure to Violence in a Nationally Representative Child Welfare Sample

    PubMed Central

    Seay, Kristen D.; Kohl, Patricia

    2012-01-01

    Using data from the National Survey of Child and Adolescent Well-Being II (NSCAW II), this article examines the impact of caregiver substance abuse on children’s exposure to violence in the home in a nationally representative sample of families involved with child protective services (CPS). Logistic regression analyses indicate an increased risk of witnessing mild and severe violence in the home for children whose primary caregiver was abusing alcohol or drugs. However, analyses did not find statistically significant relationships between child report of direct victimization in the home by mild or severe violence and caregiver alcohol or drug abuse. PMID:23440502

  12. [Child abuse in Tlaxcala: a case-control study].

    PubMed

    Herrada-Huidobro, A; Nazar-Beutelspacher, A; Cassaball-Núñez, M; Vega-Ramos, R; Nava-Cruz, C B

    1992-01-01

    A longitudinal, retrospective and descriptive study about child abuse was carried out in the Hospitals of the Tlaxcala Secretariat of Health, Mexico. The information was obtained from hospitalized children's charts between January first and November 30, 1991. The charts included were those belonging to zero to 14 year old children with injuries, poisoning, and II-III degrees of malnutrition. Four child-abuse criteria were established: physical, sexual, non organic malnutrition and mixed (physical and non organic malnutrition). Two control groups were defined. Different patterns were observed between accidental and non accidental injuries, malnutrition and poisoning among the case and the control groups. The study provides useful information for the integral diagnosis of child abuse in hospitalized children.

  13. Disordered eating among preadolescent boys and girls: the relationship with child and maternal variables.

    PubMed

    Gonçalves, Sónia; Silva, Margarida; Gomes, A Rui; Machado, Paulo P P

    2012-04-01

    (i) To analyze the eating behaviors and body satisfaction of boys and girls and to examine their mothers' perceptions of these two domains; and (ii) to evaluate eating problem predictors using child body mass index (BMI), self-esteem, and body satisfaction as well as maternal BMI, eating problems, and satisfaction with their child's body. The participants included 111 children (54.1% girls aged between 9 and 12 years old) and their mothers. Assessment measures included the Child Eating Attitude Test, the Self-Perception Profile for Children, the Eating Disorders Questionnaire, and the Child Eating Behavior Questionnaire. Child and maternal measures also included BMI and Collins Figure Drawings. (i) No association between child and maternal BMI for either sex was found; (ii) no difference was found between boys and girls with regard to eating behavior; (iii) most children revealed a preference for an ideal body image over their actual body image; (iv) most mothers preferred thinner bodies for their children; (v) greater BMI was related to higher body dissatisfaction; and (vi) child BMI and dissatisfaction with body image predicted eating disturbances in boys, whereas self-esteem, maternal BMI, and eating behavior predicted them in girls. Maternal eating problems and BMI were related to female eating problems only.

  14. The burden of disaster: part II. applying interventions across the child's social ecology.

    PubMed

    Pfefferbaum, Rose L; Jacobs, Anne K; Noffsinger, Mary A; Pfefferbaum, Betty; Sherrieb, Kathleen; Norris, Fran H

    2012-01-01

    This second of two articles describes the application of disaster mental health interventions within the context of the childs social ecology consisting of the Micro-, Meso-, Exo-, and Macrosystems. Microsystem interventions involving parents, siblings, and close friends include family preparedness planning andpractice, psychoeducation, role modeling, emotional support, and redirection. Mesosystem interventions provided by schools and faith-based organizations include safety and support, assessment, referral, and counseling. Exosystem interventions include those provided through community-based mental health programs, healthcare organizations, the workplace, the media, local volunteer disaster organizations, and other local organizations. Efforts to build community resilience to disasters are likely to have influence through the Exosystem. The Macrosystem - including the laws, history, cultural and subcultural characteristics, and economic and social conditions that underlie the other systems - affects the child indirectly through public policies and disaster programs and services that become available in the child's Exosystem in the aftermath of a disaster The social ecology paradigm, described more fully in a companion article (Noffsinger Pfefferbaum, Pfefferbaum, Sherrieb, & Norris,2012), emphasizes relationships among systems and can guide the development and delivery of services embedded in naturally-occurring structures in the child's environment.

  15. [Influence of cryoglobulinemic syndrome and insulin resistance on the progression of liver cirrhosis in patients with chronic hepatitis C].

    PubMed

    Kondratiuk, L O; Bezrodna, O V; Kuliesh, O V

    2014-01-01

    The article presents the results of analysis of the frequency of detection of cryoglobulinemic syndrome (CGS) and insulin resistance (IR) in patients with HCV-associated liver cirrhosis (LC) depending on its stage. There were also evaluated clinical and laboratory features of the disease. The study involved 72 patients with chronic hepatitis C who were divided into 3 main groups according to the presence of LC. The I group included 32 patients with chronic hepatitis C without LC. The II group consisted of 19 patients with compensated HCV-associated LC and III group included 21 patients with decompensated LC. It was shown that terminal stages of the LC (class B-C by Child-Pugh) are characterized by more frequent presence of IR and CGS with more severe clinical picture, which may be caused not only by the influence of the hepatitis C virus (HCV), but also by the progression of LC.

  16. Cranial vault remodeling in microcephalic osteodysplastic primordial dwarfism type II and craniosynostosis.

    PubMed

    Engel, Michael; Castrillon-Oberndorfer, Gregor; Hoffmann, Jürgen; Egermann, Marcus; Freudlsperger, Christian; Thiele, Oliver Christian

    2012-09-01

    This is a survey of the long-term result after various surgical treatments in a child with microcephalic osteodysplastic primordial dwarfism type II (MOPD II) and craniosynostosis. We report a 17-year-old patient with MOPD II but some unusual clinical signs including bilateral knee dislocation, a misplaced upper lobe bronchus, and hypoplasia of the anterior corpus callosum. Because of premature fusion of several cranial sutures, the child developed signs of increased intracranial pressure with somnolence and papilledema. Cranial vault remodeling with fronto-orbital advancement was performed twice at the age of 16 and 21 months to open the abnormally closed suture, increase the intracranial volume, and relieve the elevated intracranial pressure. Following this procedure, the child's neurologic situation recovered significantly. Surgical procedure of fronto-orbital advancement and the performed reoperation in our patient were safe with no major complications intraoperatively and postoperatively with good functional and satisfying aesthetic outcomes in the long-term follow-up, expressed by the patient, his parents, and the surgeons.

  17. Attitudes toward child rearing in female clinical nurses working in three shifts.

    PubMed

    Ha, Eun-Ho

    2016-12-01

    The balance between child-rearing and work may be one of the most challenging issues facing female clinical nurses, particularly those who work in three shifts. This study aimed to identify attitudes toward child-rearing in this particular cohort, female clinical nurses working three shifts. Q methodology, a research method concerned with individuals' subjective points of view, was used. Thirty-five selected Q statements from 51 participants were divided into a normal distribution using a nine-point bipolar scale, and the collected data were analyzed using the QUANL program. Three discrete factors emerged: Factor I: child-rearing is natural work (child-rearing and work are separate); Factor II: child-rearing is hard work (child-rearing and work are in conflict); and Factor III: child-rearing requires help from someone (child-rearing and work are balanced). The subjective viewpoints of the three identified factors can be applied to develop diverse strategies to support child-rearing in female clinical nurses. © 2016 John Wiley & Sons Australia, Ltd.

  18. 45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

  19. 45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

  20. 45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

  1. 45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

  2. 45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

  3. Disordered Eating among Preadolescent Boys and Girls: The Relationship with Child and Maternal Variables

    PubMed Central

    Gonçalves, Sónia; Silva, Margarida; Gomes, A. Rui; Machado, Paulo P. P.

    2012-01-01

    Objective: (i) To analyze the eating behaviors and body satisfaction of boys and girls and to examine their mothers’ perceptions of these two domains; and (ii) to evaluate eating problem predictors using child body mass index (BMI), self-esteem, and body satisfaction as well as maternal BMI, eating problems, and satisfaction with their child’s body. The participants included 111 children (54.1% girls aged between 9 and 12 years old) and their mothers. Assessment measures included the Child Eating Attitude Test, the Self-Perception Profile for Children, the Eating Disorders Questionnaire, and the Child Eating Behavior Questionnaire. Child and maternal measures also included BMI and Collins Figure Drawings. Results: (i) No association between child and maternal BMI for either sex was found; (ii) no difference was found between boys and girls with regard to eating behavior; (iii) most children revealed a preference for an ideal body image over their actual body image; (iv) most mothers preferred thinner bodies for their children; (v) greater BMI was related to higher body dissatisfaction; and (vi) child BMI and dissatisfaction with body image predicted eating disturbances in boys, whereas self-esteem, maternal BMI, and eating behavior predicted them in girls. Discussion: Maternal eating problems and BMI were related to female eating problems only. PMID:22606370

  4. Is 'gut feeling' by medical staff better than validated scores in estimation of mortality in a medical intensive care unit? - The prospective FEELING-ON-ICU study.

    PubMed

    Radtke, Anne; Pfister, Roman; Kuhr, Kathrin; Kochanek, Matthias; Michels, Guido

    2017-10-01

    The aim of the FEELING-ON-ICU study was to compare mortality estimations of critically ill patients based on 'gut feeling' of medical staff and by Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA). Medical staff estimated patients' mortality risks via questionnaires. APACHE II, SAPS II and SOFA were calculated retrospectively from records. Estimations were compared with actual in-hospital mortality using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). 66 critically ill patients (60.6% male, mean age 63±15years (range 30-86)) were evaluated each by a nurse (n=66, male 32.4%) and a physician (n=66, male 67.6%). 15 (22.7%) patients died on the intensive care unit. AUC was largest for estimations by physicians (AUC 0.814 (95% CI 0.705-0.923)), followed by SOFA (AUC 0.749 (95% CI 0.629-0.868)), SAPS II (AUC 0.723 (95% CI 0.597-0.849)), APACHE II (AUC 0.721 (95% CI 0.595-0.847)) and nursing staff (AUC 0.669 (95% CI 0.529-0.810)) (p<0.05 for all results). The concept of physicians' 'gut feeling' was comparable to classical objective scores in mortality estimations of critically ill patients. Concerning practicability physicians' evaluations were advantageous to complex score calculation. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Deficiencies of Circulating Mucosal-associated Invariant T Cells and Natural Killer T Cells in Patients with Multiple Trauma.

    PubMed

    Jo, Young Goun; Choi, Hyun Jung; Kim, Jung Chul; Cho, Young Nan; Kang, Jeong Hwa; Jin, Hye Mi; Kee, Seung Jung; Park, Yong Wook

    2017-05-01

    Mucosal-associated invariant T (MAIT) cells and natural killer T (NKT) cells are known to play important roles in autoimmunity, infectious diseases and cancers. However, little is known about the roles of these invariant T cells in multiple trauma. The purposes of this study were to examine MAIT and NKT cell levels in patients with multiple trauma and to investigate potential relationships between these cell levels and clinical parameters. The study cohort was composed of 14 patients with multiple trauma and 22 non-injured healthy controls (HCs). Circulating MAIT and NKT cell levels in the peripheral blood were measured by flow cytometry. The severity of injury was categorised according to the scoring systems, such as Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, and Injury Severity Score (ISS). Circulating MAIT and NKT cell numbers were significantly lower in multiple trauma patients than in HCs. Linear regression analysis showed that circulating MAIT cell numbers were significantly correlated with age, APACHE II, SAPS II, ISS category, hemoglobin, and platelet count. NKT cell numbers in the peripheral blood were found to be significantly correlated with APACHE II, SAPS II, and ISS category. This study shows numerical deficiencies of circulating MAIT cells and NKT cells in multiple trauma. In addition, these invariant T cell deficiencies were found to be associated with disease severity. These findings provide important information for predicting the prognosis of multiple trauma. © 2017 The Korean Academy of Medical Sciences.

  6. Risk stratification and prognostic performance of the predisposition, infection, response, and organ dysfunction (PIRO) scoring system in septic patients in the emergency department: a cohort study.

    PubMed

    Chen, Yun-Xia; Li, Chun-Sheng

    2014-04-16

    The predisposition, infection, response and organ dysfunction (PIRO) staging system was designed as a stratification tool to deal with the inherent heterogeneity of septic patients. The present study was conducted to assess the performance of PIRO in predicting multiple organ dysfunction (MOD), intensive care unit (ICU) admission, and 28-day mortality in septic patients in the emergency department (ED), and to compare this scoring system with the Mortality in Emergency Department Sepsis (MEDS) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores. Consecutive septic patients (n = 680) admitted to the ED of Beijing Chao-Yang Hospital were enrolled. PIRO, MEDS, and APACHE II scores were calculated for each patient on ED arrival. Organ function was reassessed within 3 days of enrollment. All patients were followed up for 28 days. Outcome criteria were the development of MOD within 3 days, ICU admission or death within 28 days after enrollment. The predictive ability of the four components of PIRO was analyzed separately. Receiver operating characteristic (ROC) curve and logistic regression analysis were used to assess the prognostic and risk stratification value of the scoring systems. Organ dysfunction independently predicted ICU admission, MOD, and 28-day mortality, with areas under the ROC curve (AUC) of 0.888, 0.851, and 0.816, respectively. The predictive value of predisposition, infection, and response was weaker than that of organ dysfunction. A negative correlation was found between the response component and MOD, as well as mortality. PIRO, MEDS, and APACHE II scores significantly differed between patients who did and did not meet the outcome criteria (P < 0.001). PIRO and APACHE II independently predicted ICU admission and MOD, but MEDS did not. All three systems were independent predictors of 28-day mortality with similar AUC values. The AUC of PIRO was 0.889 for ICU admission, 0.817 for MOD, and 0.744 for 28-day mortality. The AUCs

  7. Population pharmacokinetics of transdermal fentanyl in patients with cancer-related pain.

    PubMed

    Kokubun, Hideya; Ebinuma, Keiichi; Matoba, Motohiro; Takayanagi, Risa; Yamada, Yasuhiko; Yago, Kazuo

    2012-06-01

    Determining the appropriate dose of transdermal fentanyl (TDF) for the alleviation of cancer pain requires determining the factors causing variations in serum fentanyl concentration after TDF treatment. The objective of this study was to identify these factors and incorporate them into a formula that can be used to predict serum fentanyl concentration after application of a TDF patch. Blood samples of cancer patients treated with a TDF patch for the alleviation of pain were collected at 24, 48, and 72 hours after application to evaluate population pharmacokinetics using the nonlinear mixed-effect model (NONMEM). Based upon this evaluation, Child-Pugh Score and use of a cytochrome P450 3A4 (CYP3A4) inducer were identified as the most significant factors in variations in serum fentanyl concentration and incorporated into the following Final Model formula: CL(fenta) (L/h) = 3.53 × (15 - Child-Pugh Score) × (1 + 1.38 × use or no use of CYP3A4 inducer). Bootstrap evaluation of the Final Model revealed a high convergence rate, suggesting that the model formula is a reliable and useful tool for determining TDF dose for the alleviation of cancer pain.

  8. Child Abuse and Neglect: Issues on Innovation and Implementation. Volume II.

    ERIC Educational Resources Information Center

    Lauderdale, Michael L., Ed.; And Others

    The proceedings of the Second Annual National Conference on Child Abuse and Neglect (1977) are presented. The first section contains discussions of the following delivery system-related topics: community resource development (planning community protective services, mobilizing communities, maximizing educational resources, approaching…

  9. Clinical Significance of Tissue Factor and CD13 Double-Positive Microparticles in Sirs Patients with Trauma and Severe Sepsis.

    PubMed

    Matsumoto, Hisatake; Yamakawa, Kazuma; Ogura, Hiroshi; Koh, Taichin; Matsumoto, Naoya; Shimazu, Takeshi

    2017-04-01

    Activated immune cells such as monocytes are key factors in systemic inflammatory response syndrome (SIRS) following trauma and sepsis. Activated monocytes induce almost all tissue factor (TF) expression contributing to inflammation and coagulation. TF and CD13 double-positive microparticles (TF/CD13MPs) are predominantly released from these activated monocytes. This study aimed to evaluate TF/CD13MPs and assess their usefulness as a biomarker of pathogenesis in early SIRS following trauma and sepsis. This prospective study comprising 24 trauma patients, 25 severe sepsis patients, and 23 healthy controls was conducted from November 2012 to February 2015. Blood samples were collected from patients within 24 h after injury and diagnosis of severe sepsis and from healthy controls. Numbers of TF/CD13MPs were measured by flow cytometry immediately thereafter. Injury Severity Score (ISS) and Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were calculated at patient enrollment. APACHE II and SOFA scores and International Society of Thrombosis and Haemostasis (ISTH) overt disseminated intravascular coagulation (DIC) diagnostic criteria algorithm were calculated at the time of enrollment of severe sepsis patients. Numbers of TF/CD13MPs were significantly increased in both trauma and severe sepsis patients versus controls and correlated significantly with ISS and APACHE II score in trauma patients and with APACHE II and ISTH DIC scores in severe sepsis patients. Increased numbers of TF/CD13MPs correlated significantly with severities in the acute phase in trauma and severe sepsis patients, suggesting that TF/CD13MPs are important in the pathogenesis of early SIRS following trauma and sepsis.

  10. Migrant Child Welfare: A State of the Field Study of Child Welfare Services for Migrant Children and Their Families Who Are In-Stream, Home Based, Or Settled-Out. Final Report, June 1977.

    ERIC Educational Resources Information Center

    Cavenaugh, David N.; And Others

    The five parts of this report present the findings and recommendations of the Migrant Child Welfare study. Part I briefly summarizes the impact of the child welfare services and the family interview results, and reviews the organizational structure of program delivery at the state and local levels. Part II synthesizes the information obtained from…

  11. Beyond the Simple Model of Child Care Facilities: Support Spaces for Quality

    ERIC Educational Resources Information Center

    Greenman, Jim

    2006-01-01

    The age of child care building on a wide scale really began in the 1970s. Before that, there had been a history of day nurseries going back to the turn of the century and Lanham Act centers during World War II to provide care for "Rosie the Riveter" mothers in the work force. The "purpose built" child care center was an economical box with almost…

  12. Big Data Approaches for the Analysis of Large-Scale fMRI Data Using Apache Spark and GPU Processing: A Demonstration on Resting-State fMRI Data from the Human Connectome Project

    PubMed Central

    Boubela, Roland N.; Kalcher, Klaudius; Huf, Wolfgang; Našel, Christian; Moser, Ewald

    2016-01-01

    Technologies for scalable analysis of very large datasets have emerged in the domain of internet computing, but are still rarely used in neuroimaging despite the existence of data and research questions in need of efficient computation tools especially in fMRI. In this work, we present software tools for the application of Apache Spark and Graphics Processing Units (GPUs) to neuroimaging datasets, in particular providing distributed file input for 4D NIfTI fMRI datasets in Scala for use in an Apache Spark environment. Examples for using this Big Data platform in graph analysis of fMRI datasets are shown to illustrate how processing pipelines employing it can be developed. With more tools for the convenient integration of neuroimaging file formats and typical processing steps, big data technologies could find wider endorsement in the community, leading to a range of potentially useful applications especially in view of the current collaborative creation of a wealth of large data repositories including thousands of individual fMRI datasets. PMID:26778951

  13. The replacement child. Variations on a theme in history and psychoanalysis.

    PubMed

    Anisfeld, L; Richards, A D

    2000-01-01

    This paper reviews the literature on the replacement child syndrome and examines its historical, theoretical, and biographical ramifications. Although a replacement child in a literal sense is one conceived to take the place of a deceased sibling, the concept may be extended to many other situations in which a child is put in the place of someone else in the family system. In his experience of survivor guilt for his deceased brother Julius, Freud may be regarded as such a metaphorical replacement child. The collective tragedy of the Holocaust gives the replacement child concept a special meaning, since the children born in its aftermath had to fill the void in the lives not only of individual parents but of the Jewish people as a whole. One of the coauthors of this paper, Leon Anisfeld, was born after World War II to parents who had lost previous spouses and children, and his personal experience as a replacement child informs the theoretical issues considered here.

  14. [The association between early blood glucose fluctuation and prognosis in critically ill patients].

    PubMed

    Tang, Jian; Gu, Qin

    2012-01-01

    To investigate the association between early blood glucose level fluctuation and prognosis of critically ill patients. A retrospective study involving 95 critically ill patients in intensive care unit (ICU) was conducted. According to the 28-day outcome after admission to ICU, the patients were divided into nonsurvivors (43 cases) and survivors (52 cases), and the blood glucose level in them was monitored in the first 72 hours. Blood glucose concentration at admission (BGadm), mean blood glucose level (MBG), hyperglycemia index (HGI), glycemic lability index (GLI), incidence of hypoglycemia and total dosage of intravenous insulin for each patient were compared. The index as an independent risk factor of mortality was determined by multivariate logistic regression analysis and the predictor value by comparing the area under the receiver operating characteristic curve (ROC curve, AUC) of each index. The BGadm (mmol/L), MBG (mmol/L), HGI and the incidence of hypoglycemia showed no significant differences between nonsurvivors and survivors [BGadm: 9.87 ± 4.48 vs. 9.26 ± 3.07, MBG: 8.59 ± 1.23 vs. 8.47 ± 1.01, HGI(6.0): 2.45 ± 0.94 vs. 1.68 ± 1.05, HGI(8.3): 0.84 ± 0.70 vs. 0.68 ± 0.51, the incidence of hypoglycemia: 9.30% vs. 5.77%, all P > 0.05], but acute physiology and chronic health evaluation II (APACHE II ) score, GLI and the total dosage of intravenous insulin (U) were significantly higher in nonsurvivors than survivors [APACHE II score: 23 ± 6 vs. 19 ± 6, GLI: 56.96 (65.43) vs. 23.87 (41.62), the total dosage of intravenous insulin: 65.5 (130.5) vs. 12.5 (90.0), all P < 0.05]. Multivariate logistic regression analysis showed that APACHE II score and GLI were both independent risk factors [APACHE II score: odds ratio (OR) = 1.09, 95% confidence interval (95%CI) 1.01-1.17; GLI: OR = 1.03, 95%CI 1.01-1.06, both P < 0.05]. When ROC curve was plotted, the AUC of APACHE II score and GLI was respectively 0.69 and 0.71, and there was no significant difference

  15. A MAA-based dosimetric study in patients with intrahepatic cholangiocarcinoma treated with a combination of chemotherapy and 90Y-loaded glass microsphere selective internal radiation therapy.

    PubMed

    Manceau, Vincent; Palard, Xavier; Rolland, Yan; Pracht, March; Le Sourd, Samuel; Laffont, Sophie; Boudjema, Karim; Lievre, Astride; Mesbah, Habiba; Haumont, Laure-Anne; Lenoir, Laurence; Brun, Vanessa; Uguen, Thomas; Edeline, Julien; Garin, Etienne

    2018-03-20

    Selective internal radiation therapy (SIRT) appears to be an interesting treatment possibility for locally-advanced intrahepatic cholangiocarcinoma (ICC), yet the appropriate dosimetry has never been evaluated in this context. We retrospectively studied data from 40 patients treated at our institution with 90 Y-loaded glass microsphere SIRT combined with chemotherapy for inoperable ICC as first-line treatment. Macroaggregated albumin (MAA)-based single-photon emission computed tomography (SPECT)/computed tomography (CT) quantitative analysis was used to calculate the tumor dose (TD), healthy-injected liver dose (HILD), and injected liver dose (ILD). Response was evaluated at 3 months using the European Association for the Study of the Liver criteria. Factors associated with response and toxicity were analyzed using univariate analysis. We assessed a total of 35 patients (five excluded) receiving 55 injections. Mean TD was 322 ± 165Gy and mean HILD was 74 ± 24Gy for a mean ILD of 128 ± 28Gy. All but two lesions responded, with a minimal TD for responding lesions of 158Gy. Six Grade 3-4 permanent liver toxicities were observed. Mean HILD was not associated with liver toxicity (73.2 ± 25.8Gy for patients with liver toxicity and 77.8 ± 16.9Gy for patients without, ns). Only underlying Child-Pugh status (p = 0.0014) and underlying cirrhosis (p = 0.0021) were associated with liver toxicity. Median progression-free survival was 12.7 months and median overall survival (OS) was 28.6 months. Median OS was 52.7 months for patients with Child-Pugh A5 status. When combined with chemotherapy, SIRT is highly effective, with a TD > 158Gy. Tolerance was good except for the few patients with cirrhosis or Child-Pugh status ≥A6, who exhibited some liver toxicity. Prospective studies are warranted to confirm.

  16. Chronic Hepatitis C-Related Cirrhosis Hospitalization Cost Analysis in Bulgaria.

    PubMed

    Dimitrova, Maria; Pavlov, Kaloyan; Mitov, Konstantin; Genov, Jordan; Petrova, Guenka Ivanova

    2017-01-01

    HCV infection is a leading cause of chronic liver disease with long-term complications-extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital "Queen Joanna-ISUL" for 3-year period (2012-2014). It is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital "Queen Joanna-ISUL" for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy) were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF), hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal-Wallis, and Friedman tests were used for statistical processing. 76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839) with an average cost per patient 4,577 BGN (€2,340). Statistically significant correlation was observed between the total cost per patient from the different payers' perspective and the Child-Pugh cirrhosis score. HCV-related cirrhosis is resource demanding and sets high

  17. Outpatient Transarterial Chemoembolization of Hepatocellular Carcinoma: Review of a Same-Day Discharge Strategy.

    PubMed

    Fritsche, Micah R; Watchmaker, Jennifer M; Lipnik, Andrew J; Baker, Jennifer C; Geevarghese, Sunil; Banovac, Filip; Omary, Reed A; Brown, Daniel B

    2018-04-01

    To test the hypothesis that same-day discharge of selected transarterial chemoembolization patients would not increase 30-day readmission rate compared with overnight observation. With institutional review board approval, 193 hepatocellular carcinoma patients who underwent transarterial chemoembolization from July 2013 to June 2016 were reviewed. Treatment was conventional/lipiodol transarterial chemoembolization with 50 mg doxorubicin/10 mg mitomycin-c/particles or drug-eluting embolics transarterial chemoembolization with 50-75 mg doxorubicin/vial. At 3 hours, patients tolerating oral intake and not requiring intravenous analgesics were considered for discharge. The primary outcome measure was 30-day readmission for observation versus discharge using chi-squared (χ 2 ) analysis. The secondary aim was to identify baseline or treatment variables independently associated with readmission, including Child-Pugh class, medically managed encephalopathy or ascites, patient age (<65 vs ≥65), tumor number (1 or >1), and level of embolization (segmental vs lobar). Patients underwent 261 transarterial chemoembolization procedures. The 30-day readmission rate was not significantly different between observed patients (n = 179, 9.0%) and discharged patients (n = 82, 13.8%; P = .33). Readmission was not related to the selected agent (conventional/lipiodol-transarterial chemoembolization, 11.0% vs drug-eluting embolics transarterial chemoembolization, 7.5%; P = .36). Baseline variables associated with readmission were Child-Pugh B/C (χ2 = 7.9, P < .01), history of encephalopathy (χ2 = 15.4, P < 0.01), and ascites (χ2 = 4.4, P < .05). Patient age (<65 vs ≥65), tumor number (1 vs >1), and level of embolization (segmental vs lobar) were not predictive of readmission (all P > .05). Same-day discharge after transarterial chemoembolization does not increase the risk of 30-day readmission. Child-Pugh B/C patients, as well as those with ascites or encephalopathy, have the

  18. Safety and effectiveness of umbilical hernia repair in patients with cirrhosis.

    PubMed

    Hew, S; Yu, W; Robson, S; Starkey, G; Testro, A; Fink, M; Angus, P; Gow, P

    2018-03-27

    Umbilical hernia is a common complication in patients with cirrhosis. Early studies have reported a high morbidity and mortality associated with hernia repair. The traditional approach has been to non-operatively manage umbilical hernias in patients with cirrhosis. There are emerging data suggesting that an elective repair is a preferable approach. This study examined the outcomes of umbilical hernia repair in patients with advanced liver disease and compared this with a control group of non-cirrhotic patients. Prospective data were collected regarding the outcome of umbilical hernia repairs performed between 2004 and 2013 at the Austin Hospital, Melbourne, Australia. Outcomes at 90 days were compared between patients with and without cirrhosis. 79 patients with cirrhosis and 249 controls were analysed. Of the patients with cirrhosis, 9% were classified as Child-Pugh A, 61% were Child-Pugh B and 30% were Child-Pugh C. Emergency repairs for complicated hernias was undertaken in 18% of the cirrhosis population and 10% in controls (P = 0.10). Post-operative complications occurred more commonly in patients with cirrhosis (26%) compared with controls (11%) (P < 0.01). Emergency hernia repairs were associated with a higher complication rate in both patients with cirrhosis (62%) and controls (20%) (P = 0.01). There was no significant difference in the rate of hernia recurrence as assessed by clinical examination between patients with cirrhosis (2.7%) and controls (6.8%) (P = 0.17) nor in 90-day mortality between patients with cirrhosis (n = 1, 1.3%) and the controls (n = 0) (P = 0.43). Within the limitations of a small study cohort and therefore an underpowered study, elective surgical repair of umbilical hernias in patients with cirrhosis, including decompensated cirrhosis, may not be associated with a significant increase in mortality when compared to a control cohort. Whilst complications are higher in cirrhotic patients, there is no

  19. Can the biliary enhancement of Gd-EOB-DTPA predict the degree of liver function?

    PubMed

    Okada, Masahiro; Ishii, Kazunari; Numata, Kazushi; Hyodo, Tomoko; Kumano, Seishi; Kitano, Masayuki; Kudo, Masatoshi; Murakami, Takamichi

    2012-06-01

    Excretion of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) in the bile may be related to liver function, because of elimination from the liver after preferential uptake by hepatocytes. The purpose of this study was to investigate the relation between liver and biliary enhancement in patients with or without liver dysfunction, and to compare the tumor-to-liver contrast in these patients. Forty patients [group 1: normal liver and Child-Pugh class A in 20 patients, group 2: Child-Pugh class B in 18 patients and Child-Pugh C in 2] were evaluated. All patients underwent MR imaging of the liver using a 1.5-Tesla system. T1-weighted 3D images were obtained at 5, 10, 15 and 20 minutes after Gd-EOB-DTPA injection. The relation between group 3 (total bilirubin <1.8 mg/dL) and group 4 (total bilirubin ≥1.8 mg/dL) was investigated at 20 minutes. Liver and biliary signals were measured, and compared between groups 1 and 2 or groups 3 and 4. Tumor-to-liver ratio was also evaluated between groups 1 and 2. Scheffe's post-hoc test after two-way repeated-measures ANOVA and Pearson's correlation test were used for statistical analysis. Liver enhancement showed significant difference at all time points between groups 1 and 2. Biliary enhancement did not show a significant difference between groups 1 and 2 at 5 minutes, but did at 10, 15 and 20 minutes. At 20 minutes, significant differences between groups 3 and 4 were seen for liver and biliary enhancement. At all time points, liver enhancement correlated with biliary enhancement in both groups. At 5 minutes and 20 minutes, statistical differences between groups 1 and 2 were seen for tumor-to-liver ratio. The degree of biliary enhancement has a close correlation to that of liver enhancement. It is especially important that insufficient liver enhancement causes lower tumor-to-liver contrast in the hepatobiliary phase of Gd-EOB-DTPA.

