Effects of cadmium on growth, metamorphosis and gonadal sex differentiation in tadpoles of the African clawed frog, Xenopus laevis

USGS Publications Warehouse

Sharma, Bibek; Patino, R.

2009-01-01

Xenopus laevis larvae were exposed to cadmium (Cd) at 0, 1, 8, 85 or 860 ??g L-1 in FETAX medium from 0 to 86 d postfertilization. Premetamorphic tadpoles were sampled on day 31; pre and prometamorphic tadpoles on day 49; and frogs (NF stage 66) between days 50 and 86. Survival, snout-vent length (SVL), tail length, total length, hindlimb length (HLL), initiation of metamorphic climax, size at and completion of metamorphosis, and gonadal condition and sex ratio (assessed histologically) were determined. Survival was unaffected by Cd until day 49, but increased mortality was observed after day 49 at 860 ??g Cd L-1. On day 31, when tadpoles were in early premetamorphosis, inhibitory effects on tadpole growth were observed only at 860 ??g Cd L-1. On day 49, when most tadpoles where in late premetamorphosis/early prometamorphosis, reductions in SVL, HLL and total length were observed at 8 and 860 but not 85 ??g L-1, thus creating a U-shaped size distribution at 0-85 ??g Cd L-1. However, this U-shaped size pattern was not evident in postmetamorphic individuals. In fact, frog size at completion of metamorphosis was slightly smaller at 85 ??g Cd L-1relative to control animals. These observations confirmed a recent report of a Cd concentration-dependent bimodal growth pattern in late-premetamorphic Xenopus tadpoles, but also showed that growth responses to varying Cd concentrations change with development. The fraction of animals initiating or completing metamorphosis during days 50-86 was reduced in a Cd concentration-dependent manner. Testicular histology and population sex ratios were unaffected by Cd suggesting that, unlike mammals, Cd is not strongly estrogenic in Xenopus tadpoles. ?? 2009 Elsevier Ltd.

Effects of cadmium on growth, metamorphosis and gonadal sex differentiation in tadpoles of the African clawed frog, Xenopus laevis

USGS Publications Warehouse

Sharma, Bibek; Patino, Reynaldo

2009-01-01

Xenopus laevis larvae were exposed to cadmium (Cd) at 0, 1, 8. 85 or 860 mu g L(-1) in FETAX medium from 0 to 86 d postfertilization. Premetamorphic tadpoles were sampled on day 3 1; pre and prometamorphic tadpoles on day 49; and frogs (NF stage 66) between days 50 and 86. Survival, snout-vent length (SVL), tail length, total length, hindlimb length (HLL), initiation of metamorphic climax, size at and completion of metamorphosis, and gonadal condition and sex ratio (assessed histologically) were determined. Survival was unaffected by Cd until day 49, but increased mortality was observed after day 49 at 860 mu g Cd L(-1). On day 31, when tadpoles were in early premetamorphosis, inhibitory effects on tadpole growth were observed only at 860 mu g Cd L(-1). On day 49, when most tadpoles where in late premetamorphosis/early prometamorphosis, reductions in SVL, HLL and total length were observed at 8 and 860 but not 85 mu g L(-1), thus creating a U-shaped size distribution at 0-85 mu g Cd L(-1). However, this U-shaped size pattern was not evident in postmetamorphic individuals. In fact, frog size at completion of metamorphosis was slightly smaller at 85 mu g Cd L(-1) relative to control animals. These observations confirmed a recent report of a Cd concentration-dependent bimodal growth pattern in late-premetamorphic Xenopus tadpoles, but also showed that growth responses to varying Cd concentrations change with development. The fraction of animals initiating or completing metamorphosis during days 50-86 was reduced in a Cd concentration-dependent manner. Testicular histology and population sex ratios were unaffected by Cd suggesting that, unlike mammals, Cd is not strongly estrogenic in Xenopus tadpoles.

The effectiveness of a multidisciplinary hip fracture care model in improving the clinical outcome and the average cost of manpower.

PubMed

Lau, T W; Fang, C; Leung, F

2017-03-01

After the implementation of the multidisciplinary geriatric hip fracture clinical pathway in 2007, the hospital length of stay and the clinical outcomes improves. Moreover, the cost of manpower for each hip fracture decreases. It proves that this care model is cost-effective. The objective of this study is to compare the clinical outcomes and the cost of manpower before and after the implementation of the multidisciplinary geriatric hip fracture clinical pathway (GHFCP). The hip fracture data from 2006 was compared with the data of four consecutive years since 2008. The efficiency of the program is assessed using the hospital length of stay. The clinical outcomes include mortality rates and complication rates are compared. Cost of manpower was also analysed. After the implementation of the GHFCP, the preoperative length of stay shortened significantly from 5.8 days in 2006 to 1.3 days in 2011. The total length of stay in both acute and rehabilitation hospitals were also shortened by 6.1 days and 14.2 days, respectively. The postoperative pneumonia rate also decreased from 1.25 to 0.25%. The short- and long-term mortalities also showed a general improvement. Despite allied health manpower was increased to meet the increased workload, the shortened length of stay accounted for a mark decrease in cost of manpower per hip fracture case. This study proves that the GHFCP shortened the geriatric hip fracture patients' length of stay and improves the clinical outcomes. It is also cost-effective which proves better care is less costly.

The use of standard operating procedures in day case anterior cruciate ligament reconstruction.

PubMed

Khan, T; Jackson, W F; Beard, D J; Marfin, A; Ahmad, M; Spacie, R; Jones, R; Howes, S; Barker, K; Price, A J

2012-08-01

The current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively ("study group"). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed ("standard practice group"). Eighty percent of patients in the study group were discharged on the day of surgery (mean length of stay=5.3h) compared to 16% in the standard practice group (mean length of stay=21.6h). This difference was statistically significant (p<0.05, Mann-Whitney U test). All patients were satisfied with the day case pathway. Ninety-two percent of the study group were discharged on the day of surgery when all SOPs were followed and 46% where they were not. High rates of day-case ACLR with excellent patient satisfaction can be achieved with the use of a specialised patient pathway with SOPs. Copyright © 2011 Elsevier B.V. All rights reserved.

Trade-offs between effectiveness and efficiency in stroke rehabilitation.

PubMed

Koh, Gerald Choon-Huat; Chen, Cynthia; Cheong, Angela; Choo, Tai Bee; Pui, Choi Kwok; Phoon, Fong Ngan; Ming, Chan Kin; Yeow, Tan Boon; Petrella, Robert; Thind, Amardeep; Koh, David; Seng, Chia Kee

2012-12-01

Most stroke research has studied rehabilitation effectiveness and rehabilitation efficiency separately and not investigated the potential trade-offs between these two indices of rehabilitation. To determine whether there is a trade-off between independent factors of rehabilitation effectiveness and rehabilitation efficiency. Using a retrospective cohort study design, we studied all stroke patients (n = 2810) from two sub-acute rehabilitation hospitals from 1996 to 2005, representing 87·5% of national bed-years during the same period. Independent predictors of poorer rehabilitation effectiveness and log rehabilitation efficiency were • older age • race-ethnicity • caregiver availability • ischemic stroke • longer time to admission • dementia • admission Barthel Index score, and • length of stay. Rehabilitation effectiveness was lower in females, and the gender differences were significantly lower in those aged ≤70 years (β -4·7 (95% confidence interval -7·4 to -2·0)). There were trade-offs between effectiveness and efficiency with respect to admission Barthel Index score and length of stay. An increase of 10 in admission Barthel Index score predicted an increase of 3·6% (95% confidence interval 3·2-4·0) in effectiveness but a decrease of 0·04 (95% confidence interval -0·05 to -0·02) in log efficiency (a reduction of efficiency by 1·0 per 30 days). An increase in log length of stay by 1 (length of stay of 2·7 days) predicted an increase of 8·0% (95% confidence interval 5·7-10·3) in effectiveness but a decrease of 0·82 (95% confidence interval -0·90 to -0·74) in log efficiency (equivalent to a reduction in efficiency by 2·3 per 30 days). For optimal rehabilitation effectiveness and rehabilitation efficiency, the admission Barthel Index score was 30-62 and length of stay was 37-41 days. There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

Effects of day-length variations on emotional responses towards unfamiliarity in Swiss mice.

PubMed

Kopp, C; Misslin, R; Vogel, E; Rettori, M C; Delagrange, P; Guardiola-Lemaitre, B

1997-11-01

Pineal melatonin secretion occurs at night in all vertebrates and the duration of its secretion is negatively correlated with day length. As an anxiolytic activity of melatonin has been shown in rats and mice, this study examined possible changes of emotional reactivity in response to day length variations in Swiss mice. Three groups of mice were observed in a free-exploratory test: a group submitted to a short-day exposure (6:18 h light-dark cycle) for 2 weeks, a group submitted to a long-day exposure (18:6 h light-dark cycle) for 2 weeks and a control group which was maintained in housing 12:12 h light-dark cycle. The short-day exposed group of mice exhibited significantly fewer attempts to enter into the unfamiliar enclosure, spent significantly more time in it and presented significantly more rears than controls whereas the long-day exposed group of mice made more attempts than controls. These results suggest a decreased emotional level in short-day exposed mice and an increased level in long-day exposed mice. This could be interpreted as confirming the idea of anxiolytic-like properties of melatonin; however, the specific role of this hormone in the changes of anxiety related to day length must be assessed by further measures of potential variations of circulating melatonin.

Artificial neural network predictions of lengths of stay on a post-coronary care unit.

PubMed

Mobley, B A; Leasure, R; Davidson, L

1995-01-01

To create and validate a model that predicts length of hospital unit stay. Ex post facto. Seventy-four independent admission variables in 15 general categories were utilized to predict possible stays of 1 to 20 days. Laboratory. Records of patients discharged from a post-coronary care unit in early 1993. An artificial neural network was trained on 629 records and tested on an additional 127 records of patients. The absolute disparity between the actual lengths of stays in the test records and the predictions of the network averaged 1.4 days per record, and the actual length of stay was predicted within 1 day 72% of the time. The artificial neural network demonstrated the capacity to utilize common patient admission characteristics to predict lengths of stay. This technology shows promise in aiding timely initiation of treatment and effective resource planning and cost control.

Photoperiod: Its importance as an impeller of pineal and seasonal reproductive rhythms

NASA Astrophysics Data System (ADS)

Reiter, R. J.

1980-03-01

A number of long day breeding rodents depend on seasonal changes in photoperiodic length to synchronize their breeding seasons with the appropriate time of the year. These relationships are particularly conspicuous in the Syrian hamster where day length is vitally important in determining periods of sexual activity and inactivity. The organ in the body whose activity is most closely attuned to the photoperiodic environment is the pineal gland. During periods of darkness the biochemical and secretory activity of the pineal is enhanced with the resultant production of antigonadotrophic principles which are strongly suppressive to reproductive physiology. In this manner, decreasing day lengths of the fall are involved with suppressing sexual capability in male and female hamsters. Throughout the winter months darkness (because of the shorter day lengths and the fact that hamsters remain underground in lightless burrows) holds the gonads in an atrophic condition and thereby prevents hamsters from breeding. As spring approaches the neuroendocrine reproductive axis becomes refractory to the inhibitory effects of darkness and the pineal gland and, as a consequence, the gonads recrudesce allowing the animals to successfully reproduce. The long days of the spring and summer serve to interrupt the refractory period so that when winter approaches shortening day lengths will again, by way of the pineal gland, induce gonadalinvolution. In this scheme both light and darkness are critically important in synchronizing the phases of the annual reproductive cycle of the hamster with the appropriate season of the year. Melatonin may be the pineal hormone which mediates the effects of darkness on reproductive physiology.

Association of Day Length and Weather Conditions with Physical Activity Levels in Older Community Dwelling People

PubMed Central

Witham, Miles D.; Donnan, Peter T.; Vadiveloo, Thenmalar; Sniehotta, Falko F.; Crombie, Iain K.; Feng, Zhiqiang; McMurdo, Marion E. T.

2014-01-01

Background Weather is a potentially important determinant of physical activity. Little work has been done examining the relationship between weather and physical activity, and potential modifiers of any relationship in older people. We therefore examined the relationship between weather and physical activity in a cohort of older community-dwelling people. Methods We analysed prospectively collected cross-sectional activity data from community-dwelling people aged 65 and over in the Physical Activity Cohort Scotland. We correlated seven day triaxial accelerometry data with daily weather data (temperature, day length, sunshine, snow, rain), and a series of potential effect modifiers were tested in mixed models: environmental variables (urban vs rural dwelling, percentage of green space), psychological variables (anxiety, depression, perceived behavioural control), social variables (number of close contacts) and health status measured using the SF-36 questionnaire. Results 547 participants, mean age 78.5 years, were included in this analysis. Higher minimum daily temperature and longer day length were associated with higher activity levels; these associations remained robust to adjustment for other significant associates of activity: age, perceived behavioural control, number of social contacts and physical function. Of the potential effect modifier variables, only urban vs rural dwelling and the SF-36 measure of social functioning enhanced the association between day length and activity; no variable modified the association between minimum temperature and activity. Conclusions In older community dwelling people, minimum temperature and day length were associated with objectively measured activity. There was little evidence for moderation of these associations through potentially modifiable health, environmental, social or psychological variables. PMID:24497925

Association of day length and weather conditions with physical activity levels in older community dwelling people.

PubMed

Witham, Miles D; Donnan, Peter T; Vadiveloo, Thenmalar; Sniehotta, Falko F; Crombie, Iain K; Feng, Zhiqiang; McMurdo, Marion E T

2014-01-01

Weather is a potentially important determinant of physical activity. Little work has been done examining the relationship between weather and physical activity, and potential modifiers of any relationship in older people. We therefore examined the relationship between weather and physical activity in a cohort of older community-dwelling people. We analysed prospectively collected cross-sectional activity data from community-dwelling people aged 65 and over in the Physical Activity Cohort Scotland. We correlated seven day triaxial accelerometry data with daily weather data (temperature, day length, sunshine, snow, rain), and a series of potential effect modifiers were tested in mixed models: environmental variables (urban vs rural dwelling, percentage of green space), psychological variables (anxiety, depression, perceived behavioural control), social variables (number of close contacts) and health status measured using the SF-36 questionnaire. 547 participants, mean age 78.5 years, were included in this analysis. Higher minimum daily temperature and longer day length were associated with higher activity levels; these associations remained robust to adjustment for other significant associates of activity: age, perceived behavioural control, number of social contacts and physical function. Of the potential effect modifier variables, only urban vs rural dwelling and the SF-36 measure of social functioning enhanced the association between day length and activity; no variable modified the association between minimum temperature and activity. In older community dwelling people, minimum temperature and day length were associated with objectively measured activity. There was little evidence for moderation of these associations through potentially modifiable health, environmental, social or psychological variables.

Effects of dietary exposure to brominated flame retardant BDE-47 on thyroid condition, gonadal development and growth of zebrafish.

PubMed

Torres, Leticia; Orazio, Carl E; Peterman, Paul H; Patiño, Reynaldo

2013-10-01

Little is known about the effects of brominated flame retardants in teleosts and some of the information currently available is inconsistent. This study examined effects of dietary exposure to 2,2',4,4'-tetrabromodiphenyl ether (BDE-47) on thyroid condition, body mass and size, and gonadal development of zebrafish. Pubertal, 49-day-old (posthatch) fish were fed diets without BDE-47 (control) or with 1, 5 or 25 μg/g BDE-47/diet. Treatments were conducted in triplicate 30-L tanks each containing 50 zebrafish, and 15 fish per treatment (5 per tank) were sampled at days 40, 80 and 120 of exposure. Measurements were taken of body mass, standard length, head depth and head length. Sex (at 40-120 days of exposure), germ cell stage (at 40 days) and thyroid condition (at 120 days; follicular cell height, colloid depletion, angiogenesis) were histologically determined. Whole-body BDE-47 levels at study completion were within the high end of levels reported in environmentally exposed (wild) fishes. Analysis of variance was used to determine differences among treatments at each sampling time. No effects were observed on thyroid condition or germ cell stage in either sex. Reduced head length was observed in females exposed to BDE-47 at 80 days but not at 40 or 120 days. In males, no apparent effects of BDE-47 were observed at 40 and 80 days, but fish exposed to 25 μg/g had lower body mass at 120 days compared to control fish. These observations suggest that BDE-47 at environmentally relevant whole-body concentrations does not affect thyroid condition or pubertal development of zebrafish but does affect growth during the juvenile-to-adult transition, especially in males.

Association between placentome size, measured using transrectal ultrasonography, and gestational age in cattle.

PubMed

Adeyinka, F D; Laven, R A; Lawrence, K E; van Den Bosch, M; Blankenvoorde, G; Parkinson, T J

2014-03-01

The aim of this study was to estimate whether fetal age could be accurately estimated using placentome size. Fifty-eight cows with confirmed conception dates in two herds were used for the study. The length of the long axis and cross-sectional area of placentomes close to the cervix were measured once every 10 days between approximately 60-130 days of gestation and once every 15 days between 130-160 days of gestation. Four to six placentomes were measured using transrectal ultrasonography in each uterine horn. A linear mixed model was used to establish the factors that were significantly associated with log mean placentome length and to create an equation to predict gestational age from mean placentome length. Limits of agreement analysis was then used to evaluate whether the predictions were sufficiently accurate for mean placentome length to be used, in practice, as a method of determining gestational age. Only age of gestation (p<0.001) and uterine horn (p=0.048) were found to have a significant effect on log mean placentome length. From the three models used to predict gestational age the one that used log mean placentome length of all placentomes, adjusting for the effect of horn, had the smallest 95% limits of agreement; ±33 days. That is, predicted gestational age had a 95% chance of being between 33 days greater and 33.7 days less than actual age. This is approximately twice that reported in studies using measurement of fetal size. Measurement of placentomes near to the cervix using transrectal ultrasonography was easily achieved. There was a significant association between placentome size and gestational age, but between-cow variation in placentome size and growth resulted in poor agreement between placentome size and gestational age. Although placentomes can be easily visualised during diagnosis of pregnancy using transrectal ultrasonography, mean placentome size should not be used to estimate gestational age.

Evaluation of predicted Medfly ( Ceratitis capitata) quarantine length in the United States utilizing degree-day and agent-based models.

PubMed

Collier, Travis; Manoukis, Nicholas

2017-01-01

Invasions by pest insects pose a significant threat to agriculture worldwide. In the case of Ceratitis capitata incursions on the US mainland, where it is not officially established, repeated detections are followed by quarantines and treatments to eliminate the invading population. However, it is difficult to accurately set quarantine duration because non-detection may not mean the pest is eliminated. Most programs extend quarantine lengths past the last fly detection by calculating the amount of time required for 3 generations to elapse under a thermal unit accumulation development model ("degree day"). A newer approach is to use an Agent-Based Simulation (ABS) to explicitly simulate population demographics and elimination. Here, predicted quarantine lengths for 11 sites in the continental United States are evaluated using both approaches. Results indicate a strong seasonality in quarantine length, with longer predictions in the second half of the year compared with the first; this pattern is more extreme in degree day predictions compared with ABS. Geographically, quarantine lengths increased with latitude, though this was less pronounced under the ABS. Variation in quarantine lengths for particular times and places was dramatically larger for degree day than ABS, generally spiking in the middle of the year for degree day and peaking in second half of the year for ABS. Analysis of 34 C. capitata quarantines from 1975 to 2017 in California shows that, for all but two, quarantines were started in the second half of the year, when degree day quarantine lengths are longest and have the highest uncertainty. For a set of hypothetical outbreaks based on these historical quarantines, the ABS produced significantly shorter quarantines than degree day calculations. Overall, ABS quarantine lengths were more consistent than degree day predictions, avoided unrealistically long values, and captured effects of rare events such as cold snaps.

Seasonal adaptations to day length in ecotypes of Diorhabda spp. (Coleoptera: Chrysomelidae) inform selection of agents against saltcedars (Tamarix spp.)

USDA-ARS?s Scientific Manuscript database

1. Seasonal adaptations to day length often limit the effective range of biocontrol insects. The leaf beetle Diorhabda carinulata was introduced into North America from Fukang, China (latitude 44°N) for the biocontrol of saltcedars (Tamarix spp.), but failed to establish below 38° latitude because o...

High temperature and oxygen supplementation can mitigate the effects of hypoxia on developmental stability of bilateral traits during incubation of broiler breeder eggs.

PubMed

Babacanoğlu, E; Güler, H C

2018-03-06

Hypoxia strongly affects embryonic development during the pre-hatch period. This study was conducted to investigate the effects of oxygen supplementation (O) and a 38.5°C high temperature (HT) at high altitude (HA, 1720 m) on morphological traits during a pre-hatch period and on relative fluctuating asymmetry (relative FA) and allometric growth during an early post-hatch period in broilers. A total of 720 eggs were obtained from a 45-week-old Ross 308 broiler breeder flock raised at sea level (2 m). The eggs were divided into six incubation condition (IC) groups and were incubated at HA. O groups were exposed to 23.5% O2 for 1 h daily from either days 0 to 11 (O0-11), days 12 to 21 (O12-21) or days 18 to 21 (O18-21) of incubation. HT groups were exposed to 38.5°C daily from either days 12 to 21 (HT12-21) or days 18 to 21 (HT18-21) of incubation. A control was maintained at 37.8°C and 21% O2. The hatched chicks were raised for 6 days at HA. Embryo/chick and beak lengths and head diameter were measured during pre- and post-hatch periods. The face, middle toe and shank lengths were measured for each chick. The relative asymmetry (RA), mean RA (MRA) and allometric growth of the lengths were computed and the existence of FA was demonstrated. The IC significantly affected the embryo length, with embryos of the O0-11 group shorter than embryos of the other O groups. Chicks were longer in the O and HT groups than those in the control, except for the O0-11. We found significant interactions between the IC and each development period for beak length. During the post-hatch period, the head diameter of the O0-11 was significantly smaller than that of the other groups, but not in O12-21. The interactions among IC, age and sex were significant for the RA of the face and middle toe lengths and for MRA. All the examined bilateral traits were evaluated as allometric growth. The FA for bilateral traits was determined in both sexes. The right (R) - left (L) and IR-Ll were the lowest in females for face length and in males for shank length from the O18-21 and in males for middle toe length from the O0-11 and HT18-21 groups. Therefore, the effects of factors such as HT and O2 could mitigate the adverse effects of HA-induced hypoxia on optimal developmental stability of bilateral traits of broiler.

Ameliorative effects of curcumin on the spermatozoon tail length, count, motility and testosterone serum level in metronidazole-treated mice.

PubMed

Karbalay-Doust, S; Noorafshan, A

2011-01-01

Metronidazole (MTZ) is used as an antiparasitic drug. Curcumin is considered as anti-oxidant and anti-inflammatory agent. The ameliorative effects of curcumin on MTZ induced toxicity on mice spermatozoon tail length, count, motility and testosterone level were investigated. MTZ was administered in 500 and 165 (high and therapeutic doses) mg/kg/day, with and without curcumin (100 mg/kg/day). After 16 days the above parameters were assessed. Spermatozoon count and motility and serum testosterone level MTZ-treated (500 and 165) mice were reduced. In the mice treated with MTZ+curcumin these parameters decreased but in a lesser extent than the MTZ-treated animals. Mid-piece and total lengths of the spermatozoon tail in control animals were 31.6 ± 9.0 μm and 100.3 ± 15.0 μm and in the mice treated with high doses (500) of MTZ were reduced. The mid-piece and total spermatozoon tail length has been decreased in a lesser extent in the mice treated with high dose MTZ+curcumin than the mice treated with high dose MTZ (p<0.01). But the length was not changed in animals treated with therapeutic dose of MTZ. It means curcumin treated animals had ~52% and ~39% average increase in mid-piece and total lengths in comparison with the MTZ-treated (500) animals. Stereological estimation of the sperm tail length, including sampling of spermatozoa and also counting of the intersections of their tails with the stereological grids was a rapid technique and took only 5-10 minutes. It can be concluded that curcumin has an ameliorative effect on the spermatozoon, testosterone level and tail length in MTZ-treated mice.

The influence of different training schedules on the learning of psychomotor skills for endoscopic surgery.

PubMed

Verdaasdonk, E G G; Stassen, L P S; van Wijk, R P J; Dankelman, J

2007-02-01

Psychomotor skills for endoscopic surgery can be trained with virtual reality simulators. Distributed training is more effective than massed training, but it is unclear whether distributed training over several days is more effective than distributed training within 1 day. This study aimed to determine which of these two options is the most effective for training endoscopic psychomotor skills. Students with no endoscopic experience were randomly assigned either to distributed training on 3 consecutive days (group A, n = 10) or distributed training within 1 day (group B, n = 10). For this study the SIMENDO virtual reality simulator for endoscopic skills was used. The training involved 12 repetitions of three different exercises (drop balls, needle manipulation, 30 degree endoscope) in differently distributed training schedules. All the participants performed a posttraining test (posttest) for the trained tasks 7 days after the training. The parameters measured were time, nontarget environment collisions, and instrument path length. There were no significant differences between the groups in the first training session for all the parameters. In the posttest, group A (training over several days) performed 18.7% faster than group B (training on 1 day) (p = 0.013). The collision and path length scores for group A did not differ significantly from the scores for group B. The distributed group trained over several days was faster, with the same number of errors and the same instrument path length used. Psychomotor skill training for endoscopic surgery distributed over several days is superior to training on 1 day.