  20. Building Child Friendly Cities in the MENA region

    NASA Astrophysics Data System (ADS)

    Nour, Osman El Hassan M.

    2013-09-01

    The notion of Child Friendly Cities (CFCs) was first developed during the Second United Nations Conference on Human Settlements (HABITAT II), held in Istanbul in 1996. The concept is based on four general principles of the United Nations Convention on the rights of the child: (1) fair treatment of every child, regardless of ethnicity, gender, religion, socioeconomic background etc.; (2) top priority of the best interests of the child; (3) the child's right to a better life and development; and (4) respect of children's views. In a CFC, children are encouraged to take part in the decision making processes that affect their lives. Instead of starting yet another programme for children, the development of a CFC mobilises and connects existing agencies and actors. Giving examples of some cities in the Middle East and North Africa (MENA) region, this paper demonstrates that building CFCs has induced the development of mechanisms and structures which have enabled cities to address children's issues in a systematic manner. These mechanisms and structures include: a municipal child-friendly legal framework, local development councils and NGO networks and local municipal development offices. The author argues that in building CFCs, the role of municipal authorities is indispensable in responding to the needs of children and young people within the municipalities' mandates.

  1. 16 CFR 312.6 - Right of parent to review personal information provided by a child.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... parent of that child, taking into account available technology; and (ii) Not be unduly burdensome to the... information provided by a child. 312.6 Section 312.6 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CHILDREN'S ONLINE PRIVACY PROTECTION RULE § 312.6 Right of parent to...

  2. 16 CFR 312.6 - Right of parent to review personal information provided by a child.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... parent of that child, taking into account available technology; and (ii) Not be unduly burdensome to the... information provided by a child. 312.6 Section 312.6 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CHILDREN'S ONLINE PRIVACY PROTECTION RULE § 312.6 Right of parent to...

  3. 16 CFR 312.6 - Right of parent to review personal information provided by a child.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... parent of that child, taking into account available technology; and (ii) Not be unduly burdensome to the... information provided by a child. 312.6 Section 312.6 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CHILDREN'S ONLINE PRIVACY PROTECTION RULE § 312.6 Right of parent to...

  4. 16 CFR 312.6 - Right of parent to review personal information provided by a child.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... parent of that child, taking into account available technology; and (ii) Not be unduly burdensome to the... information provided by a child. 312.6 Section 312.6 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CHILDREN'S ONLINE PRIVACY PROTECTION RULE § 312.6 Right of parent to...

  5. 16 CFR 312.6 - Right of parent to review personal information provided by a child.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... parent of that child, taking into account available technology; and (ii) Not be unduly burdensome to the... information provided by a child. 312.6 Section 312.6 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CHILDREN'S ONLINE PRIVACY PROTECTION RULE § 312.6 Right of parent to...

  6. Percutaneous radiofrequency ablation for early hepatocellular carcinoma: Risk factors for survival

    PubMed Central

    Kikuchi, Luciana; Menezes, Marcos; Chagas, Aline L; Tani, Claudia M; Alencar, Regiane SSM; Diniz, Marcio A; Alves, Venâncio AF; D’Albuquerque, Luiz Augusto Carneiro; Carrilho, Flair José

    2014-01-01

    AIM: To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival- and recurrence-related factors. METHODS: Consecutive patients diagnosed with early HCC by computed tomography (CT) or magnetic resonance imaging (MRI) (single nodule of ≤ 5 cm, or multi- (up to 3) nodules of ≤ 3 cm each) and who underwent RFA treatment with curative intent between January 2010 and August 2011 at the Instituto do Câncer do Estado de São Paulo, Brazil were enrolled in the study. RFA of the liver tumors (with 1.0 cm ablative margin) was carried out under CT-fluoro scan and ultrasonic image guidance of the percutaneous ablation probes. Procedure-related complications were recorded. At 1-mo post-RFA and 3-mo intervals thereafter, CT and MRI were performed to assess outcomes of complete response (absence of enhancing tissue at the tumor site) or incomplete response (enhancing tissue remaining at the tumor site). Overall survival and disease-free survival rates were estimated by the Kaplan-Meier method and compared by the log rank test or simple Cox regression. The effect of risk factors on survival was assessed by the Cox proportional hazard model. RESULTS: A total of 38 RFA sessions were performed during the study period on 34 patients (age in years: mean, 63 and range, 49-84). The mean follow-up time was 22 mo (range, 1-33). The study population showed predominance of male sex (76%), less severe liver disease (Child-Pugh A, n = 26; Child-Pugh B, n = 8), and single tumor (65%). The maximum tumor diameters ranged from 10 to 50 mm (median, 26 mm). The initial (immediately post-procedure) rate of RFA-induced complete tumor necrosis was 90%. The probability of achieving complete response was significantly greater in patients with a single nodule (vs patients with multi-nodules, P = 0.04). Two patients experienced major complications, including acute pulmonary edema (resolved with intervention) and intestinal perforation

  7. Evidence in Gabon for an intrafamilial clustering with mother-to-child and sexual transmission of a new molecular variant of human T-lymphotropic virus type-II subtype B.

    PubMed

    Tuppin, P; Gessain, A; Kazanji, M; Mahieux, R; Cosnefroy, J Y; Tekaia, F; Georges-Courbot, M C; Georges, A; de Thé, G

    1996-01-01

    Following the observation of an HTLV-II seropositive 60-year-old woman living in Gabon (Central Africa), a serologic and molecular study of her family members was conducted in an attempt to determine the duration of the HTLV-II infection and the modes of transmission of the virus. Among 41 family members, five were HTLV-I seropositive and 7 exhibited specific HTLV-II antibodies in their sera as demonstrated by high immunofluorescence titers on C19 cells and/or specific Western-blot pattern. The second husband of the index case and two of his sisters were infected by the virus, suggesting the presence of HTLV-II in this family over two generations. Sequence analysis of an amplified fragment of 172 nucleotides within the gp21 of the env region (6469-6640) of four HTLV-II infected individuals revealed a new HTLV-II molecular variant of the subtype b diverging from the prototypes NRA and G12 by seven (4.1%) and five (2.9%) bases substitutions, respectively. Molecular analysis of the total env gene (1462 bp) and fragments of the pol and pX regions confirmed that this new African variant was the most divergent HTLV-II subtype b yet described, exhibiting 2.3% of nucleotide substitutions in the env gene (33 bases) as compared to the two HTLV-II b prototypes. These data demonstrate, for the first time in Africa, intrafamilial both mother-to-child transmission and sexual transmission between spouses of an HTLV-II b molecular variant, and also suggest that this virus has been present in Gabon for a long period of time.

  8. Ii. Moving sleep and child development research forward: priorities and recommendations from the srcd-sponsored forum on sleep and child development.

    PubMed

    El-Sheikh, Mona; Buckhalt, Joseph A

    2015-03-01

    Prevalent in typically developing children, insufficient or poor-quality sleep are matters of public health concern. Programmatic studies of the predictors and sequelae of sleep are increasing rapidly and yielding novel research paradigms that explicate connections between sleep, family processes, and child development within the sociocultural milieu. In an SRCD-sponsored Forum, established researchers and junior scholars from disparate areas of inquiry (e.g., Pediatrics; Public Health; Psychology; Anthropology) convened. An overarching goal of the Forum was to promote dialogue and collaborations, identify pivotal areas in the study of typically developing children's sleep, and integrate knowledge of sleep and child development across disciplines toward making conceptual advances about the ways that sleep and waking behaviors are intertwined. In addition to conceptual advances, a second goal focused on the need for methodological advances, including contemporary approaches and tools in the measures and analyses of sleep to help accelerate the pace and enhance the quality of research in this interdisciplinary field. © 2015 The Society for Research in Child Development, Inc.

  9. Children's responses to low parental mood. II: Associations with family perceptions of parenting styles and child distress.

    PubMed

    Solantaus-Simula, Tytti; Punamäki, Raija-Leena; Beardslee, William R

    2002-03-01

    In an earlier article (part 1) the authors identified four patterns of children's responses to parental low mood: Active Empathy, Emotional Overinvolvement, Indifference, and Avoidance. They then hypothesized that these response patterns were related to parenting styles and to discrepancies in family members' perceptions of parenting and child mental distress. A normal population sample of 990 twelve-year-old Finnish children and their mothers (843) and fathers (573) was used. Within-family multivariate analyses conducted in mother-father-child triads (470) were used to examine whether quality of parenting varied according to children's responses and whether parents' and children's perceptions of parenting and child distress were different. Children in the Active Empathy and Indifference groups experienced more positive parenting than those in the other two groups. Discrepancies in family members' perceptions of child distress and mothering and fathering were especially characteristic of the Emotional Overinvolvement group. Typical for the Avoidance group was a within-family agreement on poor parenting and severe child distress. Children's response patterns as regards parental low mood are related to family dynamics. The study suggests that discrepancies in parents' and children's perceptions of parenting and child distress can be meaningful in understanding family interactions and child development and well-being.

  10. Recalibration of risk prediction models in a large multicenter cohort of admissions to adult, general critical care units in the United Kingdom.

    PubMed

    Harrison, David A; Brady, Anthony R; Parry, Gareth J; Carpenter, James R; Rowan, Kathy

    2006-05-01

    To assess the performance of published risk prediction models in common use in adult critical care in the United Kingdom and to recalibrate these models in a large representative database of critical care admissions. Prospective cohort study. A total of 163 adult general critical care units in England, Wales, and Northern Ireland, during the period of December 1995 to August 2003. A total of 231,930 admissions, of which 141,106 met inclusion criteria and had sufficient data recorded for all risk prediction models. None. The published versions of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE II UK, APACHE III, Simplified Acute Physiology Score (SAPS) II, and Mortality Probability Models (MPM) II were evaluated for discrimination and calibration by means of a combination of appropriate statistical measures recommended by an expert steering committee. All models showed good discrimination (the c index varied from 0.803 to 0.832) but imperfect calibration. Recalibration of the models, which was performed by both the Cox method and re-estimating coefficients, led to improved discrimination and calibration, although all models still showed significant departures from perfect calibration. Risk prediction models developed in another country require validation and recalibration before being used to provide risk-adjusted outcomes within a new country setting. Periodic reassessment is beneficial to ensure calibration is maintained.

  11. Mortality indicators and risk factors for intra-abdominal hypertension in severe acute pancreatitis.

    PubMed

    Zhao, J G; Liao, Q; Zhao, Y P; Hu, Y

    2014-01-01

    This study assessed the risk factors associated with mortality and the development of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP). To identify significant risk factors, we assessed the following variables in 102 patients with SAP: age, gender, etiology, serum amylase level, white blood cell (WBC) count, serum calcium level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, computed tomography severity index (CTSI) score, pancreatic necrosis, surgical interventions, and multiple organ dysfunction syndrome (MODS). Statistically significant differences were identified using the Student t test and the χ (2) test. Independent risk factors for survival were analyzed by Cox proportional hazards regression. The following variables were significantly related to both mortality and IAH: WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, pancreatic necrosis >50%, and MODS. However, it was found that surgical intervention had no significant association with mortality. MODS and pancreatic necrosis >50% were found to be independent risk factors for survival in patients with SAP. Mortality and IAH from SAP were significantly related to WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, and MODS. However, Surgical intervention did not result in higher mortality. Moreover, MODS and pancreatic necrosis >50% predicted a worse prognosis in SAP patients.

  12. Under the influence with a child in the car: implications for child safety and caregiver intervention.

    PubMed

    Lawson, Karla A; Yuma-Guerrero, Paula J; von Sternberg, Kirk; Duzinski, Sarah V; Garcia, Nilda M; Brown, Carlos V; Wakefield, Sarah M; Crawford, Natalie M; Velasquez, Mary M; Maxson, R Todd

    2011-11-01

    Injury is the leading cause of death for those aged 1 year to 44 years in the United States, with motor vehicle collisions (MVCs) the leading cause of injury-related deaths. Little data exist on the relationship between caregiver alcohol and drug use at the time of MVC and child passenger outcomes. We examined the relationship between caregiver substance use in MVCs and a number of demographic, crash severity, and medical outcomes for caregivers and children. We identified family groups treated in the emergency department of a regional Level II trauma center after an MVC in a 1-year period from July 1, 2005, to June 30, 2006. The distribution and means of characteristics for substance and nonsubstance users were compared using χ analysis and Student's t tests, respectively. One in 10 vehicles contained an intoxicated caregiver at the time of MVC. In 363 identified caregivers, intoxication was associated with being male (p < 0.001), lack of safety device use (p = 0.003), rollover (p = 0.008), and ejection (p = 0.016). In the 278 family groups, intoxicated caregivers were related to child ejection (p = 0.009), the need for child hospital admission (p < 0.001), and driver intoxication was related to child lack of restraint (p = 0.045). These findings suggest a substantial number of child MVC victims arrive at the emergency room after riding with an intoxicated caregiver. Findings support the need for prevention programs focusing on substance use and driving for male caregivers, and further investigation on the need for screening and intervention for caregivers' risky alcohol and drug use after a child's MVC.

  13. Plasma granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor levels in critical illness including sepsis and septic shock: relation to disease severity, multiple organ dysfunction, and mortality.

    PubMed

    Presneill, J J; Waring, P M; Layton, J E; Maher, D W; Cebon, J; Harley, N S; Wilson, J W; Cade, J F

    2000-07-01

    To define the circulating levels of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) during critical illness and to determine their relationship to the severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the development of multiple organ dysfunction, or mortality. Prospective cohort study. University hospital intensive care unit. A total of 82 critically ill adult patients in four clinically defined groups, namely septic shock (n = 29), sepsis without shock (n = 17), shock without sepsis (n = 22), and nonseptic, nonshock controls (n = 14). None. During day 1 of septic shock, peak plasma levels of G-CSF, interleukin (IL)-6, and leukemia inhibitory factor (LIF), but not GM-CSF, were greater than in sepsis or shock alone (p < .001), and were correlated among themselves (rs = 0.44-0.77; p < .02) and with the APACHE II score (rs = 0.25-0.40; p = .03 to .18). G-CSF, IL-6, and UF, and sepsis, shock, septic shock, and APACHE II scores were strongly associated with organ dysfunction or 5-day mortality by univariate analysis. However, multiple logistic regression analysis showed that only septic shock remained significantly associated with organ dysfunction and only APACHE II scores and shock with 5-day mortality. Similarly, peak G-CSF, IL-6, and LIF were poorly predictive of 30-day mortality. Plasma levels of G-CSF, IL-6, and LIF are greatly elevated in critical illness, including septic shock, and are correlated with one another and with the severity of illness. However, they are not independently predictive of mortality, or the development of multiple organ dysfunction. GM-CSF was rarely elevated, suggesting different roles for G-CSF and GM-CSF in human septic shock.

  14. Outcome and prognostic factors of malaria-associated acute kidney injury requiring hemodialysis: A single center experience

    PubMed Central

    Kute, V. B.; Shah, P. R.; Munjappa, B. C.; Gumber, M. R.; Patel, H. V.; Jain, S. H.; Engineer, D. P.; Naresh, V. V. Sai; Vanikar, A. V.; Trivedi, H. L.

    2012-01-01

    Acute kidney injury (AKI) is one of the most dreaded complications of severe malaria. We carried out prospective study in 2010, to describe clinical characteristics, laboratory parameters, prognostic factors, and outcome in 59 (44 males, 15 females) smear-positive malaria patients with AKI. The severity of illness was assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) score, Multiple Organ Dysfunction Score (MODS), and Glasgow Coma Scale (GCS) scores. All patients received artesunate and hemodialysis (HD). Mean age of patients was 33.63 ± 14 years. Plasmodium falciparum malaria was seen in 76.3% (n = 45), Plasmodium vivax in 16.9% (n = 10), and mixed infection in 6.8% (n = 4) patients. Presenting clinical features were fever (100%), nausea-vomiting (85%), oliguria (61%), abdominal pain/tenderness (50.8%), and jaundice (74.5%). Mean APACHE II, SOFA, MODS, and GCS scores were 18.1 ± 3, 10.16 ± 3.09, 9.71 ± 2.69, and 14.15 ± 1.67, respectively, all were higher among patients who died than among those who survived. APACHE II ≥20, SOFA and MODS scores ≥12 were associated with higher mortality (P < 0.05). 34% patients received blood component transfusion and exchange transfusion was done in 15%. Mean number of HD sessions required was 4.59 ± 3.03. Renal biopsies were performed in five patients (three with patchy cortical necrosis and two with acute tubular necrosis). 81.3% of patients had complete renal recovery and 11.8% succumbed to malaria. Prompt diagnosis, timely HD, and supportive therapy were associated with improved survival and recovery of kidney functions in malarial with AKI. Mortality was associated with higher APACHE II, SOFA, MODS, GCS scores, requirement of inotrope, and ventilator support. PMID:22279340

  15. Prognostic Factors in Cholinesterase Inhibitor Poisoning.

    PubMed

    Sun, In O; Yoon, Hyun Ju; Lee, Kwang Young

    2015-09-28

    Organophosphates and carbamates are insecticides that are associated with high human mortality. The purpose of this study is to investigate the prognostic factors affecting survival in patients with cholinesterase inhibitor (CI) poisoning. This study included 92 patients with CI poisoning in the period from January 2005 to August 2013. We divided these patients into 2 groups (survivors vs. non-survivors), compared their clinical characteristics, and analyzed the predictors of survival. The mean age of the included patients was 56 years (range, 16-88). The patients included 57 (62%) men and 35 (38%) women. When we compared clinical characteristics between the survivor group (n=81, 88%) and non-survivor group (n=11, 12%), there were no differences in renal function, pancreatic enzymes, or serum cholinesterase level, except for serum bicarbonate level and APACHE II score. The serum bicarbonate level was lower in non-survivors than in survivors (12.45±2.84 vs. 18.36±4.73, P<0.01). The serum APACHE II score was higher in non-survivors than in survivors (24.36±5.22 vs. 12.07±6.67, P<0.01). The development of pneumonia during hospitalization was higher in non-survivors than in survivors (n=9, 82% vs. n=31, 38%, P<0.01). In multiple logistic regression analysis, serum bicarbonate concentration, APACHE II score, and pneumonia during hospitalization were the important prognostic factors in patients with CI poisoning. Serum bicarbonate and APACHE II score are useful prognostic factors in patients with CI poisoning. Furthermore, pneumonia during hospitalization was also important in predicting prognosis in patients with CI poisoning. Therefore, prevention and active treatment of pneumonia is important in the management of patients with CI poisoning.

  16. The prognostic and risk-stratified value of heart-type fatty acid-binding protein in septic patients in the emergency department.

    PubMed

    Chen, Yun-Xia; Li, Chun-Sheng

    2014-08-01

    To evaluate the prognostic and risk-stratified ability of heart-type fatty acid-binding protein (H-FABP) in septic patients in the emergency department (ED). From August to November 2012, 295 consecutive septic patients were enrolled. Circulating H-FABP was measured. The predictive value of H-FABP for 28-day mortality, organ dysfunction on ED arrival, and requirement for mechanical ventilation or a vasopressor within 6 hours after ED arrival was assessed by the receiver operating characteristic curve and logistic regression and was compared with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Mortality in Emergency Department Sepsis (MEDS) score, and Sequential Organ Failure Assessment score. The 28-day mortality, APACHE II, MEDS, and Sequential Organ Failure Assessment scores were much higher in H-FABP-positive patients. The incidence of organ dysfunction at ED arrival and requirement for mechanical ventilation or a vasopressor within 6 hours after ED arrival was higher in H-FABP-positive patients. Heart-type fatty acid-binding protein was an independent predictor of 28-day mortality and organ dysfunction. The area under the receiver operating characteristic curve for H-FABP predicting 28-day mortality and organ dysfunction was 0.784 and 0.755, respectively. Combination of H-FABP and MEDS improved the performance of MEDS in predicting organ dysfunction, and the difference of AUC was statistically significant (P<.05). The combinations of H-FABP and MEDS or H-FABP and APACHE II also improved the prognostic value of MEDS and APACHE II, but the areas under the curve were not statistically different. Heart-type fatty acid-binding protein was helpful for prognosis and risk stratification of septic patients in the ED. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Prognostic value of severity by various visceral proteins in critically ill patients with SIRS during 7 days of stay.

    PubMed

    Bouharras-El Idrissi, Hicham; Molina-López, Jorge; Herrera-Quintana, Lourdes; Domínguez-García, Álvaro; Lobo-Támer, Gabriela; Pérez-Moreno, Irene; Pérez-de la Cruz, Antonio; Planells-Del Pozo, Elena

    2016-11-29

    Critically ill patients typically develop a catabolic stress state as a result of a systemic inflammatory response (SIRS) that alters clinical-nutritional biomarkers, increasing energy demands and nutritional requirements. To evaluate the status of albumin, prealbumin and transferrin in critically ill patients and the association between these clinical-nutritional parameters with the severity during a seven day stay in intensive care unit (ICU). Multicenter, prospective, observational and analytical follow-up study. A total of 115 subjects in critical condition were included in this study. Clinical and nutritional parameters and severity were monitored at admission and at the seventh day of the ICU stay. A significant decrease in APACHE II and SOFA (p < 0.05) throughout the evolution of critically ill patients in ICU. In general, patients showed an alteration of most of the parameters analyzed. The status of albumin, prealbumin and transferrin were below reference levels both at admission and the 7th day in ICU. A high percentage of patients presented an unbalanced status of albumin (71.3%), prealbumin (84.3%) and transferrin (69.0%). At admission, 27% to 47% of patients with altered protein parameters had APACHE II above 18. The number of patients with altered protein parameters and APACHE II below 18 were significantly higher than severe ones throughout the ICU stay (p < 0.01). Regarding the multivariate analysis, low prealbumin status was the best predictor of severity critical (p < 0.05) both at admission and 7th day of the ICU stay. The results of the present study support the idea of including low prealbumin status as a severity predictor in APACHE II scale, due to the association found between severity and poor status of prealbumin.

  18. Temporal Variations of Telluric Water Vapor Absorption at Apache Point Observatory

    NASA Astrophysics Data System (ADS)

    Li, Dan; Blake, Cullen H.; Nidever, David; Halverson, Samuel P.

    2018-01-01

    Time-variable absorption by water vapor in Earth’s atmosphere presents an important source of systematic error for a wide range of ground-based astronomical measurements, particularly at near-infrared wavelengths. We present results from the first study on the temporal and spatial variability of water vapor absorption at Apache Point Observatory (APO). We analyze ∼400,000 high-resolution, near-infrared (H-band) spectra of hot stars collected as calibration data for the APO Galactic Evolution Experiment (APOGEE) survey. We fit for the optical depths of telluric water vapor absorption features in APOGEE spectra and convert these optical depths to Precipitable Water Vapor (PWV) using contemporaneous data from a GPS-based PWV monitoring station at APO. Based on simultaneous measurements obtained over a 3° field of view, we estimate that our PWV measurement precision is ±0.11 mm. We explore the statistics of PWV variations over a range of timescales from less than an hour to days. We find that the amplitude of PWV variations within an hour is less than 1 mm for most (96.5%) APOGEE field visits. By considering APOGEE observations that are close in time but separated by large distances on the sky, we find that PWV is homogeneous across the sky at a given epoch, with 90% of measurements taken up to 70° apart within 1.5 hr having ΔPWV < 1.0 mm. Our results can be used to help simulate the impact of water vapor absorption on upcoming surveys at continental observing sites like APO, and also to help plan for simultaneous water vapor metrology that may be carried out in support of upcoming photometric and spectroscopic surveys.

  19. Mississippi Curriculum Framework for Child Care and Guidance Management and Services (Program CIP: 20.0201--Child Care & Guidance Workers and Managers). Secondary Programs.

    ERIC Educational Resources Information Center

    Mississippi Research and Curriculum Unit for Vocational and Technical Education, State College.

    This document, which reflects Mississippi's statutory requirement that instructional programs be based on core curricula and performance-based assessment, contains outlines of the instructional units required in local instructional management plans and daily lesson plans for child care and guidance management and services I and II. Presented first…

  20. Remote sensing analysis of vegetation at the San Carlos Apache Reservation, Arizona and surrounding area

    USGS Publications Warehouse

    Norman, Laura M.; Middleton, Barry R.; Wilson, Natalie R.

    2018-01-01

    Mapping of vegetation types is of great importance to the San Carlos Apache Tribe and their management of forestry and fire fuels. Various remote sensing techniques were applied to classify multitemporal Landsat 8 satellite data, vegetation index, and digital elevation model data. A multitiered unsupervised classification generated over 900 classes that were then recoded to one of the 16 generalized vegetation/land cover classes using the Southwest Regional Gap Analysis Project (SWReGAP) map as a guide. A supervised classification was also run using field data collected in the SWReGAP project and our field campaign. Field data were gathered and accuracy assessments were generated to compare outputs. Our hypothesis was that a resulting map would update and potentially improve upon the vegetation/land cover class distributions of the older SWReGAP map over the 24,000  km2 study area. The estimated overall accuracies ranged between 43% and 75%, depending on which method and field dataset were used. The findings demonstrate the complexity of vegetation mapping, the importance of recent, high-quality-field data, and the potential for misleading results when insufficient field data are collected.

  1. The appropriate and inappropriate use of child restraint seats in Manitoba.

    PubMed

    Blair, John; Perdios, Angeliki; Babul, Shelina; Young, Kevin; Beckles, Janice; Pike, Ian; Cripton, Peter; Sasges, Debbie; Mulpuri, Krishore; Desapriya, Ediriweera

    2008-09-01

    The objective of this research was to describe the use and incorrect use of child restraint systems in Manitoba, Canada. In 2004, a team of inspectors made up of Royal Canadian Mounted Police officers and trained car seat technicians from the Manitoba child seat coalition conducted a descriptive survey of types and frequency of child restraint systems' incorrect use. The setting was 10 roadside inspection sites located around the city of Winnipeg, Manitoba. The subjects were parents and primary caregivers of children using child restraint systems. The main outcome measured was the reported appropriate use rate as determined by the compliance to safety standards for correct installation and use of child restraints. A total of 340 child restraint systems were assessed. The overall rate of incorrect use was 70%. The errors present in stage III systems (booster seats) are much lower than the errors present in stage I systems (rear-facing child safety seats) and stage II systems (forward-facing child safety seats). The data presented illustrate that incorrect use of child restraint systems in the province of Manitoba is a large problem and must be dealt with immediately in order to ensure child safety now and in the future. Community-wide information and enhanced enforcement campaigns, consisting of activities such as mass media, information and publicity, child restraint systems displays and special enforcement strategies (check points, dedicated law enforcement officials, alternative penalties) should be used to increase the correct use of child restraint systems. Failure to use child restraint systems properly can contribute to serious injury or death of a child.

  2. Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution.

    PubMed

    Rodríguez, I; Fluiters, E; Pérez-Méndez, L F; Luna, R; Páramo, C; García-Mayor, R V

    2004-02-01

    This study was carried out to investigate the clinical and biochemical factors which might be of importance in predicting the outcome of patients with myxoedema coma. Eleven patients (ten female) aged 68.1+/-19.5 years attended our institution over a period of 18 years. Glasgow and APACHE II scores and serum free thyroxine and TSH were measured in all the patients on entry. Patients were selected at random to be treated with two different regimens of l-thyroxine. Four patients died with the mortality rate being 36.4%. The patients in coma at entry had significantly higher mortality rates than those with minor degrees of consciousness (75% vs 14.3% respectively, P=0.04). The surviving patients had significantly higher Glasgow scores than those who died (11.85+/-2.3 vs 5.25+/-2.2 respectively, P<0.001). Comparison of the mean values of APACHE II scores between the surviving group and those who died was significantly different (18.0+/-2.08 vs 31.5+/-2.08 respectively, P<0.0001). The degree of consciousness, the Glasgow score and the severity of the illness measured by APACHE II score on entry were the main factors that determined the post-treatment outcome of patients with myxoedema coma.

  3. Comparison of mortality prediction models in burns ICU patients in Pinderfields Hospital over 3 years.

    PubMed

    Douglas, Helen E; Ratcliffe, Andrew; Sandhu, Rajdeep; Anwar, Umair

    2015-02-01

    Many different burns mortality prediction models exist; however most agree that important factors that can be weighted include the age of the patient, the total percentage of body surface area burned and the presence or absence of smoke inhalation. A retrospective review of all burns primarily admitted to Pinderfields Burns ICU under joint care of burns surgeons and intensivists for the past 3 years was completed. Predicted mortality was calculated using the revised Baux score (2010), the Belgian Outcome in Burn Injury score (2009) and the Boston group score by Ryan et al. (1998). Additionally 28 of the 48 patients had APACHE II scores recorded on admission and the predicted and actual mortality of this group were compared. The Belgian score had the highest sensitivity and negative predictive value (72%/85%); followed by the Boston score (66%/78%) and then the revised Baux score (53%/70%). APACHE II scores had higher sensitivity (81%) and NPV (92%) than any of the burns scores. In our group of burns ICU patients the Belgian model was the most sensitive and specific predictor of mortality. In our subgroup of patients with APACHE II data, this score more accurately predicted survival and mortality. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  4. The prevalence of different kinds of child abuse and the characteristics that differentiate abused from nonabused male adolescents.

    PubMed

    Mikaeili, Niloofar; Barahmand, Usha; Abdi, Reza

    2013-03-01

    Child abuse has proved to be one of the most important social challenges. The present study attempts (a) to determine the prevalence of child abuse in an urban area in Iran and (b) to differentiate abused from non-abused adolescent boys using parental and child characteristics. A survey was conducted to determine the prevalence of different types of child abuse. The prevalence sample comprised 2,100 students selected through a multistage random sampling procedure. Data were collected using the Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory, II (BDI-II), State Trait Anxiety Inventory (STAI), modified Hazan & Shaver Attachment Style Questionnaire (ASQ) and Symptom Check List 90 (SCL-90-R). Descriptive statistics and discriminant function analysis were used to analyze the data. The results showed that 14.85% of the subjects were exposed to child abuse, with emotional abuse being most prevalent (52.09%). Also, it appeared that variables such as parental depression and anxiety and children's attachment styles, anxiety, and aggression can help discriminate abused boys from their non-abused counterparts.