Length bias correction in one-day cross-sectional assessments - The nutritionDay study.

PubMed

Frantal, Sophie; Pernicka, Elisabeth; Hiesmayr, Michael; Schindler, Karin; Bauer, Peter

2016-04-01

A major problem occurring in cross-sectional studies is sampling bias. Length of hospital stay (LOS) differs strongly between patients and causes a length bias as patients with longer LOS are more likely to be included and are therefore overrepresented in this type of study. To adjust for the length bias higher weights are allocated to patients with shorter LOS. We determined the effect of length-bias adjustment in two independent populations. Length-bias correction is applied to the data of the nutritionDay project, a one-day multinational cross-sectional audit capturing data on disease and nutrition of patients admitted to hospital wards with right-censoring after 30 days follow-up. We applied the weighting method for estimating the distribution function of patient baseline variables based on the method of non-parametric maximum likelihood. Results are validated using data from all patients admitted to the General Hospital of Vienna between 2005 and 2009, where the distribution of LOS can be assumed to be known. Additionally, a simplified calculation scheme for estimating the adjusted distribution function of LOS is demonstrated on a small patient example. The crude median (lower quartile; upper quartile) LOS in the cross-sectional sample was 14 (8; 24) and decreased to 7 (4; 12) when adjusted. Hence, adjustment for length bias in cross-sectional studies is essential to get appropriate estimates. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Maternal effects and larval survival of marbled sole Pseudopleuronectes yokohamae

NASA Astrophysics Data System (ADS)

Higashitani, Tomomi; Takatsu, Tetsuya; Nakaya, Mitsuhiro; Joh, Mikimasa; Takahashi, Toyomi

2007-07-01

Maternal effects of animals are the phenotypic influences of age, size, and condition of spawners on the survival and phenotypic traits of offspring. To clarify the maternal effects for marbled sole Pseudopleuronectes yokohamae, we investigated the effects of body size, nutrient condition, and growth history of adult females on egg size, larval size, and starvation tolerance, growth, and feeding ability of offspring. The fecundity of adult females was strongly dependent on body size. Path analysis revealed that the mother's total length positively affected mean egg diameter, meaning that large females spawned large eggs. In contrast, the relative growth rate of adult females negatively affected egg diameter. Egg diameters positively affected both notochord length and yolk sac volume of the larvae at hatching. Under starvation conditions, notochord length at hatching strongly and positively affected days of survival at 14 °C but not at 9 °C. Under adequate food conditions (1000 rotifers L - 1 ), the notochord length of larvae 5 days after hatching positively affected feeding rate, implying that large larvae have high feeding ability. In addition, the mean growth rate of larvae between 0 and 15 days increased with increasing egg diameter under homogenous food conditions, suggesting that larvae hatched from large eggs might have a growth advantage for at least to 15 days after hatching. In marbled sole, these relationships (i.e., mother's body size-egg size-larval size-larval resistance to starvation-larval feeding ability) may help explain recruitment variability.

Administrative license suspension: Does length of suspension matter?

PubMed

Fell, James C; Scherer, Michael

2017-08-18

Administrative license revocation (ALR) laws, which provide that the license of a driver with a blood alcohol concentration at or over the illegal limit is subject to an immediate suspension by the state department of motor vehicles, are an example of a traffic law in which the sanction rapidly follows the offense. The power of ALR laws has been attributed to how swiftly the sanction is applied, but does the length of suspension matter? Our objectives were to (a) determine the relationship of the ALR suspension length to the prevalence of drinking drivers relative to sober drivers in fatal crashes and (b) estimate the extent to which the relationship is associated to the general deterrent effect compared to the specific deterrent effect of the law. Data comparing the impact of ALR law implementation and ALR law suspension periods were analyzed using structural equation modeling techniques on the ratio of drinking drivers to nondrinking drivers in fatal crashes from the Fatality Analysis Reporting System (FARS). States with an ALR law with a short suspension period (1-30 days) had a significantly lower drinking driver ratio than states with no ALR law. States with a suspension period of 91-180 days had significantly lower ratios than states with shorter suspension periods, while the three states with suspension lengths of 181 days or longer had significantly lower ratios than states with shorter suspension periods. The implementation of any ALR law was associated with a 13.1% decrease in the drinking/nondrinking driver fatal crash ratio but only a 1.8% decrease in the intoxicated/nonintoxicated fatal crash ratio. The ALR laws and suspension lengths had a significant general deterrent effect, but no specific deterrent effect. States might want to keep (or adopt) ALR laws for their general deterrent effects and pursue alternatives for specific deterrent effects. States with short ALR suspension periods should consider lengthening them to 91 days or longer.

Social and photoperiod effects on reproduction in five species of Peromyscus.

PubMed

Trainor, Brian C; Martin, Lynn B; Greiwe, Kelly M; Kuhlman, Joshua R; Nelson, Randy J

2006-09-01

At temperate latitudes, mammals and birds use changes in day length to time their reproductive activities to coincide with seasonal fluctuations in the environment. Close to the equator, however, conditions permissive of breeding do not track changes in day length as well, so other cues may be more important than photoperiod. In a variety of vertebrates, social interactions regulate breeding condition. We hypothesized that individuals of different species of Peromyscus mice found closer to the equator would respond more strongly to housing with an opposite sex conspecific than they would to photoperiod. To test this hypothesis, we compared the effects of long and short day lengths versus 8 days of pair housing with a female on reproductive tissue weights and testosterone (T) concentrations in five species of Peromyscus (P. aztecus, P. eremicus, P. maniculatus, P. melanophrys, and P. polionotus). After 13 weeks of short days (8L:16D), P. maniculatus, P. melanophrys, and P. polionotus significantly reduced relative testes mass compared to long day (16L:8D) housed animals. Social housing, however, had no effect on tissue weights in any species. However, male P. polionotus paired with females for 8 days increased T concentrations compared to single-housed males, whereas paired P. maniculatus reduced T. These data suggest that mechanisms of photoperiodic and social regulation of reproductive function are mediated by different physiological mechanisms among closely-related species and that both phylogeny and environmental factors contribute to patterns of reproductive plasticity.

Short-term absence from industry: I Literature, definitions, data, and the effect of age and length of service

PubMed Central

Froggatt, P.

1970-01-01

Froggatt, P. (1970).Brit. J. industr. Med.,27, 199-210. Short-term absence from industry. I. Literature, definitions, data, and the effect of age and length of service. This, with two subsequent papers, comprises the first extensive study directed only to short-term absence from industry, an entity common in all branches of organized work and now one of the greatest personnel problems of an industrial society. This first paper reviews the literature and background of industrial absence, describes the sources of the data and the groups for study, defines terms used throughout, discusses the rationale of the selection criteria, and examines the effect on the numbers of one-day and two-day absences of age and length of service in the organization. The observations are from two light engineering works and two government departments and cover in all some 2 300 male and female personnel, both salaried and hourly-paid, over periods of up to seven years. Twenty study groups were identified for the analyses, each comprising members of similar `works centre', sex, supervisory grade, and marital status, who neither changed relevant status during the study period nor were absent for more than 65 days in any year. This stringency in delimitation enhanced the validity of the conclusions drawn by (a) ensuring necessary homogeneity for crucial variables, and (b) permitting examination of the consistency of the results over groups and organizations. Multiple regression analysis for the effect of age and length of service on short-term absence showed that, generally, length of service had no effect but that age was (weakly) negatively linearly associated with the number of one-day absences but independent of the number of two-day absences. Transforming the skewed dependent variates to normal functions for completely valid analysis had no important effect on these results, which were also confirmed by data from a longitudinal study in one company. This association between age and one-day absences was too weak (more than 90% of the variation in the latter was unattributable to linear regression on the former) to be of executive importance but it is relevant to the validity of inferences from curve-fitting analysis presented in a later paper. PMID:5448118

DNA damage as a biomarker for assessing the effects of suspended solids on the orange-spotted grouper, Epinephelus coioides.

PubMed

Tse, C Y; Chan, K M; Wong, C K

2010-06-01

In Hong Kong, suspended solids (SS) introduced by dredging and mud disposal activities are a major cause of mass mortality in cage-cultured marine fish. We have used DNA damage in liver cells, as determined by the comet assay, to assess the impact of SS on the orange-spotted grouper Epinephelus coioides. Seabed sediments were collected from a heavily polluted site in Victoria Harbor and two less polluted sites in Port Shelter and Mirs Bay. Sediments from Victoria Harbor contained higher levels of copper (Cu) and polycyclic aromatic hydrocarbons (PAHs) than those from the other sites. In a 10-day experiment, SS from all three sites induced significant increase in comet tail length, but not in percentage (%) tail DNA. In a 20-day experiment, fish exposed to polluted SS from Victoria Harbor exhibited a significant increase in comet tail length after 5 days and % tail DNA after 10 days. After a 10-day recovery period, however, DNA damage was reduced as tail length and % tail DNA returned to control levels. These results suggest that DNA damage measured by the comet assay is a highly sensitive biomarker for assessing the genotoxic effects of SS to marine fish.

Effects of dietary exposure to brominated flame retardant BDE-47 on thyroid condition, gonadal development and growth of zebrafish

USGS Publications Warehouse

Torres, Leticia; Orazio, Carl E.; Peterman, Paul H.; Patino, Reynaldo

2013-01-01

Little is known about the effects of brominated flame retardants in teleosts and some of the information currently available is inconsistent. This study examined effects of dietary exposure to 2,2′,4,4′-tetrabromodiphenyl ether (BDE-47) on thyroid condition, body mass and size, and gonadal development of zebrafish. Pubertal, 49-day-old (posthatch) fish were fed diets without BDE-47 (control) or with 1, 5 or 25 μg/g BDE-47/diet. Treatments were conducted in triplicate 30-L tanks each containing 50 zebrafish, and 15 fish per treatment (5 per tank) were sampled at days 40, 80 and 120 of exposure. Measurements were taken of body mass, standard length, head depth and head length. Sex (at 40–120 days of exposure), germ cell stage (at 40 days) and thyroid condition (at 120 days; follicular cell height, colloid depletion, angiogenesis) were histologically determined. Whole-body BDE-47 levels at study completion were within the high end of levels reported in environmentally exposed (wild) fishes. Analysis of variance was used to determine differences among treatments at each sampling time. No effects were observed on thyroid condition or germ cell stage in either sex. Reduced head length was observed in females exposed to BDE-47 at 80 days but not at 40 or 120 days. In males, no apparent effects of BDE-47 were observed at 40 and 80 days, but fish exposed to 25 μg/g had lower body mass at 120 days compared to control fish. These observations suggest that BDE-47 at environmentally relevant whole-body concentrations does not affect thyroid condition or pubertal development of zebrafish but does affect growth during the juvenile-to-adult transition, especially in males.

Embryo loss in cattle between Days 7 and 16 of pregnancy.

PubMed

Berg, D K; van Leeuwen, J; Beaumont, S; Berg, M; Pfeffer, P L

2010-01-15

Embryo loss between embryonic Days 7 and 16 (Day 0=day of IVF) in nonlactating cattle, Bos taurus, was analyzed using transfer of 2449 (in groups of 3 to 30) in vitro-produced (IVP) blastocysts. In 152 transfers, pregnancy losses attributable solely to recipient failings amounted to between 6% (beef heifers) and 16% (parous dairy cows), of which 3% were caused by uterine infections. Neither season, year, nor the age of the embryos on retrieval affected pregnancy rates. The latter observation indicated that the reason that a recipient failed to retain embryos was already present at the time of transfer. Notably, the proportion of embryos recovered decreased (P=0.03) as more embryos were transferred, particularly at later stages (Day 14, P<0.01). The average length of embryos decreased by approximately 5% for every additional embryo transferred (P<0.0001). These effects may be linked to embryonic migration. Embryo mortality inherent to the embryo during the second week of pregnancy was 24%. Additionally, 9% of Day 14 embryos were of inferior quality, as they did not contain an epiblast. Combining embryo and recipient causes but excluding infection effects, embryonic loss of IVP embryos during the second week of pregnancy amounted to 26% (heifers) or 34% (parous dairy cows). The length of embryos doubled every day between Days 9 and 16, with a 4.4-fold range in sizes representing two thirds of the variation in length. Embryos retrieved from heifers were twice the size of those incubated in parous cows (P<0.0001), indicating faster embryonic development/trophoblast proliferation in heifers. Whereas season did not affect embryo recoveries, length was lower (50%) in winter (winter-autumn, P<0.05; winter-spring, P<0.001). Lastly, transuterine migration in cattle, when transferring multiple embryos, commenced at Day 14 (4%) and had occurred in all recipients by Day 16 (38% of embryos found contralaterally).

Use of sublethal endpoints in sediment toxicity tests with the amphipod Hyalella azteca

USGS Publications Warehouse

Ingersoll, Chris G.; Brunson, Eric L.; Dwyer, F. James; Hardesty, Douglas K.; Kemble, Nile E.

1998-01-01

Short-term sediment toxicity tests that only measure effects on survival can be used to identify high levels of contamination but may not be able to identify marginally contaminated sediments. The objective of the present study was to develop a method for determining the potential sublethal effects of contaminants associated with sediment on the amphipod Hyalella azteca (e.g., reproduction). Exposures to sediment were started with 7- to 8-d-old amphipods. On day 28, amphipods were isolated from the sediment and placed in water-only chambers where reproduction was measured on day 35 and 42. Typically, amphipods were first in amplexus at about day 21 to 28 with release of the first brood between day 28 to 42. Endpoints measured included survival (day 28, 35, and 42), growth (as length and weight on day 28 and 42), and reproduction (number of young/female produced from day 28 to 42). This method was used to evaluate a formulated sediment and field-collected sediments with low to moderate concentrations of contaminants. Survival of amphipods in these sediments was typically >85% after the 28-d sediment exposures and the 14-d holding period in water to measure reproduction. Reproduction was more variable than growth; hence, more replicates might be needed to establish statistical differences among treatments. Previous studies have demonstrated that growth of H. azteca in sediment tests often provides unique information that can be used to discriminate toxic effects of exposure to contaminants. Either length or weight can be measured in sediment tests with H. azteca. However, additional statistical options are available if length is measured on individual amphipods, such as nested analysis of variance that can account for variance in length within replicates. Ongoing water-only studies testing select contaminants will provide additional data on the relative sensitivity and variability of sublethal endpoints in toxicity tests with H. azteca.

Impact of Music Therapy on Hospitalized Patients Post-Elective Orthopaedic Surgery: A Randomized Controlled Trial.

PubMed

Gallagher, Lisa M; Gardner, Vickie; Bates, Debbie; Mason, Shelley; Nemecek, Jeanine; DiFiore, Jacquelyn Baker; Bena, James; Li, Manshi; Bethoux, Francois

Music therapy (MT) research has demonstrated positive effects on fatigue, depressed mood, anxiety, and pain in perioperative care areas. However, there has been limited research on the effects of MT for surgical patients on orthopaedic units. The purpose of this study was to understand the impact of MT sessions on post-elective orthopaedic surgery patients' pain, mood, nausea, anxiety, use of narcotics and antiemetics, and length of stay. This was a randomized controlled study with an experimental arm (MT sessions) and a control arm (standard medical care). Patients received MT within 24 hours of admission to the unit, as well as every day of their stay. Same-day pre- and postdata were collected 30 minutes apart for both arms, including patient self-reported mood, pain, anxiety, and nausea. Use of medications and length of stay were gleaned from the electronic medical record. Data were obtained for 163 patients, age 60.5 ± 11.1 years, 56% of whom were male. Joints targeted by surgeries were hips (54%), knees (42%), and shoulders (4%). There were significantly greater changes favoring the MT group on Day 1 (pain, anxiety, and mood), Day 2 (pain, anxiety, mood, and nausea), and Day 3 (pain, anxiety, and mood). Among participants with a pre-pain score of 2 or more on Day 1, a decrease of at least 2 points was noted in 36% of the MT group and 10% of the control group (P < .001). Overall, 73% of MT patients versus 41% of control patients reported improved pain (P < .001). No significant between-group differences in medications or length of stay were noted. We observed greater same-day improvements of pain, emotional status, and nausea with MT sessions, compared to usual care, in patients hospitalized after elective orthopaedic surgeries. Effects on narcotic and antiemetic usage, as well as length of stay, were not observed. More research needs to be conducted to better understand the benefits of MT pre- and post-elective orthopaedic surgery.

Effect of colostral volume, interval between calving and first milking, and photoperiod on colostral IgG concentrations in dairy cows.

PubMed

Morin, Dawn E; Nelson, Stephanie V; Reid, Eric D; Nagy, Dusty W; Dahl, Geoffrey E; Constable, Peter D

2010-08-15

To identify cow and management factors associated with colostral IgG concentration in dairy cows. Prospective observational study. 81 multiparous Holstein-Friesian cows from a single herd. Serum was obtained at the start of the nonlactating period, and cows were assigned to 1 of 4 photoperiod groups: natural day length (n = 22 cows), long days (16 h of light/d [21]) or short days (8 h of light/d [20]) for the entire nonlactating period, or natural day length followed by short days for the last 21 days of the nonlactating period (18). Serum and colostrum were collected at the first milking after calving. Regression analysis was used to investigate associations between colostral IgG concentration and the interval between calving and first milking, colostral volume, photoperiod, length of the nonlactating period, and season of calving. Colostral IgG concentration decreased by 3.7% during each subsequent hour after calving because of postparturient secretion by the mammary glands. The interval between calving and first milking and the colostral volume were significantly and negatively associated with colostral IgG concentration, with the former effect predominating. Photoperiod had no effect on colostral IgG concentration or volume. Serum protein concentration at calving correlated poorly with colostral IgG concentration. Dairy producers should harvest colostrum as soon as possible after calving to optimize transfer of passive immunity in neonatal calves. Photoperiod can be manipulated without adversely affecting colostral IgG concentration.

Phytotoxicity of glyphosate in the germination of Pisum sativum and its effect on germinated seedlings

PubMed Central

2017-01-01

The present study evaluated the effects of glyphosate on Pisum sativum germination as well as its effect on the physiology and biochemistry of germinated seedlings. Different physico-chemical biomarkers, viz., chlorophyll, root and shoot length, total protein and soluble sugar, along with sodium and potassium concentration, were investigated in germinated seedlings at different glyphosate concentrations. This study reports the influence of different concentrations of glyphosate on pea seeds and seedlings. Physicochemical biomarkers were significantly changed by glyphosate exposure after 15 days. The germination of seedlings under control conditions (0 mg/L) was 100% after 3 days of treatment but at 3 and 4 mg/L glyphosate, germination was reduced to 55 and 40%, respectively. Physiological parameters like root and shoot length decreased monotonically with increasing glyphosate concentration, at 14 days of observation. Average root and shoot length (n=30 in three replicates) were reduced to 14.7 and 17.6%, respectively, at 4 mg/L glyphosate. Leaf chlorophyll content also decreased, with a similar trend to root and shoot length, but the protein content initially decreased and then increased with an increase in glyphosate concentration to 3 mg/L. The study suggests that glyphosate reduces the soluble sugar content significantly, by 21.6% (v/v). But internal sodium and potassium tissue concentrations were significantly altered by glyphosate exposure with increasing concentrations of glyphosate. Biochemical and physiological analysis also supports the inhibitory effect of glyphosate on seed germination and biochemical effects on seedlings. PMID:28728354

Effect of a photoperiodic green light programme during incubation on embryo development and hatch process.

PubMed

Tong, Q; McGonnell, I M; Demmers, T G M; Roulston, N; Bergoug, H; Romanini, C E; Verhelst, R; Guinebretière, M; Eterradossi, N; Berckmans, D; Exadaktylos, V

2018-04-01

This study was conducted to evaluate the effect of a 12-h light, 12-h dark (12L : 12D) photoperiod of green light during day 1 to day 18 of incubation time, on embryo growth, hormone concentration and the hatch process. In the test group, monochromatic light was provided by a total of 204 green light-emitting diodes (522 nm) mounted in a frame which was placed above the top tray of eggs to give even spread of illumination. No light-dark cycle was used in the control group. Four batches of eggs (n=300/group per batch) from fertile Ross 308 broiler breeders were used in this experiment. The beak length and crown-rump length of embryos incubated under green light were significantly longer than that of control embryos at day 10 and day 12, respectively (P<0.01). Furthermore, green light-exposed embryos had a longer third toe length compared with control embryos at day 10, day 14 and day 17 (P=0.02). At group level (n=4 batches), light stimulation had no effect on chick weight and quality at take-off, the initiation of hatch and hatch window. However, the individual hatching time of the light exposure focal chicks (n=33) was 3.4 h earlier (P=0.49) than the control focal chicks (n=36) probably due to the change in melatonin rhythm of the light group. The results of this study indicate that green light accelerates embryo development and alters hatch-related hormones (thyroid and corticosterone), which may result in earlier hatching.

Effect of calving interval and parity on milk yield per feeding day in Danish commercial dairy herds.

PubMed

Lehmann, J O; Fadel, J G; Mogensen, L; Kristensen, T; Gaillard, C; Kebreab, E

2016-01-01

The idea of managing cows for extended lactations rather than lactations of the traditional length of 1 yr primarily arose from observations of increasing problems with infertility and cows being dried off with high milk yields. However, it is vital for the success of extended lactation practices that cows are able to maintain milk yield per feeding day when the length of the calving interval (CInt) is increased. Milk yield per feeding day is defined as the cumulated lactation milk yield divided by the sum of days between 2 consecutive calvings. The main objective of this study was to investigate the milk production of cows managed for lactations of different lengths, and the primary aim was to investigate the relationship between CInt, parity, and milk yield. Five measurements of milk yield were used: energy-corrected milk (ECM) yield per feeding day, ECM yield per lactating day, cumulative ECM yield during the first 305 d of lactation, as well as ECM yield per day during early and late lactation. The analyses were based on a total of 1,379 completed lactations from cows calving between January 2007 and May 2013 in 4 Danish commercial dairy herds managed for extended lactation for several years. Herd-average CInt length ranged from 414 to 521 d. The herds had Holstein, Jersey, or crosses between Holstein, Jersey, and Red Danish cows with average milk yields ranging from 7,644 to 11,286 kg of ECM per cow per year. A significant effect of the CInt was noted on all 5 measurements of milk yield, and this effect interacted with parity for ECM per feeding day, ECM per lactating day and ECM per day during late lactation. The results showed that cows were at least able to produce equivalent ECM per feeding day with increasing CInt, and that first- and second-parity cows maintained ECM per lactating day. Cows with a CInt between 17 and 19 mo produced 476 kg of ECM more during the first 305 d compared with cows with a CInt of less than 13 mo. Furthermore, early-lactation ECM yield was greater for all cows and late-lactation ECM yield was less for second-parity and older cows when undergoing an extended compared with a shorter lactation. Increasing CInt increased the dry period length with 3 to 5d. In conclusion, the group of cows with longer CInt were able to produce at least equivalent amounts of ECM per feeding day when the CInt was up to 17 to 19 mo on these 4 commercial dairy farms. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effects of Photoperiod and Temperature on Growth and Development in Clouded Salamander (Hynobius nebulosus) Larvae.

PubMed

Kukita, Sayuri; Gouda, Mika; Ikeda, Sakiko; Ishibashi, Sakiko; Furuya, Tatsunori; Nakamura, Keiji

2015-06-01

Day length is one of the most important factors that organisms use to predict seasonal changes in their environment. Several amphibians regulate their growth and development in response to photoperiod. However, many studies have not focused on the ecological effects of the photoperiodic response on growth and development because they use tropical animals, animals from a commercial source or from unknown localities, or extreme light regimens for experiments. In the present study, we examined the effects of photoperiod on growth and development in the clouded salamander (Hynobius nebulosus) by raising larvae under different photoperiods and at different temperatures in the laboratory. The average larval period under a long-day photoperiod of L16:D8 was longer than that under L12:D12 at 15°C or 20°C, although the difference between the photoperiods was only significant for 15°C. Juveniles weighed more at metamorphosis under L16:D8 than those under L12:D12, irrespective of temperature, suggesting that a longer developmental period results in a heavier body weight. The head width of juveniles did not differ for different photoperiods at either temperature. However, the growth rate of the head width under L12:D12 was faster than that under L16:D8 at 15°C. Long day length appears to produce larger H. nebulosus juveniles in a relatively stable aquatic environment with a low population density. Thus, development may be accelerated when the day length becomes shorter as winter approaches, and larvae may have increased the growth rate of their head widths to compensate for the shorter growing period under shorter day lengths.

Chlorination by-products in drinking water and menstrual cycle function.

PubMed

Windham, Gayle C; Waller, Kirsten; Anderson, Meredith; Fenster, Laura; Mendola, Pauline; Swan, Shanna

2003-06-01

We analyzed data from a prospective study of menstrual cycle function and early pregnancy loss to explore further the effects of trihalomethanes (THM) on reproductive end points. Premenopausal women ((italic)n(/italic) = 403) collected urine samples daily during an average of 5.6 cycles for measurement of steroid metabolites that were used to define menstrual parameters such as cycle and phase length. Women were asked about consumption of various types of water as well as other habits and demographics. A THM level was estimated for each cycle based on residence and quarterly measurements made by water utilities during a 90-day period beginning 60 days before the cycle start date. We found a monotonic decrease in mean cycle length with increasing total THM (TTHM) level; at > 60 microg/L, the adjusted decrement was 1.1 days [95% confidence interval (CI), -1.8 to -0.40], compared with less than or equal to 40 microg/L. This finding was also reflected as a reduced follicular phase length (difference -0.94 day; 95% CI, -1.6 to -0.24). A decrement in cycle and follicular phase length of 0.18 days (95% CI, -0.29 to -0.07) per 10 microg/L unit increase in TTHM concentration was found. There was little association with luteal phase length, menses length, or cycle variability. Examining the individual THMs by quartile, we found the greatest association with chlorodibromomethane or the sum of the brominated compounds. Incorporating tap water consumption showed a similar pattern of reduced cycle length with increasing TTHM exposure. These findings suggest that THM exposure may affect ovarian function and should be confirmed in other studies.

Effects of fluoride on screech owl reproduction: Teratological evaluation, growth, and blood chemistry in hatchlings

USGS Publications Warehouse

Hoffman, D.J.; Pattee, O.H.; Wiemeyer, Stanley N.

1985-01-01

The effects on reproduction in screech owls (Otus asio) of chronic dietary sodium fluoride administration at 0, 40, and 200 ppm were examined. Fluoride at 40 ppm resulted in a significantly smaller egg volume, while 200 ppm also resulted in lower egg weights and lengths. Day-one hatchlings in the 200 ppm group weighed almost 10% less than controls and had shorter crown-rump lengths. No gross abnormalities were apparent. Skeletal clearing and staining revealed significantly shorter tibiotarsus lengths in the 40 ppm and 200 ppm groups and a shorter radius-ulna length in the 200 ppm group. By 7 days of age, body weights and lengths did not differ from controls, but the tibiotarsus in the 200 ppm group remained shorter. No significant differences were detected in hematocrit, hemoglobin, plasma calcium or alkaline phosphatase. Plasma phosphorus levels were higher in the 40 ppm group than in controls. These results, in combination with the findings of Pattee et al. [25], revealed significant impairment of overall reproduction, suggesting that sodium fluoride could cause slight to moderate reproduction disorders in owls in fluoride-polluted areas.

Gestational length assignment based on last menstrual period, first trimester crown-rump length, ovulation, and implantation timing.

PubMed

Mahendru, Amita A; Wilhelm-Benartzi, Charlotte S; Wilkinson, Ian B; McEniery, Carmel M; Johnson, Sarah; Lees, Christoph

2016-10-01

Understanding the natural length of human pregnancy is central to clinical care. However, variability in the reference methods to assign gestational age (GA) confound our understanding of pregnancy length. Assignation from ultrasound measurement of fetal crown-rump length (CRL) has superseded that based on last menstrual period (LMP). Our aim was to estimate gestational length based on LMP, ultrasound CRL, and implantation that were known, compared to pregnancy duration assigned by day of ovulation. Prospective study in 143 women trying to conceive. In 71 ongoing pregnancies, gestational length was estimated from LMP, CRL at 10-14 weeks, ovulation, and implantation day. For each method of GA assignment, the distribution in observed gestational length was derived and both agreement and correlation between the methods determined. Median ovulation and implantation days were 16 and 27, respectively. The gestational length based on LMP, CRL, implantation, and ovulation was similar: 279, 278, 276.5 and 276.5 days, respectively. The distributions for observed gestational length were widest where GA was assigned from CRL and LMP and narrowest when assigned from implantation and ovulation day. The strongest correlation for gestational length assessment was between ovulation and implantation (r = 0.98) and weakest between CRL and LMP (r = 0.88). The most accurate method of predicting gestational length is ovulation day, and this agrees closely with implantation day. Prediction of gestational length from CRL and known LMP are both inferior to ovulation and implantation day. This information could have important implications on the routine assignment of gestational age.

The effects of pay-for-performance on tuberculosis treatment in Taiwan.

PubMed

Li, Ya-Hsin; Tsai, Wen-Chen; Khan, Mahmud; Yang, Wen-Ta; Lee, Tsuey-Fong; Wu, Yi-Chun; Kung, Pei-Tseng

2010-07-01

In order to make tuberculosis (TB) treatment more effective and to lower the transmission rate of the disease, the Bureau of National Health Insurance (BNHI) in Taiwan implemented the 'Pay-for-Performance on Tuberculosis' programme (P4P on TB) in 2004. This study investigates the effectiveness of the P4P system in terms of cure rate and length of treatment. This retrospective study obtained information on all TB cases in the national data sets of Taiwan for the years 2002 to 2005. The number of cases in pre-P4P years (2002 and 2003) was 25 754, compared with 33 536 in the post-P4P implementation years (2004 and 2005). The effectiveness of the programme was evaluated by comparing the TB cure rate and length of treatment before and after the implementation of the P4P programme, and between participating and non-participating hospitals. Logistic regression analysis was conducted to explore the factors affecting TB patients' cure rate within a 12-month treatment period. The cure rate and the average length of treatment before the implementation of P4P were 46.9% and 256.24 days, respectively, compared with 63.0% and 249.74 days after implementation of P4P. The cure rate and length of treatment in P4P hospitals were 68.1% and 249.13 days, respectively, compared with 42.4% and 53.71 days in non-P4P hospitals. This study found that both the cure rate and average length of treatment for cured cases improved significantly after the implementation of the P4P on TB programme in Taiwan. Compared with non-P4P hospitals, P4P hospitals had significantly better treatment outcomes. Patients' age, income level, the physician density of a patient's place of residence, and whether the hospital has joined the P4P on TB programme are factors affecting the treatment outcomes of TB patients in Taiwan.

Length of Storage of Red Blood Cells and Patient Survival After Blood Transfusion: A Binational Cohort Study.

PubMed

Halmin, Märit; Rostgaard, Klaus; Lee, Brian K; Wikman, Agneta; Norda, Rut; Nielsen, Kaspar René; Pedersen, Ole B; Holmqvist, Jacob; Hjalgrim, Henrik; Edgren, Gustaf

2017-02-21

Possible negative effects, including increased mortality, among persons who receive stored red blood cells (RBCs) have recently garnered considerable attention. Despite many studies, including 4 randomized trials, no consensus exists. To study the association between the length of RBC storage and mortality in a large population-based cohort of patients who received transfusions, allowing detection of small yet clinically significant effects. Binational cohort study. All transfusion recipients in Sweden and Denmark. 854 862 adult patients who received transfusions from 2003 to 2012. Patients were followed from first blood transfusion. Relative and absolute risks for death in 30 days or 1 year in relation to length of RBC storage were assessed by using 3 independent analytic approaches. All analyses were conducted by using Cox proportional hazards regression. Regardless of the analytic approach, no association was found between the length of RBC storage and mortality. The difference in 30-day cumulative mortality between patients receiving blood stored for 30 to 42 days and those receiving blood stored for 10 to 19 days was -0.2% (95% CI, -0.5% to 0.1%). Even among patients who received more than 6 units of RBCs stored for 30 days or longer, the hazard ratio of death was 1.00 (CI, 0.96 to 1.05) compared with those who received no such units. Observational study; risk of confounding by indication. Consistent with previous randomized trials, this study found no association between the length of storage of transfused RBCs and patient mortality. Results were homogeneous, with differences in absolute mortality consistently less than 1% among the most extreme exposure categories. These findings suggest that the current practice of storing RBCs for up to 42 days does not need to be changed. The Swedish Research Council, Swedish Heart-Lung Foundation, Swedish Society for Medical Research, Strategic Research Program in Epidemiology at Karolinska Institutet, and Danish Council for Independent Research.

Effect of waterlogging at different growth stages on some morphological traits of wheat varieties.

PubMed

Ghobadi, Mohammad Eghbal; Ghobadi, Mokhtar; Zebarjadi, Alireza

2017-04-01

Excess rainfalls may be the cause of waterlogging in soil, which affects the growth and development of wheat. Therefore, the objectives of this study were to examine the effects of waterlogging on shoot and root growth and physiological characteristics of wheat. Three experiments were conducted: experiment 1 (E1): evaluation of seedling growth on ten Iranian winter wheat varieties with waterlogging periods (1-4, 4-8, 8-12, and 12-16 days starting from seed germination). Seminal roots and plumule were investigated at seedling. The others are E2: pretreatment of waterlogging (15 days) at tillering and stem elongation stages and its effects on shoot and root growth at anthesis stage and experiment 3 (E3): pretreatment of waterlogging (15 days) at tillering and jointing stages and its effects on yield and yield components and also evaluation of stress tolerance indexes. The results of the seedling growth test (E1) showed that 1-4- and 4-8-day waterlogging severity reduced seminal root length (94.5 to 93.7 %) and plumule length (86.2 to 50.0 %) compared to control. Results of E2 indicated that waterlogging stress decreased shoot dry weight, root dry weight, total secondary root length, and chlorophyll a + b content of flag leaf by 28-31, 44-35, 20-31, and 28-35 %, respectively. Also, result of E3 showed that the grain yields of wheat varieties at two conditions of stress were different in base tolerance indexes. In general, the responses of wheat varieties to waterlogging were different at the three experiments. The varieties that had the most of dry weight and length of the root were tolerant. Thus, it is possible to use these characteristics as an index for selecting the varieties with tolerance to waterlogging.

Effect of waterlogging at different growth stages on some morphological traits of wheat varieties

NASA Astrophysics Data System (ADS)

Ghobadi, Mohammad Eghbal; Ghobadi, Mokhtar; Zebarjadi, Alireza

2017-04-01

Excess rainfalls may be the cause of waterlogging in soil, which affects the growth and development of wheat. Therefore, the objectives of this study were to examine the effects of waterlogging on shoot and root growth and physiological characteristics of wheat. Three experiments were conducted: experiment 1 (E1): evaluation of seedling growth on ten Iranian winter wheat varieties with waterlogging periods (1-4, 4-8, 8-12, and 12-16 days starting from seed germination). Seminal roots and plumule were investigated at seedling. The others are E2: pretreatment of waterlogging (15 days) at tillering and stem elongation stages and its effects on shoot and root growth at anthesis stage and experiment 3 (E3): pretreatment of waterlogging (15 days) at tillering and jointing stages and its effects on yield and yield components and also evaluation of stress tolerance indexes. The results of the seedling growth test (E1) showed that 1-4- and 4-8-day waterlogging severity reduced seminal root length (94.5 to 93.7 %) and plumule length (86.2 to 50.0 %) compared to control. Results of E2 indicated that waterlogging stress decreased shoot dry weight, root dry weight, total secondary root length, and chlorophyll a + b content of flag leaf by 28-31, 44-35, 20-31, and 28-35 %, respectively. Also, result of E3 showed that the grain yields of wheat varieties at two conditions of stress were different in base tolerance indexes. In general, the responses of wheat varieties to waterlogging were different at the three experiments. The varieties that had the most of dry weight and length of the root were tolerant. Thus, it is possible to use these characteristics as an index for selecting the varieties with tolerance to waterlogging.

Long-Period Tidal Variations in the Length of Day

NASA Technical Reports Server (NTRS)

Ray, Richard D.; Erofeeva, Svetlana Y.

2014-01-01

A new model of long-period tidal variations in length of day is developed. The model comprises 80 spectral lines with periods between 18.6 years and 4.7 days, and it consistently includes effects of mantle anelasticity and dynamic ocean tides for all lines. The anelastic properties followWahr and Bergen; experimental confirmation for their results now exists at the fortnightly period, but there remains uncertainty when extrapolating to the longest periods. The ocean modeling builds on recent work with the fortnightly constituent, which suggests that oceanic tidal angular momentum can be reliably predicted at these periods without data assimilation. This is a critical property when modeling most long-period tides, for which little observational data exist. Dynamic ocean effects are quite pronounced at shortest periods as out-of-phase rotation components become nearly as large as in-phase components. The model is tested against a 20 year time series of space geodetic measurements of length of day. The current international standard model is shown to leave significant residual tidal energy, and the new model is found to mostly eliminate that energy, with especially large variance reduction for constituents Sa, Ssa, Mf, and Mt.

Performance Contracting and Quality Improvement in Outpatient Treatment: Effects on Waiting Time and Length of Stay

PubMed Central

Stewart, Maureen T.; Horgan, Constance M.; Garnick, Deborah W.; Ritter, Grant; McLellan, A. Thomas

2012-01-01

We evaluate effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n = 12,368) and Maryland (n = 147,151) for 1998 – 2006. Results of difference-in-difference analyses indicate waiting time declined 13 days following the PC, after controlling for client characteristics and historical trends. Participation in the PC and a formal QI program was associated with a decrease of 20 days. LOS increased 22 days under the PC and 24 days under the PC and QI programs, after controlling for client characteristics. The PC and QI program were associated with improvements in LOS and waiting time, although we cannot determine which aspects of the programs (incentives, training, monitoring) resulted in these changes. PMID:22445031

Correlation and path coefficient analysis of quantitative characters in spine gourd (Momordica dioica Roxb.).

PubMed

Aliya, F; Begum, H; Reddy, M T; Sivaraj, N; Pandravada, S R; Narshimulu, G

2014-05-01

Fifty genotypes of spine gourd (Momordica dioica Roxb.) were evaluated in a randomized block design with two replications at the Vegetable Research Station, Rajendranagar, Hyderabad, Andhra Pradesh, India during kharif, 2012. Correlation and path coefficient analysis were carried out to study the character association and contribution, respectively for twelve quantitative characters namely vine length (m), number of stems per plant, days to first female flower appearance, first female flowering node, days to first fruit harvest, days to last fruit harvest, fruiting period (days), fruit length (cm), fruit width (cm), fruit weight (g), number of fruits per plant and fruit yield per plant (kg) for identification of the potential selection indices. Correlation and path coefficient analyses revealed that fruiting period and number of fruits per plant not only had positively significant correlation with fruit yield but also had positively high direct effect on it and are regarded as the main determinants of fruit yield. Days to first fruit harvest had positively moderate direct effect on fruit yield and its association was negatively significant, days to last fruit harvest had negatively high direct effect on fruit yield and its association was significant positively, hence restricted simultaneous selection can be made for days to first fruit harvest and days to last fruit harvest. The improvement in fruit yield can be effective if selection is based on days to first fruit harvest, days to last fruit harvest, fruiting period and number of fruits per plant.

Cystectomy for bladder cancer in elderly patients is not associated with increased 30- and 90-day mortality or readmission, length of stay, and cost: propensity score matching using a population database.

PubMed

Lin, Wei-Yu; Wu, Chun-Te; Chen, Miao-Fen; Chang, Ying-Hsu; Lin, Cheng-Li; Kao, Chia-Hung

2018-01-01

Radical cystectomy (RC) is an effective but underused treatment for bladder cancer in elderly patients. This study performed analysis of propensity scores (PSs) to determine the outcomes of RC for elderly patients, with results generalizable at the population-based level. We conducted a population-based, retrospective cohort study of patients who underwent RC in Taiwan during 2000-2010. Multivariable logistic regression was implemented to evaluate 30- and 90-day mortality and readmission rates, length of intensive care unit (ICU) stay, length of hospital stay (LOS), and cost. Enrolled patients were divided into younger (≤75 years) and older groups (>75 years) who were matched according to their PSs. We identified 430 patients with bladder cancer who underwent RC between 2000 and 2010. Older age was not significantly associated with 30-day readmission (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.38-1.70), 90-day readmission (OR = 1.10, 95% CI = 0.60-2.00), 30-day mortality (OR = 3.07, 95% CI = 0.31-30.0), or 90-day mortality (OR = 2.98, 95% CI = 0.91-9.70) in the PS-matched group. Similar trends were also observed for both groups regarding the mean length of ICU stay, LOS, and overall medical expenditure within the same admission. No significant differences existed between the older and younger groups for 30-and 90-day mortality and readmission rates, length of ICU stay, LOS, and medical expenditure in patients undergoing RC for bladder cancer. Some healthy elderly patients may be good candidates for this extensive curative treatment.

The effect of a short course of moderate pressure sunflower oil massage on the weight gain velocity and length of NICU stay in preterm infants.

PubMed

Taheri, Peymaneh Alizadeh; Goudarzi, Zahra; Shariat, Mamak; Nariman, Shahin; Matin, Elahe Nikzinat

2018-02-01

The aim of this study was to evaluate the efficacy of five-day course of sunflower oil massage with moderate pressure on the weight gain and length of NICU stay in preterm infants. Forty-four healthy preterm infants with a corrected gestational age of 30-36 weeks at the time of the study, were randomly assigned to the study group receiving body massage with sunflower oil and the control group receiving only routine NICU care. The massage was performed three times per day, each session including three consecutive five-minute stages, for five days. The primary outcome was to evaluate the efficacy of a short course of moderate pressure sunflower oil massage on the weight gain velocity. The secondary outcome was to compare the length of NICU stay between the two groups. During the study period, the increase in the average daily and fifth-day weight gain was significant in the intervention group. The length of NICU stay was shorter in the intervention group significantly. Our findings suggest that even a short course of body massage with sunflower oil for only five days increases preterm infants' weight gain and decreases their duration of NICU stay significantly. Copyright © 2017 Elsevier Inc. All rights reserved.

Payment source and length of use among home health agency discharges.

PubMed

Han, Beth; Remsburg, Robin E; Lubitz, James; Goulding, Margie

2004-11-01

Our study compared (1) length of use among home health care (HHC) discharges with Medicare, Medicaid, or private health insurance between 1991 and 2000 and (2) factors associated with length of HHC use among discharges with Medicare, Medicaid, or private health insurance. Data were obtained from the 1992, 1994, 1996, 1998, and 2000 National Home and Hospice Care Surveys (n = 18,416). Logistic regressions and stratified analyses by primary payment source were applied. After adjusting for covariates, Medicare HHC patients were from 0.52 to 0.75 times less likely to be discharged within 30 days in 1991-1996 than in 1997-1998. Medicaid patients were 0.37 times less likely to be discharged within 30 days in 1991-1992 than in 1997-1998. Patients with private insurance were 2.05 times more likely to be discharged within 30 days in 1993-1994 than in 1997-1998. No significant difference in length of use was found at the multivariate level between 1997-1998 and 1999-2000 among HHC patients with Medicare, Medicaid, or private health insurance. Results for being discharged within 60 days were similar to these described above. Our study shows that length of HHC use among Medicare discharges decreased after the implementation of the Medicare interim payment system. We did not find a spillover effect of the Medicare interim payment system on length of HHC use among discharges with Medicaid or private health insurance. Our results can help health professionals and policy makers better understand the dynamic associations between payment systems and length of use of HHC services.

Effect of dry period length on the effect of an intramammary teat sealant on the risk of mastitis in cattle treated with antibiotics at drying off.

PubMed

Laven, R A; Balcomb, C C; Tulley, W T; Lawrence, K E

2014-07-01

The aim of this study was to evaluate, under farm conditions, the use of a teat sealant in addition to whole herd dry cow antibiotic therapy on the risk of clinical mastitis in dairy cattle at pasture, and to evaluate the impact of dry period length on that risk and the impact of the teat sealant on that risk. Dairy cows in three herds which used routine whole herd antibiotic therapy were randomly assigned to receive either treatment with an internal teat sealant (n=322) or no additional treatment (n=313) at drying-off between March and May 2010. All clinical mastitis cases during the dry period and to the end of the subsequent lactation were recorded by farm staff; factors affecting risk of clinical mastitis were then analysed using a Cox proportional hazards model. Median duration of the dry period was 112 days with >25% of cows having a dry period >130 days. The incidence risk of mastitis during lactation for cows treated with teat sealant was 9.9 (95% CI=6.9-13.7) cases per 100 cows compared with 17.9 (95% CI=13.8-22.6) cases per 100 cows for cows treated with antibiotic alone. The addition of a teat sealant to dry cow antibiotic therapy decreased the risk of clinical mastitis only in the first 33 days after calving (Hazard risk 0.24 (95% CI=0.12-0.48)). Length of dry period did not significantly affect the risk of clinical mastitis, or the effect of adding teat sealant to dry cow antibiotic therapy on the risk of clinical mastitis. In these herds where, based on the mastitis history, whole herd antibiotic therapy had been recommended, the use of a teat sealant significantly reduced the risk of clinical mastitis. This effect was limited to the first 33 days after calving; subsequently there was no significant effect of treatment. There was no effect of dry period length on risk of clinical mastitis, nor any significant interaction with treatment. Combination therapy with teat sealant and antibiotic was effective under New Zealand conditions in herds using whole herd antibiotic treatment at drying off. Teat sealant reduced risk of clinical mastitis in cattle with dry periods substantially longer than 100 days, and there was no evidence that this effect changed as dry period length increased.

Length of day-care attendance and attachment behavior in eighteen-month-old infants.

PubMed

Schwartz, P

1983-08-01

Differences in the attachment behavior of 18-month-old full-time, part-time, and non-day-care infants from intact middle-class homes were compared. Mothers of the day-care infants had made arrangements to return to work before their infants' birth, and all the infants had been placed in day-care homes before 9 months of age. The study involved 2 sessions: a home observation and the strange-situation procedure in a laboratory setting. The home-observation and rating scale scores of maternal behaviors directed at the child yielded few group differences. More full-time day-care children (but not part-time children) were found to display avoidance of the mother during the final reunion episode of the strange-situation procedure than did non-day-care children. The length of the daily separation appears to be an important determinant of day-care effects on infant-mother attachment.

Climate effects of a hypothetical regional nuclear war: Sensitivity to emission duration and particle composition

NASA Astrophysics Data System (ADS)

Pausata, Francesco S. R.; Lindvall, Jenny; Ekman, Annica M. L.; Svensson, Gunilla

2016-11-01

Here, we use a coupled atmospheric-ocean-aerosol model to investigate the plume development and climate effects of the smoke generated by fires following a regional nuclear war between emerging third-world nuclear powers. We simulate a standard scenario where 5 Tg of black carbon (BC) is emitted over 1 day in the upper troposphere-lower stratosphere. However, it is likely that the emissions from the fires ignited by bomb detonations include a substantial amount of particulate organic matter (POM) and that they last more than 1 day. We therefore test the sensitivity of the aerosol plume and climate system to the BC/POM ratio (1:3, 1:9) and to the emission length (1 day, 1 week, 1 month). We find that in general, an emission length of 1 month substantially reduces the cooling compared to the 1-day case, whereas taking into account POM emissions notably increases the cooling and the reduction of precipitation associated with the nuclear war during the first year following the detonation. Accounting for POM emissions increases the particle size in the short-emission-length scenarios (1 day/1 week), reducing the residence time of the injected particle. While the initial cooling is more intense when including POM emission, the long-lasting effects, while still large, may be less extreme compared to the BC-only case. Our study highlights that the emission altitude reached by the plume is sensitive to both the particle type emitted by the fires and the emission duration. Consequently, the climate effects of a nuclear war are strongly dependent on these parameters.

Potential Adverse Effects of Broad-Spectrum Antimicrobial Exposure in the Intensive Care Unit.

PubMed

Wiens, Jenna; Snyder, Graham M; Finlayson, Samuel; Mahoney, Monica V; Celi, Leo Anthony

2018-02-01

The potential adverse effects of empiric broad-spectrum antimicrobial use among patients with suspected but subsequently excluded infection have not been fully characterized. We sought novel methods to quantify the risk of adverse effects of broad-spectrum antimicrobial exposure among patients admitted to an intensive care unit (ICU). Among all adult patients admitted to ICUs at a single institution, we selected patients with negative blood cultures who also received ≥1 broad-spectrum antimicrobials. Broad-spectrum antimicrobials were categorized in ≥1 of 5 categories based on their spectrum of activity against potential pathogens. We performed, in serial, 5 cohort studies to measure the effect of each broad-spectrum category on patient outcomes. Exposed patients were defined as those receiving a specific category of broad-spectrum antimicrobial; nonexposed were all other patients in the cohort. The primary outcome was 30-day mortality. Secondary outcomes included length of hospital and ICU stay and nosocomial acquisition of antimicrobial-resistant bacteria (ARB) or Clostridium difficile within 30 days of admission. Among the study cohort of 1918 patients, 316 (16.5%) died within 30 days, 821 (42.8%) had either a length of hospital stay >7 days or an ICU length of stay >3 days, and 106 (5.5%) acquired either a nosocomial ARB or C. difficile . The short-term use of broad-spectrum antimicrobials in any of the defined broad-spectrum categories was not significantly associated with either primary or secondary outcomes. The prompt and brief empiric use of defined categories of broad-spectrum antimicrobials could not be associated with additional patient harm.