  5. Medical Problems. Child Health and Safety Series (Module IV).

    ERIC Educational Resources Information Center

    Iscoe, Louise; And Others

    This manual for child care personnel in day care homes and centers provides guidelines and information on the detection, treatment, and control of medical problems of children. Introductory materials focus on signs of illness which carepersons can recognize. Section II concentrates on insect, animal and human bites. Section III discusses skin…

  6. FOUR Score Predicts Early Outcome in Patients After Traumatic Brain Injury.

    PubMed

    Nyam, Tee-Tau Eric; Ao, Kam-Hou; Hung, Shu-Yu; Shen, Mei-Li; Yu, Tzu-Chieh; Kuo, Jinn-Rung

    2017-04-01

    The aim of the study was to determine whether the Full Outline of UnResponsiveness (FOUR) score, which includes eyes opening (E), motor function (M), brainstem reflex (B), and respiratory pattern (R), can be used as an alternate method to the Glasgow Coma Scale (GCS) in predicting intensive care unit (ICU) mortality in traumatic brain injury (TBI) patients. From January 2015 to June 2015, patients with isolated TBI admitted to the ICU were enrolled. Three advanced practice nurses administered the FOUR score, GCS, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Therapeutic Intervention Scoring System (TISS) concurrently from ICU admissions. The endpoint of observation was mortality when the patients left the ICU. Data are presented as frequency with percentages, mean with standard deviation, or median with interquartile range. Each measurement tool used area under the receiver operating characteristic curve to compare the predictive power between these four tools. In addition, the difference between survival and death was estimated using the Wilcoxon rank sum test. From 55 TBI patients, males (72.73 %) were represented more than females, the mean age was 63.1 ± 17.9, and 19 of 55 observations (35 %) had a maximum FOUR score of 16. The overall mortality rate was 14.6 %. The area under the receiver operating characteristic curve was 74.47 % for the FOUR score, 74.73 % for the GCS, 81.78 % for the APACHE II, and 53.32 % for the TISS. The FOUR score has similar predictive power of mortality compared to the GCS and APACHE II. Each of the parameters-E, M, B, and R-of the FOUR score showed a significant difference between mortality and survival group, while the verbal and eye-opening components of the GCS did not. Having similar predictive power of mortality compared to the GCS and APACHE II, the FOUR score can be used as an alternative in the prediction of early mortality in TBI patients in the ICU.

  7. Early physiological response to intensive care as a clinically relevant approach to predicting the outcome in severe acute pancreatitis.

    PubMed

    Flint, Richard; Windsor, John A

    2004-04-01

    The physiological response to treatment is a better predictor of outcome in acute pancreatitis than are traditional static measures. Retrospective diagnostic test study. The criterion standard was Organ Failure Score (OFS) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score at the time of hospital admission. Intensive care unit of a tertiary referral center, Auckland City Hospital, Auckland, New Zealand. Consecutive sample of 92 patients (60 male, 32 female; median age, 61 years; range, 24-79 years) with severe acute pancreatitis. Twenty patients were not included because of incomplete data. The cause of pancreatitis was gallstones (42%), alcohol use (27%), or other (31%). At hospital admission, the mean +/- SD OFS was 8.1 +/- 6.1, and the mean +/- SD APACHE II score was 19.9 +/- 8.2. All cases were managed according to a standardized protocol. There was no randomization or testing of any individual interventions. Survival and death. There were 32 deaths (pretest probability of dying was 35%). The physiological response to treatment was more accurate in predicting the outcome than was OFS or APACHE II score at hospital admission. For example, 17 patients had an initial OFS of 7-8 (posttest probability of dying was 58%); after 48 hours, 7 had responded to treatment (posttest probability of dying was 28%), and 10 did not respond (posttest probability of dying was 82%). The effect of the change in OFS and APACHE II score was graphically depicted by using a series of logistic regression equations. The resultant sigmoid curve suggests that there is a midrange of scores (the steep portion of the graph) within which the probability of death is most affected by the response to intensive care treatment. Measuring the initial severity of pancreatitis combined with the physiological response to intensive care treatment is a practical and clinically relevant approach to predicting death in patients with severe acute pancreatitis.

  8. N-terminal pro-brain natriuretic peptide and cardiac troponin I for the prognostic utility in elderly patients with severe sepsis or septic shock in intensive care unit: A retrospective study.

    PubMed

    Cheng, Hui; Fan, Wei-Ze; Wang, Sheng-Chi; Liu, Zhao-Hui; Zang, Hui-Ling; Wang, Li-Zhong; Liu, Hong-Juan; Shen, Xiao-Hui; Liang, Shao-Qing

    2015-06-01

    Using biomarkers to predict mortality in patient with severe sepsis or septic shock is of importance, as these patients frequently have high mortality and unsatisfied outcome. N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) play extremely important roles in prognostic value in the mortality of severe sepsis and septic shock. The present study was retrospectively designed to evaluate the predicting mortality of NT-proBNP and cTnI in elderly patients with severe sepsis or septic shock administered in the intensive care unit (ICU) and also to evaluate whether the predicting ability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score or C-reactive protein (CRP) was increased in combination with the biomarkers. A cohort of 430 patients (aged ≥65 years) with severe sepsis or septic shock admitted to our ICU between October 2011 and December 2013 was included in the study. Patient data including clinical, laboratory, and survival and mortality were collected. All patients were examined with NT-proBNP, cTnI, CRP, and APACHE-II score and were categorized as the survived and deceased groups according to the outcome 30 days after ICU treatment. The levels of NT-proBNP and cTnI (P < .01) or CRP (P < .05) were significantly higher in the deceased group than those in the survived group. The predicting mortality of APACHE-II score alone was low but largely improved, when it was combined with both NT-proBNP and cTnI (P < .05). The alteration of NT-proBNP and cTnI levels strongly predicated the ICU prognosis in elderly patients with severe sepsis or septic shock. N-terminal pro-brain natriuretic peptide and cTnI were superior to CRP in predicting mortality. The predicting ability of APACHE-II score was improved only when combined with NT-proBNP and cTnI. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Seeking the Balance: A Native Women's Dialogue. Panel Presentation at the State of Indian American Conference, Cornell University (October 10, 1992).

    ERIC Educational Resources Information Center

    Cook, Katsi; And Others

    1993-01-01

    Seven Native American women (including Mohawk, Bolivian, Apache, Nicaraguan Miskito, and Hopi women) discuss women's responsibilities and roles within the family and community, spirituality, birth and puberty ceremonies, child rearing and traditional education of the young (particularly girls), the healing of men through women, union organizing in…

  10. Child behaviour problems and childhood illness: development of the Eczema Behaviour Checklist.

    PubMed

    Mitchell, A E; Morawska, A; Fraser, J A; Sillar, K

    2017-01-01

    Children with atopic dermatitis are at increased risk of both general behaviour problems, and those specific to the condition and its treatment. This can hamper the ability of parents to carry out treatment and manage the condition effectively. To date, there is no published instrument available to assess child behaviour difficulties in the context of atopic dermatitis management. Our aim was to develop a reliable and valid instrument to assess atopic dermatitis-specific child behaviour problems, and parents' self-efficacy (confidence) for managing these behaviours. The Eczema Behaviour Checklist (EBC) was developed as a 25-item questionnaire to measure (i) extent of behaviour problems (EBC Extent scale), and (ii) parents' self-efficacy for managing behaviour problems (EBC Confidence scale), in the context of child atopic dermatitis management. A community-based sample of 292 parents completed the EBC, measures of general behaviour difficulties, self-efficacy with atopic dermatitis management and use of dysfunctional parenting strategies. There was satisfactory internal consistency and construct validity for EBC Extent and Confidence scales. There was a negative correlation between atopic dermatitis-specific behaviour problems and parents' self-efficacy for dealing with behaviours (r = -.53, p < .001). Factor analyses revealed a three-factor structure for both scales: (i) treatment-related behaviours; (ii) symptom-related behaviours; and (iii) behaviours related to impact of the illness. Variation in parents' self-efficacy for managing their child's atopic dermatitis was explained by intensity of illness-specific child behaviour problems and parents' self-efficacy for dealing with the behaviours. The new measure of atopic dermatitis-specific child behaviour problems was a stronger predictor of parents' self-efficacy for managing their child's condition than was the measure of general child behaviour difficulties. Results provide preliminary evidence of

  11. [Value of procalcitonin on predicting the severity and prognosis in patients with early ARDS: a prospective observation study].

    PubMed

    Yu, Zhixin; Ji, Musen; Hu, Xiulan; Yan, Jun; Jin, Zhaochen

    2017-01-01

    To investigate the value of procalcitonin (PCT) on predicting the severity and prognosis in patients with early acute respiratory distress syndrome (ARDS). A prospective observation study was conducted. A total of 113 patients with ARDS undergoing mechanical ventilation admitted to intensive care unit (ICU) of Affiliated People's Hospital of Jiangsu University from October 2012 to April 2016 were enrolled. Based on oxygenation index (PaO 2 /FiO 2 ), the patients were classified into mild, moderate, and severe groups according to Berlin Definition. Twenty-five healthy volunteers were served as controls. Demographics, acute physiology and chronic health evaluation II (APACHE II) score, and Murray lung injury score were recorded. Within 24 hours after diagnosis of ARDS, the serum levels of PCT and C-reactive protein (CRP) were determined by enzyme-linked fluorescence analysis (ELFA) and immune turbidimetric method, respectively. The patients were also divided into survival and non-survival groups according to clinical outcome within 28-day follow-up, and the clinical data were compared between the two groups. Spearman rank correlation was applied to determine the correlation between variables. The predictive value of the parameters on 28-day mortality was evaluated with receiver operating characteristic curve (ROC). Kaplan-Meier survival curve analysis was used to compare different PCT levels of patients with 28-day cumulative survival rate. After excluding patients who did not meet the inclusion criteria and loss to follow-up, the final 89 patients were enrolled in the analysis. Among 89 ARDS patients analyzed, 27 of them were mild, 34 moderate, and 28 severe ARDS. No significant differences were found in age and gender between ARDS and healthy control groups. Infection and trauma were the most common etiology of ARDS (55.1% and 34.8%, respectively). Compared with healthy control group, both CRP and PCT in serum of ARDS group were higher [CRP (mg/L): 146.32 (111

  12. Depression, anxiety and alexithymia symptoms are major determinants of health related quality of life (HRQoL) in cirrhotic patients.

    PubMed

    Nardelli, Silvia; Pentassuglio, Ilaria; Pasquale, Chiara; Ridola, Lorenzo; Moscucci, Federica; Merli, Manuela; Mina, Concetta; Marianetti, Massimo; Fratino, Mariangela; Izzo, Chiara; Merkel, Carlo; Riggio, Oliviero

    2013-06-01

    HRQoL is impaired in cirrhosis. Establishing the relevance of depression, anxiety, alexithymia and cirrhosis stage on the patients' HRQoL. Sixty cirrhotics underwent a neuropsychological assessment, including ZUNG-SDS, STAI Y1-Y2 and TAS-20. Minimal hepatic encephalopathy (MHE) was detected by PHES, HRQoL by Short-Form-36 (SF-36). Depression was detected in 34 patients (57 %, 95%CI = 44-70 %), state-anxiety in 16 (27 %, 95%CI = 15-38 %), trait-anxiety in 17 (28 %, 95%CI = 17-40 %), alexithymia in 14 (31 % 95%CI = 16-46 %) and MHE in 22 (37 %, 95%CI = 24-49 %). Neuropsychological symptoms were unrelated to cirrhosis stage, hepatocellular carcinoma or MHE. A significant correlation was observed among psychological test scores and summary components of SF-36. At multiple linear regression analysis including Child-Pugh and MELD scores, previous-HE and the psychological test scores as possible covariates, alexithymia and depression as well as to the Child-Pugh score were significantly related to the SF-36 mental component; while trait-anxiety was the only variable significantly and independently related to the SF-36 physical component. Depression, state and trait-anxiety and alexithymia symptoms are frequent in cirrhotics and are among the major determinants of the altered HRQoL.

  13. An epidemiological study of the association of coffee with chronic liver disease.

    PubMed

    Walton, H B; Masterton, G S; Hayes, P C

    2013-11-01

    Chronic liver disease affects 855 people per million in the UK. Previous studies have reported that coffee appears protective against the development of abnormal liver enzymes, hepatic fibrosis and cirrhosis. The aim of this study, the first in a Scottish population, was to compare coffee consumption in patients with liver disease and that of control populations to determine correlations between coffee intake and the incidence of non-cancerous liver disease and with Child's-Pugh and model for end-stage liver disease (MELD) scores. Two hundred and eighty-six patients attending the liver outpatient department at the Royal Infirmary of Edinburgh completed a questionnaire regarding coffee consumption and lifestyle factors. Control questionnaires were also completed by 100 orthopaedic outpatients and 120 medical students. Patients with cirrhosis (n = 95) drank significantly less coffee than those without cirrhosis (p = <0.001). There was no correlation between Child's-Pugh (-0.018) and MELD scores (-0.132) with coffee consumption. Coffee drinking is associated with a reduced prevalence of cirrhosis in patients with chronic liver disease. However, there was no significant difference in the amount of coffee drunk by liver patients and the control groups. It is possible that by changing the amount of coffee drunk, the development of cirrhosis in liver disease could be postponed.

  14. [Correlation between red blood cell count and liver function status].

    PubMed

    Xie, Xiaomeng; Wang, Leijie; Yao, Mingjie; Wen, Xiajie; Chen, Xiangmei; You, Hong; Jia, Jidong; Zhao, Jingmin; Lu, Fengmin

    2016-02-01

    To investigate the changes in red blood cell count in patients with different liver diseases and the correlation between red blood cell count and degree of liver damage. The clinical data of 1427 patients with primary liver cancer, 172 patients with liver cirrhosis, and 185 patients with hepatitis were collected, and the Child-Pugh class was determined for all patients. The differences in red blood cell count between patients with different liver diseases were retrospectively analyzed, and the correlation between red blood cell count and liver function status was investigated. The Mann-Whitney U test, Kruskal-Wallis H test, rank sum test, Spearman rank sum correlation test, and chi-square test were performed for different types of data. Red blood cell count showed significant differences between patients with chronic hepatitis, liver cancer, and liver cirrhosis and was highest in patients with chronic hepatitis and lowest in patients with liver cirrhosis (P < 0.05). In the patients with liver cirrhosis, red blood cell count tended to decrease in patients with a higher Child-Pugh class (P < 0.05). For patients with liver cirrhosis, red blood cell count can reflect the degree of liver damage, which may contribute to an improved liver function prediction model for these patients.

  15. Modelling determinants of child mortality and poverty in the Comoros.

    PubMed

    Lachaud, Jean-Pierre

    2004-03-01

    Based on the Demographic and Health Survey of the Comoros of 1996, the analysis of the determinants of child mortality reaches three conclusions. Firstly, differentiated analytical options generate partially convergent results and provide different dimensions of child mortality. Secondly, the study shows that the low standard of living of households in terms of assets is associated with high child mortality. Thirdly, the determinants of infant and infanto-juvenile mortality are relatively comparable. On the one hand, some common factors to both analytical options affect negatively child health: (i) geographical location in rural zones and/or on the islands of Anjouan and Mohéli; (ii) the low standard of living of households in terms of assets; (iii) some community elements, in particular morbidity, the insufficiency of vaccination and the absence of childbirth assisted by qualified persons. On the other hand, characteristics of mothers and births have an impact on infant and infanto-juvenile survival.

  16. [Types of child rearing behavior of parents during early childhood: Q-methodological approach].

    PubMed

    Park, Sun-Jung; Kang, Kyung-Ah; Kim, Shin-Jeong

    2013-08-01

    The purpose of this study was to identify the awareness of child rearing among parents of children in early childhood and to provide fundamental data for parent education programs according to child rearing type. Q-methodology which provides a method of analyzing the subjectivity of each item was used. Forty Q items which were derived from a literature review and interviews with nurturing mothers were classified into a normal distribution using a 9-point scale. Collected data were analyzed using the QUANAL PC Program. Four types of parents' child rearing were identified. Type I was named 'affection-respect type', type II, 'concern-rule compliant type', type III, 'solicitude-model type', and type IV, 'geniality-encouragement type'. For proper growth and development during early childhood, parents should have rational information and awareness of their child rearing type. Results of this study can be used as essential data to develop child rearing education programs according to parents' child rearing attitude.

  17. Disentangling the effects of parental food restriction on child's risk of overweight.

    PubMed

    Godefroy, Valérie; Champel, Camille; Trinchera, Laura; Rigal, Natalie

    2018-04-01

    The links between parental restriction of food intake, child's eating behaviour and child's adiposity are still unclear. Our aim was to validate a model suggesting an underlying mechanism for the impact of parental restriction on child's adiposity through a broad dimension of child's eating temperament entitled the appetite reactivity (including both appetite arousal and appetite persistence). Using an online questionnaire administered at home to children aged between 8 and 11 years (N = 414) with one or both of their parents, we measured: based on child's reports, the perceived maternal restriction of child's food intake, the appetite reactivity and both the desired and the eaten mean food portion sizes; based on parental reports, the mean food portion size given to the child and the child's BMI. Structural equation modelling was used to test a model linking measured variables. A well-fitting structural model (AGFI = 0.91; RMSEA = 0.07; SRMR = 0.08) was identified, showing that: (i) perceived maternal restriction of child's food intake negatively impacts child's appetite arousal and food portion size but positively influences child's appetite persistence; (ii) the two components of appetite reactivity have a positive effect on child's adiposity which is partly mediated by child's actual food portion size. Results suggest an explanation for the controversy surrounding the links between parental food restriction and child's adiposity: through its negative impact on child's appetite arousal and food portion size, parental control may protect against overweight, but because of its positive effect on appetite persistence, it can also be detrimental. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Child Support Enforcement (9th Annual Report to Congress for the Period Ending September 30, 1984).

    ERIC Educational Resources Information Center

    Office of Child Support Enforcement (DHHS), Washington, DC.

    Described in this report are fiscal year 1984 activities of the Child Support Enforcement (CSE) program, a program established in 1975 as part D of title IV of the Social Security Act. Following an executive summary, chapter I describes the mission and organization of the CSE. Chapter II reviews the child support enforcement amendments of 1984,…

  19. The Apache Point Observatory Galactic Evolution Experiment (APOGEE) and its successor, APOGEE-2

    NASA Astrophysics Data System (ADS)

    Majewski, S. R.; APOGEE Team; APOGEE-2 Team

    2016-09-01

    The Apache Point Observatory Galactic Evolution Experiment (APOGEE) of Sloan Digital Sky Survey III (SDSS-III) has produced a large catalog of high resolution ({R = 22 500}), high quality (S/N > 100), infrared (H-band) spectra for stars throughout all stellar populations of the Milky Way, including in regions veiled by significant dust opacity. APOGEE's half million spectra collected on > 163 000 unique stars, with time series information via repeat visits to each star, are being applied to numerous problems in stellar populations, Galactic astronomy, and stellar astrophysics. From among the early results of the APOGEE project - which span from measurements of Galactic dynamics, to multi-element chemical maps of the disk and bulge, new views of the interstellar medium, explorations of stellar companions, the chemistry of star clusters, and the discovery of rare stellar species - I highlight a few results that demonstrate APOGEE's unique ability to sample and characterize the Galactic disk and bulge. Plans are now under way for an even more ambitious successor to APOGEE: the six-year, dual-hemisphere APOGEE-2 project. Both phases of APOGEE feature a strong focus on targets having asteroseismological measurements from either Kepler or {CoRoT}, from which it is possible to derive relatively precise stellar ages. The combined APOGEE and APOGEE-2 databases of stellar chemistry, dynamics and ages constitute an unusually comprehensive, systematic and homogeneous resource for constraining models of Galactic evolution.

  20. The Rotation of M Dwarfs Observed by the Apache Point Galactic Evolution Experiment

    NASA Astrophysics Data System (ADS)

    Gilhool, Steven H.; Blake, Cullen H.; Terrien, Ryan C.; Bender, Chad; Mahadevan, Suvrath; Deshpande, Rohit

    2018-01-01

    We present the results of a spectroscopic analysis of rotational velocities in 714 M-dwarf stars observed by the SDSS-III Apache Point Galactic Evolution Experiment (APOGEE) survey. We use a template-fitting technique to estimate v\\sin i while simultaneously estimating {log}g, [{{M}}/{{H}}], and {T}{eff}. We conservatively estimate that our detection limit is 8 km s‑1. We compare our results to M-dwarf rotation studies in the literature based on both spectroscopic and photometric measurements. Like other authors, we find an increase in the fraction of rapid rotators with decreasing stellar temperature, exemplified by a sharp increase in rotation near the M4 transition to fully convective stellar interiors, which is consistent with the hypothesis that fully convective stars are unable to shed angular momentum as efficiently as those with radiative cores. We compare a sample of targets observed both by APOGEE and the MEarth transiting planet survey and find no cases where the measured v\\sin i and rotation period are physically inconsistent, requiring \\sin i> 1. We compare our spectroscopic results to the fraction of rotators inferred from photometric surveys and find that while the results are broadly consistent, the photometric surveys exhibit a smaller fraction of rotators beyond the M4 transition by a factor of ∼2. We discuss possible reasons for this discrepancy. Given our detection limit, our results are consistent with a bimodal distribution in rotation that is seen in photometric surveys.

  1. The value of the girl child in Singapore.

    PubMed

    Thein, M M; Goh, L G

    1991-01-01

    Son preference exists in many countries in Asia. In countries like Pakistan, Bangladesh and Nepal, such preference has been shown to result in excess female mortality. In Singapore, there is also son preference but excess female mortality is not seen because of several factors: Government's policy of equal educational opportunities for boys and girls since World War II, the protection of women's rights through the Women's Charter, the family planning message that "Boy or Girl, two is enough", urbanisation and industrialisation. Singapore is seeing increasing participation of women in the workforce, not only as clerks and factory operators but also as decision makers in middle and senior management positions. In this modern age, the girl child should be given as much value as the boy child. Only when such an egalitarian attitude towards the girl child exists would she be able to develop into her full potential to be an asset to her country. Government policies to promote the well-being, protect the rights, and to improve the lot of the girl child appear necessary in countries where son preference leads to excess mortality of girls from sex discrimination in nutrition and/or health care.

  2. Parent and family impact of raising a child with perinatal stroke

    PubMed Central

    2014-01-01

    Background Perinatal stroke is a leading cause of early brain injury, cerebral palsy, and lifelong neurological morbidity. No study to date has examined the impact of raising a child with perinatal stroke on parents and families. However, a large breadth of research suggests that parents, especially mothers, may be at increased risk for psychological concerns. The primary aim of this study was to examine the impact of raising a child with perinatal stroke on mothers’ wellbeing. A secondary aim was to examine how caring for a child with perinatal stroke differentially affects mothers and fathers. Methods In Study I, a matched case-control design was used to compare the wellbeing of mothers of children with perinatal stroke and mothers of children with typical development. In Study II, a matched case-control design was used to compare mother-father dyads. Participants completed validated measures of anxiety and depression, stress, quality of life and family functioning, marital satisfaction, and marital distress. Parents of children with perinatal stroke also completed a recently validated measure of the psychosocial impact of perinatal stroke including guilt and blame outcomes. Disease severity was categorized by parents, validated by the Pediatric Stroke Outcome Measure (PSOM), and compared across the above outcomes in Study I. Results A total of 112 mothers participated in Study I (n = 56 per group; mean child age = 7.42 years), and 56 parents participated in Study II (n = 28 per group; mean child age = 8.25 years). In Study I, parent assessment of disease severity was correlated with PSOM scores (γ = 0.75, p < .001) and associated with parent outcomes. Mothers of children with mild conditions were indistinguishable from controls on the outcome measures. However, mothers of children with moderate/severe conditions had poorer outcomes on measures of depression, marital satisfaction, quality of life, and family functioning. In Study II

  3. Parent and family impact of raising a child with perinatal stroke.

    PubMed

    Bemister, Taryn B; Brooks, Brian L; Dyck, Richard H; Kirton, Adam

    2014-07-14

    Perinatal stroke is a leading cause of early brain injury, cerebral palsy, and lifelong neurological morbidity. No study to date has examined the impact of raising a child with perinatal stroke on parents and families. However, a large breadth of research suggests that parents, especially mothers, may be at increased risk for psychological concerns. The primary aim of this study was to examine the impact of raising a child with perinatal stroke on mothers' wellbeing. A secondary aim was to examine how caring for a child with perinatal stroke differentially affects mothers and fathers. In Study I, a matched case-control design was used to compare the wellbeing of mothers of children with perinatal stroke and mothers of children with typical development. In Study II, a matched case-control design was used to compare mother-father dyads. Participants completed validated measures of anxiety and depression, stress, quality of life and family functioning, marital satisfaction, and marital distress. Parents of children with perinatal stroke also completed a recently validated measure of the psychosocial impact of perinatal stroke including guilt and blame outcomes. Disease severity was categorized by parents, validated by the Pediatric Stroke Outcome Measure (PSOM), and compared across the above outcomes in Study I. A total of 112 mothers participated in Study I (n = 56 per group; mean child age = 7.42 years), and 56 parents participated in Study II (n = 28 per group; mean child age = 8.25 years). In Study I, parent assessment of disease severity was correlated with PSOM scores (γ = 0.75, p < .001) and associated with parent outcomes. Mothers of children with mild conditions were indistinguishable from controls on the outcome measures. However, mothers of children with moderate/severe conditions had poorer outcomes on measures of depression, marital satisfaction, quality of life, and family functioning. In Study II, mothers and fathers had similar

  4. The Century of the Child, Part II: Back to the Future or Forward to the Past?

    ERIC Educational Resources Information Center

    Ronnberg, Margareta

    In 1900, the Swedish writer and social commentator Ellen Key published a book called "The Century of the Child," presenting changes she believed were necessary in the care of children in the twentieth century. This article examines the reality of childhood and child care in Sweden, comparing Key's wishes to both actual changes and…

  5. 75 FR 71648 - Federal Motor Vehicle Safety Standards, Child Restraint Systems; Hybrid III 10-Year-Old Child...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-24

    ...This document proposes to amend Federal Motor Vehicle Safety Standard (FMVSS) No. 213, Child Restraint Systems, regarding a Hybrid III 10-year-old child test dummy that the agency seeks to use in the compliance test procedures of the standard. This document supplements a 2005 notice of proposed rulemaking (NPRM) and a 2008 SNPRM previously published in this rulemaking (RIN 2127-AJ44) regarding this test dummy. In the 2005 NPRM, in response to Anton's Law, NHTSA proposed to adopt the 10-year-old child test dummy into FMVSS No. 213 to test child restraints for older children. Subsequently, to address variation that was found in dummy readings due to chin-to-chest contact, NHTSA published the 2008 SNPRM to propose a NHTSA-developed procedure for positioning the test dummy in belt-positioning seats. Comments on the SNPRM objected to the positioning procedure, and some suggested an alternative procedure developed by the University of Michigan Transportation Research Institute (UMTRI). Today's SNPRM proposes to use the UMTRI procedure to position the test dummy rather than the NHTSA-developed procedure. We note that the 10-year-old child dummy may sometimes experience stiff contact between its chin and upper sternal bib region which may result in an unrealistically high value of the head injury criterion (HIC) \\1\\ referenced in the standard. Accordingly, NHTSA proposes that the dummy's HIC measurement will not be used to assess the compliance of the tested child restraint. This SNPRM also proposes other amendments to FMVSS No. 213, including a proposal to permit NHTSA to use, at the manufacturer's option, the Hybrid II or Hybrid III versions of the 6-year-old test dummy, and a proposal to use the UMTRI procedure to position the Hybrid III 6-year- old and 10-year-old dummies when testing belt-positioning seats. ---------------------------------------------------------------------------

  6. Exploratory analysis of textual data from the Mother and Child Handbook using a text mining method (II): Monthly changes in the words recorded by mothers.

    PubMed

    Tagawa, Miki; Matsuda, Yoshio; Manaka, Tomoko; Kobayashi, Makiko; Ohwada, Michitaka; Matsubara, Shigeki

    2017-01-01

    The aim of the study was to examine the possibility of converting subjective textual data written in the free column space of the Mother and Child Handbook (MCH) into objective information using text mining and to compare any monthly changes in the words written by the mothers. Pregnant women without complications (n = 60) were divided into two groups according to State-Trait Anxiety Inventory grade: low trait anxiety (group I, n = 39) and high trait anxiety (group II, n = 21). Exploratory analysis of the textual data from the MCH was conducted by text mining using the Word Miner software program. Using 1203 structural elements extracted after processing, a comparison of monthly changes in the words used in the mothers' comments was made between the two groups. The data was mainly analyzed by a correspondence analysis. The structural elements in groups I and II were divided into seven and six clusters, respectively, by cluster analysis. Correspondence analysis revealed clear monthly changes in the words used in the mothers' comments as the pregnancy progressed in group I, whereas the association was not clear in group II. The text mining method was useful for exploratory analysis of the textual data obtained from pregnant women, and the monthly change in the words used in the mothers' comments as pregnancy progressed differed according to their degree of unease. © 2016 Japan Society of Obstetrics and Gynecology.

  7. Advancing the Assessment of Parent-Child Interactions: Development of the Parent Instruction-Giving Game with Youngsters

    ERIC Educational Resources Information Center

    Hupp, Stephen D. A.; Reitman, David; Forde, Debra A.; Shriver, Mark D.; Kelley, Mary Lou

    2008-01-01

    This study investigates the validity of the Parent Instruction-Giving Game with Youngsters (PIGGY), a newly developed direct-observation system. The PIGGY is a derivative of the Dyadic Parent-Child Interaction Coding System II [DPICS-II; Eyberg, S. M., Bessmer, J., Newcomb, K., Edwards, D., Robinson, E. (1994). Manual for the Dyadic Parent-Child…

  8. Patients Admitted to Three Spanish Intensive Care Units for Poisoning: Type of Poisoning, Mortality, and Functioning of Prognostic Scores Commonly Used

    PubMed Central

    Banderas-Bravo, María Esther; Arias-Verdú, Maria Dolores; Macías-Guarasa, Ines; Castillo-Lorente, Encarnación; Pérez-Costillas, Lucia; Gutierrez-Rodriguez, Raquel; Quesada-García, Guillermo; Rivera-Fernández, Ricardo

    2017-01-01

    Objectives. To evaluate the gravity and mortality of those patients admitted to the intensive care unit for poisoning. Also, the applicability and predicted capacity of prognostic scales most frequently used in ICU must be evaluated. Methods. Multicentre study between 2008 and 2013 on all patients admitted for poisoning. Results. The results are from 119 patients. The causes of poisoning were medication, 92 patients (77.3%), caustics, 11 (9.2%), and alcohol, 20 (16,8%). 78.3% attempted suicides. Mean age was 44.42 ± 13.85 years. 72.5% had a Glasgow Coma Scale (GCS) ≤8 points. The ICU mortality was 5.9% and the hospital mortality was 6.7%. The mortality from caustic poisoning was 54.5%, and it was 1.9% for noncaustic poisoning (p < 0.001). After adjusting for SAPS-3 (OR: 1.19 (1.02–1.39)) the mortality of patients who had ingested caustics was far higher than the rest (OR: 560.34 (11.64–26973.83)). There was considerable discrepancy between mortality predicted by SAPS-3 (26.8%) and observed (6.7%) (Hosmer-Lemeshow test: H = 35.10; p < 0.001). The APACHE-II (7,57%) and APACHE-III (8,15%) were no discrepancies. Conclusions. Admission to ICU for poisoning is rare in our country. Medication is the most frequent cause, but mortality of caustic poisoning is higher. APACHE-II and APACHE-III provide adequate predictions about mortality, while SAPS-3 tends to overestimate. PMID:28459061

  9. HbA1c is outcome predictor in diabetic patients with sepsis.

    PubMed

    Gornik, Ivan; Gornik, Olga; Gasparović, Vladimir

    2007-07-01

    We have investigated predictive value of HbA1c for hospital mortality and length of stay (LOS) in patients with type 2 diabetes admitted because of sepsis. A prospective observational study was implemented in a university hospital, 286 patients with type 2 diabetes admitted with sepsis were included. Leukocyte count, CRP, admission plasma glucose, APACHE II and SOFA score were noted at admission, HbA1c was measured on the first day following admission. Hospital mortality and hospital length of stay (LOS) were the outcome measures. Admission HbA1c was significantly lower in surviving patients than in non-survivors (median 8.2% versus 9.75%, respectively; P<0.001). There was a significant correlation between admission HbA1c and hospital LOS of surviving patients (r=0.29; P<0.001). Logistic regression showed that HbA1c is an independent predictor of hospital mortality (odds ratio 1.36), together with female sex (OR 2.24), APACHE II score (OR 1.08) and SOFA score (OR 1.28). Multiple regression showed that HbA1c and APACHE II score are independently related to hospital LOS. According to our results, HbA1c is an independent predictive factor for hospital mortality and hospital LOS of diabetic patients with sepsis.

  10. Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis

    PubMed Central

    Sun, Zhao-Xi; Huang, Hai-Rong; Zhou, Hong

    2006-01-01

    AIM: To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine (e.g. Dahuang) in treating abdominal compartment syndrome of fulminant acute pancreatitis. METHODS: Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group (group 1) and control group (group 2). Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE II scores were applied for analysis. RESULTS: On the second and fifth days after treatment, APACHE II scores of group 1 and 2 patients were significantly different. Comparison of effectiveness (abdominalgia and burbulence relief time, hospitalization time) between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated (r = 0.552, 0.748, 0.923, P < 0.01) with APACHE II scores. CONCLUSION: Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration (SVVH), gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis. PMID:16937509

  11. Prevalence of vulvovaginitis and relation to physical findings in girls assessed for suspected child sexual abuse.

    PubMed

    Rahman, Gisel; Ocampo, Dolores; Rubinstein, Anahí; Risso, Paula

    2015-10-01

    The presence of sexually transmitted infections (STIs) in patients with suspected sexual abuse is uncommon in the field of pediatrics. To establish the prevalence of anogenital findings and their relation to the presence of STIs in girls referred for suspected child sexual abuse. Retrospective study conducted between January 1st, 2003 and December 31st, 2013. Physical findings and detection of STIs in girls with suspected child sexual abuse were analyzed. One thousand thirty-four patients were included. Their median age was 7.9 years old. Anogenital findings were classified as class I (normal):38.4%, class II (nonspecific):38.1%, class III (specific):19.9% and class IV (definitive):3.6%. STIs were observed in 42 patients (4.1%). A relation was established between STIs and the classification of physical findings: 10 (class II: 9; class III: 1) Neisseria gonorrhoeae, 17 (class I: 2; class II: 8; class III: 7) Chlamydia trachomatis, 15 (class I: 2; class II: 10; class III: 3) Trichomonas vaginalis. Statistically significant differences for Trichomonas vaginalis (p= 0.01) and Neisseria gonorrhoeae (p < 0.0001) were observed, with predominance of nonspecific clinical signs. Both nonspecific and specific findings were similarly observed for Chlamydia trachomatis (p= 0.03). Most cases of girls with suspected child sexual abuse had normal or nonspecific anogenital findings. The prevalence of STIs in these girls is low. Trichomonas vaginalis and Neisseria gonorrhoeae were related to nonspecific findings, while both nonspecific and specific findings were observed for Chlamydia trachomatis.

  12. Measuring hepatic functional reserve using T1 mapping of Gd-EOB-DTPA enhanced 3T MR imaging: A preliminary study comparing with 99mTc GSA scintigraphy and signal intensity based parameters.

    PubMed

    Nakagawa, Masataka; Namimoto, Tomohiro; Shimizu, Kie; Morita, Kosuke; Sakamoto, Fumi; Oda, Seitaro; Nakaura, Takeshi; Utsunomiya, Daisuke; Shiraishi, Shinya; Yamashita, Yasuyuki

    2017-07-01

    To determine the utility of liver T1-mapping on gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance (MR) imaging for the measurement of liver functional reserve compared with the signal intensity (SI) based parameters, technetium-99m-galactosyl serum albumin ( 99m Tc-GSA) scintigraphy and indocyanine green (ICG) clearance. This retrospective study included 111 patients (Child-Pugh-A 90; -B 21) performed with both Gd-EOB-DTPA enhanced liver MR imaging and 99m Tc-GSA (76 patients with ICG). Receiver operating characteristic (ROC) curve analysis was performed to compare diagnostic performances of T1-relaxation-time parameters [pre-(T1pre) and post-contrast (T1hb) Gd-EOB-DTPA], SI based parameters [relative enhancement (RE), liver-to-muscle-ratio (LMR), liver-to-spleen-ratio (LSR)] and 99m Tc-GSA scintigraphy blood clearance index (HH15)] for Child-Pugh classification. Pearson's correlation was used for comparisons among T1-relaxation-time parameters, SI-based parameters, HH15 and ICG. A significant difference was obtained for Child-Pugh classification with T1hb, ΔT1, all SI based parameters and HH15. T1hb had the highest AUC followed by RE, LMR, LSR, ΔT1, HH15 and T1pre. The correlation coefficients with HH15 were T1pre 0.22, T1hb 0.53, ΔT1 -0.38 of T1 relaxation parameters; RE -0.44, LMR -0.45, LSR -0.43 of SI-based parameters. T1hb was highest for correlation with HH15. The correlation coefficients with ICG were T1pre 0.29, T1hb 0.64, ΔT1 -0.42 of T1 relaxation parameters; RE -0.50, LMR -0.61, LSR -0.58 of SI-based parameters; 0.64 of HH15. Both T1hb and HH15 were highest for correlation with ICG. T1 relaxation time at post-contrast of Gd-EOB-DTPA (T1hb) was strongly correlated with ICG clearance and moderately correlated HH15 with 99m Tc-GSA. T1hb has the potential to provide robust parameter of liver functional reserve. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. A switch in the source of ATP production and a loss in capacity to perform glycolysis are hallmarks of hepatocyte failure in advance liver disease.

    PubMed

    Nishikawa, Taichiro; Bellance, Nadège; Damm, Aaron; Bing, Han; Zhu, Zhen; Handa, Kan; Yovchev, Mladen I; Sehgal, Vasudha; Moss, Tyler J; Oertel, Michael; Ram, Prahlad T; Pipinos, Iraklis I; Soto-Gutierrez, Alejandro; Fox, Ira J; Nagrath, Deepak

    2014-06-01

    The cause of hepatic failure in the terminal stages of chronic injury is unknown. Cellular metabolic adaptations in response to the microenvironment have been implicated in cellular breakdown. To address the role of energy metabolism in this process we studied mitochondrial number, respiration, and functional reserve, as well as cellular adenosine-5'-triphosphate (ATP) production, glycolytic flux, and expression of glycolysis related genes in isolated hepatocytes from early and terminal stages of cirrhosis using a model that produces hepatic failure from irreversible cirrhosis in rats. To study the clinical relevance of energy metabolism in terminal stages of chronic liver failure, we analyzed glycolysis and energy metabolism related gene expression in liver tissue from patients at different stages of chronic liver failure according to Child-Pugh classification. Additionally, to determine whether the expression of these genes in early-stage cirrhosis (Child-Pugh Class A) is related to patient outcome, we performed network analysis of publicly available microarray data obtained from biopsies of 216 patients with hepatitis C-related Child-Pugh A cirrhosis who were prospectively followed up for a median of 10years. In the early phase of cirrhosis, mitochondrial function and ATP generation are maintained by increasing energy production from glycolytic flux as production from oxidative phosphorylation falls. At the terminal stage of hepatic injury, mitochondria respiration and ATP production are significantly compromised, as the hepatocytes are unable to sustain the increased demand for high levels of ATP generation from glycolysis. This impairment corresponds to a decrease in glucose-6-phosphatase catalytic subunit and phosphoglucomutase 1. Similar decreased gene expression was observed in liver tissue from patients at different stages of chronic liver injury. Further, unbiased network analysis of microarray data revealed that expression of these genes was down

  14. Best Interest of the Child and Parental Alienation: A Survey of State Statutes.

    PubMed

    Baker, Amy J L; Asayan, Mariann; LaCheen-Baker, Alianna

    2016-07-01

    State statutes regarding the best interests of the child (BIC) in deciding disputed custody were reviewed and independently coded with respect to three issues (i) the child's preference and any limits (ii) parental alienation and (iii) psychological maltreatment. Results revealed that many states allowed for the child's preferences to be considered and none qualified that preference when undue influence has occurred; parental alienation as a term was not found in any state statutes but 70% of the states included at least one BIC factor relevant to its core construct of the parent supporting the child's relationship to the other parent; and many states included a history of domestic violence or child abuse but only three states explicitly mentioned psychological maltreatment. These findings highlight yet another way in which the BICS factors lack specificity in ways that could negatively impact children caught in their parents' conflict. © 2016 American Academy of Forensic Sciences.

  15. Parent-Child Agreement on Parent-to-Child Maltreatment.

    PubMed

    Compier-de Block, Laura H C G; Alink, Lenneke R A; Linting, Mariëlle; van den Berg, Lisa J M; Elzinga, Bernet M; Voorthuis, Alexandra; Tollenaar, Marieke S; Bakermans-Kranenburg, Marian J

    2017-01-01

    Parent-child agreement on child maltreatment was examined in a multigenerational study. Questionnaires on perpetrated and experienced child maltreatment were completed by 138 parent-child pairs. Multi-level analyses were conducted to explore whether parents and children agreed about levels of parent-to-child maltreatment (convergence), and to examine whether parents and children reported equal levels of child maltreatment (absolute differences). Direct and moderating effects of age and gender were examined as potential factors explaining differences between parent and child report. The associations between parent- and child-reported maltreatment were significant for all subtypes, but the strength of the associations was low to moderate. Moreover, children reported more parent-to-child neglect than parents did. Older participants reported more experienced maltreatment than younger participants, without evidence for differences in actual exposure. These findings support the value of multi-informant assessment of child maltreatment to improve accuracy, but also reveal the divergent perspectives of parents and children on child maltreatment.

  16. Characterization of vibration transfer paths in nose gearboxes of an AH-64 Apache

    NASA Astrophysics Data System (ADS)

    Islam, A. K. M. Anwarul; Dempsey, Paula J.; Feldman, Jason; Larsen, Chris

    2014-03-01

    Health monitoring of rotorcraft components, which is currently being performed by Health and Usage Monitoring Systems (HUMS) through analyzing vibration signatures of dynamic mechanical components, is very important for their safe and economic operation. Vibration diagnostic algorithms in HUMS analyze vibration signatures associated with faults and quantify them as condition indicators (CI) to predict component behavior. Vibration transfer paths (VTP) play important roles in CI response and are characterized by frequency response functions (FRF) derived from vibration signatures of dynamic mechanical components of a helicopter. With an objective to investigate the difference in VTP of a component in a helicopter and test stand, and to relate that to the CI response, VTP measurements were recorded from 0-50 kHz under similar conditions in the left and right nose gearboxes (NGBs) of an AH-64 Apache and an isolated left NGB in a test stand at NASA Glenn Research Center. The test fixture enabled the application of measured torques - common during an actual operation. Commercial and lab piezo shakers, and an impact hammer were used in both systems to collect the vibration response using two types of commercially available accelerometers under various test conditions. The FRFs of both systems were found to be consistent, and certain real-world installation and maintenance issues, such as sensor alignments, locations and installation torques, had minimal effect on the VTP. However, gear vibration transfer path dynamics appeared to be somewhat dependent on presence of oil, and the lightly-damped ring gear produced sharp and closer transfer path resonances.

  17. A Multimedia Child Developmental Screening Checklist: Design and Validation.

    PubMed

    Cheng, Hsin-Yi Kathy; Chen, Li-Ying; Cheng, Chih-Hsiu; Ju, Yan-Ying; Chen, Chia-Ling; Tseng, Kevin C

    2016-10-24

    Identifying disability early in life confers long-term benefits for children. The Taipei City Child Development Screening tool, second version (Taipei II) provides checklists for 13 child age groups from 4 months to 6 years. However, the usability of a text-based screening tool largely depends on the literacy level and logical reasoning ability of the caregivers, as well as language barriers caused by increasing numbers of immigrants. The objectives of this study were to (1) design and develop a Web-based multimedia version of the current Taipei II developmental screening tool, and (2) investigate the measurement equivalence of this multimedia version to the original paper-based version. To develop the multimedia version of Taipei II, a team of experts created illustrations, translations, and dubbing of the original checklists. The developmental screening test was administered to a total of 390 primary caregivers of children aged between 4 months and 6 years. Psychometric testing revealed excellent agreement between the paper and multimedia versions of Taipei II. Good to excellent reliabilities were demonstrated for all age groups for both the cross-mode similarity (mode intraclass correlation range 0.85-0.96) and the test-retest reliability (r=.93). Regarding the usability, the mean score was 4.80 (SD 0.03), indicating that users were satisfied with their multimedia website experience. The multimedia tool produced essentially equivalent results to the paper-based tool. In addition, it had numerous advantages, such as it can facilitate active participation and promote early screening of target populations. Clinicaltrials.gov NCT02359591; https://clinicaltrials.gov/ct2/show/NCT02359591 (Archived by WebCite at http://www.webcitation.org/6l21mmdNn).

  18. Comparison and relationship of thyroid hormones, IL-6, IL-10 and albumin as mortality predictors in case-mix critically ill patients.

    PubMed

    Quispe E, Álvaro; Li, Xiang-Min; Yi, Hong

    2016-05-01

    To compare the ability of thyroid hormones, IL-6, IL-10, and albumin to predict mortality, and to assess their relationship in case-mix acute critically ill patients. APACHE II scores and serum thyroid hormones (FT3, FT4, and TSH), IL-6, IL-10, and albumin were obtained at EICU admission for 79 cases of mix acute critically ill patients without previous history of thyroid disease. Patients were followed for 28 days with patient's death as the primary outcome. All mean values were compared, correlations assessed with Pearson' test, and mortality prediction assessed by multivariate logistic regression and ROC. Non survivors were older, with higher APACHE II score (p=0.000), IL-6 (p<0.05), IL-10 (p=0.000) levels, and lower albumin (p=0.000) levels compared to survivors at 28 days. IL-6 and IL-10 had significant negative correlation with albumin (p=0.001) and FT3 (p ⩽ 0.05) respectively, while low albumin had a direct correlation with FT3 (p<0.05). In the mortality prediction assessment, IL-10, albumin and APACHE II were independent morality predictors and showed to have a good (0.70-0.79) AUC-ROC (p<0.05). Despite that the entire cohort showed low FT3 serum levels (p=0.000), there was not statistical difference between survivors and non-survivors; neither showed any significance as mortality predictor. IL-6 and IL-10 are correlated with Low FT3 and hypoalbuminemia. Thyroid hormones assessed at EICU admission did not have any predictive value in our study. And finally, high levels of IL-6 and IL-10 in conjunction with albumin could improve our ability to evaluate disease's severity and predict mortality in the critically ill patients. When use in combination with APACHE II scores, our model showed improved mortality prediction. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Prognostic value of N-terminal pro-brain natriuretic peptide in hospitalised patients with community-acquired pneumonia.

    PubMed

    Jeong, Ki Young; Kim, Kyuseok; Kim, Tae Yun; Lee, Christopher C; Jo, Si On; Rhee, Joong Eui; Jo, You Hwan; Suh, Gil Joon; Singer, Adam J

    2011-02-01

    The prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with community-acquired pneumonia (CAP) has not been evaluated. The aim of the present study was to investigate whether NT-proBNP level could predict mortality in hospitalised CAP patients. We performed a structured medical record review of all hospitalised CAP patients from May 2003 to October 2006, and classified patients into the 30-day survival and non-survival group. Data included demographic and clinical characteristics, and laboratory findings including NT-proBNP levels. The APACHE II scores, PSI (pneumonia severity index) and CURB65 (confusion, urea, respiratory rate, blood pressure and aged 65 or more) scores were calculated. Comparisons between survivors and non-survivors were made with χ(2), non-parametric tests and logistic regression and ROC analysis were used to compare the ability of NT-proBNP (adjusted for age, heart failure and creatinine), APACHE II, PSI and CURB65 to predict mortality. Of 502 patients, 61 (12.2%) died within 30 days. NT-proBNP levels were measured in 167 patients and were significantly higher in non-survivors compared to survivors (median 841.7 (IQR 267.1-3137.3) pg/ml vs 3658.0 (1863.0-7025.0) pg/ml, p=0.019). NT-proBNP was an independent predictor of mortality (adjusted OR 1.53; 95% CI 1.16 to 2.02, p=0.002). The AUC for NT-proBNP was 0.712 (95% CI, 0.613 to 0.812), which was comparable to those of PSI (0.749, p=0.531) and CURB65 (0.698, p=0.693), but inferior to that of APACHE II (0.831, p=0.037). Adding NT-proBNP to APACHE II, PSI and CURB65 did not significantly increase the AUCs, respectively. NT-proBNP level is an independent predictor of mortality in hospitalised CAP patients. The performance of NT-proBNP level is comparable to those of PSI and CURB65 in predicting mortality.

  20. Factors influencing intensive care unit survival for critically ill elderly patients.

    PubMed

    Kleinpell, R M; Ferrans, C E

    1998-01-01

    To examine factors influencing intensive care unit (ICU) survival for critically ill elderly patients and to compare survivors and nonsurvivors of ICU on demographic and illness-related variables. Retrospective, ex post facto research design. Adult medical and surgical ICUs. The records of 164 survivors and 111 nonsurvivors from 2 medical-surgical ICUs were examined. Patients were placed into 3 age groups (middle-aged, young-old, and old-old) to compare outcomes for elderly ICU patients. ICU survival, ICU treatments received, severity of illness. The Acute Physiology Age and Chronic Health Evaluation II (APACHE II) was used to assess illness severity. Additional illness-related information was collected by chart review. Predictors of ICU nonsurvival were severity of illness (measured by APACHE II scores) and intubation. Comparison of survivors and nonsurvivors revealed no statistically significant differences in sex or age. For all age groups, nonsurvivors had significantly higher mean days of ICU hospitalization (F (1,239) = 7.20 P < .0078) and higher APACHE II scores (F (1,239) = 106.5 P < .0001). Analysis of ICU treatments received by the 3 age groups of survivors revealed a significant difference only on oxygen therapy, (chi-square = 10.2, df = 2, P = .006), with more young-old (aged 65 to 79) and old-old (aged 80 and older) ICU patients receiving oxygen therapy than middle-aged patients (aged 45 to 64). The findings of this study demonstrated that severity of illness was a predictor of ICU outcome; age was not. Additionally, age was not related to ICU treatments received.

  1. Leptin Is Associated With Persistence of Hyperglycemia in Acute Pancreatitis

    PubMed Central

    Kennedy, James I.C.; Askelund, Kathryn J.; Premkumar, Rakesh; Phillips, Anthony R.J.; Murphy, Rinki; Windsor, John A.; Petrov, Maxim S.

    2016-01-01

    Abstract Adipokines have many homeostatic roles, including modulation of glucose metabolism, but their role in the pathophysiology of hyperglycemia associated with acute and critical illnesses in general, and acute pancreatitis (AP) in particular, is largely unknown. This study aimed to investigate the relationship between a panel of adipokines and hyperglycemia in the early course of AP, as well as the role of adipokines as predictors of AP severity. Adiponectin, leptin, omentin, resistin, and visfatin were measured on a daily basis in the first 72 hours after hospital admission. A first set of analyses was undertaken with admission glycemia stratified by severity, and a second set of analyses was undertaken based on persistence of early hyperglycemia. All of the analyses were adjusted for confounders. A total of 32 patients with AP were included in this study. None of the studied adipokines was significantly associated with glucose level on admission. Leptin was significantly (P = 0.003) increased in patients with persistent hyperglycemia. Adiponectin was significantly associated with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in patients with persistent hyperglycemia (P = 0.015), visfatin with APACHE II score in patients with persistent hyperglycemia (P = 0.014), and omentin with APACHE II score in all of the patients regardless of the presence or absence of hyperglycemia (P = 0.021). Leptin is significantly associated with persistent hyperglycemia in the early course of AP. Omentin has a potential to become an accurate predictor of AP severity. PMID:26871770

  2. Child development in primary care: a surveillance proposal.

    PubMed

    Coelho, Renato; Ferreira, José Paulo; Sukiennik, Ricardo; Halpern, Ricardo

    2016-01-01

    To evaluate a child development surveillance tool proposal to be used in primary care, with simultaneous use of the Denver II scale. This was a cross-sectional study of 282 infants aged up to 36 months, enrolled in a public daycare in a countryside community in Rio Grande do Sul/Brazil. Child development was assessed using the surveillance tool and the Denver II scale. The prevalence of probable developmental delay was 53%; most of these cases were in the alert group and 24% had normal development, but with risk factors. At the Denver scale, the prevalence of suspected developmental delay was 32%. When risk factors and sociodemographic variables were assessed, no significant difference was observed. The evaluation of this surveillance tool resulted in objective and comparable data, which were adequate for a screening test. It is easily applicable as a screening tool, even though it was originally designed as a surveillance tool. The inclusion of risk factors to the scoring system is an innovation that allows for the identification of children with suspected delay in addition to developmental milestones, although the definition of parameters and choice of indicators should be thoroughly studied. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  3. Plasma Prothrombin Time and Esophageal Varices in Patients with Cirrhosis of Liver.

    PubMed

    Islam, Md Nasirul; Khan, Mobin; Ahmad, Nooruddin; Mamun-Al-Mahtab; Karim, Md Fazal

    2016-01-01

    Cirrhosis of the liver is a common complication of chronic liver disease and is associated with portal hypertension and esophageal varices. In this study, we checked the implication of prothrombin time, if any, in the genesis of esophageal varices. Sixty patients with cirrhosis of the liver were randomly assigned into two groups: Group I - 30 cirrhotic patients with esophageal varices, and group II - 30 cirrhotic patients without esophageal varices. The prothrombin time was checked for both groups. A positive correlation was found between the prolonged plasma prothrombin time (> 4 seconds) and esophageal varices with a sensitivity of 56.67% and specificity of 73.33%. The Child-Pugh score showed a correlation; however, the size of varices did not exhibit any such relation. Prothrombin time may be cautiously used to assess portal hypertension in a field level and rural setting where endoscopy is not available or feasible. Islam MN, Khan M, Ahmad N, Al-Mahtab M, Karim MF. Plasma Prothrombin Time and Esophageal Varices in Patients with Cirrhosis of Liver. Euroasian J Hepato-Gastroenterol 2016;6(1):10-12.

  4. Child Abuse Issues for Child Care Providers.

    ERIC Educational Resources Information Center

    Bates, Marlys; Koskie, Beth

    Written for child caregivers, this booklet provides very basic information about child abuse and neglect, discusses early warnings that signal when a family is in trouble or when a child is at risk, and indicates how caregivers can helpfully intervene. Also suggested are ways caregivers might protect themselves against the charge of child abuse.…

  5. Serum iron parameters in liver cirrhosis

    NASA Astrophysics Data System (ADS)

    Siregar, G. A.; Maail, W.

    2018-03-01

    The liver plays a fundamental role in iron homeostasis. Iron parameters change, especially ferritin, need to be evaluated in patients with liver cirrhosis. Serum ferritin could predict the prognosis of patients with decompensated cirrhosis since it reflects immunemediated and infectious stimuli. Ferritin could express the severity of liver disease and possible subsequent complications. Finally, it might reflect an iron overload condition resulting in significant morbidity and early mortality. 70 patients with decompensated liver cirrhosis divided into three Child-Pugh subgroups. Serum iron parameters include serum iron (SI), total iron binding capacity (TIBC) and ferritin was measured in these groups. From these 70 patients, 30 (42.9%) with HbsAg positive, 26 (37.1%) with anti-HCV positive and 14 (20%) with both HbsAg and anti-HCV positive. Of the 70 patients, 14 (20%) had CTP Class A cirrhosis, 17 (24.3%) had CTP Class B cirrhosis, and 39 (55.7%) had CTP C cirrhosis. The median (range) value of serum iron was 36 (10-345) μg/dl, TIBC was 160 (59-520) μg/dl, Ferritin was 253.5 (8-6078) ng/ml and the transferrin saturation was 22.9 (3.65-216.98) %.We found a significant difference in serum ferritin level with CTP score. Ferritin levels increased as Child-Pugh class progressed (p<0.001).

  6. Likelihood of malignancy in gallbladder polyps and outcomes following cholecystectomy in primary sclerosing cholangitis.

    PubMed

    Eaton, John E; Thackeray, Erin W; Lindor, Keith D

    2012-03-01

    Patients with primary sclerosing cholangitis (PSC) have an increased risk for gallbladder cancer. We aimed to define the postoperative outcomes in PSC patients after cholecystectomy and determine if size of a gallbladder lesion on imaging predicts the presence of neoplasia. We conducted a retrospective review of patients with PSC who underwent cholecystectomy at Mayo Clinic between 1 January 1995 and 31 December 2008. Patients with a prior history of a liver transplant or cholangiocarcinoma were excluded. A total of 57 patients were included in our primary analysis during the early postoperative period. The most common indication for undergoing a cholecystectomy was the presence of a gallbladder polyp or mass. The sensitivity and specificity of a gallbladder lesion of 0.80 cm and the presence of gallbladder neoplasia was 100% (95% confidence interval (CI) 77-100%) and 70% (95% CI 35-93%), respectively. Of the patients, 23 (40%) had an early postoperative complication. The Child-Pugh score was the only predictor of postoperative outcomes in the multivariate model (odds ratio 1.78, 95% CI 1.11-3.12, P=0.02). Cholecystectomy in patients with PSC is associated with a high morbidity. Gallbladder polyps <0.80 cm are unlikely to be malignant and observation of these small polyps should be considered. A higher Child-Pugh score was associated with early postoperative complications.

  7. Comparison of lipid profile between degrees of severity of hepatic cirrhosis in Haji Adam Malik general hospital Medan

    NASA Astrophysics Data System (ADS)

    Siregar, G. A.; Tampubolon, S. E.

    2018-03-01

    Lipid metabolism disorders usually occurred in chronic liver disease. A cross- sectional study was conducted in liver cirrhosis (LC) patients who came to Central Hospital Haji Adam Malik, Medan on July-December 2016 to evaluatethe comparison of total cholesterol, LDL, HDL, triglyceride in Child-Pugh class. Inclusions criteria were apatient diagnosed with LC from anamnesis, physic diagnostic, laboratory, and imaging. The patientswere being evaluated with Child-Pugh (CP). P-value was calculated by using univariate and bivariate analysis of variance test (ANOVA). There were 80 subjects which included 45 men (56.3%) and 35 women (43.8%). Mean age was 51.36±12.6 years. There were 40% with HBsAg(+) and 12.5% with Anti-HCV (+). There was 60% patient with CP-C, 21.3% CP-B, and 18.8% CP-A. There were significant differences between LDL and HDL level among LC patient grade in CP-A, B, and C (p<0.05). HDL and LDL level significantly lower in CP-C compared with CP-A. There were significantly differences between LDL and HDL level among LC patient grade in CP-A, B, and C (p<0.05). HDL and LDL level significantly lower in CP-C compared with CP-A. There weren’t any statistically difference between total cholesterol and triglyceride level in LC patients with CP- A, B, and C.

  8. Population pharmacokinetics of oxycodone in patients with cancer-related pain.

    PubMed

    Komatsu, Toshiaki; Kokubun, Hideya; Suzuki, Ai; Takayanagi, Risa; Yamada, Yasuhiko; Matoba, Motohiro; Yago, Kazuo

    2012-09-01

    Oxycodone is an opioid widely prescribed to cancer patients for pain relief. However, the pharmacokinetics of oxycodone has not been sufficiently examined. Therefore the aim of this work was to study population pharmacokinetics of oxycodone in patients with cancer pain. The authors analyzed 108 serum oxycodone samples of 33 individuals with nonlinear mixed-effects model (NONMEM). Population pharmacokinetics was calculated using the one-compartment model of clearance, volume of distribution, bioavailability, absorption constant rate, and lag time. An exponential error model was used to determine interindividual variability and a relative error model was applied to assess residual variability. Population pharmacokinetics of oxycodone at the end point were as follows: CL(L/h) = 10.7 × [1 + (2 - Child-Pugh Classification)] (Class: A = 0, B = 1, C = 2); V(d) (L) = 193; k(a) (h(-1)) = 0.336; T(lag) (h) = 0.859; F (%) = 63.9. Interindividual variability was CL: 30.5%, V(d): 44.6%, and F: 37.0%, and residual variability was 16.2%. As the total clearance in patients with liver dysfunction (Child-Pugh class B) was reduced to 33.3%, serum concentration of oxycodone increased by 1.5. Therefore, it became clear that dose adjustments are essential when treating patients with liver dysfunction. These findings suggest that population parameters are useful for evaluating pharmacokinetics of oxycodone in patients with cancer pain.