5 CFR 890.1006 - Notice of proposed mandatory debarment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 30 days prior to the proposed effective date. (b) Contents of the notice. The notice shall contain information indicating the: (1) Effective date of the debarment; (2) Minimum length of the debarment; (3... business days after it was sent. (f) Procedures if notice cannot be delivered. (1) If OPM learns that a...

5 CFR 890.1006 - Notice of proposed mandatory debarment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 30 days prior to the proposed effective date. (b) Contents of the notice. The notice shall contain information indicating the: (1) Effective date of the debarment; (2) Minimum length of the debarment; (3... business days after it was sent. (f) Procedures if notice cannot be delivered. (1) If OPM learns that a...

5 CFR 890.1006 - Notice of proposed mandatory debarment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 30 days prior to the proposed effective date. (b) Contents of the notice. The notice shall contain information indicating the: (1) Effective date of the debarment; (2) Minimum length of the debarment; (3... business days after it was sent. (f) Procedures if notice cannot be delivered. (1) If OPM learns that a...

5 CFR 890.1006 - Notice of proposed mandatory debarment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 30 days prior to the proposed effective date. (b) Contents of the notice. The notice shall contain information indicating the: (1) Effective date of the debarment; (2) Minimum length of the debarment; (3... business days after it was sent. (f) Procedures if notice cannot be delivered. (1) If OPM learns that a...

5 CFR 890.1006 - Notice of proposed mandatory debarment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 30 days prior to the proposed effective date. (b) Contents of the notice. The notice shall contain information indicating the: (1) Effective date of the debarment; (2) Minimum length of the debarment; (3... business days after it was sent. (f) Procedures if notice cannot be delivered. (1) If OPM learns that a...

Effects of egg storage on hatchability, chick quality, performance and immunocompetence parameters of broiler chickens.

PubMed

Goliomytis, Michael; Tsipouzian, Theofania; Hager-Theodorides, Ariadne L

2015-09-01

Pre-incubation egg storage is a necessity for the poultry industry. This study evaluated the effects of pre-incubation storage length of broiler eggs on hatchability, 1-day-old chick quality, subsequent performance, and immunocompetence. To this end, a total of 360 hatching eggs were stored for 4, 12, or 16 d prior to incubation. Hatchability and chick quality were assessed at hatch, and growth performance and immunocompetence parameters were assessed during a 35 d rearing period. Hatchability of set and fertile eggs, and embryonic mortality, were not affected by egg storage. On the contrary, 1-day-old chick BW and length were linearly negatively correlated with egg storage length (P-linear<0.05). Nevertheless, BW corrected for egg weight prior to setting was unaffected, and corrected chick length was positively affected by storage length. One-day-old chick Tona score, navel quality, and post-hatch growth performance (BW at 7 and 35 d, cumulative feed intake, and feed conversion ratio at 35 d) were unaffected by egg storage (P, P-linear>0.05). Lymphoid organ weights at 2 and 35 d, the titre of maternal anti-NDV antibodies, most of the thymocyte subpopulations defined by CD3, CD4, and CD8 cell surface expression in the thymus of 2-d-old chicks, cellular responses to the PHA skin test, humoral responses to primary SRBC, and NDV immunizations were also not influenced by length of storage (P, P-linear>0.05). On the contrary, the length of egg storage was found to negatively influence the abundance of CD3+CD4-CD8- thymocytes that represent the majority of γδ-T cells in the thymus of 2-day-old chicks, as well as the humoral response to booster NDV immunization of the birds. In brief, pre-incubation storage of broiler hatching eggs for up to 16 d did not affect most developmental and growth parameters investigated, except for BW and length at hatch. Egg storage was found to suppress some aspects of the immunocompetence of the birds, particularly aspects of acquired immunity. © 2015 Poultry Science Association Inc.

Assessing the Effect of School Days and Absences on Test Score Performance. CEP Discussion Paper No. 1302

ERIC Educational Resources Information Center

Aucejo, Esteban M.; Romano, Teresa Foy

2014-01-01

While instructional time is viewed as crucial to learning, little is known about the effectiveness of reducing absences relative to increasing the number of school days. In this regard, this paper jointly estimates the effect of absences and length of the school calendar on test score performance. Using administrative data from North Carolina…

Healthcare Spending and Performance of Specialty Hospitals: Nationwide Evidence from Colorectal-Anal Specialty Hospitals in South Korea.

PubMed

Kim, Sun Jung; Lee, Sang Gyu; Kim, Tae Hyun; Park, Eun-Cheol

2015-11-01

Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government's specialty hospital. Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed. Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges. Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out.

The results of a randomized trial of a quality improvement intervention in the care of patients with heart failure. The MISCHF Study Investigators.

PubMed

Philbin, E F; Rocco, T A; Lindenmuth, N W; Ulrich, K; McCall, M; Jenkins, P L

2000-10-15

Quality improvement and disease management programs for heart failure have improved quality of care and patient outcomes at large tertiary care hospitals. The purpose of this study was to measure the effects of a regional, multihospital, collaborative quality improvement intervention on care and outcomes in heart failure in community hospitals. This randomized controlled study included 10 acute care community hospitals in upstate New York. After a baseline period, 5 hospitals were randomly assigned to receive a multifaceted quality improvement intervention (n = 762 patients during the baseline period; n = 840 patients postintervention), while 5 were assigned to a "usual care" control (n = 640 patients during the baseline period; n = 664 patients postintervention). Quality of care was determined using explicit criteria by reviewing the charts of consecutive patients hospitalized with the primary diagnosis of heart failure during the baseline period and again in the postintervention period. Clinical outcomes included hospital length of stay and charges, in-hospital and 6-month mortality, hospital readmission, and quality of life measured after discharge. Patients had similar characteristics in the baseline and postintervention phases in the intervention and control groups. Using hospital-level analyses, the intervention had mixed effects on 5 quality-of-care markers that were not statistically significant. The mean of the average length of stay among hospitals decreased from 8.0 to 6.2 days in the intervention group, with a smaller decline in mean length of stay in the control group (7.7 to 7.0 days). The net effects of the intervention were nonsignificant changes in length of stay of -1.1 days (95% confidence interval [CI]: -2.9 to 0.7 days, P = 0.18) and in hospital charges of -$817 (95% CI: -$2560 to $926, P = 0.31). There were small and nonsignificant effects on mortality, hospital readmission, and quality of life. The incremental effect of regional collaboration among peer community hospitals toward the goal of quality improvement was small and limited to a slightly, but not significantly, shorter length of stay.

Day length is associated with physical activity and sedentary behavior among older women.

PubMed

Schepps, Mitchell A; Shiroma, Eric J; Kamada, Masamitsu; Harris, Tamara B; Lee, I-Min

2018-04-26

Physical activity may be influenced by one's physical environment, including day length and weather. Studies of physical activity, day length, and weather have primarily used self-reported activity, broad meteorological categorization, and limited geographic regions. We aim to examine the association of day length and physical activity in a large cohort of older women, covering a wide geographic range. Participants (N = 16,741; mean (SD) age = 72.0 (SD = 5.7) years) were drawn from the Women's Health Study and lived throughout the United States. Physical activity was assessed by accelerometer (ActiGraph GT3X+) between 2011 and 2015. Day length and weather information were obtained by matching weather stations to the participants' location using National Oceanic and Atmospheric Administration databases. Women who experienced day lengths greater than 14 hours had 5.5% more steps, 9.4% more moderate-to-vigorous physical activity, and 1.6% less sedentary behavior, compared to women who experienced day lengths less than 10 hours, after adjusting for age, accelerometer wear, temperature, and precipitation. Day length is associated with physical activity and sedentary behavior in older women, and needs to be considered in programs promoting physical activity as well as in the analyses of accelerometer data covering wide geographic regions.

Short-day treatment alters Douglas-fir seedling dehardening and transplant root proliferation at varying rhizosphere temperatures

Treesearch

Douglass F. Jacobs; Anthony S. Davis; BArrett C. Wilson; R. Kasten Dumroese; Rosa C. Goodman; K. Francis Salifu

2008-01-01

We tested effects of shortened day length during nursery culture on Douglis-fir (Pseudotsuga menziesii var. menziesii (Mirb.) Franco) seedling development at dormancy release. Seedlings from a 42 N source were grown either under ambient photoperiods (long-day (LD)) or with a 28 day period of 9 h light: 15 h dark photoperiods (short...

Effect of day of the week of primary total hip arthroplasty on length of stay at a university-based teaching medical center.

PubMed

Rathi, Pranav; Coleman, Sheldon; Durbin-Johnson, Blythe; Giordani, Mauro; Pereira, Gavin; Di Cesare, Paul E

2014-12-01

Length of hospital stay (LHS) after primary total hip arthroplasty (THA) constitutes a critical outcome measure, as prolonged LHS implies increased resource expenditure. Investigations have highlighted factors that affect LHS after THA. These factors include advanced age, medical comorbidities, obesity, intraoperative time, anesthesia technique, surgical site infection, and incision length. We retrospectively analyzed the effect of day of the week of primary THA on LHS. We reviewed the surgery and patient factors of 273 consecutive patients who underwent THA at our institution, a tertiary-care teaching hospital. There was a 15% increase in LHS for patients who underwent THA on Thursday versus Monday when controlling for other covariates that can affect LHS. Other statistically significant variables associated with increased LHS included American Society of Anesthesiologists grade, transfusion requirements, and postoperative complications. The day of the week of THA may be an independent variable affecting LHS. Institutions with reduced weekend resources may want to perform THA earlier in the week to try to reduce LHS.

Effect of Day of the Week of Primary Total Hip Arthroplasty on Length of Stay at a University-Based Teaching Medical Center

PubMed Central

Rathi, Pranav; Coleman, Sheldon; Durbin-Johnson, Blythe; Giordani, Mauro; Pereira, Gavin; Di Cesare, Paul E.

2016-01-01

Length of hospital stay (LHS) after primary total hip arthroplasty (THA) constitutes a critical outcome measure, as prolonged LHS implies increased resource expenditure. Investigations have highlighted factors that affect LHS after THA. These factors include advanced age, medical comorbidities, obesity, intraoperative time, anesthesia technique, surgical site infection, and incision length. We retrospectively analyzed the effect of day of the week of primary THA on LHS. We reviewed the surgery and patient factors of 273 consecutive patients who underwent THA at our institution, a tertiary-care teaching hospital. There was a 15% increase in LHS for patients who underwent THA on Thursday versus Monday when controlling for other covariates that can affect LHS. Other statistically significant variables associated with increased LHS included American Society of Anesthesiologists grade, transfusion requirements, and post-operative complications. The day of the week of THA may be an independent variable affecting LHS. Institutions with reduced weekend resources may want to perform THA earlier in the week to try to reduce LHS. PMID:25490016

Factors Associated with Hospital Length of Stay among Cancer Patients with Febrile Neutropenia

PubMed Central

Rosa, Regis G.; Goldani, Luciano Z.

2014-01-01

Purpose This study sought to evaluate factors associated with hospital length of stay in cancer patients with febrile neutropenia. Methods A prospective cohort study was performed at a single tertiary referral hospital in southern Brazil from October 2009 to August 2011. All adult cancer patients with febrile neutropenia admitted to the hematology ward were evaluated. Stepwise random-effects negative binomial regression was performed to identify risk factors for prolonged length of hospital stay. Results In total, 307 cases of febrile neutropenia were evaluated. The overall median length of hospital stay was 16 days (interquartile range 18 days). According to multiple negative binomial regression analysis, hematologic neoplasms (P = 0.003), high-dose chemotherapy regimens (P<0.001), duration of neutropenia (P<0.001), and bloodstream infection involving Gram-negative multi-drug-resistant bacteria (P = 0.003) were positively associated with prolonged hospital length of stay in patients with febrile neutropenia. The condition index showed no evidence of multi-collinearity effect among the independent variables. Conclusions Hematologic neoplasms, high-dose chemotherapy regimens, prolonged periods of neutropenia, and bloodstream infection with Gram-negative multi-drug-resistant bacteria are predictors of prolonged length hospital of stay among adult cancer patients with febrile neutropenia. PMID:25285790

Three-dimensional engineered heart tissue from neonatal rat cardiac myocytes.

PubMed

Zimmermann, W H; Fink, C; Kralisch, D; Remmers, U; Weil, J; Eschenhagen, T

2000-04-05

A technique is presented that allows neonatal rat cardiac myocytes to form spontaneously and coherently beating 3-dimensional engineered heart tissue (EHT) in vitro, either as a plane biconcaval matrix anchored at both sides on Velcro-coated silicone tubes or as a ring. Contractile activity was monitored in standard organ baths or continuously in a CO(2) incubator for up to 18 days (=26 days after casting). Long-term measurements showed an increase in force between days 8 and 18 after casting and stable forces thereafter. At day 10, the twitch amplitude (TA) of electrically paced EHTs (average length x width x thickness, 11 x 6 x 0.4 mm) was 0.51 mN at length of maximal force development (L(max)) and a maximally effective calcium concentration. EHTs showed typical features of neonatal rat heart: a positive force-length and a negative force-frequency relation, high sensitivity to calcium (EC(50) 0.24 mM), modest positive inotropic (increase in TA by 46%) and pronounced positive lusitropic effect of isoprenaline (decrease in twitch duration by 21%). Both effects of isoprenaline were sensitive to the muscarinic receptor agonist carbachol in a pertussis toxin-sensitive manner. Adenovirus-mediated gene transfer of beta-galactosidase into EHTs reached 100% efficiency. In summary, EHTs retain many of the physiological characteristics of rat cardiac tissue and allow efficient gene transfer with subsequent force measurement. Copyright 2000 John Wiley & Sons, Inc.

Orientation and length of mammalian skeletal myocytes in response to a unidirectional stretch

NASA Technical Reports Server (NTRS)

Collinsworth, A. M.; Torgan, C. E.; Nagda, S. N.; Rajalingam, R. J.; Kraus, W. E.; Truskey, G. A.

2000-01-01

Effects of mechanical forces exerted on mammalian skeletal muscle cells during development were studied using an in vitro model to unidirectionally stretch cultured C2C12 cells grown on silastic membrane. Previous models to date have not studied these responses of the mammalian system specifically. The silastic membrane upon which these cells were grown exhibited linear strain behavior over the range of 3.6-14.6% strain, with a Poisson's ratio of approximately 0.5. To mimic murine in utero long bone growth, cell substrates were stretched at an average strain rate of 2.36%/day for 4 days or 1.77%/day for 6 days with an overall membrane strain of 9.5% and 10.6%, respectively. Both control and stretched fibers stained positively for the contractile protein, alpha-actinin, demonstrating muscle fiber development. An effect of stretch on orientation and length of myofibers was observed. At both strain rates, stretched fibers aligned at a smaller angle relative to the direction of stretch and were significantly longer compared to randomly oriented control fibers. There was no effect of duration of stretch on orientation or length, suggesting the cellular responses are independent of strain rate for the range tested. These results demonstrate that, under conditions simulating mammalian long bone growth, cultured myocytes respond to mechanical forces by lengthening and orienting along the direction of stretch.

Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer.

PubMed

Steffens, Daniel; Beckenkamp, Paula R; Hancock, Mark; Solomon, Michael; Young, Jane

2018-03-01

To investigate the effectiveness of preoperative exercises interventions in patients undergoing oncological surgery, on postoperative complications, length of hospital stay and quality of life. Intervention systematic review with meta-analysis. MEDLINE, Embase and PEDro. Trials investigating the effectiveness of preoperative exercise for any oncological patient undergoing surgery were included. The outcomes of interest were postoperative complications, length of hospital stay and quality of life. Relative risks (RRs), mean differences (MDs) and 95% CI were calculated using random-effects models. Seventeen articles (reporting on 13 different trials) involving 806 individual participants and 6 tumour types were included. There was moderate-quality evidence that preoperative exercise significantly reduced postoperative complication rates (RR 0.52, 95% CI 0.36 to 0.74) and length of hospital stay (MD -2.86 days, 95% CI -5.40 to -0.33) in patients undergoing lung resection, compared with control. For patients with oesophageal cancer, preoperative exercise was not effective in reducing length of hospital stay (MD 2.00 days, 95% CI -2.35 to 6.35). Although only assessed in individual studies, preoperative exercise improved postoperative quality of life in patients with oral or prostate cancer. No effect was found in patients with colon and colorectal liver metastases. Preoperative exercise was effective in reducing postoperative complications and length of hospital stay in patients with lung cancer. Whether preoperative exercise reduces complications, length of hospital stay and improves quality of life in other groups of patients undergoing oncological surgery is uncertain as the quality of evidence is low. PROSPEROREGISTRATION NUMBER. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effect of different dry period lengths on milk production and somatic cell count in subsequent lactations in commercial Dutch dairy herds.

PubMed

Steeneveld, W; Schukken, Y H; van Knegsel, A T M; Hogeveen, H

2013-05-01

Shortening the dry period (DP) has been proposed as a management strategy to improve energy balance in early lactation. It is well known that both shortening and complete omission of the DP reduces milk production in the subsequent lactations. In most of these studies milk production data were obtained from planned animal experiments where cows were randomly assigned to DP length treatments, and cow management and diet composition did not differ among treatments. It may therefore be hypothesized that cows on commercial herds which apply a no-DP or short-DP-strategy, and support this by management adjustments, will have a less dramatic reduction in milk production. In this study, milk production and somatic cell count (SCC) following different DP lengths was investigated under commercial circumstances. Milk production of 342 cows (2,077 test-day records) was available from 5 Dutch commercial dairy herds which started a no DP-strategy for all cows. Test days of the year before applying the no-DP strategy are used as control (323 cows, 1,717 test-day records). Six other herds applied an individual cow approach and have different preplanned DP lengths within one herd. From these herds, information on 81 cows (482 test-day records) with a DP length between 0 and 20 d, 127 cows (925 test-day records) with a DP length between 21 and 35 d, and 143 cows (1,075 test-day records) with a DP length of more than 35 d was available. A generalized linear model incorporating an autoregressive covariance structure accounting for repeated test-day yields within cow was developed to estimate the daily yield (milk, fat and protein) and SCC of all cows. Applying no DP for all cows in the herd resulted in a reduction in postpartum milk production compared with within-herd control lactations (until 305 DIM) between 3.2 and 9.1 kg/d, which was a reduction of 12 and 32%, respectively. For the 6 herds that applied an individual cow approach with different preplanned DP lengths, the cow-specific DP strategy was based on milk production and SCC approximately 2 mo before calving. Cows with a preplanned DP length ranging between 0 and 20 d had a reduction in postpartum milk production between 5.7 and 13 kg/d compared with cows with a DP length of >35 d. Cows with a preplanned DP length ranging from 21 to 35 d had a numerically lower milk production (between 0.6 and 5.3 kg/d) than cows with a preplanned DP length of >35 d, but this difference was significant in only one herd. When corrected for milk yield, no difference in postpartum SCC for cows with different DP lengths was found. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Analysis of a Precambrian resonance-stabilized day length

NASA Astrophysics Data System (ADS)

Bartlett, Benjamin C.; Stevenson, David J.

2016-06-01

During the Precambrian era, Earth's decelerating rotation would have passed a 21 h period that would have been resonant with the semidiurnal atmospheric thermal tide. Near this point, the atmospheric torque would have been maximized, being comparable in magnitude but opposite in direction to the lunar torque, halting Earth's rotational deceleration, maintaining a constant day length, as detailed by Zahnle and Walker (1987). We develop a computational model to determine necessary conditions for formation and breakage of this resonant effect. Our simulations show the resonance to be resilient to atmospheric thermal noise but suggest a sudden atmospheric temperature increase like the deglaciation period following a possible "snowball Earth" near the end of the Precambrian would break this resonance; the Marinoan and Sturtian glaciations seem the most likely candidates for this event. Our model provides a simulated day length over time that resembles existing paleorotational data, though further data are needed to verify this hypothesis.

The effect of gravity on plant germination

NASA Astrophysics Data System (ADS)

Takakura, T.; Goto, E.; Tanaka, M.

1996-01-01

An axis clinostat was constructed to create micro and negative gravity also a rotated flat disk was constructed with different rotation rates to give increased gravity, by centrifugal force up to 48g. Rice seeds were grown on agar in tubes at the constant air temperature of 20 degC under an average light condition of 110 mumol/m^2/sec(PPF). Humidity was not controlled but was maintained above 90%. Since the tube containers were not large enough for long cultivation, shoot and root growth were observed every 12 hours until the sixth day from seeding. The lengths of shoots and roots for each individual plant were measured on the last day. The stem lengths were increased by microgravity but the root lengths were not. Under the negative gravity, negative orthogeotropism and under micro gravity, diageotropism was observed. No significant effect of increased gravity was observed on shoot and root growth.

Single versus divided administration of intravenous immunoglobulin for sepsis: a retrospective and historical control study.

PubMed

Nakamura, Kensuke; Inokuchi, Ryota; Fukushima, Kazutaka; Naraba, Hiromu; Takahashi, Yuji; Sonoo, Tomohiro; Hashimoto, Hideki; Doi, Kent; Morimura, Naoto

2018-05-28

Intravenous immunoglobulin (IVIG) is regarded as effective, theoretically, for sepsis. The IVIG regimen for severe infection covered by Japanese health insurance is administration of 5 g per day for three days: an extremely low dosage. We investigated its effectiveness by comparison between divided dosage and single dosage of 15 g × one day. Patients who were admitted to our hospital's Emergency Medical Center and treated with IVIG for sepsis were included and were analyzed retrospectively. The dosage regimen was 5 g × three days in the early half period, and 15 g × one day in the latter half period employing the same indication criteria. Each group included 57 patients. No significant difference was found in their baseline characteristics, survival probability, or length of mechanical ventilation. However, the ICU stay and hospital stay lengths were shortened significantly by administration of the single dosage regimen. Disseminated intravascular coagulopathy markers and inflammatory indices were improved significantly earlier in the 15 g × one day group. Regarding adverse events, no significant difference was found. For sepsis treatment, single administration of 15 g IVIG for one day improved the condition and inflammation earlier than divided dosage.

Effect of a Dedicated Orthopaedic Advanced Practice Provider in a Level I Trauma Center: Analysis of Length of Stay and Cost.

PubMed

Hiza, Elise A; Gottschalk, Michael B; Umpierrez, Erica; Bush, Patricia; Reisman, William M

2015-07-01

The objective of this study is to analyze the effect of an orthopaedic trauma advanced practice provider on length of stay (LOS) and cost in a level I trauma center. The hypothesis of this study is that the addition of a single full-time nurse practitioner (NP) to the orthopaedic trauma team at a level I Trauma center would decrease overall LOS and hospital cost. A retrospective chart review of all patients discharged from the orthopaedic surgery service 1 year before the addition of a NP (pre-NP) and 1 year after the hiring of a NP (post-NP) were reviewed. Chart review included age, gender, LOS, discharge destination, intravenous antibiotic use, wound VAC therapy, admission location, and length of time to surgery. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test. The hiring of a NP yielded a statistically significant decrease in the LOS across the following patient subgroups: patients transferred from the trauma service (13.56 compared with 7.02 days, P < 0.001), patients aged 60 years and older (7.34 compared with 5.04 days, P = 0.037), patients discharged to a rehabilitation facility (10.84 compared with 8.31 days, P = 0.002), and patients discharged on antibiotics/wound VAC therapy (15.16 compared with 11.24 days, P = 0.017). Length of time to surgery was also decreased (1.48 compared with 1.31 days, P = 0.37). The addition of a dedicated orthopaedic trauma advanced practice provider at a county level I trauma center resulted in a statistically significant decrease in LOS and thus reduced indirect costs to the hospital. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Analysis of a Precambrian Resonance-Stabilized Day Length

NASA Astrophysics Data System (ADS)

Bartlett, B. C.; Stevenson, D. J.

2014-12-01

Calculations indicate the average rate of decrease of Earth's angular momentum must have been less than its present value in the past; otherwise, the Earth should have a longer day length. Existing stromatolite data suggests the Earth's rotational frequency would have been near that of the atmospheric resonance frequency toward the end of the Precambrian era, approximately 600Ma. The semidiurnal atmospheric tidal torque would have reached a maximum near this day length of 21hr. At this point, the atmospheric torque would have been comparable in magnitude but opposite in direction to the lunar torque, creating a stabilizing effect which could preserve a constant day length while trapped in this resonant state, as suggested by Zahnle and Walker (1987). We examine the hypothesis that this resonant stability was encountered and sustained for a large amount of time during the Precambrian era and was broken by a large and relatively fast increase in global temperature, possibly in the deglaciation period following a snowball event. Computational simulations of this problem were performed, indicating that a persistent increase in temperature larger than around 10K over a period of time less than 107 years will break resonance (though these values vary with Q), but that the resonant stability is not easily broken by random high-amplitude high-frequency atmospheric temperature fluctuation or other forms of thermal noise. Further work also indicates it is possible to escape resonance simply by increasing the lunar tidal torque on the much longer timescale of plate tectonics, particularly for low atmospheric Q-factors, or that resonance could have never formed in the first place, had the lunar torque been very high or Q been very low when the Earth's rotational frequency was near the atmospheric resonance frequency. However, the need to explain the present day length given the current lunar torque favors the interpretation we offer, in which Earth's length of day was stabilized for hundreds of millions of years, escaping this stability in the aftermath of a sudden global temperature change.

The effect of funding policy on day of week admissions and discharges in hospitals: the cases of Austria and Canada.

PubMed

Leonard, Kevin J; Rauner, Marion S; Schaffhauser-Linzatti, Michaela Maria; Yap, Richard

2003-03-01

This paper compares two different funding policies for inpatients, the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of these funding policies on length of stay of inpatients as one key measure of health outcome. In our study, six major clinical categories for inpatients are selected in which the day of the week for admission is matched to the particular day of the week of discharge for each individual case. The strategic statistical analysis proves that funding policies have a significant impact on the expected length of stay of inpatients. For all six clinical categories, Austrian inpatients stayed longer in hospitals compared to Canadian inpatients. Moreover, inpatients were not admitted and discharged equally throughout the week. We also statistically prove for certain clinical categories that more inpatients are discharged on certain days such as Mondays or Fridays depending on the funding policy. Our study is unique in the literature and our conclusions indicate that, with the right incentives in place, the length of stay can be decreased and discharge anomalies can be eliminated, which ultimately leads to a decrease in healthcare expenditures and an increase in healthcare effectiveness.

Full- and Half-Day Kindergarten Programmes: Examining Impacts on Second Language Learners

ERIC Educational Resources Information Center

Bingham, Gary E.; Hall-Kenyon, Kendra M.

2013-01-01

This study investigated the effect of full- and half-day kindergarten programmes on English language learners (ELL) and English-only-speaking children's literacy and mathematics performance in a large urban school district. Considerations were given to how the length of the school day, children's language status (ELL and non-ELL), and children's…

Potential Adverse Effects of Broad-Spectrum Antimicrobial Exposure in the Intensive Care Unit

PubMed Central

Wiens, Jenna; Finlayson, Samuel; Mahoney, Monica V; Celi, Leo Anthony

2018-01-01

Abstract Background The potential adverse effects of empiric broad-spectrum antimicrobial use among patients with suspected but subsequently excluded infection have not been fully characterized. We sought novel methods to quantify the risk of adverse effects of broad-spectrum antimicrobial exposure among patients admitted to an intensive care unit (ICU). Methods Among all adult patients admitted to ICUs at a single institution, we selected patients with negative blood cultures who also received ≥1 broad-spectrum antimicrobials. Broad-spectrum antimicrobials were categorized in ≥1 of 5 categories based on their spectrum of activity against potential pathogens. We performed, in serial, 5 cohort studies to measure the effect of each broad-spectrum category on patient outcomes. Exposed patients were defined as those receiving a specific category of broad-spectrum antimicrobial; nonexposed were all other patients in the cohort. The primary outcome was 30-day mortality. Secondary outcomes included length of hospital and ICU stay and nosocomial acquisition of antimicrobial-resistant bacteria (ARB) or Clostridium difficile within 30 days of admission. Results Among the study cohort of 1918 patients, 316 (16.5%) died within 30 days, 821 (42.8%) had either a length of hospital stay >7 days or an ICU length of stay >3 days, and 106 (5.5%) acquired either a nosocomial ARB or C. difficile. The short-term use of broad-spectrum antimicrobials in any of the defined broad-spectrum categories was not significantly associated with either primary or secondary outcomes. Conclusions The prompt and brief empiric use of defined categories of broad-spectrum antimicrobials could not be associated with additional patient harm. PMID:29479546

Interactions among cluster-root investment, leaf phosphorus concentration, and relative growth rate in two Lupinus species.

PubMed

Wang, Xing; Veneklaas, Erik J; Pearse, Stuart J; Lambers, Hans

2015-09-01

Cluster-root (CR) formation is a desirable trait to improve phosphorus (P) acquisition as global P resources are dwindling. CRs in some lupine species are suppressed at higher P status. Whether increased growth rate enhances CR formation due to a "dilution" of leaf P concentration is unknown. We investigated interactive effects of leaf P status and relative growth rate (RGR) on CR formation in two Lupinus species, which differ in their CR biomass investment. Variation in RGR was imposed by varying day length. Lupinus albus and L. pilosus were grown hydroponically with KH2PO4 at a day length of 6, 10, or 14 h. We used a slightly higher P supply at longer day lengths to avoid a decline in leaf P concentration, which would induce CRs. Cluster-root percentage, leaf P concentrations, and RGR were determined at 22, 38, and 52 d after sowing. Lupinus species grown at similar root P availability, but with a faster growth rate, as dependent on day length, showed a greater CR percentage. Because our aim to achieve exactly the same leaf P concentrations at different day lengths was only partially achieved, we carried out a multiple regression analysis. This analysis showed the CR percentage was strongly and negatively correlated with plant P status and only marginally and positively correlated with RGR. The two Lupinus species invariably formed fewer cluster roots at higher leaf P status, irrespective of RGR. Differences in RGR or leaf P concentration cannot explain the species-specific variation in cluster-root investment. © 2015 Botanical Society of America.

[Length of stay in maternity wards after normal delivery: diverging point of views].

PubMed

Vautrin, E; Fontaine, A; Lanba, P; Guérin, V; Engelmann, P

2000-02-01

To compare maternity ward professionals' and patients' views regarding the length of stay in the maternity after a normal delivery and to explore working relationships with ambulatory health professionals. Three surveys General professional agreement on a minimum of 4 days; few contacts with ambulatory health professionals. One third of the women found their length of stay excessive. Most did not appear to gain new skills after 3 days, nor to encounter major difficulties once they returned to their home. and conclusion. It will be essential to organize effective working relationships between the maternity ward and ambulatory health professionals to ensure appropriate follow-up after an earlier discharge from the hospital, in agreement with the capabilities and expectations of a majority of women.

Growth and differentiation of mammalian embryonic tissues exposed to hypergravity in vivo and in vitro

NASA Technical Reports Server (NTRS)

Duke, J.; Janer, L.; Moore, J.

1985-01-01

Decreased cartilage areas in embryonic limbs developing under excess g in vitro, is reported, as well as delayed skeletal development in embryos and fetuses exposed to excess g in utero. 12.5-day mouse limb buds were cultured at 2.6 g, and fixed at two days and six days of culture. In vivo experiments used alizarin-stained 18-day fetuses exposed to 2.3 g. In all studies, cartilage areas were determined using a digitized tablet. Form factor analysis determined that the main effect of in vitro centrifugation was a reduction in length of the limb elements, probably due to the precocious chondrogenesis seen in the upper regions of centrifuged limbs. Similar reductions in length of ossified areas was seen in the in utero studies.

Effects of community-based virtual reality treadmill training on balance ability in patients with chronic stroke.

PubMed

Kim, Nara; Park, YuHyung; Lee, Byoung-Hee

2015-03-01

[Purpose] We aimed to examine the effectiveness of a community-based virtual reality treadmill training (CVRTT) program on static balance abilities in patients with stroke. [Subjects and Methods] Patients (n = 20) who suffered a stroke at least 6 months prior to the study were recruited. All subjects underwent conventional physical therapy for 60 min/day, 5 days/week, for 4 weeks. Additionally, the CVRTT group underwent community-based virtual reality scene exposure combined with treadmill training for 30 min/day, 3 days/week, for 4 weeks, whereas the control group underwent conventional physical therapy, including muscle strengthening, balance training, and indoor and outdoor gait training, for 30 min/day, 3 days/week, for 4 weeks. Outcome measurements included the anteroposterior, mediolateral, and total postural sway path lengths and speed, which were recorded using the Balancia Software on a Wii Fit(™) balance board. [Results] The postural sway speed and anteroposterior and total postural sway path lengths were significantly decreased in the CVRTT group. Overall, the CVRTT group showed significantly greater improvement than the control group. [Conclusions] The present study results can be used to support the use of CVRTT for effectively improving balance in stroke patients. Moreover, we determined that a CVRTT program for stroke patients is both feasible and suitable.

Healthcare Spending and Performance of Specialty Hospitals: Nationwide Evidence from Colorectal-Anal Specialty Hospitals in South Korea

PubMed Central

Kim, Sun Jung; Lee, Sang Gyu; Kim, Tae Hyun

2015-01-01

Purpose Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government's specialty hospital. Materials and Methods Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed. Results Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges. Conclusion Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out. PMID:26446659

The effect of ethanol vapour exposure on atrial and ventricular walls of chick embryos.

PubMed

Kamran, Kiran; Khan, Muhammad Yunus; Minhas, Liaqat Ali

2016-10-01

To study the effects of ethanol vapour exposure on atrial and ventricular walls of heart in chick embryo. The study design was experimental, conducted at Islamabad Centre of College of Physicians and Surgeons, Pakistan. One hundred and eighty chicken eggs were divided into two groups, experimental and control, of 90 eggs each. Each group was subdivided into three subgroups of 30 eggs each based on the day of sacrifice. Experimental group was exposed to ethanol vapours and then compared with age matched controls. The thickness of atrial and ventricular walls along with lengths of valvular cusps increased in hearts of day 7 and day 10 chick embryos in experimental group. There was thinning of walls and decreased length of valvular cusps in hearts of experimental chicks on hatching as compared to age matched controls. Ethanol vapour exposure during development causes cardiac and septal wall thickening during initial days of development followed by cardiac and septal wall thinning which is a classical picture of alcohol induced cardiomyopathies.

The effects of GnRH analogue (buserelin) or hCG (Chorulon) on Day 12 of pregnancy on ovarian function, plasma hormone concentrations, conceptus growth and placentation in ewes and ewe lambs.

PubMed

Khan, T H; Beck, N F G; Khalid, M

2007-12-01

The objectives of this study were to determine the effect of GnRH analogue (buserelin) or human chorionic gonadotrophin (hCG, Chorulon) treatment on Day 12 of pregnancy on ovarian function, plasma hormone concentrations, conceptus growth and placentation in ewes and ewe lambs. After oestrus synchronization with progestagen sponges and eCG, all the animals were mated with fertile rams. Both ewes and ewe lambs (20 per treatment group) were given either normal saline or 4 microg GnRH or 200 IU hCG on Day 12 post-mating. Pre- and post-treatment plasma hormone concentrations were determined in seven pregnant animals per treatment group in samples collected 1h before and 0, 2, 4, 6, 8, 24, 48 and 72 h after treatment. Overall mean progesterone concentrations were higher (P<0.001) in ewes as compared with ewe lambs in saline-treated controls. GnRH or hCG treatment increased (P<0.001) mean plasma progesterone concentrations in both age groups, however, post-treatment concentrations were significantly (P<0.05) higher in ewes than in ewe lambs. Oestradiol concentrations were similar in the two control groups. In ewes, but not in ewe lambs, both GnRH and hCG treatments significantly (P<0.05) increased the mean oestradiol concentrations above pre-treatment levels. Moreover, post-treatment oestradiol concentrations in GnRH- and hCG-treated animals were significantly (P<0.05) higher than those in the saline-treated controls. LH release in response to GnRH treatment was greater (P<0.05) in ewes than in ewe lambs, whereas FSH release in ewes was less (P<0.05) than that of ewe lambs. The effects of GnRH or hCG on conceptus growth and placentation was determined at slaughter on Day 25. In ewes, GnRH treatment increased (P<0.05) luteal weight, amniotic sac width and length, and crown-rump length compared with controls, but had no effect on these parameters in ewe lambs. In ewes, hCG treatment also enhanced (P<0.05) luteal weight, amniotic sac width and length, crown-rump length, embryo weight and number of placentomes as compared with controls. In ewe lambs, there was no difference (P<0.05) between hCG and control groups in luteal weight, embryo weight and amniotic sac width but crown-rump length, amniotic sac length and the number of placentomes forming the placenta were greater (P<0.05). In conclusion, GnRH or hCG treatment on Day 12 of pregnancy can increase ovarian function, conceptus growth and placental attachment in ewes. However, these treatments were less effective in ewe lambs.

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital.

PubMed

Forster, Alan J; Taljaard, Monica; Oake, Natalie; Wilson, Kumanan; Roth, Virginia; van Walraven, Carl

2012-01-10

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital is not yet fully understood. We determined the independent impact of hospital-acquired infection with C. difficile on length of stay in hospital. We conducted a retrospective observational cohort study of admissions to hospital between July 1, 2002, and Mar. 31, 2009, at a single academic hospital. We measured the association between infection with hospital-acquired C. difficile and time to discharge from hospital using Kaplan-Meier methods and a Cox multivariable proportional hazards regression model. We controlled for baseline risk of death and accounted for C. difficile as a time-varying effect. Hospital-acquired infection with C. difficile was identified in 1393 of 136,877 admissions to hospital (overall risk 1.02%, 95% confidence interval [CI] 0.97%-1.06%). The crude median length of stay in hospital was greater for patients with hospital-acquired C. difficile (34 d) than for those without C. difficile (8 d). Survival analysis showed that hospital-acquired infection with C. difficile increased the median length of stay in hospital by six days. In adjusted analyses, hospital-acquired C. difficile was significantly associated with time to discharge, modified by baseline risk of death and time to acquisition of C. difficile. The hazard ratio for discharge by day 7 among patients with hospital-acquired C. difficile was 0.55 (95% CI 0.39-0.70) for patients in the lowest decile of baseline risk of death and 0.45 (95% CI 0.32-0.58) for those in the highest decile; for discharge by day 28, the corresponding hazard ratios were 0.74 (95% CI 0.60-0.87) and 0.61 (95% CI 0.53-0.68). Hospital-acquired infection with C. difficile significantly prolonged length of stay in hospital independent of baseline risk of death.

A pragmatic implementation of a 6-day physiotherapy service in a mixed inpatient rehabilitation unit.

PubMed

Caruana, Erin L; Kuys, Suzanne S; Clarke, Jane; Bauer, Sandra G

2017-08-01

This study determined the impact of a pragmatic 6-day physiotherapy service on length of stay, functional independence, gait and balance in people undergoing inpatient rehabilitation, compared to a 5-day service. A prospective cohort study with historical comparison was undertaken in a mixed inpatient rehabilitation unit. Intervention period participants (2011) meeting inclusion criteria were eligible for a 6-day physiotherapy service. All other participants, including the historical cohort (2010) received usual care (5-day physiotherapy). Length of stay, functional independence, gait and balance performance were measured. A total of 536 individuals participated in this study; 270 in 2011 (60% received 6-day physiotherapy) and 266 in 2010. Participants in 2011 showed a trend for reduced length of stay (1.7 days, 95%CI -0.53 to 3.92) compared to 2010. Other measures showed no significant differences between cohorts. In 2011, those receiving 6-day physiotherapy were more dependent, but showed significantly improved functional independence and balance compared to those receiving 5-day physiotherapy (p < 0.040) without impacting length of stay. Implementing a 6-day physiotherapy service in a "real-world" rehabilitation setting demonstrated a trend towards reduced length of stay, and improved functional gains. This service could lead to cost-savings for hospitals and improved patient flow. Implications for Rehabilitation "Real-world" implementation of a 6-day physiotherapy service in rehabilitation shows a trend for reducing length of stay. This reduction in length of stay may lead to cost-savings for the hospital system, and improve patient flow into rehabilitation. Patients receiving 6-day physiotherapy made significant gains in balance and functional independence compared to patients receiving 5-day physiotherapy services in the rehabilitation setting.

Ambiguities in the relationship between gonadal steroids and reproduction in axolotls (Ambystoma mexicanum).

PubMed

Eisthen, Heather L; Krause, Brianne Chung

2012-05-01

Axolotls (Ambystoma mexicanum) are aquatic salamanders that are widely used in research. Axolotls have been bred in laboratories for nearly 150 years, yet little is known about the basic biology of reproduction in these animals. We investigated the effects of changing day length, time of year, and food availability on levels of circulating estradiol and androgens in adult female and male axolotls, respectively. In addition, we examined the effects of these variables on the mass of ovaries, oviducts, and eggs in females and on mass of testes in males relative to each individual's body weight, to calculate a form of gonadosomatic index (GSI). In both sexes, GSI was not correlated with levels of circulating steroids. In female axolotls, estradiol levels were influenced by food availability, changes in day length, and season, even when animals were held at a constant temperature and day length was decorrelated with calendar date. In addition, the mass of ovaries, oviducts, and eggs varied seasonally, peaking in the winter months and declining during the summer months, even though our animals were not breeding and shedding eggs. In males, levels of androgens appeared to vary independently of external conditions, but GSI varied dramatically with changes in day length. These results suggest that reproduction in axolotls may vary seasonally, as it does in many other ambystomid species, although both male and female axolotls are capable of reproducing several times each year. The physiological basis of this ability remains enigmatic, given the indications of seasonality contained in our data. Copyright © 2012 Elsevier Inc. All rights reserved.

Lung Biopsies with the Curved Radial Reload™ Stapler.

PubMed

ElSaegh, Mohamed Moneer; Petsa, Afroditi; Dunning, Joel

2016-04-01

We describe our experience at the James Cook University Hospital (UK) in using the curved Radial Reload™ (RR) stapler (Medtronic, Dublin, Ireland) for lung wedge resections, which is an endoscopic stapler used mainly in endoscopic general surgery. A single center experience (James Cook University Hospital) for patients who had superficial or deep video-assisted thoracoscopic surgery (VATS) lung wedge resection, using the curved RR stapler. Seven patients had superficial or deep VATS lung biopsies-their ages ranged from 38 to 75 years, with a median length of hospital stay of two days (one to six days), and a mean length of hospital stay of 2.5 days. No complications were encountered. The curved RR stapler is effective in several situations and allows fewer firing of staplers. Our experience would suggest that they are as haemostatic and pneumostatic as the straight staplers and can be used effectively in both superficial and deep lung biopsies.

The effect of menstruation on psychiatric hospitalization.

PubMed

Weston, Jaclyn; Speroni, Karen Gabel; Ellis, Terri; Daniel, Marlon G

2012-07-01

This study evaluated the effect of menstruation on psychiatric hospitalization. We conducted a retrospective chart review of the medical records of 177 women who met the eligibility criteria. Data collected included demographic details, primary and secondary diagnoses, date of last menstrual period (LMP), medication adherence, psychiatric hospitalization length of stay, previous psychiatric admissions (including those related to menstruation), discharge referrals, and readmissions. The majority of women were admitted for major depression, were single, Caucasian, and had a mean age of 34. A disproportionate percentage (37%) of women had their LMP within 5 days of psychiatric hospitalization (p = 0.0006). The overall average length of stay was 4.37 days, and 48.3% had a previous psychiatric admission. Medication adherence was routinely not documented (77.4%). Psychiatric hospitalizations for women are significantly greater within 5 days of their LMP. Nursing education and improved documentation are warranted to decrease the potential for readmission. Copyright 2012, SLACK Incorporated.

The Role of the Plant Hormone Benzyl Adenine to Promote Growth for the Diatom Thalassiosira pseudonana

NASA Astrophysics Data System (ADS)

Gutierrez Franco, D.; Vernet, M.; Walters, R. J.; Tan, M.

2016-02-01

This study was inspired by the establishment of autoinduction in the model diatom Thalassiosira pseudonana, and the identification of the cytokinin plant hormone benzyl adenine (BA) as a potential autoinducer in this species via comparative genome studies. The effects of a wide range (0.0017518 mg/L-500 mg/L) of concentrations of benzyl adenine on the growth dynamics of T. pseudonana have been explored. The results suggest that a concentration of 5 mg BA/L has the highest positive effect on the growth rate of T. pseudonana batch cultures, compared to the other concentrations tested. Furthermore, concentrations of >100 mg BA/L were lethal. No marked effects on the lag phase length were observed. However, it is possible that some trade-offs between growth rate and lag phase length exist as a result of benzyl adenine. For instance, the BA concentration that exhibited the highest growth rate (5mg BA/L; µ=1.06 d-1) had a negative effect on the lag phase length (6 days), as compared to our control (lag phase length = 5 d; µ=0.81 d-1). On the other hand, at 10 mg BA/L, a slightly smaller growth rate of 1.01 d-1 was observed, with a shorter lag phase length of 4 days, suggesting that benzyl adenine may not have a positive effect on all growth parameters at once. These results provide insight into the physiological and biochemical mechanisms of cell-to-cell communication employed by diatoms, and supports the hypothesis that hormones may play an important role in bloom development.

Prognostic Significance of Creatinine Increases During an Acute Heart Failure Admission in Patients With and Without Residual Congestion: A Post Hoc Analysis of the PROTECT Data.

PubMed

Metra, Marco; Cotter, Gad; Senger, Stefanie; Edwards, Christopher; Cleland, John G; Ponikowski, Piotr; Cursack, Guillermo C; Milo, Olga; Teerlink, John R; Givertz, Michael M; O'Connor, Christopher M; Dittrich, Howard C; Bloomfield, Daniel M; Voors, Adriaan A; Davison, Beth A

2018-05-01

The importance of a serum creatinine increase, traditionally considered worsening renal function (WRF), during admission for acute heart failure has been recently debated, with data suggesting an interaction between congestion and creatinine changes. In post hoc analyses, we analyzed the association of WRF with length of hospital stay, 30-day death or cardiovascular/renal readmission and 90-day mortality in the PROTECT study (Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function). Daily creatinine changes from baseline were categorized as WRF (an increase of 0.3 mg/dL or more) or not. Daily congestion scores were computed by summing scores for orthopnea, edema, and jugular venous pressure. Of the 2033 total patients randomized, 1537 patients had both available at study day 14. Length of hospital stay was longer and 30-day cardiovascular/renal readmission or death more common in patients with WRF. However, these were driven by significant associations in patients with concomitant congestion at the time of assessment of renal function. The mean difference in length of hospital stay because of WRF was 3.51 (95% confidence interval, 1.29-5.73) more days ( P =0.0019), and the hazard ratio for WRF on 30-day death or heart failure hospitalization was 1.49 (95% confidence interval, 1.06-2.09) times higher ( P =0.0205), in significantly congested than nonsignificantly congested patients. A similar trend was observed with 90-day mortality although not statistically significant. In patients admitted for acute heart failure, WRF defined as a creatinine increase of ≥0.3 mg/dL was associated with longer length of hospital stay, and worse 30- and 90-day outcomes. However, effects were largely driven by patients who had residual congestion at the time of renal function assessment. URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458. © 2018 American Heart Association, Inc.

Current Trends in Racial, Ethnic, and Healthcare Disparities Associated with Pediatric Cardiac Surgery Outcomes

PubMed Central

Peterson, Jennifer K.; Chen, Yanjun; Nguyen, Danh V.; Setty, Shaun P.

2017-01-01

Objective Despite overall improvements in congenital heart disease outcomes, racial and ethnic disparities have continued. The purpose of this study is to examine the effect of race and ethnicity, as well as other risk factors on congenital heart surgery length of stay and in-hospital mortality. Design From the 2012 Healthcare Cost and Utilization Project Kids Inpatient Database (KID), we identified 13,130 records with Risk Adjustment in Congenital Heart Surgery complexity score-eligible procedures. Multivariate logistic and linear regression modeling with survey weights, stratification and clustering was used to examine the relationships between predictor variables and length of stay as well as in-hospital mortality. Results No significant mortality differences were found among all race and ethnicity groups across each age group. Black neonates and black infants had a longer length of stay (neonatal Estimate = 8.73 days, p = .0034; infant Estimate 1.10 days, p = 0.0253), relative to whites. Government-sponsored insurance was associated with increased odds of neonatal mortality (odds ratio = 1.51, p = .0055), increased length of stay in neonates (Estimate = 4.26 days, p = .0009) and infants (Estimate = 1.52 days, p = .0181), relative to private insurance. Government-sponsored insurance was associated with increased number of chronic conditions, which were also associated with increased LOS (estimate 8.39 days, p < 0.001 in neonates; estimate 3.60 days, p < 0.001 in infants; estimate 1.87 days, p < 0.001 children). Conclusions Racial/ethnic disparities in congenital heart surgical outcomes may be changing compared to previous studies using the KID database. Increased length of stay in children with government-sponsored insurance may reflect expansion of individual states government-sponsored insurance eligibility criteria for children with complex chronic medical conditions. These findings warrant cautious optimism regarding racial and ethnic disparities in congenital heart surgery outcomes. PMID:28544396

Infant Growth in Length Follows Prolonged Sleep and Increased Naps

PubMed Central

Lampl, Michelle; Johnson, Michael L.