  9. Dark adaptation in vitamin A-deficient adults awaiting liver transplantation: improvement with intramuscular vitamin A treatment.

    PubMed

    Abbott-Johnson, Winsome J; Kerlin, Paul; Abiad, Ghassan; Clague, Alan E; Cuneo, Ross C

    2011-04-01

    Although vitamin A deficiency is common in chronic liver disease, limited data exist on impairment of dark adaptation and response to therapy. The aims were (1) to assess dark adaptation in patients, (2) to assess the relationship between dark adaptation and vitamin A status, zinc and Child-Pugh score, (3) to compare perceived and measured dark adaptation and (4) to assess the dark adaptation response to intramuscular vitamin A. This was a prospective study of 20 patients (alcoholic liver disease 10, other parenchymal diseases six, cholestatic diseases four) awaiting liver transplantation. Selection was based on low serum retinol. There were 15 age-matched controls. Dark adaptation was measured with a SST-1 dark adaptometer and perception by questionnaire. Eight patients received 50, 000 IU of retinyl palmitate, and dark adaptation was repeated at 1 month. Forty per cent of patients had impaired dark adaptation. Patients with alcoholic liver disease were more impaired than those with other parenchymal diseases (p=0.015). No relationship was found between dark adaptation and the biochemical indicators or Child-Pugh score. Seventy-five per cent of patients with impairment did not perceive a problem. After intervention, light of half the previous intensity could be seen (p=0.05). Dark-adaptation impairment was common, was worse in alcoholic liver disease, was largely not appreciated by the patients and improved with vitamin A treatment.

  10. Effect of Oral Supplementation with Branched-chain Amino Acid (BCAA) during Radiotherapy in Patients with Hepatocellular Carcinoma: A Double-Blind Randomized Study

    PubMed Central

    Lee, Ik Jae; Bae, Jung Im; You, Sei Hwan; Rhee, Yumie; Lee, Jong Ho

    2011-01-01

    Purpose The present study evaluated whether oral supplementation with a branched-chain amino acid (BCAA) improves the biochemical and amino acid profiles of liver tumor patients undergoing radiotherapy. Materials and Methods Patients were randomly assigned to one of 2 groups: a group given oral supplementation with BCAA granules (LIVACT granules; Samil Pharm Co., Korea, each granule containing L-isoleucine 952 mg, L-leucine 1,904 mg, and L-valine 1,144 mg) during radiotherapy, or a placebo group. Physical and biochemical examinations and measurements, including subjective symptoms, Child-Pugh class, body mass index, plasma albumin concentration, and plasma amino acid profiles were monitored. Results Fifty were enrolled between November 2005 and November 2006. We also analyzed data from 37 hepatocellular carcinoma (HCC) patients in order to evaluate a more homogenous group. The two groups of patients were comparable in terms of age, gender, Child-Pugh score, and underlying hepatitis virus type. Serum albumin, total protein, liver enzymes, and cholesterol showed a tendency to increase in the BCAA group. In this group, the percentage of cases that reverted to normal serum albumin levels between 3 and 10 weeks after administration of BCAA was significantly higher (41.18%) than in the placebo group (p=0.043). Conclusion Oral supplementation with a BCAA preparation seems to help HCC patients undergoing radiotherapy by increasing the BCAA concentration. PMID:21509160

  11. Effect of Oral Supplementation with Branched-chain Amino Acid (BCAA) during Radiotherapy in Patients with Hepatocellular Carcinoma: A Double-Blind Randomized Study.

    PubMed

    Lee, Ik Jae; Seong, Jinsil; Bae, Jung Im; You, Sei Hwan; Rhee, Yumie; Lee, Jong Ho

    2011-03-01

    The present study evaluated whether oral supplementation with a branched-chain amino acid (BCAA) improves the biochemical and amino acid profiles of liver tumor patients undergoing radiotherapy. Patients were randomly assigned to one of 2 groups: a group given oral supplementation with BCAA granules (LIVACT granules; Samil Pharm Co., Korea, each granule containing L-isoleucine 952 mg, L-leucine 1,904 mg, and L-valine 1,144 mg) during radiotherapy, or a placebo group. Physical and biochemical examinations and measurements, including subjective symptoms, Child-Pugh class, body mass index, plasma albumin concentration, and plasma amino acid profiles were monitored. Fifty were enrolled between November 2005 and November 2006. We also analyzed data from 37 hepatocellular carcinoma (HCC) patients in order to evaluate a more homogenous group. The two groups of patients were comparable in terms of age, gender, Child-Pugh score, and underlying hepatitis virus type. Serum albumin, total protein, liver enzymes, and cholesterol showed a tendency to increase in the BCAA group. In this group, the percentage of cases that reverted to normal serum albumin levels between 3 and 10 weeks after administration of BCAA was significantly higher (41.18%) than in the placebo group (p=0.043). Oral supplementation with a BCAA preparation seems to help HCC patients undergoing radiotherapy by increasing the BCAA concentration.

  12. Maternal and Child Health Handbook use for maternal and child care: a cluster randomized controlled study in rural Java, Indonesia.

    PubMed

    Osaki, Keiko; Hattori, Tomoko; Toda, Akemi; Mulati, Erna; Hermawan, Lukas; Pritasari, Kirana; Bardosono, Saptawati; Kosen, Soewarta

    2018-01-09

    Effectiveness of the Maternal and Child Health Handbook (MCHHB), a home-based booklet for pregnancy, delivery and postnatal/child health, was evaluated on care acquisition and home care in rural Java, a low service-coverage area. We conducted a health centre-based randomized trial, with a 2-year follow-up. Intervention included (i) MCHHB provision at antenatal care visits; (ii) records and guides by health personnel on and with the MCHHB; and (iii) sensitization of care by volunteers using the MCHHB. The follow-up rate was 70.2% (183, intervention area; 271, control area). Respondents in the intervention area received consecutive MCH services including two doses of tetanus toxoid injections and antenatal care four times or more during pregnancy, professional assistance during child delivery and vitamin A supplements administration to their children, after adjustment for confounding variables and cluster effects (OR = 2.03, 95% CI: 1.19-3.47). In the intervention area, home care (continued breastfeeding; introducing complementary feeding; proper feeding order; varied foods feeding; self-feeding training; and care for cough), perceived support by husbands, and lower underweight rates and stunting rates among children were observed. MCHHB use promoted continuous care acquisition and care at home from pregnancy to early child-rearing stages in rural Java. © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health.

  13. Your Child's Checkups

    MedlinePlus

    ... Child's Checkup: 9 Months Your Child's Checkup: 1 Year (12 Months) Your Child's Checkup: 15 Months Your Child's ... Your Child's Checkup: 11 Years Your Child's Checkup: 12 Years Your Child's Checkup: 13 Years Your Child's Checkup: ...

  14. Aboriginal child and adolescent mental health: a rural worker training model.

    PubMed

    Bartik, Warren; Dixon, Angela; Dart, Katrina

    2007-04-01

    The Third National Mental Health Plan places a strong emphasis on the development of an Aboriginal mental health workforce. This paper documents the establishment, implementation and initial evaluation of the Aboriginal and Torres Strait Islander Child and Adolescent Mental Health Traineeship Program, a partnership initiative involving Hunter New England Area Health Service (HNEAHS), Hunter New England Aboriginal Mental Health (HNEAMH) and the Department of Psychological Medicine at the Children's Hospital at Westmead (CHW), with guidance and input from additional collaborators. The program includes: (i) employment as a child and adolescent mental health worker and professional support and supervision through HNEAHS; (ii) a mentoring program provided through HNEAMH; (iii) formal academic studies in Aboriginal Mental Health; and (iv) a clinical education and supervision program conducted through the Department of Psychological Medicine, CHW. Initial feedback suggests that this is a promising program to train Aboriginal child and adolescent mental health workers. Further evaluation will provide information about its viability and effectiveness in providing an integrated, collaborative child and adolescent mental health service for Aboriginal and Torres Strait Islander children and their families.

  15. Child poverty and changes in child poverty.

    PubMed

    Chen, Wen-Hao; Corak, Miles

    2008-08-01

    This article offers a cross-country overview of child poverty, changes in child poverty, and the impact of public policy in North America and Europe. Levels and changes in child poverty rates in 12 Organisation for Economic Co-operation and Development (OECD) countries during the 1990s are documented using data from the Luxembourg Income Study project, and a decomposition analysis is used to uncover the relative role of demographic factors, labor markets, and income transfers from the state in determining the magnitude and direction of the changes. Child poverty rates fell noticeably in only three countries and rose in three others. In no country were demographic factors a force for higher child poverty rates, but these factors were also limited in their ability to cushion children from adverse shocks originating in the labor market or the government sector. Increases in the labor market engagement of mothers consistently lowered child poverty rates, while decreases in the employment rates and earnings of fathers were a force for higher rates. Finally, there is no single road to lower child poverty rates. Reforms to income transfers intended to increase labor supply may or may not end up lowering the child poverty rate.

  16. A Multimedia Child Developmental Screening Checklist: Design and Validation

    PubMed Central

    Cheng, Hsin-Yi Kathy; Chen, Li-Ying; Cheng, Chih-Hsiu; Ju, Yan-Ying; Chen, Chia-Ling

    2016-01-01

    Background Identifying disability early in life confers long-term benefits for children. The Taipei City Child Development Screening tool, second version (Taipei II) provides checklists for 13 child age groups from 4 months to 6 years. However, the usability of a text-based screening tool largely depends on the literacy level and logical reasoning ability of the caregivers, as well as language barriers caused by increasing numbers of immigrants. Objective The objectives of this study were to (1) design and develop a Web-based multimedia version of the current Taipei II developmental screening tool, and (2) investigate the measurement equivalence of this multimedia version to the original paper-based version. Methods To develop the multimedia version of Taipei II, a team of experts created illustrations, translations, and dubbing of the original checklists. The developmental screening test was administered to a total of 390 primary caregivers of children aged between 4 months and 6 years. Results Psychometric testing revealed excellent agreement between the paper and multimedia versions of Taipei II. Good to excellent reliabilities were demonstrated for all age groups for both the cross-mode similarity (mode intraclass correlation range 0.85-0.96) and the test-retest reliability (r=.93). Regarding the usability, the mean score was 4.80 (SD 0.03), indicating that users were satisfied with their multimedia website experience. Conclusions The multimedia tool produced essentially equivalent results to the paper-based tool. In addition, it had numerous advantages, such as it can facilitate active participation and promote early screening of target populations. ClinicalTrial Clinicaltrials.gov NCT02359591; https://clinicaltrials.gov/ct2/show/NCT02359591 (Archived by WebCite at http://www.webcitation.org/6l21mmdNn) PMID:27777218

  17. Parental distress, parenting practices, and child adaptive outcomes following traumatic brain injury.

    PubMed

    Micklewright, Jackie L; King, Tricia Z; O'Toole, Kathleen; Henrich, Chris; Floyd, Frank J

    2012-03-01

    Moderate and severe pediatric traumatic brain injuries (TBI) are associated with significant familial distress and child adaptive sequelae. Our aim was to examine the relationship between parental psychological distress, parenting practices (authoritarian, permissive, authoritative), and child adaptive functioning 12-36 months following TBI or orthopedic injury (OI). Injury type was hypothesized to moderate the relationship between parental distress and child adaptive functioning, demonstrating a significantly stronger relationship in the TBI relative to OI group. Authoritarian parenting practices were hypothesized to mediate relationship between parental distress and child adaptive functioning across groups. Groups (TBI n = 21, OI n = 23) did not differ significantly on age at injury, time since injury, sex, race, or SES. Parents completed the Brief Symptom Inventory, Parenting Practices Questionnaire, and Vineland-II. Moderation and mediation hypotheses were tested using hierarchical multiple regression and a bootstrapping approach, respectively. Results supported moderation and revealed that higher parental psychological distress was associated with lower child adaptive functioning in the TBI group only. Mediation results indicated that higher parental distress was associated with authoritarian parenting practices and lower adaptive functioning across groups. Results suggest that parenting practices are an important area of focus for studies attempting to elucidate the relationship between parent and child functioning following TBI.

  18. Developing child autonomy in pediatric healthcare: towards an ethical model.

    PubMed

    Martakis, Kyriakos; Brand, Helmut; Schröder-Bäck, Peter

    2018-06-01

    The changes initiated by the new National Civil and Commercial Code in Argentina underline the pediatric task to empower children's and adolescents' developing autonomy. In this paper, we have framed a model describing autonomy in child healthcare. We carried out a literature review focusing on i) the concept of autonomy referring to the absolute value of the autonomous individual, and ii) the age-driven process of competent decisionmaking development. We summarized our findings developing a conceptual model that includes the child, the pediatrician and the parents. The pediatricianchild relationship is based on different forms of guidance and cooperation, resulting in varying levels of activity and passivity. Parental authority influences the extent of autonomy, based on the level of respect of the child's moral equality. Contextual, existential, conceptual, and socialethical conditions shall be considered when applying the model to facilitate dialogue between pediatricians, children, parents and other actors. Sociedad Argentina de Pediatría.

  19. Teacher-Child Relationships: Contribution of Teacher and Child Characteristics

    ERIC Educational Resources Information Center

    Choi, Ji Young; Dobbs-Oates, Jennifer

    2016-01-01

    This study investigates potential predictors of teacher-child relationships (i.e., closeness and conflict) focusing on child gender, teacher-child ethnicity match, and teacher education. Additionally, the study explores the possible moderation effect of teacher education on the associations between teacher-child relationships and child gender or…

  20. The Relationships between Child Temperament, Teacher-Child Relationships, and Teacher-Child Interactions

    ERIC Educational Resources Information Center

    Oren, Meral; Jones, Ithel

    2009-01-01

    The purpose of the study was to examine the relationships between child temperament, teacher-child relationships, and teacher-child interactions in four preschool classrooms. The preliminary analyses revealed classroom differences for all variables. In all the classrooms except one, the temperament factor Reactivity had positive and high…

  1. Maternal emotion regulation during child distress, child anxiety accommodation, and links between maternal and child anxiety.

    PubMed

    Kerns, Caroline E; Pincus, Donna B; McLaughlin, Katie A; Comer, Jonathan S

    2017-08-01

    Environmental contributions are thought to play a primary role in the familial aggregation of anxiety, but parenting influences remain poorly understood. We examined dynamic relations between maternal anxiety, maternal emotion regulation (ER) during child distress, maternal accommodation of child distress, and child anxiety. Mothers (N=45) of youth ages 3-8 years (M=4.8) participated in an experimental task during which they listened to a standardized audio recording of a child in anxious distress pleading for parental intervention. Measures of maternal and child anxiety, mothers' affective states, mothers' ER strategies during the child distress, and maternal accommodation of child anxiety were collected. Mothers' resting respiratory sinus arrhythmia (RSA) reactivity during the recording was also acquired. Higher maternal negative affect and greater maternal ER switching (i.e., using multiple ER strategies in a short time without positive regulatory results) during child distress were associated with child anxiety. Sequential mediation modeling showed that maternal anxiety predicted ineffective maternal ER during child distress exposure, which in turn predicted greater maternal accommodation, which in turn predicted higher child anxiety. Findings support the mediating roles of maternal ER and accommodation in linking maternal and child anxiety, and suggest that ineffective maternal ER and subsequent attempts to accommodate child distress may act as mechanisms underlying the familial aggregation of anxiety. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. A retrospective evaluation of critically ill patients infected with H1N1 influenza A virus in Bursa, Turkey, during the 2009-2010 pandemic.

    PubMed

    Nermin, Kelebek Girgin; Remzi, Iscimen; Zeynep, Akogul; Ilker, Cimen; Meltem, Oner Torlar; Guven, Ozkaya; Ferda, Kahveci; Halis, Akalin

    2015-06-01

    H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in Bursa, Turkey. Demographic characteristics, clinical features, and outcome relating to H1N1 infection were retrospectively analysed in patients treated in the ICU. Twenty-three cases of H1N1 infection were treated in the ICU. The mean age of patients was 37 years range: (17-82). Fifteen patients were female (65.2%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 range: (5-39). The most common symptoms were dyspnea (73.9%), fever (69.6%), and cough (60.9%). Mechanical ventilation was required for all patients. Oseltamivir and antibiotics were administered to all patients. Six (26.1%) patients died. APACHE II scores were higher in the deceased 28.5 range: [16-39] vs. 14 range: [5-28] in survivors; p = 0.013). When compared to the literature, the demographic, epidemiological, and clinical characteristics were similar in the cases we encountered. The mortality rate was high despite the use of appropriate treatment. We believe that the high mortality is related to higher APACHE II scores. The H1N1 virus should be considered in community acquired pneumonia, especially in younger patients presenting with severe pneumonia.

  3. Surgical intensive care unit resource use in a specialty referral hospital: I. Predictors of early death and cost implications.

    PubMed

    Borlase, B C; Baxter, J T; Benotti, P N; Stone, M; Wood, E; Forse, R A; Blackburn, G L; Steele, G

    1991-06-01

    The rationing of medical care prioritizes the need for early predictors of death in the surgical intensive care unit (SICU). We prospectively studied 100 consecutive SICU admissions, looking for predictors of early death in the SICU and the cost implications of these findings. Serial APACHE II scores on days 1, 3, and 5 were subjected to multinomial logistic regression analysis to determine significant predictors of death in the SICU on day 1. Survivors had significantly lower (p less than 0.05) mean day-1 APACHE II scores than had nonsurvivors (13.6 vs 22.1). Half of the patients with scores greater than 18 died, and all patients with scores on day 1 of 25 or greater died. Significant predictors of death on SICU day 1 were APACHE II scores, Acute Physiology Score, Glasgow Coma Score, creatinine level, and Chronic Health Evaluation Score. Forty-one patients had been transferred from community hospitals as a results of acute illness; this population accounted for two thirds of the deaths in the SICU. Ten of 18 nonsurvivors were predicted on day 1, with these patients incurring a total cost of approximately $1 million. If therapy had been modified on days 5, 10, or 15, the potential cost savings would have been $340,000, $240,000, or $140,000, respectively. Integration of the results of this study into the management decision-making process and treatment guidelines may reduce the cost of care in the SICU.

  4. The predictive value of resting heart rate following osmotherapy in brain injury: back to basics.

    PubMed

    Hasanpour Mir, Mahsa; Yousefshahi, Fardin; Abdollahi, Mohammad; Ahmadi, Arezoo; Nadjafi, Atabak; Mojtahedzadeh, Mojtaba

    2012-12-30

    The importance of resting heart rate as a prognostic factor was described in several studies. An elevated heart rate is an independent risk factor for adverse cardiovascular events and total mortality in patients with coronary artery disease, chronic heart failure, and the general population. Also heart rate is elevated in the Multi Organ Dysfunction Syndrome (MODS) and the mortality due to MODS is highly correlated with inadequate sinus tachycardia.To evaluate the value of resting heart rate in predicting mortality in patients with traumatic brain injury along scoring systems like Acute Physiology and Chronic Health Evaluation(APACHE II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Score (GCS). By analyzing data which was collected from an open labeled randomized clinical trial that compared the different means of osmotherapy (mannitol vs bolus or infusion hypertonic saline), heart rate, GCS, APACHE II and SOFA score were measured at baseline and daily for 7 days up to 60 days and the relationship between elevated heart rate and mortality during the first 7 days and 60th day were assessed. After adjustments for confounding factors, although there was no difference in mean heart rate between either groups of alive and expired patients, however, we have found a relative correlation between 60th day mortality rate and resting heart rate (P=0.07). Heart rate can be a prognostic factor for estimating mortality rate in brain injury patients along with APACHE II and SOFA scores in patients with brain injury.

  5. Factors among patients receiving prone positioning for the acute respiratory distress syndrome found useful for predicting mortality in the intensive care unit.

    PubMed

    Modrykamien, Ariel M; Daoud, Yahya

    2018-01-01

    Optimal mechanical ventilation management in patients with the acute respiratory distress syndrome (ARDS) involves the use of low tidal volumes and limited plateau pressure. Refractory hypoxemia may not respond to this strategy, requiring other interventions. The use of prone positioning in severe ARDS resulted in improvement in 28-day survival. To determine whether mechanical ventilation strategies or other parameters affected survival in patients undergoing prone positioning, a retrospective analysis was conducted of a consecutive series of patients with severe ARDS treated with prone positioning. Demographic and clinical information involving mechanical ventilation strategies, as well as other variables associated with prone positioning, was collected. The rate of in-hospital mortality was obtained, and previously described parameters were compared between survivors and nonsurvivors. Forty-three patients with severe ARDS were treated with prone positioning, and 27 (63%) died in the intensive care unit. Only three parameters were significant predictors of survival: APACHE II score ( P = 0.03), plateau pressure ( P = 0.02), and driving pressure ( P = 0.04). The ability of each of these parameters to predict mortality was assessed with receiver operating characteristic curves. The area under the curve values for APACHE II, plateau pressure, and driving pressure were 0.74, 0.69, and 0.67, respectively. In conclusion, in a group of patients with severe ARDS treated with prone positioning, only APACHE II, plateau pressure, and driving pressure were associated with mortality in the intensive care unit.

  6. Child Poverty and Changes in Child Poverty

    PubMed Central

    CHEN, WEN-HAO; CORAK, MILES

    2008-01-01

    This article offers a cross-country overview of child poverty, changes in child poverty, and the impact of public policy in North America and Europe. Levels and changes in child poverty rates in 12 Organisation for Economic Co-operation and Development (OECD) countries during the 1990s are documented using data from the Luxembourg Income Study project, and a decomposition analysis is used to uncover the relative role of demographic factors, labor markets, and income transfers from the state in determining the magnitude and direction of the changes. Child poverty rates fell noticeably in only three countries and rose in three others. In no country were demographic factors a force for higher child poverty rates, but these factors were also limited in their ability to cushion children from adverse shocks originating in the labor market or the government sector. Increases in the labor market engagement of mothers consistently lowered child poverty rates, while decreases in the employment rates and earnings of fathers were a force for higher rates. Finally, there is no single road to lower child poverty rates. Reforms to income transfers intended to increase labor supply may or may not end up lowering the child poverty rate. PMID:18939660

  7. Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth.

    PubMed

    O'Brien, Jennifer E; White, Kevin; Wu, Qi; Killian-Farrell, Candace

    2016-07-01

    Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.

  8. Child Care Service II: Ages and Stages, Home and Family Education: 6755.03.

    ERIC Educational Resources Information Center

    Ahrens, Thea

    The second in a series of four Quinmester courses, this course is planned for any junior or senior high school student interested in possible employment as a Child Care Aide, or as a worker with exceptional children. It focuses on the stages of childhood growth and development, emphasizing the achievement of a positive self-concept. The main…

  9. What makes a child a 'competent' child?

    PubMed

    van Rooyen, Amanda; Water, Tineke; Rasmussen, Shayne; Diesfeld, Kate

    2015-12-04

    Competence is a vital component of the informed consent process. The perceived level of a child's competence may influence their degree of participation in health decisions that affect them. It is the responsibility of the health professional to gauge a child's level of competence. Child competence, however, is not a static attribute that is linked to age. Rather, it is dynamic, changing in nature and dependent on a child's previous experiences, personal attributes, network of relationships around them and cultural and environmental context. Consequently, there is no single verified assessment tool to assist in the recognition of competence for New Zealand children. Adding to this complexity are the unclear interpretations of New Zealand health legislation and policy regarding whether or not a child can legally consent or refuse healthcare advice and treatment without the consent of a legal guardian. Under the Care of Children Act 2004 and the Code of Health and Disability Services Consumers' Rights 1996, the Health and Disability Commissioner states "a child may consent themselves [to health treatment] if and when the child achieves sufficient understanding and maturity to understand fully what is proposed". This paper poses the question: What is 'competency' and how is this decided? For the purpose of this article, 'child' pertains to those under the age of 16 years.

  10. Federal Standards for Child Abuse and Neglect Prevention and Treatment Programs and Projects.

    ERIC Educational Resources Information Center

    Higgs, A. Catherine

    Presented are federal standards designed to synthesize and describe the knowledge available on the prevention and treatment of child abuse and negect. A summary chapter (Chapter I) covers background information, organization and content of the standards, and utilization of the standards. Chapter II discusses the relationships among children,…

  11. Child Abuse

    MedlinePlus

    ... puts a child at risk of harm. Child abuse can be physical, sexual or emotional. Neglect, or not providing for a child's needs, is also a form of abuse. Most abused children suffer greater emotional than physical damage. An abused child may become ...

  12. [Vitamin D deficiency in chronic liver disease, clinical-epidemiological analysis and report after vitamin d supplementation].

    PubMed

    Fernández Fernández, Nereida; Linares Torres, Pedro; Joáo Matias, Diana; Jorquera Plaza, Francisco; Olcoz Goñi, Jose Luis

    2016-05-01

    Vitamin D (VD) is known to have multiple extra-skeletal health functions. There is emerging interest in exploring the relationship between vitamin D and chronic liver disease (CLD). To determine the prevalence of VD deficiency in patients with CLD in our setting and to assess whether VD supplementation influences plasma levels and is associated with improved liver function. We conducted a study in 2 phases. First, we analysed clinical and epidemiological characteristics in 94 patients with CLD; second, different doses of calcifediol (25-OH-VD) were administered to patients with VD deficiency (<20ng/mL) and insufficiency (20-30ng/mL). Plasma concentrations and liver function (Child-Pugh and MELD) at the end of treatment were compared with baseline data. Deficient or insufficient VD levels were found in 87% of the patients, with an average concentration of 18.8ng/mL. Levels were lower in patients with cirrhosis (15.9ng/mL) (P=.002) and in alcoholic liver disease. VD levels were inversely proportional to the degree of liver function: Child A (16.52ng/mL) vs C (7.75ng/mL). After VD supplementation, optimal serum levels were achieved in 94% of patients and significant improvements were observed in platelet count, albumin levels (P<.05) and functional status assessed by the Child-Pugh scale (P<.05). Given the high prevalence of VD deficiency or insufficiency, the need for screening should be considered in the population with CLD. VD supplementation could be safe and effective. Copyright © 2015 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

  13. Assessing the Contribution of Superconducting Gravimetry and GPS to Lunar Laser Ranging at Apache Point Observatory, New Mexico

    NASA Astrophysics Data System (ADS)

    Crossley, D. J.; Murphy, T.; Borsa, A. A.; Boy, J. P.

    2016-12-01

    Lunar laser ranging (LLR) is one of the main techniques used to test fundamental aspects of theories of the general relativity by monitoring the Earth-Moon distance to high accuracy. A current limitation of the APO processing is knowledge of the deformation of the telescope orientation at the sub-cm level in response to local loading and attraction effects. To this end in 2009 a superconducting gravimeter was installed at the Apache Point Observatory (APO), close to one of the Plate Boundary Observatory (PBO) GPS sites at the Sunspot solar observatory. APO is also visited regularly for AG measurements by the NGA. We present a comprehensive analysis of the 7 years of gravity data from APO, and the height variations from GPS, to give accurate estimates of the local elastic parameters and vertical variations common to both sites. By including the full spectrum (e.g. from tides, polar motion, and hydrology) of known loading and surface mass variability effects on gravity and GPS, we assess the vertical control that such geodetic techniques can bring to LLR measurements, and by extension, to other astronomical installations.

  14. Are child-centric aspects in newborn and child health systematic review and meta-analysis protocols and reports adequately reported?-two systematic reviews.

    PubMed

    Farid-Kapadia, Mufiza; Joachim, Kariym C; Balasingham, Chrinna; Clyburne-Sherin, April; Offringa, Martin

    2017-03-06

    Evidence suggests that newborn and child health systematic reviews and meta-analyses exhibit poor quality in reporting. The "Preferred Reporting Items in Systematic Review and Meta-Analysis" (PRISMA) and PRISMA-Protocols (PRISMA-P) checklists have been developed to improve the reporting of systematic review results and protocols, respectively. We aimed to evaluate the clarity and transparency in reporting of child-centric items in child health systematic reviews (SRs) and SR protocols and to identify areas where reporting could be strengthened. Two preliminary lists of potential child-centric reporting items were used to examine current reporting. The Cochrane, DARE, MEDLINE, and EMBASE libraries were searched from 2010 to 2014 for systematic reviews that included children. Each report and protocol that met the inclusion criteria had their quality of reporting assessed by their reporting of child-centric items. Quality of reporting was assessed per whether one third, one to two thirds, or more than two thirds of papers complied with potential child-centric potential modifications/extensions to PRISMA and were analyzed by the following: (i) paper type (i.e., report vs. protocol), (ii) publication type (i.e., Cochrane vs. non-Cochrane), and (iii) population type (i.e., child-only vs. mixed populations vs. family/maternal). Of the 414 eligible articles, 248 reports and 76 protocols were included. In 21 of 24 potential SR reporting items and 13 of 14 potential SR protocol reporting items, less than two thirds of papers met the child-centric reporting item requirements. Mixed population studies displayed significantly poorer reporting in comparison to child-only and family/maternal intervention studies for 11 potential SR reporting items (p < 0.05) and five potential SR protocol items (p < 0.05). When comparing non-Cochrane to Cochrane reports and protocols, five items in both lists were found to perform significantly poorer in non-Cochrane reports (p < 0

  15. Clinical impact of sepsis at admission to the ICU of a private hospital in Salvador, Brazil.

    PubMed

    Juncal, Verena Ribeiro; Britto Neto, Lelivaldo Antonio de; Camelier, Aquiles Assunção; Messeder, Octavio Henrique Coelho; Farias, Augusto Manoel de Carvalho

    2011-01-01

    To describe the clinical characteristics, laboratory data, and clinical outcomes of patients with and without sepsis admitted to the ICU of a private hospital in the city of Salvador, Brazil, and to identify clinical variables related to a worse prognosis in those with sepsis. This was a longitudinal study including all patients admitted to the general ICU of the Hospital Português, in the city of Salvador, Brazil, between June of 2008 and March of 2009. At ICU admission, two groups of patients were identified: with sepsis and without sepsis. Epidemiological, clinical and laboratory data were collected, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated. Of the 144 patients in the study, 29 (20.1%) had sepsis. Among the patients with sepsis, males accounted for 55.2%, the mean age was 73.1 ± 14.6 years, and the mean APACHE II score was 23.8 ± 9.1, compared with 36.3%, 68.7 ± 17.7 years, and 18.4 ± 9.5, respectively, among those without sepsis. There were significant associations between a diagnosis of sepsis and the following variables: APACHE II score; in-hospital mortality; ICU mortality; HR; mean arterial pressure; hematocrit level; white blood cell count; and antibiotic use. The use of life support measures and lower hematocrit levels were associated with a worse prognosis in the patients with sepsis. The patients diagnosed with sepsis presented worse clinical outcomes, probably due to their greater severity. Hematocrit level was the only variable that was a predictor of mortality risk in the patients with sepsis.