2011-01-01

Study Objectives: The mechanisms underlying infant sleep irregularity are unknown. This study tests the hypothesis that sleep and episodic (saltatory) growth in infant length are temporally coupled processes. Study design: Daily parental diaries continuously recorded sleep onset and awakening for 23 infants (14 females) over 4-17 months (n = 5798 daily records). Multiple model-independent methods compared day-to-day sleep patterns and saltatory length growth. Measurements and Results: Approximate entropy (ApEn) quantified temporal irregularity in infant sleep patterns; breastfeeding and infant sex explained 44% of inter-individual variance (P = 0.001). Random effects mixed-model regression identified that saltatory length growth was associated with increased total daily sleep hours (P < 0.001) and number of sleep bouts (P = 0.001), with breastfeeding, infant sex, and age as covariates. Infant size and illness onset were non-contributory. CLUSTER analysis identified peaks in individual sleep of 4.5 more h and/or 3 more naps per day, compared to intervening intervals, that were non-randomly concordant with saltatory length growth for all individuals (P < 0.05), with a time lag of 0-4 days. Subject-specific probabilities of a growth saltation associated with sleep included a median odds ratio of 1.20 for each additional hour (n = 8, 95% CI 1.15 to 1.29) and 1.43 for each additional sleep bout (n = 12, 95% CI 1.21-2.03). Increased sleep bout duration predicted weight (P < 0.001) and abdominal skinfold accrual (P = 0.05) contingent on length growth, and truncal adiposity independent of growth (P < 0.001). Conclusions: Sleeping and length growth are temporally related biological processes, suggesting an integrated anabolic system. Infant behavioral state changes may reflect biological mechanisms underlying the timing and control of human growth. Citation: Lampl M; Johnson ML. Infant growth in length follows prolonged sleep and increased naps. SLEEP 2011;34(5):641-650. PMID:21532958

The effect of 10 days of intermittent fasting on Wingate anaerobic power and prolonged high-intensity time-to-exhaustion cycling performance.

PubMed

Naharudin, Mohamed Nashrudin Bin; Yusof, Ashril

2018-06-01

Many physically active individuals have undertaken intermittent fasting to reduce their daily caloric intake. However, abstaining from meals for a specific length of time may lead to the acute disturbance of highly carbohydrate-dependent exercise performance. The purpose of this study was to observe the effect of 10 days of intermittent fasting on high-intensity type exercises, Wingate anaerobic (WT) and prolonged high-intensity time-to-exhaustion (HIT) cycling test. Twenty participants were randomised into an intermittent fasting (FAS) and a control group (CON). One day after baseline data collection on Day-0 where participants consumed their recommended daily caloric intake (FAS = 2500 ± 143 kcal day -1 ; CON = 2492 ± 20 kcal day -1 ) served over a course of five meals, the FAS group consumed only four meals where 40% was restricted by the omission of lunch (FAS = 1500 ± 55 kcal day -1 ). This diet was then continued for 10 days. Data on exercise performance and other dependent variables were collected on Day-2, -4, -6, -8 and -10. A reduction in WT power in the FAS group was observed on Day-2 (821.74 ± 66.07 W) compared to Day-0 (847.63 ± 95.94 W) with a moderate effect size (p < .05, ES = 0.4), while HIT time-to-exhaustion performance declined over the 10 days with a trend of recovery from a large to a minimum effect size (p < .05, ES = 0.8-0.3). Body weight and triglyceride were consistently reduced in the FAS group (p < .01). The present study suggests that intermittent fasting must exceed 10 days to ensure that high-intensity performance does not deteriorate because this length of time seems to be required for effective adaptation to the new dietary regimen.

Demarcating Circulation Regimes of Synchronously Rotating Terrestrial Planets within the Habitable Zone

NASA Astrophysics Data System (ADS)

Haqq-Misra, Jacob; Wolf, Eric. T.; Joshi, Manoj; Zhang, Xi; Kopparapu, Ravi Kumar

2018-01-01

We investigate the atmospheric dynamics of terrestrial planets in synchronous rotation within the habitable zone of low-mass stars using the Community Atmosphere Model. The surface temperature contrast between the day and night hemispheres decreases with an increase in incident stellar flux, which is opposite the trend seen in gas giants. We define three dynamical regimes in terms of the equatorial Rossby deformation radius and the Rhines length. The slow rotation regime has a mean zonal circulation that spans from the day to the night sides, which occurs for planets around stars with effective temperatures of 3300–4500 K (rotation period > 20 days), with both the Rossby deformation radius and the Rhines length exceeding the planetary radius. Rapid rotators have a mean zonal circulation that partially spans a hemisphere and with banded cloud formation beneath the substellar point, which occurs for planets orbiting stars with effective temperatures of less than 3000 K (rotation period < 5 days), with the Rossby deformation radius less than the planetary radius. In between is the Rhines rotation regime, which retains a thermally direct circulation from the day side to the night side but also features midlatitude turbulence-driven zonal jets. Rhines rotators occur for planets around stars in the range of 3000–3300 K (rotation period ∼5–20 days), where the Rhines length is greater than the planetary radius but the Rossby deformation radius is less than the planetary radius. The dynamical state can be observationally inferred from a comparison of the morphologies of the thermal emission phase curves of synchronously rotating planets.

Lowering Temperature is the Trigger for Glycogen Build-Up and Winter Fasting in Crucian Carp (Carassius carassius).

PubMed

Varis, Joonas; Haverinen, Jaakko; Vornanen, Matti

2016-02-01

Seasonal changes in physiology of vertebrate animals are triggered by environmental cues including temperature, day-length and oxygen availability. Crucian carp (Carassius carassius) tolerate prolonged anoxia in winter by using several physiological adaptations that are seasonally activated. This study examines which environmental cues are required to trigger physiological adjustments for winter dormancy in crucian carp. To this end, crucian carp were exposed to changing environmental factors under laboratory conditions: effects of declining water temperature, shortening day-length and reduced oxygen availability, separately and in different combinations, were examined on glycogen content and enzyme activities involved in feeding (alkaline phosphatase, AP) and glycogen metabolism (glycogen synthase, GyS; glycogen phosphorylase, GP). Lowering temperature induced a fall in activity of AP and a rise in glycogen content and rate of glycogen synthesis. Relative mass of the liver, and glycogen concentration of liver, muscle and brain increased with lowering temperature. Similarly activity of GyS in muscle and expression of GyS transcripts in brain were up-regulated by lowering temperature. Shortened day-length and oxygen availability had practically no effects on measured variables. We conclude that lowering temperature is the main trigger in preparation for winter anoxia in crucian carp.

Plant resistance to cold stress: mechanisms and environmental signals triggering frost hardening and dehardening.

PubMed

Beck, Erwin H; Heim, Richard; Hansen, Jens

2004-12-01

This introductory overview shows that cold, in particular frost, stresses a plant in manifold ways and that the plant's response, being injurious or adaptive, must be considered a syndrome rather than a single reaction. In the course of the year perennial plants of the temperate climate zones undergo frost hardening in autumn and dehardening in spring. Using Scots pine (Pinus sylvestris L.) as a model plant the environmental signals inducing frost hardening and dehardening, respectively, were investigated. Over 2 years the changes in frost resistance of Scots pine needles were recorded together with the annual courses of day-length and ambient temperature. Both act as environmental signals for frost hardening and dehardening. Climate chamber experiments showed that short day-length as a signal triggering frost hardening could be replaced by irradiation with far red light, while red light inhibited hardening. The involvement of phytochrome as a signal receptor could be corroborated by respective night-break experiments. More rapid frost hardening than by short day or far red treatment was achieved by applying a short period (6 h) of mild frost which did not exceed the plant's cold resistance. Both types of signals were independently effective but the rates of frost hardening were not additive. The maximal rate of hardening was - 0.93 degrees C per day and frost tolerance of less than < - 72 degrees C was achieved. For dehardening, temperature was an even more effective signal than day-length.

Exposure of xenopus laevis tadpoles to cadmium reveals concentration-dependent bimodal effects on growth and monotonic effects on development and thyroid gland activity

USGS Publications Warehouse

Sharma, Bibek; Patino, R.

2008-01-01

Xenopus laevis were exposed to 0-855 ??g cadmium (Cd)/l (measured concentrations) in FETAX medium from fertilization to 47 days postfertilization. Measurements included embryonic survival and, at 47 days, tadpole survival, snout-vent length, tail length, total length, hindlimb length, weight, Nieuwkoop-Faber (NF) stage of development, initiation of metamorphic climax (??? NF 58), and thyroid follicle cell height. Embryonic and larval survival were unaffected by Cd. Relative to control tadpoles, reduced tail and total length were observed at 0.1- 8 and at 855 ??g Cd/l; and reduced snout-vent length, hindlimb length, and weight were observed at 0.1-1 and at 855 ??g Cd/l. Mean stage of development and rate of initiation of climax were unaffected by Cd at 0-84 ??g/l; however, none of the tadpoles exposed to 855 ??g Cd/l progressed beyond mid-premetamorphosis (NF 51). Thyroid glands with fully formed follicles were observed in all tadpoles ??? NF 49 examined. Follicle cell height was unaffected by Cd at 0-84 ??g/l but it was reduced at 855 ??g/l; in the latter, cell height was reduced even when compared with NF 49-51 tadpoles pooled from the 0 to 84 ??g Cd/l groups. In conclusion, (1) Cd affected tadpole growth in a bimodal pattern with the first and second inhibitory modes at concentrations below and above 84 ??g Cd/l, respectively; (2) exposure to high Cd concentrations (855 ??g/l) reduced thyroid activity and arrested tadpole development at mid-premetamorphosis; and (3) unlike its effect on growth, Cd inhibited tadpole development and thyroid function in a seemingly monotonic pattern.

Comparing the Relationship Between Age and Length of Disability Across Common Chronic Conditions

PubMed Central

Jetha, Arif; Besen, Elyssa; Smith, Peter M.

2016-01-01

Objective: The aim of this study was to compare the association between age and disability length across common chronic conditions. Methods: Analysis of 39,915 nonwork-related disability claims with a diagnosis of arthritis, diabetes, hypertension, coronary artery disease, depression, low back pain, chronic pulmonary disease, or cancer. Ordinary least squares regression models examined age-length of disability association across chronic conditions. Results: Arthritis (76.6 days), depression (63.2 days), and cancer (64.9 days) were associated with longest mean disability lengths; hypertension was related to shortest disability lengths (41.5 days). Across chronic conditions, older age was significantly associated with longer work disability. The age–length of disability association was most significant for chronic pulmonary disease and cancer. The relationship between age and length of work disability was linear among most chronic conditions. Conclusions: Work disability prevention strategies should consider both employee age and chronic condition diagnosis. PMID:27164446

Potentiation of glucocorticoid release does not modify the long-term effects of a single exposure to immobilization stress.

PubMed

Dal-Zotto, Silvina; Martí, Octavi; Delgado, Raúl; Armario, Antonio

2004-12-01

Previous work has shown that a single exposure of rats to a severe stressor (immobilization, IMO) results, days to weeks later, in a reduced response (desensitization) of the hypothalamic-pituitary-adrenal (HPA) axis to a second exposure to the same stressor. In the present work, we studied the influence of both length of exposure to IMO and circulating levels of corticosterone on the first day on the degree of desensitization of two sets of physiological variables: HPA hormones and food intake. Rats were given SC saline or ACTH administration and then exposed to IMO for 0, 1 or 20 min. Seven days later, all rats were exposed to 20 min IMO. HPA response was followed on both experimental days by repeated blood sampling and food intake was measured on a 24-h basis. Both ACTH administration and IMO activates the HPA axis and IMO reduced food intake for several days. A single previous experience with IMO enhanced the post-IMO return of HPA hormones to basal levels on day 8 and reduced the degree of anorexia. The protective effect of previous IMO on food intake was independent of, whereas that on HPA activation was positively related to, the length of exposure on day 1. Concomitant ACTH administration on day 1 did not modify the observed effects. Long-term protective effects of a single exposure to IMO are observed even with a brief exposure, but they are not potentiated by increasing corticosterone levels during the first exposure.

The predictive value of quantitative fibronectin testing in combination with cervical length measurement in symptomatic women.

PubMed

Bruijn, Merel M C; Kamphuis, Esme I; Hoesli, Irene M; Martinez de Tejada, Begoña; Loccufier, Anne R; Kühnert, Maritta; Helmer, Hanns; Franz, Marie; Porath, Martina M; Oudijk, Martijn A; Jacquemyn, Yves; Schulzke, Sven M; Vetter, Grit; Hoste, Griet; Vis, Jolande Y; Kok, Marjolein; Mol, Ben W J; van Baaren, Gert-Jan

2016-12-01

The combination of the qualitative fetal fibronectin test and cervical length measurement has a high negative predictive value for preterm birth within 7 days; however, positive prediction is poor. A new bedside quantitative fetal fibronectin test showed potential additional value over the conventional qualitative test, but there is limited evidence on the combination with cervical length measurement. The purpose of this study was to compare quantitative fetal fibronectin and qualitative fetal fibronectin testing in the prediction of spontaneous preterm birth within 7 days in symptomatic women who undergo cervical length measurement. We performed a European multicenter cohort study in 10 perinatal centers in 5 countries. Women between 24 and 34 weeks of gestation with signs of active labor and intact membranes underwent quantitative fibronectin testing and cervical length measurement. We assessed the risk of preterm birth within 7 days in predefined strata based on fibronectin concentration and cervical length. Of 455 women who were included in the study, 48 women (11%) delivered within 7 days. A combination of cervical length and qualitative fibronectin resulted in the identification of 246 women who were at low risk: 164 women with a cervix between 15 and 30 mm and a negative fibronectin test (<50 ng/mL; preterm birth rate, 2%) and 82 women with a cervix at >30 mm (preterm birth rate, 2%). Use of quantitative fibronectin alone resulted in a predicted risk of preterm birth within 7 days that ranged from 2% in the group with the lowest fibronectin level (<10 ng/mL) to 38% in the group with the highest fibronectin level (>500 ng/mL), with similar accuracy as that of the combination of cervical length and qualitative fibronectin. Combining cervical length and quantitative fibronectin resulted in the identification of an additional 19 women at low risk (preterm birth rate, 5%), using a threshold of 10 ng/mL in women with a cervix at <15 mm, and 6 women at high risk (preterm birth rate, 33%) using a threshold of >500 ng/mL in women with a cervix at >30 mm. In women with threatened preterm birth, quantitative fibronectin testing alone performs equal to the combination of cervical length and qualitative fibronectin. Possibly, the combination of quantitative fibronectin testing and cervical length increases this predictive capacity. Cost-effectiveness analysis and the availability of these tests in a local setting should determine the final choice. Copyright © 2016 Elsevier Inc. All rights reserved.

WISE 2005-2006: 60-days of Head-Down Bed Rest Increases the Incidence of Menstrual Cycle Disruption

NASA Astrophysics Data System (ADS)

Wade, Charles

Objective: It has been suggested that acute bed rest of short duration (11 days) disrupts the menstrual cycle of healthy subjects. Furthermore, use of countermeasures such as heavy exercise or dietary manipulations may adversely effect the menstrual cycle. We hypothesized that bed rest of 60 days and the use of countermeasures would increase the incidence of disruption of the menstrual cycle (MC). Methods: Twenty-four healthy subjects with a mean age of 32±0.8 yr, body mass of 59±0.8 kg and MC lengths of 25-32 days were enrolled. Three months prior to the study subjects did not use hormonal birth control methods. Subjects were assigned to one of three groups (n=8 per group): control, exercise countermeasures, and dietary countermeasures. MC lengthening was defined as an increase in duration of 10 or more days. Analysis was performed accounting for the effects of bedrest as well as treatment group. Results: Effects of countermeasures were not significant in the present analysis. After the conclusion of the study, subjects were classified as either normal (N; n=16) or oligomenorrhea (O; n=8) as determined by MC length during the pre-bed rest (PB) and bed rest (BR) periods. During the control period prior to bed rest one subject (4%) had an increase MC length. During the control period the average MC length was 31±0.8 days with a leutinizing hormone (LH) surge 12±0.8 days prior to menses. The duration of menses was 4±0.4 days. During BR there was an increase to 33% (p¡0.05) in the number of subjects having MC lengthening. In these subjects the mean length was increased from 31±0.9 to 62±8.2 days (p¡0.05). There was no change in the period from the LH surge prior to the next menses, 11±0.8 days, or duration of menses, 4±0.2 days. Plasma LH, follicle stimulating hormone (FSH), prolacin (PRL), progesterone (PRG), estradiol (E2), dehydroepiandrosterone sulfate (DHEA-S), aldosterone (Aldo), testosterone (T) and cortisol (C) were measured during PB, BR, early post bed rest (day 0-day 60;EPBR) and late post bed rest (day 60-day 367;LPBR). Plasma PRG was significantly higher (p¡0.02) in the N group before BR and continued throughout the BR period. A significant difference in E2 was observed in the N group between PB and BR, BR and EPBR, and EPBR and LPBR (p¡0.01). E2 was significantly different between N and O during BR (p¡0.02). No differences were observed in the other plasma measurements. Daily urine samples demonstrated no changes in C or Aldo over the course of the study. At 6 and 12 months following completion of the study all subjects reported normal MC. Conclusion: The lengthening of menstrual cycle during bed rest is a result of a delay in ovulation due to the absence of a LH surge (ovulation) associated with lower PRG and E2 levels. In females, changes in menstrual cycles may be a contributing factor to the adverse responses to bed rest such as loss of bone mass, reductions in blood volume and decreased work performance.

Earth rotation and ENSO events: combined excitation of interannual LOD variations by multiscale atmospheric oscillations

NASA Astrophysics Data System (ADS)

Zheng, Dawei; Ding, Xiaoli; Zhou, Yonghong; Chen, Yongqi

2003-03-01

Time series of the length of day characterizing the rate of Earth rotation, the atmospheric angular momentum and the Southern Oscillation Index from 1962 to 2000 are used to reexamine the relationships between the ENSO events and the changes in the length of day, as well as the global atmospheric angular momentum. Particular attention is given to the different effects of the 1982-1983 and 1997-1998 ENSO events on the variations of Earth rotation. The combined effects of multiscale atmospheric oscillations (seasonal, quasi-biennial and ENSO time scales) on the anomalous variations of the interannual rates of Earth rotation are revealed in this paper by studying the wavelet spectra of the data series.

Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies.

PubMed

Chant, Clarence; Smith, Orla M; Marshall, John C; Friedrich, Jan O

2011-05-01

To determine whether catheter-associated urinary tract infections are associated with increased morbidity and mortality in critically ill patients. MEDLINE, HealthStar, EMBASE, and CINAHL databases from inception to June 2010 and bibliographies of included studies without language restriction. Studies reporting mortality or morbidity in adult intensive care unit patients with and without catheter-associated urinary tract infections. Two authors independently selected studies and extracted data on study methodology, quality, and patient outcomes using a standardized form. Meta-analyses were performed using random-effects models. Of 720 citations, 11 studies enrolling 2,745 patients with and 60,719 patients without catheter-associated urinary tract infections met inclusion criteria. Catheter-associated urinary tract infection was associated with a significant increase in mortality (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.72-2.31; p < .00001; I2 = 54%; eight studies; 62,063 patients) and length of stay in the intensive care unit (weighted mean difference of + 12 days; 95% CI, 9-15; p < .00001; I2 = 96%; seven studies; 13,011 patients) and hospital (mean difference + 21 days; 95% CI, 11-32; p < .0001; I2 = 98%; five studies; 10,183 patients). Restricting the analysis only to the two studies that adjusted for other outcome predictors, catheter-associated urinary tract infections were not associated with an increase in mortality (OR, 0.97; 95% CI, 0.82-1.16; p = .77; I2 = 0%; two studies; 5,626 patients). Although both studies individually demonstrated significantly increased intensive care unit length of stay after adjustment, pooled data showed that catheter-associated urinary tract infections were associated with a significant increase in intensive care unit length of stay using only a fixed effects model (mean difference + 2.6 days; 95% CI, 2.3-3.0; p < .00001) and not a random effects model (mean difference + 8 days; 95% CI, -13 to +28 days; p = .46) due to the high degree of heterogeneity for this outcome between the two studies (I2 = 99.6%) which results in a larger CI. Catheter-associated urinary tract infection is associated with significantly increased mortality and length of stay in unmatched studies. Increased mortality and possibly increased length of stay appear to be consequences of confounding by unmeasured variables. These findings highlight the importance of evaluating risks and benefits of commonly used treatments such as antibiotics to manage catheter-associated urinary tract infection.

Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery-a randomized controlled pilot study.

PubMed

Giger, Urs; Büchler, Markus; Farhadi, Jian; Berger, Dieter; Hüsler, Jürg; Schneider, Heinz; Krähenbühl, Stephan; Krähenbühl, Lukas

2007-10-01

Perioperative administration of immunoenriched diets attenuates the perioperative inflammatory response and reduces postoperative infection complications. However, many questions still remain unresolved in this area, such as the length of diet administration, diet composition, and the mechanisms involved. We performed an open, randomized, triple-arm study comparing the effect of two perioperative feeding regimens with a postoperative one. 46 candidates for major elective surgery for malignancy in the upper gastrointestinal tract were randomized to drink preoperatively either 1 L of an immunoenriched formula (Impact) for 5 days (IEF group) or 1 L of Impact plus (Impact enriched with glycine) for 2 days (IEF plus group). The same product as the patient received preoperatively was given to both groups for 7 days postoperatively. In the control group (CON group), patients only received Impact for 7 days postoperatively; there was no preoperative treatment. The main outcome measures were postoperative C-reactive protein (CRP) serum levels. In the two preoperatively supplemented groups (treatment groups), perioperative endotoxin levels, CRP (postoperative day 7), and TNF-alpha (postoperative days 1 and 3) levels were significantly lower compared to the CON group (p < .01). Furthermore, the length of postoperative IMU/ICU stay (Impact 1.9 +/- 1.3 days; Impact plus 2.2 +/- 1.1 days; control group 5.9 +/- 0.8 days) and length of hospital stay (Impact 19.7 +/- 2.3 days; Impact plus 20.1 +/- 1.3 days; control group 29.1 +/- 3.6 days) were both reduced in the treatment groups compared to the control group. Infectious complications (Impact 2/14 (14%); Impact plus 5/17 (29%); control group 10/15 (67%)) also showed a trend toward reduction in the treatment groups. Perioperative administration of an immunoenriched diet significantly reduces systemic perioperative inflammation and postoperative complications in patients undergoing major abdominal cancer surgery, when compared with postoperative diet administration alone. A shortened preoperative feeding regimen of 2 days with Impact enriched with glycine (Impact plus) was as effective as Impact administered for 5 days preoperatively.

Medium- and Long-term Prediction of LOD Change by the Leap-step Autoregressive Model

NASA Astrophysics Data System (ADS)

Wang, Qijie

2015-08-01

The accuracy of medium- and long-term prediction of length of day (LOD) change base on combined least-square and autoregressive (LS+AR) deteriorates gradually. Leap-step autoregressive (LSAR) model can significantly reduce the edge effect of the observation sequence. Especially, LSAR model greatly improves the resolution of signals’ low-frequency components. Therefore, it can improve the efficiency of prediction. In this work, LSAR is used to forecast the LOD change. The LOD series from EOP 08 C04 provided by IERS is modeled by both the LSAR and AR models. The results of the two models are analyzed and compared. When the prediction length is between 10-30 days, the accuracy improvement is less than 10%. When the prediction length amounts to above 30 day, the accuracy improved obviously, with the maximum being around 19%. The results show that the LSAR model has higher prediction accuracy and stability in medium- and long-term prediction.

Change In Length of Stay and Readmissions among Hospitalized Medical Patients after Inpatient Medicine Service Adoption of Mobile Secure Text Messaging.