  16. The Syrian civil war: The experience of the Surgical Intensive Care Units.

    PubMed

    Ozdogan, Hatice Kaya; Karateke, Faruk; Ozdogan, Mehmet; Cetinalp, Sibel; Ozyazici, Sefa; Gezercan, Yurdal; Okten, Ali Ihsan; Celik, Muge; Satar, Salim

    2016-01-01

    Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts.

  17. The normal transverse mesocolon and involvement of the mesocolon in acute pancreatitis: an MRI study.

    PubMed

    Chi, Xiao Xiao; Zhang, Xiao Ming; Chen, Tian Wu; Huang, Xiao Hua; Yang, Lin; Tang, Wei; Xiao, Bo

    2014-01-01

    To study the MRI findings of the normal transverse mesocolon and the involvement of the mesocolon in acute pancreatitis (AP) as well as the relationship between the involvement of the mesocolon and the severity of AP. Forty patients without pancreatic disorders were retrospectively analyzed to observe the normal transverse mesocolon using MRI; 210 patients with AP confirmed by clinical and laboratory tests were retrospectively analyzed using MRI to observe transverse-mesocolon involvement (TMI). The severity of TMI was recorded as zero points (no abnormalities and transverse-mesocolon vessel involvement), one point (linear and patchy signal in the transverse mesocolon) or two points (transverse-mesocolon effusion). The AP severity was graded by the MRI severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation II (APACHE II) scoring system. The correlations of TMI with MRSI and APACHE-II were analyzed. In a normal transverse mesocolon, the display rates of the middle colic artery, the middle colic vein and the gastrocolic trunk on MRI were 95.0%, 82.5% and 100.0%, respectively. Of the 210 patients with AP, 130 patients (61.9%) had TMI. According to the TMI grading, 40%, 39% and 20% of the patients were graded at zero, one and two points, respectively. TMI was strongly correlated with the MRSI score (r = 0.759, P = 0.000) and the APACHE-II score (r = 0.384, P = 0.000). MRI could be used to visualize transverse-mesocolon involvement. The severity of TMI could reflect that of AP in the clinical setting and imaging. TMI might be a supplementary indicator of the severity of AP.

  18. The Normal Transverse Mesocolon and Involvement of the Mesocolon in Acute Pancreatitis: An MRI Study

    PubMed Central

    Zhang, Xiao Ming; Huang, Xiao Hua; Yang, Lin; Tang, Wei; Xiao, Bo

    2014-01-01

    Objective To study the MRI findings of the normal transverse mesocolon and the involvement of the mesocolon in acute pancreatitis (AP) as well as the relationship between the involvement of the mesocolon and the severity of AP. Materials and Methods Forty patients without pancreatic disorders were retrospectively analyzed to observe the normal transverse mesocolon using MRI; 210 patients with AP confirmed by clinical and laboratory tests were retrospectively analyzed using MRI to observe transverse-mesocolon involvement (TMI). The severity of TMI was recorded as zero points (no abnormalities and transverse-mesocolon vessel involvement), one point (linear and patchy signal in the transverse mesocolon) or two points (transverse-mesocolon effusion). The AP severity was graded by the MRI severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation II (APACHE II) scoring system. The correlations of TMI with MRSI and APACHE-II were analyzed. Results In a normal transverse mesocolon, the display rates of the middle colic artery, the middle colic vein and the gastrocolic trunk on MRI were 95.0%, 82.5% and 100.0%, respectively. Of the 210 patients with AP, 130 patients (61.9%) had TMI. According to the TMI grading, 40%, 39% and 20% of the patients were graded at zero, one and two points, respectively. TMI was strongly correlated with the MRSI score (r = 0.759, P = 0.000) and the APACHE-II score (r = 0.384, P = 0.000). Conclusion MRI could be used to visualize transverse-mesocolon involvement. The severity of TMI could reflect that of AP in the clinical setting and imaging. TMI might be a supplementary indicator of the severity of AP. PMID:24705446

  19. Looking Back: Events That Have Shaped Our Current Child Care Delivery System.

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2000-01-01

    Reports findings of an unscientific survey of early childhood professionals asked to reflect upon the history, landmark events, and significant trends in the child care delivery system. Three events viewed as most influential are highlighted: (1) World War II; (2) women's movement; and (3) Head Start. Eleven other events also cited are discussed.…

  20. Adding the s-Process Element Cerium to the APOGEE Survey: Identification and Characterization of Ce II Lines in the H-band Spectral Window

    NASA Astrophysics Data System (ADS)

    Cunha, Katia; Smith, Verne V.; Hasselquist, Sten; Souto, Diogo; Shetrone, Matthew D.; Allende Prieto, Carlos; Bizyaev, Dmitry; Frinchaboy, Peter; García-Hernández, D. Anibal; Holtzman, Jon; Johnson, Jennifer A.; Jőnsson, Henrik; Majewski, Steven R.; Mészáros, Szabolcs; Nidever, David; Pinsonneault, Mark; Schiavon, Ricardo P.; Sobeck, Jennifer; Skrutskie, Michael F.; Zamora, Olga; Zasowski, Gail; Fernández-Trincado, J. G.

    2017-08-01

    Nine Ce II lines have been identified and characterized within the spectral window observed by the Apache Point Observatory Galactic Evolution Experiment (APOGEE) survey (between λ1.51 and 1.69 μm). At solar metallicities, cerium is an element that is produced predominantly as a result of the slow capture of neutrons (the s-process) during asymptotic giant branch stellar evolution. The Ce II lines were identified using a combination of a high-resolution (R=λ /δ λ ={{100,000}}) Fourier Transform Spectrometer (FTS) spectrum of α Boo and an APOGEE spectrum (R = 22,400) of a metal-poor, but s-process enriched, red giant (2M16011638-1201525). Laboratory oscillator strengths are not available for these lines. Astrophysical gf-values were derived using α Boo as a standard star, with the absolute cerium abundance in α Boo set by using optical Ce II lines that have precise published laboratory gf-values. The near-infrared Ce II lines identified here are also analyzed, as consistency checks, in a small number of bright red giants using archival FTS spectra, as well as a small sample of APOGEE red giants, including two members of the open cluster NGC 6819, two field stars, and seven metal-poor N- and Al-rich stars. The conclusion is that this set of Ce II lines can be detected and analyzed in a large fraction of the APOGEE red giant sample and will be useful for probing chemical evolution of the s-process products in various populations of the Milky Way.

  1. Child abuse and neglect experts' determination of when a child being left home alone constitutes child neglect.

    PubMed

    Jennissen, Charles A; Evans, Erin; Oral, Resmiye; Denning, Gerene

    2018-04-10

    Only 14 states have laws or guidelines regarding the minimum age a child may be left home alone. These ages range from 6 to 14 years. Our objective was to identify factors that influence child neglect determination by experts with regards to parents leaving children home alone. American Academy of Pediatrics Section on Child Abuse and Neglect members (N = 523) were surveyed from July-August, 2015. Respondents were asked whether scenarios involving a child of varying age knowingly left home alone for 4 h were neglect in the presence or absence of injury to the child and the legality of the situation. Comparisons were performed using the chi-square test. One hundred ninety-three members responded (36.9%). In the scenario where there were no relevant laws and the child was uninjured, nearly 100% of the child experts determined this as being child neglect when the child was 6 years old. For 8, 10, 12, and 14 year olds, this was 88, 48, 4, and 1%, respectively. However, a significantly higher percentage of experts considered it child neglect for most ages when there was a law making the scenario illegal as compared when there was no law, and when the child was injured versus when they were not. The only demographic variable that showed a difference in child neglect determination was that females were more likely to consider higher aged children as having been neglected when there were no laws but the child was injured. The vast majority of experts (85%) stated that leaving a child home alone for 4 h should be illegal if the child is < 9 years old, and nearly one-half (44%) said it should be illegal for children < 11 years old. A number of factors affect how experts view children being left home alone as potential child neglect. Our data suggests that such cases may be evaluated differently due to variations in state laws, even though the risk to the child is the same. These results call for child safety law reform to provide greater uniformity in the

  2. Removing Hydrology Signals to Determine Ground Motion at the Apache Point Lunar Laser Ranging Site, New Mexico

    NASA Astrophysics Data System (ADS)

    Crossley, D. J.; Borsa, A. A.; Murphy, T.

    2017-12-01

    We continue the analysis of superconducting gravimeter (SG) and GPS data at Apache Point Observatory (APO) as part of the astrophysical effort to reduce LLR errors to the mm level. With 8 years of data accumulated, the main impediment to getting benefit from the SG data is the assessment of the hydrology signal that arises mainly from the attraction of local water masses close to the site. Traditional SG processing attempts to remove as much signal as possible from the loading and attraction contributions, but we are limited at APO because here is no hydrology ground truth. Nevertheless, we produce a gravity residual that corresponds to some extent with the rather noisy vertical GPS data from Plate Boundary Site PB07 close to Sunspot observatory 2 km from APO. The main goal of this paper, apart from updating the gravity and GPS correction using recent models, is to construct simulated SG and GPS time series from the synthetic source functions - ground uplift, hydrology attraction and loading - and to perform an inversion to see what can be recovered of the vertical ground motion. The simulation will also include a first look at the effect of this synthetic local data on the current Planetary Ephemeris Program solution for the lunar distance.

  3. Developing Online Communities with LAMP (Linux, Apache, MySQL, PHP) - the IMIA OSNI and CHIRAD Experiences.

    PubMed

    Murray, Peter J; Oyri, Karl

    2005-01-01

    Many health informatics organisations do not seem to use, on a practical basis, for the benefit of their activities and interaction with their members, the very technologies that they often promote for use within healthcare environments. In particular, many organisations seem to be slow to take up the benefits of interactive web technologies. This paper presents an introduction to some of the many free/libre and open source (FLOSS) applications currently available and using the LAMP - Linux, Apache, MySQL, PHP architecture - as a way of cheaply deploying reliable, scalable, and secure web applications. The experience of moving to applications using LAMP architecture, in particular that of the Open Source Nursing Informatics (OSNI) Working Group of the Special Interest Group in Nursing Informatics of the International Medical Informatics Association (IMIA-NI), in using PostNuke, a FLOSS Content Management System (CMS) illustrates many of the benefits of such applications. The experiences of the authors in installing and maintaining a large number of websites using FLOSS CMS to develop dynamic, interactive websites that facilitate real engagement with the members of IMIA-NI OSNI, the IMIA Open Source Working Group, and the Centre for Health Informatics Research and Development (CHIRAD), as well as other organisations, is used as the basis for discussing the potential benefits that could be realised by others within the health informatics community.

  4. Human Leucocyte Antigen Profile and Transmission of Mutans Streptococci in Mother-Child Pairs.

    PubMed

    Wallengren, Marie L; Hedström, Kristin; Zbroszczyk, Katarzyna; Hamberg, Kristina

    2015-01-01

    To investigate possible association between the transmission of mutans streptococci and sharing the immune system component Human Leucocyte Antigen (HLA) class II in mother-child pairs. Plaque samples from 43 mother-child pairs were cultivated and screened for mutans streptococci. In 14 pairs where both mother and child harboured the bacteria, the strains were genotyped by Random Amplified Polymorphic DNA and samples were run on PAGE gels. Analysis of genetic identity between mother and child strains was performed with help of software and Dice similarity index. The distribution of HLA of serogroup DR4 (HLA DR4) was studied in relation to maternal transmission and mutans streptococci colonisation in children. The study hypothesis was that in pairs where both mother and child were HLA DR4 positive, transmission of mutans streptococci was more likely. No correlation between the presence of HLA DR4 in mother and child and maternal transmission of mutans streptococci was established. However, the results showed no linkage between mutans streptococci colonisation and HLA DR 4. Of 15 children with mutans streptococci, 12 were HLA DR4 positive. The result suggests that presence of HLA DR4 could be a predisposing factor for colonisation with mutans streptococci in children.

  5. Teacher-Child Relationship Quality: The Roles of Child Temperament and Teacher-Child Interactions

    ERIC Educational Resources Information Center

    Rudasill, Kathleen Moritz; Rimm-Kaufman, Sara E.

    2009-01-01

    Young children's relationships with teachers predict social and academic success. This study examines contributions of child temperament (shyness, effortful control) and gender to teacher-child relationship quality both directly and indirectly through the frequency of teacher-child interactions in the classroom. Using an NICHD SECCYD sample of 819…

  6. Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment.

    PubMed

    Afifi, Tracie O; Taillieu, Tamara; Cheung, Kristene; Katz, Laurence Y; Tonmyr, Lil; Sareen, Jitender

    2015-07-01

    Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment. Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children). Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment. More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes.

  7. Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment

    PubMed Central

    Afifi, Tracie O; Taillieu, Tamara; Cheung, Kristene; Katz, Laurence Y; Tonmyr, Lil; Sareen, Jitender

    2015-01-01

    Objective: Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment. Method: Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children). Results: Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment. Conclusions: More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes. PMID:26175390

  8. The role of the father in child sleep disturbance: child, parent, and parent-child relationship.

    PubMed

    Millikovsky-Ayalon, Maaian; Atzaba-Poria, Naama; Meiri, Gal

    2015-01-01

    The majority of studies on child sleep problems focus primarily on mothers, neglecting paternal influences. Guided by the transactional framework, we explored how child temperament, paternal and maternal stress, and the parent-child interactions differ between families having children with sleep disturbances and a selected comparison group. The role of paternal involvement in child caregiving as a moderator of these differences was assessed. The sample consisted of 51 children (1-3 years old) and their mothers and fathers. Data were collected during home visits, when mothers and fathers completed questionnaires and were interviewed. In addition, mother-child and father-child interactions were videotaped. Results indicate that compared to the comparison group, fathers rated children with sleep disturbances as fussier, both their mothers and fathers experienced higher levels of stress, and reported using more bedtime interactions that interfere with child's sleep-wake self-regulation. In addition, their fathers were less sensitive during father-child interaction and less involved in child caregiving. Finally, paternal involvement moderated the group differences seen in maternal stress, suggesting that high paternal involvement acted as a buffer to protect parents of children with sleep disturbances from experiencing parental stress. The important role of fathers in families having children with sleep disturbances is discussed. © 2014 Michigan Association for Infant Mental Health.

  9. The Effect of Drotrecogin Alfa (activated) on Long-Term Survival after Severe Sepsis

    PubMed Central

    Angus, Derek C.; Laterre, Pierre-Francois; Helterbrand, Jeff; Ely, E. Wesley; Ball, Daniel E.; Garg, Rekha; Weissfeld, Lisa A.; Bernard, Gordon

    2016-01-01

    Objective To determine long-term survival for subjects with severe sepsis enrolled in the previous multicenter trial (PROWESS) of drotrecogin alfa (activated) [DrotAA] versus placebo. Design Retrospective, cross-sectional, blinded follow-up of subjects enrolled in a previous randomized, controlled trial. Setting 164 tertiary care institutions in 11 countries. Interventions DrotAA (n=850), 24 μg/kg/h for 96 hours, or placebo (n=840). Participants The 1690 subjects with severe sepsis enrolled and treated with study drug in PROWESS, of whom 1220 were alive at 28 days (the end of the original PROWESS follow-up). Measurements and Main Results Long-term survival data were collected. We had follow-up information on 100% of subjects at 28 days, 98% at hospital discharge, 94% at 3 months, and 93% at 1 year. The longest follow-up was 3.6 years. Hospital survival was higher with DrotAA versus placebo (70.3% vs. 65.1%, p=0.03). There was no statistically significant difference in duration of survival time or in landmark survival rates in subjects who received DrotAA compared with those who received placebo, [median duration of survival = 1113d vs. 846d for DrotAA vs. placebo, p=0.10; landmark survival rates for DrotAA vs. placebo, 66.1% vs. 62.4% at 3 months (p=0.11), 62.2% vs. 60.3% at 6 months (p=0.44), 58.9% vs. 57.2% at 1 year (p=0.49), and 52.6% vs. 49.3% at 2½ years (p=0.21)]. There was a significant interaction (p=0.0008) between treatment assignment and baseline APACHE II scores, suggesting qualitative differences in treatment effect with severity of illness. Subjects with APACHE II ≥25 had better survival time with DrotAA (median duration of survival: 450d vs. 71d, p=0.0005). Survival rates were also higher at landmark timepoints [DrotAA vs. placebo, 58.9% vs. 48.4% at 3 months (p=0.003), 55.2% vs. 45.3% at 6 months (p=0.005), 52.1% vs. 41.3% at 1 year (p=0.002), and 41.7% vs. 32.9% at 2½ years (p=0.001)]. In the APACHE II <25 group there was no significant

  10. The prevalence of mental health problems in children 1(1/2) years of age - the Copenhagen Child Cohort 2000.

    PubMed

    Skovgaard, Anne Mette; Houmann, Tine; Christiansen, Eva; Landorph, Susanne; Jørgensen, Torben; Olsen, E M; Heering, K; Kaas-Nielsen, S; Samberg, V; Lichtenberg, A

    2007-01-01

    The Copenhagen Child Cohort, CCC 2000, was established to investigate developmental psychopathology prospectively from birth in a general population. A random sample of 211 children from the CCC 2000 was investigated when the children were 1(1/2) years of age. The prevalence and associates of mental health problems and psychopathology were studied by clinical and standardised strategies, including videotape recordings, parent interviews and the following instruments: The Child Behavior Check List 1(1/2)-5 (CBCL 1(1/2)-5), The Infant Toddler Symptom Check List (ITSCL), Checklist for Autism in Toddlers (CHAT), Bayley Scales of Infant Development II (BSID II), The Parent Child Early Relationship Assessment (PC ERA) and Parent Infant Relationship Global Assessment Scale (PIR-GAS). Mental health problems according to International Classification of Diseases (ICD-10) and Diagnostic Classification Zero to Three (DC 0-3) diagnoses were found in 16-18% of 1(1/2)-year-old children. Most common were disturbances of emotion, behaviour and eating and the DC 0-3 diagnosis of regulatory disorder. Parent-child relationship disturbances were found in 8%. High psychosocial risk was significantly associated with emotional and behavioural disorders (OR 3.1 95% (1.2-8.1)) and disturbed parent-child relationship (OR 5.0 95% (1.6-16.0)). The strongest association of risk was found between relationship disorders and emotional and behavioural disorders (OR 11.6 95% (3.8-37.5)). The prevalence and distribution of psychopathology in 1(1/2)-year-old children seem to correspond to the distributions among older children. Disturbances in parent-child relationship have a key position in the risk mechanisms in early child psychopathology.

  11. Maternal prepregnancy body mass index and child psychosocial development at 6 years of age.

    PubMed

    Jo, Heejoo; Schieve, Laura A; Sharma, Andrea J; Hinkle, Stefanie N; Li, Ruowei; Lind, Jennifer N

    2015-05-01

    Both obesity and developmental disabilities have increased in recent decades. Limited studies suggest associations between maternal prepregnancy obesity and child neurodevelopment. The Infant Feeding Practices Study II, a US nationally distributed longitudinal study of maternal health and infant health and feeding practices, was conducted from 2005 to 2007. In 2012, mothers were recontacted for information on their children's health and development. We examined associations between maternal prepregnancy BMI and child psychosocial development in 1311 mother-child pairs included in this follow-up study. Children's development was assessed by maternal report of child psychosocial difficulties from the Strengths and Difficulties Questionnaire, past developmental diagnoses, and receipt of special needs services. Adjusting for sociodemographic factors, children of obese class II/III mothers (BMI >35.0) had increased odds of emotional symptoms (adjusted odds ratio [aOR] 2.24; 95% confidence interval [CI], 1.27-3.98), peer problems (aOR 2.07; 95% CI, 1.26-3.40), total psychosocial difficulties (aOR 2.17; 95% CI, 1.24-3.77), attention-deficit/hyperactivity disorder diagnosis (aOR 4.55; 95% CI, 1.80-11.46), autism or developmental delay diagnosis (aOR 3.13; 95% CI, 1.10-8.94), receipt of speech language therapy (aOR 1.93; 95% CI, 1.18-3.15), receipt of psychological services (aOR 2.27; 95% CI, 1.09-4.73), and receipt of any special needs service (aOR 1.99; 95% CI, 1.33-2.97) compared with children of normal weight mothers (BMI 18.5-24.9). Adjustment for potential causal pathway factors including pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression, and child's birth weight did not substantially affect most estimates. Children whose mothers were severely obese before pregnancy had increased risk for adverse developmental outcomes. published in the public domain by the American Academy of Pediatrics.

  12. [Predictive value of early phrase echocardiography and cardiac biological markers in patients with severe sepsis: a five-year single-center retrospective study].

    PubMed

    Zang, Xuefeng; Chen, Wei; Sheng, Bo; Zhao, Lei; Gu, Xuyun; Zhen, Jie; Liu, Ping

    2018-04-01

    To assess the predictive value of early phrase echocardiography and cardiac biomarkers in patients with severe sepsis. A retrospective analysis of severe septic patients (patients with acute coronary syndrome and end stage renal disease were excluded) in department of intensive care unit of Capital Medical University Affiliated Beijing Shijitan Hospital from January 2013 to December 2017 was conducted. The acute physiology and chronic health evaluation II (APACHE II) score, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB) within 6 hours after admission, and bedside echocardiography indexes [left ventricular ejection fraction (LVEF), the ratio of the peak blood flow velocity in the early stage of the mitral valve and the peak blood flow rate of the mitral valve (E/A ratio)] within 6 hours after diagnosis were recorded. The differences of indexes between patients with decreased contractile function (LVEF < 0.50) group and normal group, and the difference between dead group and survival group within 28-day were compared. Receiver operating characteristic (ROC) curve and Logistic regression analysis were conducted to assess the early detected prognostic value in severe sepsis patients. (1) A total of 316 patients were enrolled in the survey period. Decreased cardiac systolic function (LVEF < 0.50) was found in 89 cases (28.2%), and cardiac diastolic function impaired (E/A ratio < 1) in 269 cases (85.1%); while 79 cases (25.0%) had both systolic function and diastolic function impairment. (2) NT-proBNP and cTnI were statistically different between cardiac systolic function impaired group and normal group. Further Logistic regression analysis showed that only NT-proBNP was significantly correlated with LVEF [β=-1.311, odds ratio (OR) = 0.269, P < 0.001]. (3) Eighty-two of 316 cases were died in 28-day, and the 28-day mortality rate was 25.9%. Compared

  13. Mothers' child-feeding practices are associated with children's sugar-sweetened beverage intake.

    PubMed

    Park, Sohyun; Li, Ruowei; Birch, Leann

    2015-04-01

    Sugar-sweetened beverage (SSB) intake is a substantial source of energy in the diet of US children. We examined the associations between mothers' child-feeding practices and SSB intake among 6-y-old children. We analyzed data from the Year 6 Follow-up of the Infant Feeding Practices Study II in 1350 US children aged 6 y. The outcome variable was child's SSB intake. The exposure variables were 4 child-feeding practices of mothers: setting limits on sweets or junk foods, regulating their child's favorite food intake to prevent overconsumption, pressuring their child to eat enough, and pressuring their child to "clean the plate." We used multinomial logistic regression and controlled for child and maternal characteristics. Analyses were stratified on child weight status. The consumption of SSBs ≥1 time/d was observed among 17.1% of underweight/normal-weight children and in 23.2% of overweight/obese children. Adjusted ORs (aORs) of consuming SSBs ≥1 time/d (vs. no SSB consumption) were significantly lower in children whose mothers reported setting limits on sweets/junk foods (aOR: 0.29; 95% CI: 0.15, 0.58 for underweight/normal-weight children; aOR: 0.16; 95% CI: 0.03, 0.79 for overweight/obese children). SSB intake was higher among underweight/normal-weight children whose mothers reported trying to keep the child from eating too much of their favorite foods (aOR: 2.03; 95% CI: 1.25, 3.29). Mothers' tendency to pressure their children to consume more food or to "clean the plate" was not associated with child's SSB intake. SSBs were commonly consumed by young children. The odds of daily SSB intake were lower among children whose mothers set limits on sweets/junk foods regardless of child's weight but were higher among underweight/normal-weight children whose mothers restricted the child's favorite food intake. Future studies can investigate the impact of alternatives to restrictive feeding practices that could reduce children's SSB intake. © 2015 American Society

  14. Basal values and changes of liver stiffness predict the risk of disease progression in compensated advanced chronic liver disease.

    PubMed

    Pons, Mònica; Simón-Talero, Macarena; Millán, Laura; Ventura-Cots, Meritxell; Santos, Begoña; Augustin, Salvador; Genescà, Joan

    2016-10-01

    Transient elastography has been proposed as a tool to predict the risk of decompensation in patients with chronic liver disease. We aimed to identify risk groups of disease progression, using a combination of baseline liver stiffness measurement (LSM) and its change over time (delta-LSM) in patients with compensated advanced chronic liver disease (cACLD). Ninety-four patients with baseline LSM ≥10kPa, Child-Pugh score 5 and without previous decompensation were included. A second LSM was performed during follow-up and data on liver function and liver-related events were collected. The primary endpoint was a composite that included death, liver decompensation and impairment in at least 1 point in Child-Pugh score. After a median follow-up of 43.6 months, 15% of patients presented the primary endpoint. Multivariate analysis identified baseline LSM (OR 1.12, P=0.002) and delta-LSM (OR 1.02, P=0.048) as independent predictors of the primary endpoint. A high risk group represented by patients with baseline LSM ≥21kPa and delta-LSM ≥10% (risk of progression 47.1%, 95% CI: 23-71%) was identified, while patients with LSM <21kPa and delta-LSM <10% presented zero risk of progression (P=0.03). Simple classification rules using baseline LSM and delta-LSM identify cACLD patients at low or high risk of disease progression. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  15. Occult hepatitis B virus infection is not associated with disease progression of chronic hepatitis C virus infection.

    PubMed

    Cho, Junhyeon; Lee, Sang Soo; Choi, Yun Suk; Jeon, Yejoo; Chung, Jung Wha; Baeg, Joo Yeong; Si, Won Keun; Jang, Eun Sun; Kim, Jin-Wook; Jeong, Sook-Hyang

    2016-11-14

    To clarify the prevalence of occult hepatitis B virus (HBV) infection (OBI) and the association between OBI and liver disease progression, defined as development of liver cirrhosis or hepatocellular carcinoma (HCC), worsening of Child-Pugh class, or mortality in cases of chronic hepatitis C virus (HCV) infection. This prospective cohort study enrolled 174 patients with chronic HCV infection (chronic hepatitis, n = 83; cirrhosis, n = 47; HCC, n = 44), and evaluated disease progression during a mean follow-up of 38.7 mo. OBI was defined as HBV DNA positivity in 2 or more different viral genomic regions by nested polymerase chain reaction using 4 sets of primers in the S, C, P and X open reading frame of the HBV genome. The overall OBI prevalence in chronic HCV patients at enrollment was 18.4%, with 16.9%, 25.5% and 13.6% in the chronic hepatitis C, liver cirrhosis and HCC groups, respectively ( P = 0.845). During follow-up, 52 patients showed disease progression, which was independently associated with aspartate aminotransferase > 40 IU/L, Child-Pugh score and sustained virologic response (SVR), but not with OBI positivity. In 136 patients who were not in the SVR state during the study period, OBI positivity was associated with neither disease progression, nor HCC development. The prevalence of OBI in chronic HCV patients was 18.4%, and OBI was not associated with disease progression in South Koreans.

  16. Assessment of liver function in primary biliary cirrhosis using Gd-EOB-DTPA-enhanced liver MRI.

    PubMed

    Nilsson, Henrik; Blomqvist, Lennart; Douglas, Lena; Nordell, Anders; Jonas, Eduard

    2010-10-01

    Gd-EOB-DTPA (gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid) is a gadolinium-based hepatocyte-specific contrast agent for magnetic resonance imaging (MRI). The aim of this study was to determine whether the hepatic uptake and excretion of Gd-EOB-DTPA differ between patients with primary biliary cirrhosis (PBC) and healthy controls, and whether differences could be quantified. Gd-EOB-DTPA-enhanced liver MRI was performed in 20 healthy volunteers and 12 patients with PBC. The uptake of Gd-EOB-DTPA was assessed using traditional semi-quantitative parameters (C(max) , T(max) and T(1/2) ), as well as model-free parameters derived after deconvolutional analysis (hepatic extraction fraction [HEF], input-relative blood flow [irBF] and mean transit time [MTT]). In each individual, all parameters were calculated for each liver segment and the median of the segmental values was used to define a global liver median (GLM). Although the PBC patients had relatively mild disease according to their Model for End-stage Liver Disease (MELD), Child-Pugh and Mayo risk scores, they had significantly lower HEF and shorter MTT values compared with the healthy controls. These differences significantly increased with increasing MELD and Child-Pugh scores. Dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) has a potential role as an imaging-based liver function test. The high spatial resolution of MRI enables hepatic function to be assessed on segmental and sub-segmental levels. © 2010 International Hepato-Pancreato-Biliary Association.

  17. Risk Factors for Post-Transplant Death in Donation after Circulatory Death Liver Transplantation.

    PubMed

    Liu, Song; Miao, Ji; Shi, Xiaolei; Wu, Yafu; Jiang, Chunping; Zhu, Xinhua; Wu, Xingyu; Ding, Yitao; Xu, Qingxiang

    2017-08-22

    In spite of the increasing success of liver transplantation, there remains inevitable risk of postoperative complications, re-operations, and even death. Risk factors that correlate with post-transplant death have not been fully identified. We performed a retrospective analysis of 65 adults that received donation after circulatory death liver transplantation. Binary logistic regression and Cox's proportional hazards regression were employed to identify risk factors that associate with postoperative death and the length of survival period. Twenty-two recipients (33.8%) deceased during 392.3 ± 45.6 days. The higher preoperative Child-Pugh score (p = .007), prolonged postoperative ICU stay (p = .02), and more postoperative complications (p = .0005) were observed in deceased patients. Advanced pathological staging (p = .02) with more common nerve invasion (p = .03), lymph node invasion (p = .02), and para-tumor satellite lesion (p = .01) were found in deceased group. The higher pre-transplant Child-Pugh score was a risk factor for post-transplant death (OR = 4.38, p = .011), and was correlated with reduced post-transplant survival period (OR = 0.35, p = .009). Nerve invasion was also a risk factor for post-transplant death (OR = 13.85, p = .014), although it failed to affect survival period. Our study emphasizes the impact of recipient's pre-transplant liver function as well as pre-transplant nerve invasion by recipient's liver cancer cells on postoperative outcome and survival period in patients receiving liver transplantation.

  18. Hyaluronic acid concentration in liver diseases.

    PubMed

    Gudowska, Monika; Gruszewska, Ewa; Panasiuk, Anatol; Cylwik, Bogdan; Flisiak, Robert; Świderska, Magdalena; Szmitkowski, Maciej; Chrostek, Lech

    2016-11-01

    The aim of this study was to evaluate the effect of liver diseases of different etiologies and clinical severity of liver cirrhosis on the serum level of hyaluronic acid. The results were compared with noninvasive markers of liver fibrosis: APRI, GAPRI, HAPRI, FIB-4 and Forn's index. Serum samples were obtained from 20 healthy volunteers and patients suffering from alcoholic cirrhosis (AC)-57 patients, non-alcoholic cirrhosis (NAC)-30 and toxic hepatitis (HT)-22. Cirrhotic patients were classified according to Child-Pugh score. Hyaluronic acid concentration was measured by the immunochemical method. Non-patented indicators were calculated using special formulas. The mean serum hyaluronic acid concentration was significantly higher in AC, NAC and HT group in comparison with the control group. There were significant differences in the serum hyaluronic acid levels between liver diseases, and in AC they were significantly higher than those in NAC and HT group. The serum hyaluronic acid level differs significantly due to the severity of cirrhosis and was the highest in Child-Pugh class C. The sensitivity, specificity, accuracy, positive and negative predictive values and the area under the ROC curve for hyaluronic acid and all non-patented algorithms were high and similar to each other. We conclude that the concentration of hyaluronic acid changes in liver diseases and is affected by the severity of liver cirrhosis. Serum hyaluronic acid should be considered as a good marker for noninvasive diagnosis of liver damage, but the combination of markers is more useful.

  19. Sarcopenia Impairs Prognosis of Patients with Hepatocellular Carcinoma: The Role of Liver Functional Reserve and Tumor-Related Factors in Loss of Skeletal Muscle Volume.

    PubMed

    Imai, Kenji; Takai, Koji; Watanabe, Satoshi; Hanai, Tatsunori; Suetsugu, Atsushi; Shiraki, Makoto; Shimizu, Masahito

    2017-09-22

    Sarcopenia impairs survival in patients with hepatocellular carcinoma (HCC). This study aimed to clarify the factors that contribute to decreased skeletal muscle volume in patients with HCC. The third lumbar vertebra skeletal muscle index (L3 SMI) in 351 consecutive patients with HCC was calculated to identify sarcopenia. Sarcopenia was defined as an L3 SMI value ≤ 29.0 cm²/m² for women and ≤ 36.0 cm²/m² for men. The factors affecting L3 SMI were analyzed by multiple linear regression analysis and tree-based models. Of the 351 HCC patients, 33 were diagnosed as having sarcopenia and showed poor prognosis compared with non-sarcopenia patients ( p = 0.007). However, this significant difference disappeared after the adjustments for age, sex, Child-Pugh score, maximum tumor size, tumor number, and the degree of portal vein invasion by propensity score matching analysis. Multiple linear regression analysis showed that age ( p = 0.015) and sex ( p < 0.0001) were significantly correlated with a decrease in L3 SMI. Tree-based models revealed that sex (female) is the most significant factor that affects L3 SMI. In male patients, L3 SMI was decreased by aging, increased Child-Pugh score (≥56 years), and enlarged tumor size (<56 years). Maintaining liver functional reserve and early diagnosis and therapy for HCC are vital to prevent skeletal muscle depletion and improve the prognosis of patients with HCC.

  20. An Evaluation of the Usefulness of Extracorporeal Liver Support Techniques in Patients Hospitalized in the ICU for Severe Liver Dysfunction Secondary to Alcoholic Liver Disease

    PubMed Central

    Piechota, Mariusz; Piechota, Anna

    2016-01-01

    Background The mortality rate in patients with severe liver dysfunction secondary to alcoholic liver disease (ALD) who do not respond to the standard treatment is exceptionally high. Objectives The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support techniques to treat this group of patients. Patients and Methods The data from 23 hospital admissions of 21 patients with ALD who were admitted to the department of anesthesiology and intensive therapy (A&IT) at the Dr Wł. Biegański Regional Specialist Hospital in Łódź between March 2013 and July 2015 were retrospectively analyzed. Results A total of 111 liver dialysis procedures were performed during the 23 hospitalizations, including 13 dialyses using fractionated plasma separation and adsorption (FPSA) with the Prometheus® system, and 98 procedures using the single pass albumin dialysis (SPAD) system. Upon admission to the intensive care unit (ICU), the median (interquartile range [IQR]) Glasgow coma scale (GCS), sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE) II, and simplified acute physiology score (SAPS) II scores were 15 (14 - 15), 9 (7 - 13), 17 (14 - 24), and 32 (22 - 50), respectively. The ICU, 30-day, and three-month mortality rates were 43.48%, 39.13%, and 73.91%, respectively. As determined by the receiver operative characteristic (ROC) analysis for single-factor models, the significant predictors of death in the ICU included the patients’ SOFA, APACHE II, SAPS II, and model of end-stage liver disease modified by the united network for organ sharing (MELD UNOS Modification) scores; the duration of stay (in days) in the A&IT Department; and bile acid, creatinine and albumin levels upon ICU admission. The ROC analysis indicated the significant discriminating power of the SOFA, APACHE II, SAPS II, and MELD UNOS modification scores on the three-month mortality rate. Conclusions The application of

  1. Research Results of the National Day Care Study. Final Report of the National Day Care Study. Volume II.

    ERIC Educational Resources Information Center

    Travers, Jeffrey; And Others

    This final report of the National Day Care Study (NDCS), Volume II, provides researchers, social scientists and lay readers with information for judging the soundness of the evidence underlying NDCS conclusions about relationships between regulatable center characteristics and the outcome of care for the child. Thus, Volume II makes free use of…

  2. Interactions between child and parent temperament and child behavior problems.

    PubMed

    Rettew, David C; Stanger, Catherine; McKee, Laura; Doyle, Alicia; Hudziak, James J

    2006-01-01

    Few studies of temperament have tested goodness-of-fit theories of child behavior problems. In this study, we test the hypothesis that interactions between child and parent temperament dimensions predict levels of child psychopathology after controlling for the effects of these dimensions individually. Temperament and psychopathology were assessed in a total of 175 children (97 boys, 78 girls; mean age, 10.99 years; SD, 3.66 years) using composite scores from multiple informants of the Junior Temperament and Character Inventory and the Achenbach System of Empirically Based Assessment. Parent temperament was assessed using the adult version of the Temperament and Character Inventory. Statistical analyses included multiple regression procedures to assess the contribution of child-parent temperament interactions after controlling for demographic variables, other types of child psychopathology, and the individual Temperament and Character Inventory and Junior Temperament and Character Inventory dimensions. Interactions between child and parent temperament dimensions predicted higher levels of externalizing, internalizing, and attention problems over and above the effects of these dimensions alone. Among others, the combination of high child novelty seeking with high maternal novelty was associated with child attention problems, whereas the combination of high child harm avoidance and high father harm avoidance was associated with increased child internalizing problems. Many child temperament dimensions also exerted significant effects independently. The association between a child temperament trait and psychopathology can be dependent upon the temperament of parents. These data lend support to previous theories of the importance of goodness-of-fit.

  3. Child impulsiveness-inattention, early peer experiences, and the development of early onset conduct problems.

    PubMed

    Snyder, James; Prichard, Joy; Schrepferman, Lynn; Patrick, M Renee; Stoolmiller, Mike

    2004-12-01

    The conjoint influence of child impulsiveness-inattention (I/I) and peer relationships on growth trajectories of conduct problems was assessed in a community sample of 267 boys and girls. I/I reliably predicted teacher- and parent-reported conduct problems at kindergarten entry and growth in those problems over the next 2 years for boys and girls. The relation of boys' I/I to conduct problems was mediated, in part, by peer rejection and involvement in coercive exchanges with peers. The relation of girls' I/I to conduct problems was less clearly mediated by peer processes, but peer difficulties had additive effects. The impact of peer relationships on trajectories of conduct problems was apparent to parents as well as to teachers. Although I/I increments risk for early and persisting conduct problems in concert with poor peer relationships, it does so in complex and gender-specific ways.

  4. Parents' perceptions of child abuse and child discipline in Bangkok, Thailand.

    PubMed

    Auemaneekul, Naruemon

    2013-12-01

    Violation of a child's right to protection is an issue for children all over the world. In Thailand, the greatest barrier to intervening in child abuse issues is the lack of awareness and the positive attitudes and beliefs on using violence as a way to discipline children. The incongruent definition used amongst Thai society and relevant sectors, causes incidences to be under reported and an obstacle to child survival and development. The present study is a qualitative study and aims to explore the perceptions of child abuse and child discipline definitions amongst parents in the Bangkok Metropolitan Area in order to extend broader knowledge for interpretation, definitions and to differentiate the line between child abuse and child discipline. Focus group discussions were used as the primary data collection method and content analysis was applied as the data analysis. The results produced two categories of parents' perceptions regarding child abuse and discipline. First, was the perception of the causes of child punishment and child discipline, and second was the meaning and difference between child abuse and child discipline. The study results would be beneficial for policy makers, health and related sectors to understand the meaning of the terms used amongst family members in order to apply and promote child protection strategies in culturally appropriate

  5. Intra- and Extra-Cranial Injury Burden as Drivers of Impaired Cerebrovascular Reactivity in Traumatic Brain Injury.

    PubMed

    Zeiler, Frederick Adam; Donnelly, Joseph; Nourallah, Basil; Thelin, Eric Peter; Calviello, Leanne; Smieleweski, Peter; Czosnyka, Marek; Ercole, Ari; Menon, David

    2018-02-12

    Impaired cerebrovascular reactivity has been associated with outcome following traumatic brain injury (TBI), but it is unknown how it is affected by trauma severity. Thus, we aimed to explore the relationship between intra-cranial (IC) and extra-cranial (EC) injury burden and cerebrovascular reactivity in TBI patients. We retrospectively included critically ill TBI patients. IC injury burden included detailed lesion and computerized tomography (CT) scoring (ie. Marshall, Rotterdam, Helsinki and Stockholm Scores) on admission. EC injury burden were characterized using the injury severity score (ISS) and APACHE II score. Pressure reactivity index (PRx), pulse amplitude index (PAx) and RAC were used to assess autoregulation/cerebrovascular reactivity. We used univariate and multi-variate logistic regression techniques to explore relationships between IC and EC injury burden and autoregulation indices. A total of 358 patients were assessed. ISS and all IC CT scoring systems were poor predictors of impaired cerebrovascular reactivity. Only subdural hematomas and thickness of SAH (p<0.05, respectively) were consistently associated with dysfunctional cerebrovascular reactivity. High age (p<0.01 for all) and admission APACHE II scores (p<0.05 for all) were the two variables strongest associated with abnormal cerebrovascular reactivity. In summary, diffuse IC injury markers (thickness of SAH and the presence of a SDH) and APACHE II were most associated with dysfunction in cerebrovascular reactivity after TBI. Standard CT scoring systems and evidence of macroscopic parenchymal damage are poor predictors, implicating potentially both microscopic injury patterns and host response as drivers of dysfunctional cerebrovascular reactivity. Age remains a major variable associated with cerebrovascular reactivity.

  6. The predictive value of resting heart rate following osmotherapy in brain injury: back to basics

    PubMed Central

    2012-01-01

    Background The importance of resting heart rate as a prognostic factor was described in several studies. An elevated heart rate is an independent risk factor for adverse cardiovascular events and total mortality in patients with coronary artery disease, chronic heart failure, and the general population. Also heart rate is elevated in the Multi Organ Dysfunction Syndrome (MODS) and the mortality due to MODS is highly correlated with inadequate sinus tachycardia. To evaluate the value of resting heart rate in predicting mortality in patients with traumatic brain injury along scoring systems like Acute Physiology and Chronic Health Evaluation(APACHE II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Score (GCS). Method By analyzing data which was collected from an open labeled randomized clinical trial that compared the different means of osmotherapy (mannitol vs bolus or infusion hypertonic saline), heart rate, GCS, APACHE II and SOFA score were measured at baseline and daily for 7 days up to 60 days and the relationship between elevated heart rate and mortality during the first 7 days and 60th day were assessed. Results After adjustments for confounding factors, although there was no difference in mean heart rate between either groups of alive and expired patients, however, we have found a relative correlation between 60th day mortality rate and resting heart rate (P=0.07). Conclusion Heart rate can be a prognostic factor for estimating mortality rate in brain injury patients along with APACHE II and SOFA scores in patients with brain injury. PMID:23351393

  7. The cost-effectiveness of cefepime plus metronidazole versus imipenem/cilastatin in the treatment of complicated intra-abdominal infection.

    PubMed

    Barie, Philip S; Rotstein, Ori D; Dellinger, E Patchen; Grasela, Thaddeus H; Walawander, Cynthia A

    2004-01-01

    Our objective was to compare the economic benefits of cefepime plus metronidazole with those of imipenem/cilastatin in the treatment of complicated intra-abdominal infections. We used a retrospective analysis of clinical outcomes and health resource utilization data collected during a randomized, double-blind, multi-center clinical trial. Seventeen university-affiliated hospitals in the United States and Canada participated, as did 323 patients with complicated intra-abdominal infections. Decision analysis was conducted using a decision node of cefepime vs. imipenem, and chance nodes that included an Acute Physiology and Chronic Health Evaluation (APACHE) II score of #15 versus .15; a need for posttreatment surgical procedures; and clinical outcomes. Effectiveness of treatment was measured by differences in the length and cost of hospital stays, the number and cost of surgical procedures after treatment, cure rates, and the cost of antibiotics. Also evalulated were the incremental costs of cure (i.e., the costs of additional cures). Comparing cefepime plus metronidazole with imipenem/cilastatin, the expected cost of patient care was $8,218 versus $10,414, respectively, and the cost-effectiveness ratio per cure was $10,058 versus $13,685. For severely ill patients (APACHE II score .15), the expected cost was $12,962 versus $23,153, and the cost-effectiveness ratio per cure was $15,321 versus $64,313. Cefepime plus metronidazole was more cost-effective than imipenem/cilastatin in the treatment of complicated intra-abdominal infections, primarily because of fewer post-treatment surgical procedures and shorter hospital stays. The primary advantage accrued to severely ill patients who had an APACHE II score .15.

  8. Combined enteral feeding and total parenteral nutritional support improves outcome in surgical intensive care unit patients.

    PubMed

    Hsu, Min-Hui; Yu, Ying E; Tsai, Yueh-Miao; Lee, Hui-Chen; Huang, Ying-Che; Hsu, Han-Shui

    2012-09-01

    For intensive care unit (ICU) patients with gastrointestinal dysfunction and in need of total parenteral nutrition (TPN) support, the benefit of additional enteral feeding is not clear. This study aimed to investigate whether combined TPN with enteral feeding is associated with better outcomes in surgical intensive care unit (SICU) patients. Clinical data of 88 patients in SICU were retrospectively collected. Variables used for analysis included route and percentage of nutritional support, total caloric intake, age, gender, body weight, body mass index, admission diagnosis, surgical procedure, Acute Physiology and Chronic Health Evaluation (APACHE) II score, comorbidities, length of hospital stay, postoperative complications, blood glucose values and hospital mortality. Wound dehiscence and central catheter infection were observed more frequently in the group of patients receiving TPN calories less than 90% of total calorie intake (p = 0.004 and 0.043, respectively). APACHE II scores were higher in nonsurvivors than in survivors (p = 0.001). More nonsurvivors received TPN calories exceeding 90% of total calorie intake and were in need of dialysis during ICU admission (p = 0.005 and 0.013, respectively). Multivariate analysis revealed that the percentage of TPN calories over total calories and APACHE II scores were independent predictors of ICU mortality in patients receiving supplementary TPN after surgery. In SICU patients receiving TPN, patients who could be fed enterally more than 10% of total calories had better clinical outcomes than patients receiving less than 10% of total calorie intake from enteral feeding. Enteral feeding should be given whenever possible in severely ill patients. 2012 Published by Elsevier B.V

  9. The significance of experiences of war and migration in older age: long-term consequences in child survivors from the Dutch East Indies.

    PubMed

    Mooren, Trudy T M; Kleber, Rolf J

    2013-11-01

    This study examines late consequences of war and migration in both non-clinical and clinical samples of child survivors of World War II. This is one of the very few studies on the mental health of children who were subjected to internment in camps, hiding, and violence under Japanese occupation in the Far East. It provides a unique case to learn about the significance of experiences of war and migration in later life. Long-term sequelae of the Japanese persecution in the Dutch East Indies (DEI) in child survivors were studied by analyzing sets of standardized questionnaires of 939 persons. Instruments dealt with post-traumatic responses, general health, and dissociation. Participants were recruited through community services and registers of clinical services. Discriminant analyses were conducted to evaluate the significance of early experiences in determining group belonging. Compared with age-matched controls that lived through the German occupation in the Netherlands during World War II, the child survivors from the DEI reported both more trauma-related experiences and mental health disturbances in later life. In particular, the number of violent events during the war, among which especially internment in a camp, contributed to the variation among groups, in support of the significance of these disruptive experiences at older age. The results underline the long-term significance of World War II-related traumatic experiences in the population of elderly child survivors who spent their childhood in the former DEI.

  10. Report of Baseline Data: Evaluation of the Child and Family Resource Program. Volume II.

    ERIC Educational Resources Information Center

    Affholter, Dennis; And Others

    This volume reports the baseline (1978) data to be used in the 6-year longitudinal evaluation of the Child and Family Resource Program (CFRP). The CFRP, funded in 11 sites across the country as a Head Start demonstration program, is intended to develop models for providing services to low-income families with children from birth to eight years.…

  11. Child Care and Child Nutrition

    ERIC Educational Resources Information Center

    Karolak, Eric

    2009-01-01

    The weak economy is challenging the child care program budget. Fluctuations in enrollment come up against rising costs making every penny count. So for many reasons a federal program that helps defray the costs of snacks and meals in child care programs is particularly important and timely. In this article, the author pushes for the…

  12. Scoliosis surgery - child

    MedlinePlus

    Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child ... may also do the procedure using a special video camera. A surgical cut in the back is ...

  13. Child-Mother and Child-Father Play Interaction Patterns with Preschoolers

    ERIC Educational Resources Information Center

    John, Aesha; Halliburton, Amy; Humphrey, Jeremy

    2013-01-01

    The study focused on qualitative and quantitative differences between maternal and paternal play interaction behaviours with their preschool children. Home observations of 18 child-mother and child-father play interactions were qualitatively analysed to derive interaction themes. In addition, the quality of child-mother and child-father…

  14. Prevention of Child Abuse and Neglect in Child Care Settings

    DTIC Science & Technology

    1988-08-01

    The purpose of this Manual is to assist child development program personnel in preventing child abuse and neglect within child care settings and in...identifying and reporting child abuse and neglect. This Manual was by the Office of the Assistant Secretary of Defense (Force Management and Personnel

  15. 45 CFR 98.20 - A child's eligibility for child care services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false A child's eligibility for child care services. 98.20 Section 98.20 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Eligibility for Services § 98.20 A child's eligibility for child care...

  16. 45 CFR 98.20 - A child's eligibility for child care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false A child's eligibility for child care services. 98.20 Section 98.20 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Eligibility for Services § 98.20 A child's eligibility for child care...

  17. 45 CFR 98.20 - A child's eligibility for child care services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false A child's eligibility for child care services. 98.20 Section 98.20 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Eligibility for Services § 98.20 A child's eligibility for child care...

  18. 45 CFR 98.20 - A child's eligibility for child care services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false A child's eligibility for child care services. 98.20 Section 98.20 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Eligibility for Services § 98.20 A child's eligibility for child care...

  19. 45 CFR 98.20 - A child's eligibility for child care services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false A child's eligibility for child care services. 98.20 Section 98.20 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Eligibility for Services § 98.20 A child's eligibility for child care...

  20. The dimensionality of stellar chemical space using spectra from the Apache Point Observatory Galactic Evolution Experiment

    NASA Astrophysics Data System (ADS)

    Price-Jones, Natalie; Bovy, Jo

    2018-03-01

    Chemical tagging of stars based on their similar compositions can offer new insights about the star formation and dynamical history of the Milky Way. We investigate the feasibility of identifying groups of stars in chemical space by forgoing the use of model derived abundances in favour of direct analysis of spectra. This facilitates the propagation of measurement uncertainties and does not pre-suppose knowledge of which elements are important for distinguishing stars in chemical space. We use ˜16 000 red giant and red clump H-band spectra from the Apache Point Observatory Galactic Evolution Experiment (APOGEE) and perform polynomial fits to remove trends not due to abundance-ratio variations. Using expectation maximized principal component analysis, we find principal components with high signal in the wavelength regions most important for distinguishing between stars. Different subsamples of red giant and red clump stars are all consistent with needing about 10 principal components to accurately model the spectra above the level of the measurement uncertainties. The dimensionality of stellar chemical space that can be investigated in the H band is therefore ≲10. For APOGEE observations with typical signal-to-noise ratios of 100, the number of chemical space cells within which stars cannot be distinguished is approximately 1010±2 × (5 ± 2)n - 10 with n the number of principal components. This high dimensionality and the fine-grained sampling of chemical space are a promising first step towards chemical tagging based on spectra alone.

  1. Closing the gaps in child health in the Pacific: An achievable goal in the next 20 years

    PubMed Central

    Duke, Trevor; Kado, Joseph H; Auto, James; Amini, James; Gilbert, Katherine

    2015-01-01

    It is not inconceivable that by 2035 the substantial gaps in child health across the Pacific can close significantly. Currently, Australia and New Zealand have child mortality rates of 5 and 6 per 1000 live births, respectively, while Pacific island developing nations have under 5 mortality rates ranging from 13 to 16 (Vanuatu, Fiji and Tonga) to 47 and 58 per 1000 live births (Kiribati and Papua New Guinea, respectively). However, these Pacific child mortality rates are falling, by an average of 1.4% per year since 1990, and more rapidly (1.9% per year) since 2000. Based on progress elsewhere, there is a need to (i) define the specific things needed to close the gaps in child health; (ii) be far more ambitious and hopeful than ever before; and (iii) form a new regional compact based on solidarity and interdependence. PMID:25586845

  2. The experiences of families living with the anticipatory loss of a school-age child with spinal muscular atrophy - the parents' perspectives.

    PubMed

    Yang, Bao-Huan; Mu, Pei-Fan; Wang, Wen-Sheng

    2016-09-01

    To probe into parents' anticipatory loss of school-age children with Type I or II spinal muscular atrophy. Spinal muscular atrophy is a rare disorder that causes death. Children die early due to either gradual atrophy or an infection of the lungs. Therefore, family members experience anticipatory loss, which causes grief before the actual loss. Family members feel physically and mentally exhausted, which results in a family crisis. Therefore, it is important to explore their experiences related to anticipatory loss to assist with the adjustment of the families to their circumstances. This study applied a phenomenology method and purposive sampling. The 19 parents who participated in this study were referred to us by two medical centers in Taiwan. Their average age was 32-49 years. Using in-depth interviews, this study explored parents' anticipatory loss. The interviews were recorded and transcribed. Meanings were extracted using Giorgi analysis, and precision was assessed according to Guba and Lincoln, which was treated as the evaluation standard. Four themes were identified from the parents' interviews. The themes included enduring the helplessness and pressure of care, suffering due to the child's rare and unknown condition, loss of hope and a reinforcement of the parent-child attachment, and avoiding the pressure of death and enriching the child's life. The research findings help nurses identify anticipatory loss among parents of school-age children with type I or II spinal muscular atrophy. They enhance health professionals' understanding of the panic that occurs in the society surrounding the families, family members' dynamic relationships, and the families' demands for care. In an attempt to providing intersubjective empathy and support with family having a child with type I and II SMA, nurses may recognize relevant family reactions and enhancing their hope and parent-child attachment. Encourage family members and child go beyond the pressure of death and

  3. Brain injury as a risk factor for fever upon admission to the intensive care unit and association with in-hospital case fatality: a matched cohort study.

    PubMed

    Rincon, Fred; Patel, Utkal; Schorr, Christa; Lee, Elizabeth; Ross, Steven; Dellinger, R Phillip; Zanotti-Cavazzoni, Sergio

    2015-02-01

    To test the hypothesis that fever was more frequent in critically ill patients with brain injury when compared to nonneurological patients and to study its effect on in-hospital case fatality. Retrospective matched cohort study utilizing a single-center prospectively compiled registry. Critically ill neurological patients ≥18 years and consecutively admitted to the intensive care unit (ICU) with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI) were selected. Patients were matched by sex, age, and Acute Physiology and Chronic Health Evaluation II (APACHE-II) to a cohort of nonneurological patients. Fever was defined as any temperature ≥37.5°C within the first 24 hours upon admission to the ICU. The primary outcome measure was in-hospital case fatality. Mean age among neurological patients was 65.6 ± 15 years, 46% were men, and median APACHE-II was 15 (interquartile range 11-20). There were 18% AIS, 27% ICH, and 6% TBI. More neurological patients experienced fever than nonneurological patients (59% vs 47%, P = .007). The mean hospital length of stay was higher for nonneurological patients (18 ± 20 vs 14 ± 15 days, P = .007), and more neurological patients were dead at hospital discharge (29% vs 20%, P < .0001). After risk factor adjustment, diagnosis (neurological vs nonneurological), and the probability of being exposed to fever (propensity score), the following variables were associated with higher in-hospital case fatality: APACHE-II, neurological diagnosis, mean arterial pressure, cardiovascular and respiratory dysfunction in ICU, and fever (odds ratio 1.9, 95% confidence interval 1.04-3.6, P = .04). These data suggest that fever is a frequent occurrence after brain injury, and that it is independently associated with in-hospital case fatality. © The Author(s) 2013.

  4. The Syrian civil war: The experience of the Surgical Intensive Care Units

    PubMed Central

    Ozdogan, Hatice Kaya; Karateke, Faruk; Ozdogan, Mehmet; Cetinalp, Sibel; Ozyazici, Sefa; Gezercan, Yurdal; Okten, Ali Ihsan; Celik, Muge; Satar, Salim

    2016-01-01

    Objective: Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. Methods: The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. Results: A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. Conclusion: The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts. PMID:27375683

  5. The Effects of a Responsive Parenting Intervention on Parent-Child Interactions during Shared Book Reading

    ERIC Educational Resources Information Center

    Landry, Susan H.; Smith, Karen E.; Swank, Paul R.; Zucker, Tricia; Crawford, April D.; Solari, Emily F.

    2012-01-01

    This study examined mother-child shared book reading behaviors before and after participation in a random-assignment responsive parenting intervention called Play and Learning Strategies (PALS) that occurred during infancy (PALS I), the toddler-preschool (PALS II) period, or both as compared with a developmental assessment (DAS) intervention (DAS…

  6. Differentiation of homicidal child molesters, nonhomicidal child molesters, and nonoffenders by phallometry.

    PubMed

    Firestone, P; Bradford, J M; Greenberg, D M; Nunes, K L

    2000-11-01

    The purpose of this study was to examine the ability of phallometry to discriminate among homicidal child molesters, nonhomicidal child molesters, and a comparison group of nonoffenders. Twenty-seven child molesters who had committed or had attempted a sexually motivated homicide, 189 nonhomicidal child molesters, and 47 nonoffenders were compared on demographic variables and psychometrically determined responses to aural descriptions of sexual vignettes. Two phallometric indexes were used: the pedophile index and the pedophile assault index. The pedophile index was computed by dividing the subject's highest response to an aural description of sex with a "consenting" child by his highest response to description of sex with a consenting adult. The pedophile assault index was computed by dividing the subject's highest response to an aural description of assault involving a child victim by his highest response to description of sex with a "consenting" child. Homicidal child molesters, nonhomicidal child molesters, and nonoffenders were not significantly different in age or IQ. Homicidal and nonhomicidal child molesters had significantly higher pedophile index scores than nonoffenders. Significantly more homicidal child molesters (14 [52%] of 27) and nonhomicidal child molesters (82 [46%] of 180) than nonoffenders (13 [28%] of 47) had pedophile index scores equal to or greater than 1.0, but homicidal and nonhomicidal child molesters did not differ from each other. Significantly more homicidal child molesters (17 [63%] of 27) than either nonhomicidal child molesters (71 [40%] of 178) or nonoffenders (17 [36%] of 47) had pedophile assault index scores equal to or greater than 1.0, and nonhomicidal child molesters and nonoffenders were not significantly different from each other. Within-group analyses revealed that of the three groups, only the nonhomicidal child molesters exhibited a significant difference between their pedophile index scores and their pedophile assault

  7. Parent- and child-reported parenting. Associations with child weight-related outcomes.

    PubMed

    Taylor, Amanda; Wilson, Carlene; Slater, Amy; Mohr, Philip

    2011-12-01

    The present study aimed to investigate associations of both parent-reported and child-perceived parenting styles and parent-reported parenting practices with child weight and weight-related behaviours. Participants were 175 children (56% female) aged between 7 and 11, and their primary caregivers (91% female), recruited through South Australian primary schools. Children completed measures of parenting style, attitude toward fruit, vegetables, and non-core food, and attraction to physical activity. Parents completed measures of parenting style and domain-specific parenting practices (feeding and activity-related practices) and reported on child dietary intake, physical activity, and sedentary behaviour. Objective height and weight measurements were taken from children, from which body mass index (BMI) was calculated. Child-reported parenting style and parent-reported parenting practices were uniquely associated with child weight-related outcomes, but styles and practices did not interact in their association with child outcomes. Child-reported parenting style was associated with child food and activity attitudes, whereas parent-reported parenting style was not associated with child outcomes. The findings of the present study generally support the recommendation of a parenting style high in demandingness and responsiveness for supporting healthy child weight-related behaviours, along with appropriate domain-specific practices. The child's perspective should be incorporated into research involving child outcomes wherever possible. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  8. Child and adult outcomes of chronic child maltreatment.