PubMed

Patel, Mitesh S; Patel, Neha; Small, Dylan S; Rosin, Roy; Rohrbach, Jeffrey I; Stromberg, Nathaniel; Hanson, C William; Asch, David A

2016-08-01

Changes in the medium of communication from paging to mobile secure text messaging may change clinical care, but the effects of these changes on patient outcomes have not been well examined. To evaluate the association between inpatient medicine service adoption of mobile secure text messaging and patient length of stay and readmissions. Observational study. Patients admitted to medicine services at the Hospital of the University of Pennsylvania (intervention site; n = 8995 admissions of 6484 patients) and Penn Presbyterian Medical Center (control site; n = 6799 admissions of 4977 patients) between May 1, 2012, and April 30, 2014. Mobile secure text messaging. Change in length of stay and 30-day readmissions, comparing patients at the intervention site to the control site before (May 1, 2012 to April 30, 2013) and after (May 1, 2013 to April 30, 2014) the intervention, adjusting for time trends and patient demographics, comorbidities, insurance, and disposition. During the pre-intervention period, the mean length of stay ranged from 4.0 to 5.0 days at the control site and from 5.2 to 6.7 days at the intervention site, but trends were similar. In the first month after the intervention, the mean length of stay was unchanged at the control site (4.7 to 4.7 days) but declined at the intervention site (6.0 to 5.4 days). Trends were mostly similar during the rest of the post-intervention period, ranging from 4.4 to 5.6 days at the control site and from 5.4 to 6.5 days at the intervention site. Readmission rates varied significantly within sites before and after the intervention, but overall trends were similar. In adjusted analyses, there was a significant decrease in length of stay for the intervention site relative to the control site during the post-intervention period compared to the pre-intervention period (-0.77 days ; 95 % CI, -1.14, -0.40; P < 0.001). There was no significant difference in the odds of readmission (OR, 0.97; 95 % CI: 0.81, 1.17; P = 0.77). These findings were supported by multiple sensitivity analyses. Compared to a control group over time, hospitalized medical patients on inpatient services whose care providers and staff were offered mobile secure text messaging showed a relative decrease in length of stay and no change in readmissions.

L-Arginine supplementation 0.5% of diet during the last 90 days of gestation and 14 days postpartum reduced uterine fluid accumulation in the broodmare.

PubMed

Mesa, A M; Warren, L K; Sheehan, J M; Kelley, D E; Mortensen, C J

2015-08-01

L-Arginine is an essential amino acid in many species that has been shown to influence reproduction. However, in horses a dose of 1% L-arginine of total dietary intake impaired absorption of other amino acids, whereas a dose of 0.5% did not. The objectives of this experiment were to evaluate postpartum parameters on mares supplemented with 0.5% L-arginine through the last 90d of gestation and 14d postpartum. Sixteen light-horse mares were randomly divided in two groups: 8 mares supplemented with 0.5% L-arginine and 8 mares fed an isonitrogenous equivalent. Gestation length, days to uterine clearance and days to first ovulation were compared. Uterine body depth, diameter of uterine horns, and length of largest pocket of uterine fluid were recorded daily via transrectal ultrasound. Measurements of foal weight, height, and cannon bone circumference were recorded for 9 weeks. Arginine treatment had no effect on gestation length (P=0.58). Supplemented mares cleared fluid quicker postpartum (6.8±0.53d; P=0.026) compared to control (9.0±0.38d). Mares supplemented with L-arginine had smaller diameter of fluid present in the postpartum uterus (P≤0.05). Days to first postpartum ovulation were not affected by treatment nor any influence on uterine involution. Finally, treatment had no effect on any foal's measured parameters. L-Arginine supplementation fed at 0.5% of daily intake during the last 90d of gestation and early postpartum in mares decreased uterine fluid accumulation, yet did not appear to have any effect on any other parameters measured. Copyright © 2015 Elsevier B.V. All rights reserved.

Acquisition session length modulates consolidation effects produced by 5-HT2C ligands in a mouse autoshaping-operant procedure.

PubMed

Walker, Ellen A; Foley, John J

2010-03-01

Although the neurotransmitter, 5-hydroxytryptamine (serotonin, 5-HT), has been implicated as a mediator of learning and memory, the specific role of 5-HT receptors in rodents requires further delineation. In this study, 5-HT2C receptor ligands of varying relative intrinsic efficacies were tested in a mouse learning and memory model called autoshaping-operant. On day 1, mice were placed in experimental chambers and presented with a tone on a variable interval schedule. The tone remained on for 6 s or until a nose-poke response occurred to produce a dipper with Ensure solution. Mice were then injected with saline, MK212 (full agonist), m-chlorophenylpiperazine (partial agonist), mianserin, and SB206 553 (inverse agonists), and methysergide and (+)-2-bromo lysergic acid diethylamide (+)-hydrogen tartrate (neutral antagonists). Each compound was injected after either 1 or 2-h acquisition sessions on day 1 to investigate the role of acquisition session length on consolidation. Day 1 injection of the 5-HT2C inverse agonist mianserin produced greater retrieval impairments of the autoshaped operant response on day 2 than any other agent tested. Furthermore, decreasing the length of the acquisition session to 1h significantly increased the difficulty of the autoshaping task further modulating the consolidation effects produced by the 5-HT2C ligands tested.

Dedicated Orthogeriatric Service Saves the HSE a Million Euro.

PubMed

Shanahan, E; Henderson, C; Butler, A; Lenehan, B; Sheehy, T; Costelloe, A; Carew, S; Peters, C; O'Connor, M; Lyons, D; Ryan, J

2016-04-11

Hip fracture is common in older adults and is associated with high morbidity, mortality and significant health care costs. A pilot orthogeriatrics service was established in an acute hospital. We aimed to establish the cost effectiveness of this service. Length of hospital stay, discharge destination and rehabilitation requirements were analysed for a one year period and compared to patients who received usual care prior to the service. We calculated the costs incurred and savings produced by the orthogeriatric service. Median length of stay was reduced by 3 days (p < 0.001) saving €266,976. There was a 19% reduction in rehabilitation requirements saving €192,600. Median rehabilitation length of stay was reduced by 6.5 days saving €171,093. Reductions in long term care requirements led to savings of €10,934 per week. Costs to establish such a service amount to €171,564. The introduction of this service led to improved patient outcomes in a cost effective manner.

Readmission after spinal cord injury: analysis of an institutional cohort of 795 patients.

PubMed

Yarbrough, Chester K; Gamble, Paul G; Burhan Janjua, Muhammad; Tang, Mengxuan; Ghenbot, Rahel; Zhang, Andrew J; Juknis, Neringa; Hawasli, Ammar H; Kelly, Michael P; Ray, Wilson Z

2018-06-01

Recent studies in other fields have suggested that healthcare on the weekend may have worse outcomes. In particular, patients with stroke and acute cardiovascular events have shown worse outcomes with weekend treatment. It is unclear whether this extends to patients with spinal cord injury. This study was designed to evaluate factors for readmission after index hospitalization for spinal cord injury. A total of 795 consecutive patients over an 11-year period were analyzed. After excluding patients with chronic spinal cord injury and surgical care at an outside hospital, 745 patients remained. The primary outcome measure evaluated was 30-day readmission. Secondary measures include perioperative complications, readmission rate when discharged on the weekend, and the effect of race and insurance status on readmission rate. Univariate and multivariate analysis were utilized to evaluate the covariates collected. The χ2 test, Fisher's exact test, and linear and logistic regression methods were utilized for statistical analysis. A total of 745 patients were analyzed after exclusions. Payer status did not affect length of stay, ICU length of stay, or perioperative complications. Neither weekend admission nor weekend operation affected length of stay, ICU length of stay, or readmission by 30 days. Patients undergoing weekend surgical treatment had lower perioperative complication rates (2.2% vs. 6.5% on weekday, P<0.01). Discharge on the weekend was associated with a significantly lower rate of readmission by 30 days (OR=0.07, 95% CI: 0.009-0.525, P<0.005). Payer status was associated with 30-day readmission (P<0.005). Patients with Medicare (20.8%) and Medicaid (20.1%) showed higher rates of readmission than patients with other payers. 21.1% of African-American patients were readmitted, versus 10.2% of other patients (Odds ratio: 2.2, 95% confidence interval 1.36-3.27, P<0.001). Correcting for payer status lessened but did not eliminate the effect of race on readmission. Weekend admission did not increase perioperative complications or hospital length of stay. After discharge, patients with Medicaid and Medicare show higher rates of 30-day readmission, as do African-American patients. The effect of race on readmission is multifactorial, and may partially explained by the increased rate of Medicaid coverage in African-Americans in our institutions catchment area.

Rapid Clozapine Titration in Patients with Treatment Refractory Schizophrenia.

PubMed

Poyraz, Cana Aksoy; Özdemir, Armağan; Sağlam, Nazife Gamze Usta; Turan, Şenol; Poyraz, Burç Çağrı; Tomruk, Nesrin; Duran, Alaattin

2016-06-01

The aim of this study is to evaluate the safety and effectiveness of rapid clozapine titration in patients with schizophrenia in hospital settings. We conducted a retrospective two-center cohort study to compare the safety and effectiveness of clozapine with different titration rates in treatment-refractory patients with schizophrenia. In the first center, clozapine was started at 25-50 mg followed by 50-100 mg as needed every 6 h on day 1, followed by increases of 50-100 mg/day. In the second center, titration was slower; clozapine initiated with 12.5-50 mg on day 1 followed by increases of 25-50 mg/day. The number of days between starting of clozapine until discharge was shorter in the rapid titration group (22.4 ± 8.72 vs 27.0 ± 10.5, p = 0.1). Number of days of total hospital stay were significantly shorter in the rapid titration group (29.6 ± 10.6 vs 41.2 ± 14.8, p = 0.002). Hypotension was more common in the rapid titration group and one patient had suspected myocarditis. Rapid clozapine titration appeared safe and effective. The length of stay following initiation of clozapine was shorter in the rapid-titration group, although this was not statistically significant. However starting clozapine earlier together with rapid titration has significantly shortened the length of hospital stay in patients with treatment refractory schizophrenia.

Analyze satellite-tracking laser data in order to study satellite ephemerides, solid-Earth and ocean tides and laser system performance

NASA Technical Reports Server (NTRS)

Gaposchkin, E. M.

1981-01-01

The decrease in the semimajor axis of Lageos is considerably larger than expected. Gravitational effects, reference system effects, solar radiation pressure, Earth albedo pressure, neutral atmospheric drag, the Poynting Robertson Effect, and electrodynamic effects were used in explaining the observations. Quick look data provided are used to determine the Earth's polar motion and length of day. This process is routine, and provides these geophysical data every five days.

Short- and long-term effects of clinical pathway on the quality of surgical non-small cell lung cancer care in China: an interrupted time series study.

PubMed

Wang, Xinyu; Su, Shaofei; Jiang, Hao; Wang, Jiaying; Li, Xi; Liu, Meina

2018-05-01

To examine the short- and long-term effect of clinical pathway for non-small cell lung cancer surgery on the length of stay, the compliance of quality indicators and risk-adjusted post-operative complication rate. A retrospective quasi-experimental study from June 2011 to October 2015. A tertiary cancer hospital in China. Patients diagnosed as non-small cell lung cancer who underwent curative resection. Clinical pathway was implemented at January 2013. Hence, the study period was divided into three periods: pre-pathway, from June 2011 to December 2012; short-term period, from January 2013 to December 2013; long-term period, from January 2014 to October 2015. Three length of hospital stay indicators, four process performance indicators and one outcome indicator. ITS showed there was a significant decline of 2 days (P = 0.0421) for total length of stay and 2.23 days (P = 0.0199) for post-operative length of stay right after the implementation of clinical pathway. Short-term level changes were found in the compliance rate of required number of lymph node sampling (-8.08%, P = 0.0392), and risk-adjusted complication rate (9.02%, P = 0.0001). There were no statistically significant changes in other quality of care indicators. The clinical pathway had a positive impact on the length of stay but showed a transient negative effect on complication rate and the quality of lymph node sampling.

Relative importance of prenatal and postnatal androgen action in determining growth of the penis and anogenital distance in the rat before, during and after puberty.

PubMed

van den Driesche, S; Scott, H M; MacLeod, D J; Fisken, M; Walker, M; Sharpe, R M

2011-12-01

Experimental animal studies show that measurement of anogenital distance (AGD) and/or penis length may provide lifelong 'read-outs' of foetal androgen exposure during the masculinization programming window (MPW). However, variation in postnatal androgen exposure may complicate interpretation of such measurements. This is important to clarify if such measurements are to be applied to humans. The present aim was to evaluate effects of prenatal and/or postnatal manipulation of androgen production/action on growth of AGD and the penis in rats. Pregnant rats were treated daily before (e13.5-e21.5) and after birth (postnatal days 1-15) with either vehicle, 500 mg/kg di(n-butyl) phthalate (DBP) or 100 mg/kg flutamide (postnatal only) in prenatal + postnatal treatment combinations (N = 6 treatment combinations); DBP impairs androgen production whereas flutamide impairs androgen action. Male offspring were killed on postnatal day 8 (prepuberty), 25 (early puberty) or 90 (adulthood) when AGD was measured, the penis dissected out and its weight and length measured; plasma testosterone and ventral prostate weight were measured at day 90 to assess endogenous androgen exposure. In controls, penis length, girth and AGD increased 2.2-, 5.3-and 5.9-fold respectively from day 8 to day 90. Significant inhibition of penis growth and final length and girth was induced by treatments that inhibited postnatal androgen action. Conversely, growth and ultimate (adult) AGD was inhibited by prenatal inhibition of androgen production whereas postnatal androgen inhibition had negligible effect. Nevertheless, AGD and penis length were highly correlated at every age (R(2) > 0.33; p < 0.0001). However, altered endogenous androgen exposure may confound interpretation of changes in adults exposed prenatally/postnatally to DBP/flutamide. We conclude that AGD provides a lifelong guide to prenatal androgen exposure (in the MPW) whereas penis size reflects both prenatal + postnatal androgen exposure. At the group treatment level, prepubertal measurement of either AGD or penis size accurately predicts their size in adulthood. © 2011 The Authors. International Journal of Andrology © 2011 European Academy of Andrology.

42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for extended length-of-stay cases (day outliers). 412.82 Section 412.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day...

42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for extended length-of-stay cases (day outliers). 412.82 Section 412.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day...

42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for extended length-of-stay cases (day outliers). 412.82 Section 412.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day...

42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for extended length-of-stay cases (day outliers). 412.82 Section 412.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day...

Population Dynamics of Aphids on Cereals: Digging in the Time-Series Data to Reveal Population Regulation Caused by Temperature

PubMed Central

Brabec, Marek; Honěk, Alois; Pekár, Stano; Martinková, Zdenka

2014-01-01

Aphid populations show periodic fluctuations and many causes are attributed to their dynamic. We investigated the regulation by temperature of the aphid populations composed of Metopolophium dirhodum, Sitobion avenae, and Rhopalosiphum padi on winter wheat using a 24 years long time series data. We computed the sum of daily temperatures above 5°C, the threshold temperature for aphid development, and the sum of daily temperatures within the [0(threshold for wheat development),5] °C interval. Applying Generalised Additive Model framework we tested influences of temperature history expressed via degree days before the start of the aphid immigration on the length of their occurrence. We aimed to estimate the magnitude and direction of this influence, and how far to the past before the start of the aphid season the temperature effect goes and then identify processes responsible for the effect. We fitted four models that differed in the way of correcting for abundance in the previous year and in specification of temperature effects. Abundance in the previous year did not affect the length of period of aphid population growth on wheat. The temperature effect on the period length increased up to 123 days before the start of the current season, i.e. when wheat completed vernalization. Increased sum of daily temperatures above 5°C and the sum of daily temperatures within the [0,5] °C interval both shortened the length of period of aphid population growth. Stronger effect of the latter suggests that wheat can escape from aphid attacks if during winter temperatures range from 0 to 5°C. The temperature influence was not homogeneous in time. The strongest effect of past temperature was about 50 to 80 and 90 to 110 days before the beginning of the current aphid season indicating important role of termination of aphid egg dormancy and egg hatching. PMID:25184219

Scanning electron microscopic studies and growth response of the plants of Helianthus annuus L. grown on tannery sludge amended soil.

PubMed

Singh, Shraddha; Sinha, Sarita

2004-05-01

The plants of Helianthus annuus L. var. modern were grown in the soil amended with different amounts of tannery sludge (10%, 25%, 35%, 50%, 75% and 100%), collected from Wastewater Treatment Plant Jajmau, Kanpur (Uttar Pradesh, India) under field conditions. The effect of tannery sludge amendments was studied on the growth performance of the plant, i.e. root length, shoot length, leaf area and number of leaves after 30, 60 and 90 days of exposures. The root length of the plant increased up to 35% tannery sludge followed by significant (p<0.01) decrease at higher amendments, whereas the shoot length of the plant increased with increase in sludge amendment ratio at all the exposure periods, compared to their respective controls. The number of leaves and leaf area in the plants of H. annuus increased at all the amendments of tannery sludge at initial exposure periods (30 and 60 days); however, it decreased at higher sludge amendments at highest exposure period (90 days) as compared to their respective controls. The analysis of scanning electron micrographs of the leaf surface of H. annuus grown on 50% and 100% tannery sludge after 90 days showed an increase in the frequency of stomata and trichomes, closure of stomata and degeneration of certain cells in the sludge grown plants.

PCB153 reduces telomerase activity and telomere length in immortalized human skin keratinocytes (HaCaT) but not in human foreskin keratinocytes (NFK)

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

Senthilkumar, P.K.; Robertson, L.W.; Department of Occupational and Environmental Health, The University of Iowa, Iowa City, IA

Polychlorinated biphenyls (PCBs), ubiquitous environmental pollutants, are characterized by long term-persistence in the environment, bioaccumulation, and biomagnification in the food chain. Exposure to PCBs may cause various diseases, affecting many cellular processes. Deregulation of the telomerase and the telomere complex leads to several biological disorders. We investigated the hypothesis that PCB153 modulates telomerase activity, telomeres and reactive oxygen species resulting in the deregulation of cell growth. Exponentially growing immortal human skin keratinocytes (HaCaT) and normal human foreskin keratinocytes (NFK) were incubated with PCB153 for 48 and 24 days, respectively, and telomerase activity, telomere length, superoxide level, cell growth, and cellmore » cycle distribution were determined. In HaCaT cells exposure to PCB153 significantly reduced telomerase activity, telomere length, cell growth and increased intracellular superoxide levels from day 6 to day 48, suggesting that superoxide may be one of the factors regulating telomerase activity, telomere length and cell growth compared to untreated control cells. Results with NFK cells showed no shortening of telomere length but reduced cell growth and increased superoxide levels in PCB153-treated cells compared to untreated controls. As expected, basal levels of telomerase activity were almost undetectable, which made a quantitative comparison of treated and control groups impossible. The significant down regulation of telomerase activity and reduction of telomere length by PCB153 in HaCaT cells suggest that any cell type with significant telomerase activity, like stem cells, may be at risk of premature telomere shortening with potential adverse health effects for the affected organism. -- Highlights: ► Human immortal (HaCaT) and primary (NFK) keratinocytes were exposed to PCB153. ► PCB153 significantly reduced telomerase activity and telomere length in HaCaT. ► No effect on telomere length and telomerase activity was found in NFK. ► Increased intracellular superoxide levels and reduced cell growth was seen in both. ► PCB153 may damage telomerase expressing cells like stem cells.« less

Effectiveness of early ureteric stenting for urosepsis associated with urinary tract calculi.

PubMed

Nishiguchi, Sho; Branch, Joel; Suganami, Yu; Kitagawa, Izumi; Tokuda, Yasuharu

2014-01-01

Patients with urosepsis associated with urinary tract calculi occasionally require drainage, primarily via ureteric stenting. Such patients require longer hospitalization. However, the indications for early ureteric stenting for this condition have not been clearly defined. To compare the length of stay (LOS) in the hospital between patients treated with earlier ureteric stenting versus those with delayed ureteric stenting. Design: Retrospective cohort study. Setting: An acute care teaching hospital in Japan. Length of hospital stay in days. Patients Patients with urosepsis associated with urinary tract calculi. Among a total of 30 patients (mean age, 72; 13 men), the mean number of days from emergency room admission to ureteric stenting was 3.5 days (range, 1-14 days), and the overall mean LOS was 36 days (range, 8-102 days). The early stenting group (mean LOS, 21 days) had a significantly shorter LOS than the delayed stenting group (mean LOS, 50 days), with an adjusted beta coefficient of -26 days [95% confidence interval (CI), -46, -6]. In patients with urosepsis associated with urinary tract calculi, performing early stenting within two days of admission may reduce the LOS in the hospital.

The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: randomized controlled trial.

PubMed

Ahn, Ki-Yong; Hur, Hyuk; Kim, Dong-Hyun; Min, Jihee; Jeong, Duck Hyoun; Chu, Sang Hui; Lee, Ji Won; Ligibel, Jennifer A; Meyerhardt, Jeffrey A; Jones, Lee W; Jeon, Justin Y; Kim, Nam Kyu

2013-05-01

This study aimed to examine the effects of a postsurgical, inpatient exercise program on postoperative recovery in operable colon cancer patients We conducted the randomized controlled trial with two arms: postoperative exercise vs. usual care. Patients with stages I-III colon cancer who underwent colectomy between January and December 2011 from the Colorectal Cancer Clinic, were recruited for the study. Subjects in the intervention group participated in the postoperative inpatient exercise program consisted of twice daily exercise, including stretching, core, balance, and low-intensity resistance exercises. The usual care group was not prescribed a structured exercise program. The primary endpoint was the length of hospital stay. Secondary endpoints were time to flatus, time to first liquid diet, anthropometric measurements, and physical function measurements. A total of 31 (86.1 %) patients completed the trial, with adherence to exercise interventions at 84.5 %. The mean length of hospital stay was 7.82 ± 1.07 days in the exercise group compared with 9.86 ± 2.66 days in usual care (mean difference, 2.03 days; 95 % confidence interval (CI), -3.47 to -0.60 days; p = 0.005) in per-protocol analysis. The mean time to flatus was 52.18 ± 21.55 h in the exercise group compared with 71.86 ± 29.2 h in the usual care group (mean difference, 19.69 h; 95 % CI, -38.33 to -1.04 h; p = 0.036). Low-to-moderate-intensity postsurgical exercise reduces length of hospital stay and improves bowel motility after colectomy procedure in patients with stages I-III colon cancer.

In-Kennel Behavior Predicts Length of Stay in Shelter Dogs

PubMed Central

Protopopova, Alexandra; Mehrkam, Lindsay Renee; Boggess, May Meredith; Wynne, Clive David Lawrence

2014-01-01

Previous empirical evaluations of training programs aimed at improving dog adoption rates assume that dogs exhibiting certain behaviors are more adoptable. However, no systematic data are available to indicate that the spontaneous behavior of shelter dogs has an effect on adopter preference. The aim of the present study was to determine whether any behaviors that dogs exhibit spontaneously in the presence of potential adopters were associated with the dogs' length of stay in the shelter. A sample of 289 dogs was videotaped for 1 min daily throughout their stay at a county shelter. To account for differences in adopter behavior, experimenters varied from solitary passive observers to pairs of interactive observers. Dogs behaved more attentively to active observers. To account for adopter preference for morphology, dogs were divided into “morphologically preferred” and “non-preferred” groups. Morphologically preferred dogs were small, long coated, ratters, herders, and lap dogs. No theoretically significant differences in behavior were observed between the two different dog morphologies. When accounting for morphological preference, three behaviors were found to have a significant effect on length of stay in all dogs: leaning or rubbing on the enclosure wall (increased median length of stay by 30 days), facing away from the front of the enclosure (increased by 15 days), and standing (increased by 7 days). When combinations of behaviors were assessed, back and forth motion was found to predict a longer stay (increased by 24 days). No consistent behavioral changes were observed due to time spent at the shelter. These findings will allow shelters to focus behavioral modification efforts only on behaviors likely to influence adopters' choices. PMID:25551460

Photoperiod history differentially impacts reproduction and immune function in adult Siberian hamsters.

PubMed

Prendergast, Brian J; Pyter, Leah M

2009-12-01

Seasonal changes in numerous aspects of mammalian immune function arise as a result of the annual variation in environmental day length (photoperiod), but it is not known if absolute photoperiod or relative change in photoperiod drives these changes. This experiment tested the hypothesis that an individual's history of exposure to day length determines immune responses to ambiguous, intermediate-duration day lengths. Immunological (blood leukocytes, delayed-type hypersensitivity reactions [DTH]), reproductive, and adrenocortical responses were assessed in adult Siberian hamsters (Phodopus sungorus) that had been raised initially in categorically long (15-h light/day; 15L) or short (9L) photoperiods and were subsequently transferred to 1 of 7 cardinal experimental photoperiods between 9L and 15L, inclusive. Initial photoperiod history interacted with contemporary experimental photoperiods to determine reproductive responses: 11L, 12L, and 13L caused gonadal regression in hamsters previously exposed to 15L, but elicited growth in hamsters previously in 9L. In hamsters with a 15L photoperiod history, photoperiods < or = 11L elicited sustained enhancement of DTH responses, whereas in hamsters with a 9L photoperiod history, DTH responses were largely unaffected by increases in day length. Enhancement and suppression of blood leukocyte concentrations occurred at 13L in hamsters with photoperiod histories of 15L and 9L, respectively; however, prior exposure to 9L imparted marked hysteresis effects, which suppressed baseline leukocyte concentrations. Cortisol concentrations were only enhanced in 15L hamsters transferred to 9L and, in common with DTH, were unaffected by photoperiod treatments in hamsters with a 9L photoperiod history. Photoperiod history acquired in adulthood impacts immune responses to photoperiod, but manifests in a markedly dissimilar fashion as compared to the reproductive system. Prior photoperiod exposure has an enduring impact on the ability of the immune system to respond to subsequent changes in day length.