    PubMed

    Jonson-Reid, Melissa; Kohl, Patricia L; Drake, Brett

    2012-05-01

    To describe how child maltreatment chronicity is related to negative outcomes in later childhood and early adulthood. The study included 5994 low-income children from St Louis, including 3521 with child maltreatment reports, who were followed from 1993-1994 through 2009. Children were 1.5 to 11 years of age at sampling. Data include administrative and treatment records indicating substance abuse, mental health treatment, brain injury, sexually transmitted disease, suicide attempts, and violent delinquency before age 18 and child maltreatment perpetration, mental health treatment, or substance abuse in adulthood. Multivariate analysis controlled for potential confounders. Child maltreatment chronicity predicted negative childhood outcomes in a linear fashion (eg, percentage with at least 1 negative outcome: no maltreatment = 29.7%, 1 report = 39.5%, 4 reports = 67.1%). Suicide attempts before age 18 showed the largest proportionate increase with repeated maltreatment (no report versus 4+ reports = +625%, P < .0001). The dose-response relationship was reduced once controls for other adverse child outcomes were added in multivariate models of child maltreatment perpetration and mental health issues. The relationship between adult substance abuse and maltreatment report history disappeared after controlling for adverse child outcomes. Child maltreatment chronicity as measured by official reports is a robust indicator of future negative outcomes across a range of systems, but this relationship may desist for certain adult outcomes once childhood adverse events are controlled. Although primary and secondary prevention remain important approaches, this study suggests that enhanced tertiary prevention may pay high dividends across a range of medical and behavioral domains.

  9. Tracers of Chromospheric Structure. I. Observations of Ca II K and Hα in M Dwarfs

    NASA Astrophysics Data System (ADS)

    Walkowicz, Lucianne M.; Hawley, Suzanne L.

    2009-02-01

    We report on our observing program4This paper is based on observations obtained with the Apache Point Observatory 3.5 m telescope, which is owned and operated by the Astrophysical Research Consortium. Some of the data presented herein were obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W. M. Keck Foundation. to capture simultaneous spectra of Ca II and Balmer lines in a sample of nearby M3 dwarfs. Our goal is to investigate the chromospheric temperature structure required to produce these lines at the observed levels. We find a strong positive correlation between instantaneous measurements of Ca II K and the Balmer lines in active stars, although these lines may not be positively correlated in time-resolved measurements. The relationship between Hα and Ca II K remains ambiguous for weak and intermediate activity stars, with Hα absorption corresponding to a range of Ca II K emission. A similar relationship is also observed between Ca II K and the higher-order Balmer lines. As our sample consists of a single spectral type, correlations between these important chromospheric tracers cannot be ascribed to continuum effects, as suggested by other authors. These data confirm prior nonsimultaneous observations of the Hα line behavior with increasing activity, showing an initial increase in the Hα absorption with increasing Ca II K emission, prior to Hα filling in and eventually becoming a pure emission line in the most active stars. We also compare our optical measurements with archival UV and X-ray measurements, finding a positive correlation between the chromospheric and coronal emission for both high and intermediate activity stars. We compare our results with previous determinations of the active fraction of low-mass stars

  10. Parental depression and child outcomes – is marital conflict the missing link?

    PubMed Central

    Hanington, L; Heron, J; Stein, A; Ramchandani, P

    2012-01-01

    Background Both maternal and paternal depression during the perinatal period are associated with adverse effects on child outcomes. Attention has started to focus on the mechanisms mediating these relationships. Marital conflict may play a role in this context. Methods In a large cohort study, the Avon Longitudinal Study of Parents and Children (n= 14 541 pregnancies), we aimed to (i) investigate the relative influences of parental postnatal depression and marital conflict on child outcomes and to attempt to determine the pathway(s) of risk; (ii) investigate the impact of two types of antenatal stress (parental depression and marital conflict) on child outcomes; and (iii) determine the relative contributions of antenatal and postnatal risk. Parents completed the Edinburgh Postnatal Depression Scale and a marital conflict scale during the second trimester and at 8 months postnatally. Child outcomes were assessed at 42 months using the Rutter revised pre-school scales. Results Marital conflict partially mediated the relationship between postnatal depression in both mothers and fathers and child outcomes, and acted as an independent risk for adverse outcomes. Parental depression (maternal and paternal) and marital conflict in the antenatal period were both associated with adverse effects which persisted even when postnatal stresses were taken into account. Conclusions These findings, if replicated, suggest that screening and intervention programmes targeted at parental depression and marital problems should be considered antenatally, as well as postnatally. PMID:21771000

  11. Assessing the Organizational Social Context (OSC) of child welfare systems: implications for research and practice.

    PubMed

    Glisson, Charles; Green, Philip; Williams, Nathaniel J

    2012-09-01

    The study: (1) provides the first assessment of the a priori measurement model and psychometric properties of the Organizational Social Context (OSC) measurement system in a US nationwide probability sample of child welfare systems; (2) illustrates the use of the OSC in constructing norm-based organizational culture and climate profiles for child welfare systems; and (3) estimates the association of child welfare system-level organizational culture and climate profiles with individual caseworker-level job satisfaction and organizational commitment. The study applies confirmatory factor analysis (CFA) and hierarchical linear models (HLM) analysis to a US nationwide sample of 1,740 caseworkers from 81 child welfare systems participating in the second National Survey of Child and Adolescent Wellbeing (NSCAW II). The participating child welfare systems were selected using a national probability procedure reflecting the number of children served by child welfare systems nationwide. The a priori OSC measurement model is confirmed in this nationwide sample of child welfare systems. In addition, caseworker responses to the OSC scales generate acceptable to high scale reliabilities, moderate to high within-system agreement, and significant between-system differences. Caseworkers in the child welfare systems with the best organizational culture and climate profiles report higher levels of job satisfaction and organizational commitment. Organizational climates characterized by high engagement and functionality, and organizational cultures characterized by low rigidity are associated with the most positive work attitudes. The OSC is the first valid and reliable measure of organizational culture and climate with US national norms for child welfare systems. The OSC provides a useful measure of Organizational Social Context for child welfare service improvement and implementation research efforts which include a focus on child welfare system culture and climate. Copyright © 2012

  12. Mother-Child and Father-Child Play.

    ERIC Educational Resources Information Center

    Roopnarine, Jaipaul L.; Mounts, Nina S.

    1985-01-01

    Examines mother-child and father-child play and the relationship between parents' fantasy play initiations and their children's receptive vocabulary skills. The sex of parent effects during play initiations and the influence on children's cooperativeness toward the parent behaviors were tested in a laboratory playroom setting. (DT)

  13. Observed child and parent toothbrushing behaviors and child oral health

    PubMed Central

    COLLETT, BRENT R.; HUEBNER, COLLEEN E.; SEMINARIO, ANA LUCIA; WALLACE, ERIN; GRAY, KRISTEN E.; SPELTZ, MATTHEW L.

    2018-01-01

    Background Parent-led toothbrushing effectively reduces early childhood caries. Research on the strategies that parents use to promote this behavior is, however, lacking. Aim To examine associations between parent–child toothbrushing interactions and child oral health using a newly developed measure, the Toothbrushing Observation System (TBOS). Design One hundred children ages 18–60 months and their parents were video-recorded during toothbrushing interactions. Using these recordings, six raters coded parent and child behaviors and the duration of toothbrushing. We examined the reliability of the coding system and associations between observed parent and child behaviors and three indices of oral health: caries, gingival health, and history of dental procedures requiring general anesthesia. Results Reliabilities were moderate to strong for TBOS child and parent scores. Parent TBOS scores and longer duration of parent-led toothbrushing were associated with fewer decayed, missing or filled tooth surfaces and lower incidence of gingivitis and procedures requiring general anesthesia. Associations between child TBOS scores and dental outcomes were modest, suggesting the relative importance of parent versus child behaviors at this early age. Conclusions Parents’ child behavior management skills and the duration of parent-led toothbrushing were associated with better child oral health. These findings suggest that parenting skills are an important target for future behavioral oral health interventions. PMID:26148197

  14. Stressful Life Events and Child Anxiety: Examining Parent and Child Mediators.

    PubMed

    Platt, Rheanna; Williams, Sarah R; Ginsburg, Golda S

    2016-02-01

    While a number of factors have been linked with excessive anxiety (e.g., parenting, child temperament), the impact of stressful life events remains under-studied. Moreover, much of this literature has examined bivariate associations rather than testing more complex theoretical models. The current study extends the literature on life events and child anxiety by testing a theory-driven meditational model. Specifically, one child factor (child cognitions/locus of control), two parent factors (parent psychopathology and parenting stress), and two parent-child relationship factors (parent-child dysfunctional interaction and parenting style) were examined as mediators in the relationship between stressful life events and severity of child anxiety. One hundred and thirty anxious parents and their nonanxious, high-risk children (ages ranged from 7 to 13 years) participated in this study. Results indicated that levels of parenting stress, parental anxious rearing, and dysfunctional parent-child interaction mediated the association between stressful life events and severity of anxiety symptoms. Child cognition and parent psychopathology factors failed to emerge as mediators. Findings provide support for more complex theoretical models linking life events and child anxiety and suggest potential targets of intervention.

  15. Stressful Life Events and Child Anxiety: Examining Parent and Child Mediators

    PubMed Central

    Platt, Rheanna; Williams, Sarah R.; Ginsburg, Golda S.

    2015-01-01

    While a number of factors have been linked with excessive anxiety (e.g., parenting, child temperament), the impact of stressful life events remains under-studied. Moreover, much of this literature has examined bivariate associations rather than testing more complex theoretical models. The current study extends the literature on life events and child anxiety by testing a theory-driven meditational model. Specifically, one child factor (child cognitions/locus of control), two parent factors (parent psychopathology and parenting stress), and two parent-child relationship factors (parent-child dysfunctional interaction and parenting style) were examined as mediators in the relationship between stressful life events and severity of child anxiety. One hundred and thirty anxious parents and their nonanxious, high-risk children (ages ranged from 7 to 13 years) participated in this study. Results indicated that levels of parenting stress, parental anxious rearing, and dysfunctional parent-child interaction mediated the association between stressful life events and severity of anxiety symptoms. Child cognition and parent psychopathology factors failed to emerge as mediators. Findings provide support for more complex theoretical models linking life events and child anxiety and suggest potential targets of intervention. PMID:25772523

  16. Case report: acquisition of three spoken languages by a child with a cochlear implant.

    PubMed

    Francis, Alexander L; Ho, Diana Wai Lam

    2003-03-01

    There have been only two reports of multilingual cochlear implant users to date, and both of these were postlingually deafened adults. Here we report the case of a 6-year-old early-deafened child who is acquiring Cantonese, English and Mandarin in Hong Kong. He and two age-matched peers with similar educational backgrounds were tested using common, standardized tests of vocabulary and expressive and receptive language skills (Peabody Picture Vocabulary Test (Revised) and Reynell Developmental Language Scales version II). Results show that this child is acquiring Cantonese, English and Mandarin to a degree comparable to two classmates with normal hearing and similar educational and social backgrounds.

  17. Domestic Minor Sex Trafficking Among Child Welfare-Involved Youth: An Exploratory Study of Correlates.

    PubMed

    O'Brien, Jennifer E; White, Kevin; Rizo, Cynthia Fraga

    2017-08-01

    Our research team used the National Survey of Child and Adolescent Well-Being II to explore relationships between demographic factors, domestic minor sex trafficking (DMST) status, and several psychosocial dependent variables for children and youth in the child welfare system who affirm that they have been paid for sex within the past 6 months. The sample included a total of 814 children and youth, 38 of whom reported DMST victimization. Results revealed that youth with a history of DMST victimization were more likely than their nonexploited peers to report runaway behavior, demonstrate externalizing behaviors, and test in the clinical range for a substance abuse problem. Research and practice implications are discussed.

  18. Shared environments: a multilevel analysis of community context and child nutritional status in Bangladesh.

    PubMed

    Corsi, Daniel J; Chow, Clara K; Lear, Scott A; Rahman, M Omar; Subramanian, S V; Teo, Koon K

    2011-06-01

    The goal of the present study was to examine the influence of community environment on the nutritional status (weight-for-age and height-for-age) of children (aged 0-59 months) in Bangladesh. In addition, we tested the association between specific characteristics of community environments and child nutritional status. Cross-sectional survey. The data are from the nationally representative 2004 Bangladesh Demographic and Health Survey. Respondents were ever-married women (aged 15-49 years) and their children (n 5731), residing in 361 communities. Child nutritional outcomes are physical measurements of weight-for-age and height-for-age in sd units. We considered the following attributes of community environments potentially related to child nutrition: (i) community water and sanitation infrastructure; (ii) availability of community health and education services; (iii) community employment and social participation; and (iv) education level of the community. Multilevel regression analysis showed that the spatial distribution of maternal and child covariates did not entirely explain the between-community variation in child nutritional status. The education level of the community emerged as the strongest community-level predictor of child height-for-age (highest v. lowest tertile, β = 0.18 (SE 0.07)) and weight-for-age (highest v. lowest tertile, β = 0.21 (SE 0.06)). In the height-for-age model, community employment and social participation also emerged as being statistically significant (highest v. lowest tertile, β = 0.13 (SE = 0.06)). The community environment influences child nutrition in Bangladesh, and maternal- and child-level covariates may fail to capture the entire influence of communities. Interventions to reduce child undernutrition in developing countries should take into consideration the wider community context.

  19. Child Temperament, Maternal Parenting Behavior, and Child Social Functioning

    PubMed Central

    Baer, Julie; Schreck, Meghan; Rettew, David C.; Harder, Valerie S.; Ayer, Lynsay; Albaugh, Matthew D.; Crehan, Eileen T.; Kuny-Slock, Ana V.; Hudziak, James J.

    2014-01-01

    We examined child temperament, maternal parenting, and the effects of their interactions with each other on child social functioning. A total of 355 children aged 5–18 years old (54% male; mean age=10.8) were evaluated. Regression equations were used to test models of the main and interactive effects of temperament and maternal parenting behavior on the Social Problems and Social Competence Subscales of the Child Behavior Checklist (CBCL), a questionnaire assessing internalizing and externalizing behavior problems in children ages 4 to 18. Higher levels of child Novelty Seeking and Harm Avoidance and lower levels of Persistence were significantly associated with poorer social functioning. When accounting for child temperament, neither maternal parenting nor the interaction between maternal parenting and child temperament were significantly associated with social functioning. However, the interaction between maternal positive involvement and harm avoidance trended toward significance, such that at higher levels of harm avoidance, more extreme levels of maternal positive involvement were related to lower levels of social functioning. Further research on the interplay between child temperament and parenting across different stages of development is warranted. PMID:26085784

  20. pH level as a marker for predicting death among patients with Vibrio vulnificus infection, South Korea, 2000-2011.

    PubMed

    Yun, Na Ra; Kim, Dong-Min; Lee, Jun; Han, Mi Ah

    2015-02-01

    Vibrio vulnificus infection can progress to necrotizing fasciitis and death. To improve the likelihood of patient survival, an early prognosis of patient outcome is clinically important for emergency/trauma department doctors. To identify an accurate and simple predictor for death among V. vulnificus-infected persons, we reviewed clinical data for 34 patients at a hospital in South Korea during 2000-2011; of the patients, 16 (47%) died and 18 (53%) survived. For nonsurvivors, median time from hospital admission to death was 15 h (range 4-70). For predicting death, the areas under the receiver operating characteristic curves of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and initial pH were 0.746 and 0.972, respectively (p = 0.005). An optimal cutoff pH of <7.35 had a sensitivity of 100% and specificity of 83%. Compared with the APACHE II score, the initial arterial blood pH level in V. vulnificus-infected patients was a more accurate predictive marker for death.

  1. Spectroscopic Classification of SN 2018bek as a Young Type II Supernova

    NASA Astrophysics Data System (ADS)

    Xiang, Danfeng; Wang, Xiaofeng; Zhang, Kaicheng; Li, Wenxiong; DerKacy, James; Baron, Eddie; Brink, Thomas; Zheng, Weikang; Filippenko, Alex; Lin, Han; Rui, Liming; Hu, Lei; Hu, Maokai; Zhang, Tianmeng; Zhang, Jujia

    2018-05-01

    We obtained a few optical spectra of SN 2018bek,discovered by Jaroslaw Grzegorzek,on UT May 05-09 2018 with the 3.5m telescope (+Dual Imaging Spectrograph) at the Apache Point Observatory, the 2.16-m telescope(+BFOSC) at Xinglong Observatory of NAOC, and the Lick 3.0-m telescope (+Kast) at Lick Observatory.

  2. An Experimental Evaluation of Hyperactivity and Food Additives. 1977-Phase II.

    ERIC Educational Resources Information Center

    Harley, J. Preston; And Others

    Phase II of a study on the effectiveness of B. Feingold's recommended diet for hyperactive children involved the nine children (mean age 9 years) who had shown the "best" response to diet manipulation in Phase I. Each child served as his own control and was challenged with specified amounts of placebo and artificial color containing food…

  3. OPeNDAP servers like Hyrax and TDS can easily support common single-sign-on authentication protocols using the Apache httpd and related software; adding support for these protocols to clients can be more challenging

    NASA Astrophysics Data System (ADS)

    Gallagher, J. H. R.; Potter, N.; Evans, B. J. K.

    2016-12-01

    OPeNDAP, in conjunction with the Australian National University, documented the installation process needed to add authentication to OPeNDAP-enabled data servers (Hyrax, TDS, etc.) and examined 13 OPeNDAP clients to determine how best to add authentication using LDAP, Shibboleth and OAuth2 (we used NASA's URS). We settled on a server configuration (architecture) that uses the Apache web server and a collection of open-source modules to perform the authentication and authorization actions. This is not the only way to accomplish those goals, but using Apache represents a good balance between functionality, leveraging existing work that has been well vetted and includes support for a wide variety of web services, include those that depend on a servlet engine such as tomcat (which both Hyrax and TDS do). Or work shows how LDAP, OAuth2 and Shibboleth can all be accommodated using this readily available software stack. Also important is that the Apache software is very widely used and is fairly robust - extremely important for security software components. In order to make use of a server requiring authentication, clients must support the authentication process. Because HTTP has included authentication for well over a decade, and because HTTP/HTTPS can be used by simply linking programs with a library, both the LDAP and OAuth2/URS authentication schemes have almost universal support within the OPeNDAP client base. The clients, i.e. the HTTP client libraries they employ, understand how to submit the credentials to the correct server when confronted by an HTTP/S Unauthorized (401) response. Interestingly OAuth2 can achieve it's SSO objectives while relying entirely on normative HTTP transport. All 13 of the clients examined worked.The situation with Shibboleth is different. While Shibboleth does use HTTP, it also requires the client to either scrape a web page or support the SAML2.0 ECP profile, which, for programmatic clients, means using SOAP messages. Since working with

  4. Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain.

    PubMed

    Lindley, K J; Glaser, D; Milla, P J

    2005-04-01

    To determine prognostic indicators in children with severe functional abdominal pain (FAP) and to test the hypothesis that "healthcare consumerism" in these families might be deleterious to the child. Retrospective analysis of a cohort of 23 children aged <16 years fulfilling the Rome II diagnostic criteria for FAP during the period December 1997 to February 2001. Poor outcome was defined as continued pain and failure to return to normal functioning >12 months after onset. Poor outcome was associated with refusal to engage with psychological services, involvement of more than three consultants, lodging of a manipulative complaint with hospital management by the child's family, and lack of development of insight into psychosocial influences on symptoms. Three of four adverse prognostic indicators reflected healthcare consumerism by the families. Actions of families who lack insight into their child's illness may perpetuate FAP in childhood. A culture of parental consumerism in healthcare, however well intentioned, needs to be accompanied by robust systems to protect the interests of the child.

  5. The Child Care Professional/Parent/Child: An Emerging Triad.

    ERIC Educational Resources Information Center

    Yawkey, Thomas D.; Bakawa, Lois J.

    The importance of parenting roles and home environments on the young child's learning is given support through an examination of current child development research and contemporary sociological theory. Some methods that can be employed by the child care professional to facilitate parent involvement and awareness include: (1) interaction groups…

  6. Observed child and parent toothbrushing behaviors and child oral health.

    PubMed

    Collett, Brent R; Huebner, Colleen E; Seminario, Ana Lucia; Wallace, Erin; Gray, Kristen E; Speltz, Matthew L

    2016-05-01

    Parent-led toothbrushing effectively reduces early childhood caries. Research on the strategies that parents use to promote this behavior is, however, lacking. To examine associations between parent-child toothbrushing interactions and child oral health using a newly developed measure, the Toothbrushing Observation System (TBOS). One hundred children ages 18-60 months and their parents were video-recorded during toothbrushing interactions. Using these recordings, six raters coded parent and child behaviors and the duration of toothbrushing. We examined the reliability of the coding system and associations between observed parent and child behaviors and three indices of oral health: caries, gingival health, and history of dental procedures requiring general anesthesia. Reliabilities were moderate to strong for TBOS child and parent scores. Parent TBOS scores and longer duration of parent-led toothbrushing were associated with fewer decayed, missing or filled tooth surfaces and lower incidence of gingivitis and procedures requiring general anesthesia. Associations between child TBOS scores and dental outcomes were modest, suggesting the relative importance of parent versus child behaviors at this early age. Parents' child behavior management skills and the duration of parent-led toothbrushing were associated with better child oral health. These findings suggest that parenting skills are an important target for future behavioral oral health interventions. © 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Concordance of Parent- and Child-Reported Physical Abuse Following Child Protective Services Investigation.

    PubMed

    Kobulsky, Julia M; Kepple, Nancy Jo; Holmes, Megan R; Hussey, David L

    2017-02-01

    Knowledge about the concordance of parent- and child-reported child physical abuse is scarce, leaving researchers and practitioners with little guidance on the implications of selecting either informant. Drawing from a 2008-2009 sample of 11- to 17-year-olds ( N = 636) from Wave 1 of the second National Survey of Child and Adolescent Well-Being, this study first examined parent-child concordance in physical abuse reporting (Parent-Child Conflict Tactic Scale). Second, it applied multivariate regression analysis to relate parent-child agreement in physical abuse to parent-reported (Child Behavior Checklist) and child-reported (Youth Self Report) child behavioral problems. Results indicate low parent-child concordance of physical abuse (κ = .145). Coreporting of physical abuse was related to clinical-level parent-reported externalizing problems ([Formula: see text] = 64.57), whereas child-only reports of physical abuse were the only agreement category related to child-reported internalizing problems ( B = 4.17, p < .001). Attribution bias theory may further understanding of reporting concordance and its implications.

  8. Majewski osteodysplastic primordial dwarfism type II: clinical findings and dental management of a child patient

    PubMed Central

    Terlemez, Arslan; Altunsoy, Mustafa; Celebi, Hakki

    2015-01-01

    Majewski osteodysplastic primordial dwarfism type II (MOPD II) is an unusual autosomal recessive inherited form of primordial dwarfism, which is characterized by a small head diameter at birth, but which also progresses to severe microcephaly, progressive bony dysplasia, and characteristic facies and personality. This report presents a case of a five-year-old girl with MOPD II syndrome. The patient was referred to our clinic with the complaint of severe tooth pain at the left mandibular primary molar teeth. Clinical examination revealed that most of the primary teeth had been decayed and all primary teeth were hypoplastic. Patient’s history revealed delayed development in the primary dentition and radiographic examination showed rootless primary molar teeth and short-rooted incisors. The treatment was not possible due to the lack of root of the left mandibular primary molars; so the teeth were extracted. Thorough and timely dental evaluation is crucial for the prevention of dental problems and the maintenance of oral health in patients with MOPD II syndrome is of utmost importance. PMID:28955524

  9. Majewski osteodysplastic primordial dwarfism type II: clinical findings and dental management of a child patient.

    PubMed

    Terlemez, Arslan; Altunsoy, Mustafa; Celebi, Hakki

    2015-01-01

    Majewski osteodysplastic primordial dwarfism type II (MOPD II) is an unusual autosomal recessive inherited form of primordial dwarfism, which is characterized by a small head diameter at birth, but which also progresses to severe microcephaly, progressive bony dysplasia, and characteristic facies and personality. This report presents a case of a five-year-old girl with MOPD II syndrome. The patient was referred to our clinic with the complaint of severe tooth pain at the left mandibular primary molar teeth. Clinical examination revealed that most of the primary teeth had been decayed and all primary teeth were hypoplastic. Patient's history revealed delayed development in the primary dentition and radiographic examination showed rootless primary molar teeth and short-rooted incisors. The treatment was not possible due to the lack of root of the left mandibular primary molars; so the teeth were extracted. Thorough and timely dental evaluation is crucial for the prevention of dental problems and the maintenance of oral health in patients with MOPD II syndrome is of utmost importance.

  10. Incest indices from microsatellite genotypes of mother-child pairs.

    PubMed

    Wenk, Robert E

    2008-02-01

    Suspected incestuous paternity is encountered infrequently and investigation may be complicated by absence of the suspected father. Incest indices (IIs) can be calculated from microsatellite (STR) types of only a mother and child, but could be misleading. Therefore, the method was evaluated. Combined incest indices (CIIs) of 50 randomly mated (RM) mothers and their children were compared with those of 50 simulated incestuous (SI) mothers and their children. Each CII was calculated from 18 individual locus IIs. Combined indices were categorized as "diagnostic" (<0.010 and >100 for RM and SI cases, respectively), "indicative" (CII was directionally correct but not erroneously diagnostic), and "misleading" (>1.0 in RM and <0.01 in SI). The relative importance was determined of each of the three variables contributing to the CII. In 41 cases (41%), CIIs attained diagnostic values. Fifty-two CIIs were indicative. CIIs were misleading in 3 RM cases and 4 SI cases. The number of mother-child (M-C) STR genotype similarities was the most important determinant of CIIs. Infrequent alleles in M-C similarities were important in raising CIIs in SI. The kind of M-C genotype similarity was the least important variable. Study of 18 STR loci produces diagnostic CIIs in only two of five suspected incest cases. Study of approximately 33 independent STRs would assure that greater than 97.5 percent of cases will have diagnostic CIIs if incest occurred. Study of loci that are more informative than typical STRs would be advantageous.

  11. Child Welfare Training in Child Psychiatry Residency: A Program Director Survey

    ERIC Educational Resources Information Center

    Lee, Terry G.; Cox, Julia R.; Walker, Sarah C.

    2013-01-01

    Objective: This study surveys child psychiatry residency program directors in order to 1) characterize child welfare training experiences for child psychiatry residents; 2) evaluate factors associated with the likelihood of program directors' endorsing the adequacy of their child welfare training; and 3) assess program directors'…

  12. Child Care Subsidies and Child Development

    ERIC Educational Resources Information Center

    Herbst, Chris M.; Tekin, Erdal

    2010-01-01

    Child care subsidies are an important part of federal and state efforts to move welfare recipients into employment. One of the criticisms of the current subsidy system, however, is that it overemphasizes work and does little to encourage parents to purchase high-quality child care. Consequently, there are reasons to be concerned about the…

  13. Fear of dental pain in Italian children: child personality traits and parental dental fear.

    PubMed

    D'Alessandro, Giovanni; Alkhamis, Nadia; Mattarozzi, Katia; Mazzetti, Michela; Piana, Gabriela

    2016-06-01

    Dental anxiety could impede dental treatment in children. Evidence shows that parents' fear of dentists contributes to children's anxiety towards dentists. The aim of the present study was to determine whether and to what extent: a) parents' anxiety and depression personality traits, b) parent's dental fear, and c) child personality traits can predict children's dental anxiety in an Italian population. One hundred and four children (5-14 years old) and one of their parents participated in the study. Well-known and validated questionnaires were administered to children (MCDASf, CFSS-DS, TAD) and parents (FDPQ, STAI Y1, Y2, and BDI-II). Dental anxiety is significantly associated with the anxiety personality trait and depression of the child and with parental fear of dental pain. A hierarchical regression analysis showed that, regardless of age and gender, the best predictor of child dental anxiety is parent's fear of dental pain, rather than relatively stable temperaments of the child. In line with the literature concerning adults, these findings highlight the children dental anxiety as a complex phenomena consisting of different components, including the child's personality traits (anxiety trait and depression) and parents' dental fear. Clinical implications of this evidence are discussed. © 2015 American Association of Public Health Dentistry.

  14. 38 CFR 10.42 - Claim of child other than legitimate child.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Claim of child other than legitimate child. 10.42 Section 10.42 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General § 10.42 Claim of child other than legitimate child. A...

  15. 38 CFR 10.42 - Claim of child other than legitimate child.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Claim of child other than legitimate child. 10.42 Section 10.42 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General § 10.42 Claim of child other than legitimate child. A...

  16. 38 CFR 10.42 - Claim of child other than legitimate child.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Claim of child other than legitimate child. 10.42 Section 10.42 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General § 10.42 Claim of child other than legitimate child. A...

  17. 38 CFR 10.42 - Claim of child other than legitimate child.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Claim of child other than legitimate child. 10.42 Section 10.42 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General § 10.42 Claim of child other than legitimate child. A...

  18. 38 CFR 10.42 - Claim of child other than legitimate child.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Claim of child other than legitimate child. 10.42 Section 10.42 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General § 10.42 Claim of child other than legitimate child. A...

  19. Mother-Child Agreement on the Child's Past Food Exposure

    ERIC Educational Resources Information Center

    Thongudomporn, Udom; Chongsuvivatwong, Virasakdi; Geater, Alan F.

    2010-01-01

    Objective: To assess mother-child agreement on the child's past food exposure, and factors affecting response discrepancy. Methods: Twelve- to 14-year-old children and their mothers (n = 78) in an urban community, a rural community, and 2 orthodontic clinics completed a 69-item food questionnaire to determine mother-child level of agreement on the…

  20. Child anger proneness moderates associations between child-mother attachment security and child behavior with mothers at 33 months.

    PubMed

    McElwain, Nancy L; Holland, Ashley S; Engle, Jennifer M; Wong, Maria S

    2012-02-01

    Child-mother attachment security, assessed via a modified Strange Situation procedure (Cassidy & Marvin, with the MacArthur Attachment Working Group, 1992), and parent-reported child proneness to anger were examined as correlates of observed child behavior toward mothers during a series of interactive tasks (N = 120, 60 girls). Controlling for maternal sensitivity and child gender and expressive language ability, greater attachment security, and lower levels of anger proneness were related to more child responsiveness to maternal requests and suggestions during play and snack sessions. As hypothesized, anger proneness also moderated several security-behavior associations. Greater attachment security was related to (a) more committed compliance during clean-up and snack-delay tasks for children high on anger proneness, (b) more self-assertiveness during play and snack for children moderate or high on anger proneness, and (c) more help-seeking during play and snack for children moderate or low on anger proneness. Findings further our understanding of the behavioral correlates of child-mother attachment security assessed during late toddlerhood via the Cassidy-Marvin system and underscore child anger proneness as a moderator of attachment-related differences in child behavior during this developmental period.