Social support and actual versus expected length of stay in inpatient rehabilitation facilities

PubMed Central

Lewis, Zakkoyya H.; Hay, Catherine Cooper; Graham, James E.; Lin, Yu-Li; Karmarkar, Amol M.; Ottenbacher, Kenneth J.

2016-01-01

Objectives Describe impairment-specific patterns in shorter- and longer-than-expected lengths of stay in inpatient rehabilitation and examine the independent effects of social support on deviations from expected lengths of stay. Design Retrospective cohort study. Setting Inpatient rehabilitation facilities across the United States. Participants Medicare fee-for-service beneficiaries (N=119,437) who were discharged from inpatient rehabilitation facilities in 2012 following stroke, lower extremity fracture, or lower extremity joint replacement. Intervention Not applicable. Main Outcome Measure Relative length of stay (actual – expected). The Centers for Medicare and Medicaid Services posts annual expected lengths of stay based on patients’ clinical profiles at admission. We created a 3-category outcome variable: short, expected, long. Our primary independent variable (social support) also included 3 categories: family/friends, paid/other, none. Results Mean (SD) actual lengths of stay for joint replacement, fracture, and stroke were 9.8 (3.6), 13.8 (4.5), and 15.8 (7.3) days, respectively; relative lengths of stay were −1.2 (3.1), −1.6 (3.7), and −1.7 (5.2) days. Nearly half of patients (47–48%) were discharged more than 1 day earlier than expected in all 3 groups, whereas 14% of joint replacement, 15% of fracture, and 20% of stroke patients were discharged more than 1 day later than expected. In multinomial regression analysis, using family/friends as the reference group, paid/other support was associated (p<.05) with higher odds of long stays in joint replacement. No social support was associated with lower odds of short stays in all 3 impairment groups and higher odds of long stays in fracture and joint replacement. Conclusion Inpatient rehabilitation experiences and outcomes can be substantially impacted by a patient’s level of social support. More research is needed to better understand these relationships and possible unintended consequences in terms of patient access issues and provider-level quality measures. PMID:27373747

Estimating the Length of the North Atlantic Basin Hurricane Season

NASA Technical Reports Server (NTRS)

Wilson, Robert M.

2012-01-01

For the interval 1945-2011, the length of the hurricane season in the North Atlantic basin averages about 130 +/- 42 days (the +/-1 standard deviation interval), having a range of 47 to 235 days. Runs-testing reveals that the annual length of season varies nonrandomly at the 5% level of significance. In particular, its trend, as described using 10-yr moving averages, generally has been upward since about 1979, increasing from about 113 to 157 days (in 2003). Based on annual values, one finds a highly statistically important inverse correlation at the 0.1% level of significance between the length of season and the occurrence of the first storm day of the season. For the 2012 hurricane season, based on the reported first storm day of May 19, 2012 (i.e., DOY = 140), the inferred preferential regression predicts that the length of the current season likely will be about 173 +/- 23 days, suggesting that it will end about November 8 +/- 23 days, with only about a 5% chance that it will end either before about September 23, 2012 or after about December 24, 2012.

Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs.

PubMed

Song, Xiaoyan; Srinivasan, Arjun; Plaut, David; Perl, Trish M

2003-04-01

To determine the impact of vancomycin-resistant enterococcal bacteremia on patient outcomes and costs by assessing mortality, excess length of stay, and charges attributable to it. A population-based, matched, historical cohort study. A 1,025-bed, university-based teaching facility and referral hospital. Two hundred seventy-seven vancomycin-resistant enterococcal bacteremia case-patients and 277 matched control-patients identified between 1993 and 2000. The crude mortality rate was 50.2% and 19.9% for case-patients and control-patients, respectively, yielding a mortality rate of 30.3% attributable to vancomycin-resistant enterococcal bacteremia. The excess length of hospital stay attributable to vancomycin-resistant enterococcal bacteremia was 17 days, of which 12 days were spent in intensive care units. On average, dollars 77,558 in extra charges was attributable to each vancomycin-resistant enterococcal bacteremia. To adjust for severity of illness, 159 pairs of case-patients and control-patients, who had the same severity of illness (All Patient Refined-Diagnosis Related Group complexity level), were further analyzed. When patients were stratified by severity of illness, the crude mortality rate was 50.3% among case-patients compared with 27.7% among control-patients, accounting for an attributable mortality rate of 22.6%. Attributable excess length of stay and charges were 17 days and dollars 81,208, respectively. Vancomycin-resistant enterococcal bacteremia contributes significantly to excess mortality and economic loss, once severity of illness is considered. Efforts to prevent these infections will likely be cost-effective.

Hospital economics of the hospitalist.

PubMed

Gregory, Douglas; Baigelman, Walter; Wilson, Ira B

2003-06-01

To determine the economic impact on the hospital of a hospitalist program and to develop insights into the relative economic importance of variables such as reductions in mean length of stay and cost, improvements in throughput (patients discharged per unit time), payer methods of reimbursement, and the cost of the hospitalist program. The primary data source was Tufts-New England Medical Center in Boston. Patient demographics, utilization, cost, and revenue data were obtained from the hospital's cost accounting system and medical records. The hospitalist admitted and managed all patients during a six-week period on the general medical unit of Tufts-New England Medical Center. Reimbursement, cost, length of stay, and throughput outcomes during this period were contrasted with patients admitted to the unit in the same period in the prior year, in the preceding period, and in the following period. The hospitalist group compared with the control group demonstrated: length of stay reduced to 2.19 days from 3.45 days (p<.001); total hospital costs per admission reduced to 1,775 dollars from 2,332 dollars (p<.001); costs per day increased to 811 dollars from 679 dollars (p<.001); no differences for readmission within 30 days of discharge to extended care facilities. The hospital's expected incremental profitability with the hospitalist was -1.44 dollars per admission excluding incremental throughput effects, and it was most sensitive to changes in the ratio of per diem to case rate reimbursement. Incremental throughput with the hospitalist was estimated at 266 patients annually with an associated incremental profitability of 1.3 million dollars. Hospital interventions designed to reduce length of stay, such as the hospitalist, should be evaluated in terms of cost, throughput, and reimbursement effects. Excluding throughput effects, the hospitalist program was not economically viable due to the influence of per diem reimbursement. Throughput improvements occasioned by the hospitalist program with high baseline occupancy levels are substantial and tend to favor a hospitalist program.

Myopia progression control lens reverses induced myopia in chicks.

PubMed

Irving, Elizabeth L; Yakobchuk-Stanger, Cristina

2017-09-01

To determine whether lens induced myopia in chicks can be reversed or reduced by wearing myopia progression control lenses of the same nominal (central) power but different peripheral designs. Newly hatched chicks wore -10D Conventional lenses unilaterally for 7 days. The myopic chicks were then randomly divided into three groups: one fitted with Type 1 myopia progression control lenses, the second with Type 2 myopia progression control lenses and the third continued to wear Conventional lenses for seven more days. All lenses had -10D central power, but Type 1 and Type 2 lenses had differing peripheral designs; +2.75D and +1.32D power rise at pupil edge, respectively. Axial length and refractive error were measured on Days 0, 7 and 14. Analyses were performed on the mean differences between treated and untreated eyes. Refractive error and axial length differences between treated and untreated eyes were insignificant on Day 0. On Day 7 treated eyes were longer (T1; 0.44 ± 0.07 mm, T2; 0.27 ± 0.06 mm, C; 0.40 ± 0.06 mm) and more myopic (T1; -9.61 ± 0.52D, T2; -9.57 ± 0.61D, C; -9.50 ± 0.58D) than untreated eyes with no significant differences between treatment groups. On Day 14 myopia was reversed (+2.91 ± 1.08D), reduced (-3.83 ± 0.94D) or insignificantly increased (-11.89 ± 0.79D) in treated eyes of Type 1, Type 2 and Conventional treated chicks respectively. Relative changes in axial lengths (T1; -0.13 ± 0.09 mm, T2; 0.36 ± 0.09 mm, C; 0.56 ± 0.05 mm) were consistent with changes in refraction. Refractive error differences were significant for all group comparisons (p < 0.001). Type 1 length differences were significantly different from Conventional and Type 2 groups (p < 0.001). Myopia progression control lens designs can reverse lens-induced myopia in chicks. The effect is primarily due to axial length changes. Different lens designs produce different effects indicating that lens design is important in modifying refractive error. © 2017 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.

Telomeres shorten and then lengthen before fledging in Magellanic penguins (Spheniscus magellanicus)

PubMed Central

Cerchiara, Jack A.; Risques, Rosa Ana; Prunkard, Donna; Smith, Jeffrey R.; Kane, Olivia J.; Dee Boersma, P.

2017-01-01

For all species, finite metabolic resources must be allocated toward three competing systems: maintenance, reproduction, and growth. Telomeres, the nucleoprotein tips of chromosomes, which shorten with age in most species, are correlated with increased survival. Chick growth is energetically costly and is associated with telomere shortening in most species. To assess the change in telomeres in penguin chicks, we quantified change in telomere length of wild known-age Magellanic penguin (Spheniscus magellanicus) chicks every 15 days during the species’ growth period, from hatching to 60 days-of-age. Magellanic penguins continue to grow after fledging so we also sampled a set of 1-year-old juvenile penguins, and adults aged 5 years. Telomeres were significantly shorter on day 15 than on hatch day but returned to their initial length by 30 days old and remained at that length through 60 days of age. The length of telomeres of newly hatched chicks, chicks aged 30, 45 and 60 days, juveniles, and adults aged 5 years were similar. Chicks that fledged and those that died had similar telomere lengths. We show that while telomeres shorten during growth, Magellanic penguins elongate telomeres to their length at hatch, which may increase adult life span and reproductive opportunities. PMID:28186493

Impact of Intraoperative Steroids on Postoperative Infection Rates and Length of Hospital Stay: A Study of 1200 Spine Surgery Patients.

PubMed

Elsamadicy, Aladine A; Wang, Timothy Y; Back, Adam G; Sergesketter, Amanda; Warwick, Hunter; Karikari, Isaac O; Gottfried, Oren N

2016-12-01

The use of intraoperative steroids and their effects are relatively unknown and remain controversial. The aim of this study was to determine the effects of intraoperative steroid use on postoperative complications and length of hospital stay after spine surgery. Medical records of 1200 adult patients undergoing spine surgery at Duke University Medical Center during the period 2008-2010 were retrospectively reviewed; 495 (41.25%) patients were administered intraoperative steroids, and 705 (58.75%) patients were not administered intraoperative steroids. Patient demographics, comorbidities, and postoperative complication rates were collected. The primary outcomes investigated were postoperative complications, specifically length of hospital stay and infection rates. Patient demographics were similar between both cohorts. Comorbidities were also similar, with the intraoperative steroid use cohort having a higher number of patients with long-term steroid use than the no intraoperative steroid use cohort (6.95% [no steroids] vs. 13.74% [steroid use], P < 0.001). Operative variables, including length of operation and median number of fusion levels operated, were also similar between the 2 groups. Lumbar spine was the most common surgical location. Patients who were administered intraoperative steroids had a shorter length of hospital stay by an average of 1 day (6.06 days ± 6.76 [no steroids] vs. 5.04 days ± 4.86 [steroid use], P = 0.0025), lower rates of urinary tract infections (10.37% [no steroids] vs. 6.88% [steroid use], P = 0.040), and lower rates of other infections that were not deep or superficial surgical site infections (9.22% [no steroids] vs. 6.06% [steroid use], P = 0.0460). Patients who receive intraoperative steroids have shorter hospital stays and lower infection rates after spine surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

An audit and feedback system for effective quality improvement in head and neck surgery: Can we become better surgeons?

PubMed

Lewis, Carol M; Monroe, Marcus M; Roberts, Dianna B; Hessel, Amy C; Lai, Stephen Y; Weber, Randal S

2015-05-15

An evaluation system was established for measuring physician performance. This study was designed to determine whether an initial evaluation with surgeon feedback improved subsequent performance. After an evaluation of an initial cohort of procedures (2004-2008), surgeons were given risk-adjusted individual feedback. Procedures in a postfeedback cohort (2009-2010) were then assessed. Both groups were further stratified into high-acuity procedure (HAP) and low-acuity procedure (LAP) groups. Negative performance measures included the length of the perioperative stay (2 days or longer for LAPs and 11 days or longer for HAPs); perioperative blood transfusions; a return to the operating room within 7 days; and readmission, surgical site infections, and mortality within 30 days. There were 2618 procedures in the initial cohort and 1389 procedures in the postfeedback cohort. Factors affecting performance included the surgeon, the procedure's acuity, and patient comorbidities. There were no significant differences in the proportions of LAPs and HAPs or in the prevalence of patient comorbidities between the 2 assessment periods. The mean length of stay significantly decreased for LAPs from 2.1 to 1.5 days (P = .005) and for HAPs from 10.5 to 7 days (P = .003). The incidence of 1 or more negative performance indicators decreased significantly for LAPs from 39.1% to 28.6% (P < .001) and trended downward for HAPs from 60.9% to 53.5% (P = .081). Periodic assessments of performance and outcomes are essential for continual quality improvement. Significant decreases in the length of stay and negative performance indicators were seen after feedback. Therefore, an audit and feedback system may be an effective means of improving quality of care and reducing practice variability within a surgical department. © 2015 American Cancer Society.

Seeking to reduce nonbeneficial treatment in the ICU: an exploratory trial of proactive ethics intervention*.

PubMed

Andereck, William S; McGaughey, J Westly; Schneiderman, Lawrence J; Jonsen, Albert R

2014-04-01

To investigate whether the proactive intervention of a clinical ethicist in cases of prolonged lengths of stay in a critical care setting reduces nonbeneficial treatment while increasing perceived patient/surrogate and provider satisfaction and reducing associated costs. Nonbeneficial treatment is defined here as the use of life-sustaining treatments delivered to patients who had been in the ICU for 5 days and did not survive to discharge. Prospective randomized exploratory trial from October 2007 to February 2010 in the adult ICU of a large, urban, not-for-profit community hospital. Medical/surgical ICU of California Pacific Medical Center, a large tertiary not-for-profit hospital in San Francisco, CA. Three hundred eighty-four patients with ICU lengths of stay of five days or greater. Patients were randomized to either an intervention arm (Proactive Ethics Intervention) (n = 174) or control arm (n = 210). There were 56 patients in the intervention arm and 52 patients in the control arm who did not survive to discharge. Proactive ethics intervention involves a trained bioethicist in the care of all ICU patients with a length of stay greater than or equal to 5 days. The intervention used a nine step process model designed to look for manifest or latent ethics conflicts and address them. The primary outcome measures were days in the ICU; overall length of hospital stay; mortality; nonbeneficial treatments, for example, provision of nutritional support; surrogate and survivor satisfaction, and cost. The intervention and control arms showed no significant difference in mortality. Proactive Ethics Intervention, at the 95% CI, was not associated with reductions of overall length of stay (23 d for intervention and 21 d for control, p = 0.74), ICU days (11 in each arm, p = 0.91), life-sustaining treatments (days on ventilator: intervention, 14.6; control, 13.7; p = 0.74; days receiving artificial nutrition and hydration: intervention, 16.5; control, 15.9; p = 0.85), or cost ($167,350.00 for intervention and $164,670.00 for control, p =0.92) in patients who did not survive to discharge. Perceptions of quality of care by patients and providers showed no difference between intervention and control arms. Our study finds that Proactive Ethics Intervention, provided to all patients in a critical care setting for 5 days, and before an ethical conflict has been recognized, is ineffective in reducing overall length of hospital stay, ICU days, nonbeneficial treatments, or hospital costs. It is also not effective in increasing perceptions of quality of care by patients or providers.

Cardiac surgery productivity and throughput improvements.

PubMed

Lehtonen, Juha-Matti; Kujala, Jaakko; Kouri, Juhani; Hippeläinen, Mikko

2007-01-01

The high variability in cardiac surgery length--is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open-heart surgery operating theatre productivity. A discrete operating theatre event simulation model with empirical operation time input data from 2603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time. A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work. A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open-heart surgery. The challenge in scheduling two open-heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired. A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.

Effects of Space Flight on Neutrophil Functions in Astronauts

NASA Technical Reports Server (NTRS)

Kaur, Indreshpal; Valadez, Victoria A.; Simons, Elizabeth R.; Pierson, Duane L.

2000-01-01

Neutrophil phagocytosis, oxidative burst, degranulation, and the expression of selected surface markers were studied in 25 astronauts following 4 space shuttle missions. Space flight duration ranged from 5 to 11 days. Blood specimens were obtained 10 days before launch, immediately after landing, and again at 3 days after landing. The number of neutrophils increased at landing by 85%. Phagocytosis of Escherichia coli (E. coli) and oxidative burst following the medium length (9 to 11 days) missions were lower than the control mean values. Whereas, following the short-duration (5 days) mission, these functions were unchanged from control values. No consistent changes in degranulation were observed following either short or medium length space missions. The expression of CD16, CD32, CD11a, CD11b, CD11c, L-selectin and CD36 were measured and found to be variable. Specifically, CD16 and CD32 did not correlate with the changes in oxidative burst. Mission duration appears to be a factor in phagocytic and oxidative functions.

Coping and sickness absence

PubMed Central

Schaufeli, Wilmar B.; van Dijk, Frank J. H.; Blonk, Roland W. B.

2007-01-01

Objectives The aim of this study is to examine the role of coping styles in sickness absence. In line with findings that contrast the reactive–passive focused strategies, problem-solving strategies are generally associated with positive results in terms of well-being and overall health outcomes; our hypothesis is that such strategies are positively related to a low frequency of sickness absence and with short lengths (total number of days absent) and durations (mean duration per spell). Methods Using a prospective design, employees’ (N = 3,628) responses on a self-report coping inventory are used to predict future registered sickness absence (i.e. frequency, length, duration, and median time before the onset of a new sick leave period). Results and conclusions In accordance with our hypothesis, and after adjustment for potential confounders, employees with an active problem-solving coping strategy are less likely to drop out because of sickness absence in terms of frequency, length (longer than 14 days), and duration (more than 7 days) of sickness absence. This positive effect is observed in the case of seeking social support only for the duration of sickness absence and in the case of palliative reaction only for the length and frequency of absence. In contrast, an avoidant coping style, representing a reactive–passive strategy, increases the likelihood of frequent absences significantly, as well as the length and duration of sickness absence. Expression of emotions, representing another reactive–passive strategy, has no effect on future sickness absenteeism. The median time before the onset of a new episode of absenteeism is significantly extended for active problem-solving and reduced for avoidance and for a palliative response. The results of the present study support the notion that problem-solving coping and reactive–passive strategies are inextricably connected to frequency, duration, length and onset of sickness absence. Especially, active problem-solving decreases the chance of future sickness absence. PMID:17701200

Coping and sickness absence.

PubMed

van Rhenen, Willem; Schaufeli, Wilmar B; van Dijk, Frank J H; Blonk, Roland W B

2008-02-01

The aim of this study is to examine the role of coping styles in sickness absence. In line with findings that contrast the reactive-passive focused strategies, problem-solving strategies are generally associated with positive results in terms of well-being and overall health outcomes; our hypothesis is that such strategies are positively related to a low frequency of sickness absence and with short lengths (total number of days absent) and durations (mean duration per spell). Using a prospective design, employees' (N = 3,628) responses on a self-report coping inventory are used to predict future registered sickness absence (i.e. frequency, length, duration, and median time before the onset of a new sick leave period). In accordance with our hypothesis, and after adjustment for potential confounders, employees with an active problem-solving coping strategy are less likely to drop out because of sickness absence in terms of frequency, length (longer than 14 days), and duration (more than 7 days) of sickness absence. This positive effect is observed in the case of seeking social support only for the duration of sickness absence and in the case of palliative reaction only for the length and frequency of absence. In contrast, an avoidant coping style, representing a reactive-passive strategy, increases the likelihood of frequent absences significantly, as well as the length and duration of sickness absence. Expression of emotions, representing another reactive-passive strategy, has no effect on future sickness absenteeism. The median time before the onset of a new episode of absenteeism is significantly extended for active problem-solving and reduced for avoidance and for a palliative response. The results of the present study support the notion that problem-solving coping and reactive-passive strategies are inextricably connected to frequency, duration, length and onset of sickness absence. Especially, active problem-solving decreases the chance of future sickness absence.

The role of feeding regimens in the growth of neonate broad-banded water snakes, Nerodia fasciata confluens, and possible effects on reproduction.

PubMed

Scudder, R M; Burghardt, G M

1985-05-01

The effect of different feeding regimens on the growth pattern of Nerodia fasciata confluens was tested using a litter of 18 captive-born neonates. The snakes were divided among three feeding groups: one group fed once per week, another fed twice per week, and the third fed on alternate days. The once per week and the twice per week groups were offered the same weight of food each week, while the alternate-day group was offered food in excess of ingestion levels during each feeding session. The results indicate that there is a shift in the allocation of energy for growth in weight, snout-vent length, and tail length with a change in the feeding regimen. Females were affected more than the males. The results are discussed in relation to their possible effect on reproduction.

Measuring newborn foot length to identify small babies in need of extra care: a cross sectional hospital based study with community follow-up in Tanzania.

PubMed

Marchant, Tanya; Jaribu, Jennie; Penfold, Suzanne; Tanner, Marcel; Armstrong Schellenberg, Joanna

2010-10-19

Neonatal mortality because of low birth weight or prematurity remains high in many developing country settings. This research aimed to estimate the sensitivity and specificity, and the positive and negative predictive values of newborn foot length to identify babies who are low birth weight or premature and in need of extra care in a rural African setting. A cross-sectional study of newborn babies in hospital, with community follow-up on the fifth day of life, was carried out between 13 July and 16 October 2009 in southern Tanzania. Foot length, birth weight and gestational age were estimated on the first day and foot length remeasured on the fifth day of life. In hospital 529 babies were recruited and measured within 24 hours of birth, 183 of whom were also followed-up at home on the fifth day. Day one foot length <7 cm at birth was 75% sensitive (95%CI 36-100) and 99% specific (95%CI 97-99) to identify very small babies (birth weight <1500 grams); foot length <8 cm had sensitivity and specificity of 87% (95%CI 79-94) and 60% (95%CI 55-64) to identify those with low birth weight (<2500 grams), and 93% (95%CI 82-99) and 58% (95%CI 53-62) to identify those born premature (<37 weeks). Mean foot length on the first day was 7.8 cm (standard deviation 0.47); the mean difference between first and fifth day foot lengths was 0.1 cm (standard deviation 0.3): foot length measured on or before the fifth day of life identified more than three-quarters of babies who were born low birth weight. Measurement of newborn foot length for home births in resource poor settings has the potential to be used by birth attendants, community volunteers or parents as a screening tool to identify low birth weight or premature newborns in order that they can receive targeted interventions for improved survival.

Meat quality attributes of Agile Wallabies.

PubMed

Geesink, Geert H; van den Heuvel, Aaron; Hunt, Warren

2017-11-01

Meat quality traits of Agile Wallaby (Macropus agilis) M. longissimus (loin) and M. semimembranosus (topside) were investigated. Both muscles exhibited a relatively high pH (>5.7) and dark colour (L*-, a*-, and b*-values). Aging the loins from 2 to 21days p.m. had a significant effect on shear force. However, the results regarding shear force, myofibrillar fragmentation index (MFI) and degradation of desmin and troponin-T suggested that the aging response largely occurred within 2days p.m. Suspension of carcasses from one leg resulted in a side effect on shear force of the loin at 2 and 7days p.m., but not on sarcomere length or MFI. Topsides from the free hanging leg exhibited lower shear force values (33 vs 42N) and greater sarcomere lengths (2.51 vs 1.84μM). Tenderness, juiciness, flavour and overall liking were higher for loins than topsides. Sensory scores for the loin and topside were slightly lower and similar, respectively, to those reported for lamb. Copyright © 2017 Elsevier Ltd. All rights reserved.

Length of Recovery From Sports-Related Concussions in Pediatric Patients Treated at Concussion Clinics.

PubMed

Thomas, Donald J; Coxe, Kathryn; Li, Hongmei; Pommering, Thomas L; Young, Julie A; Smith, Gary A; Yang, Jingzhen

2018-01-01

We quantified the length of recovery time by week in a cohort of pediatric sports-related concussion patients treated at concussion clinics, and examined patient and injury characteristics associated with prolonged recovery. A retrospective, cohort design. Seven concussion clinics at a Midwest children's hospital. Patients aged 10 to 17 years with a diagnosed sports-related concussion presenting to the clinic within 30 days of injury. Length of recovery by week. Unadjusted and adjusted multinomial logistic regression analyses were used to model the effect of patient and injury characteristics on length of recovery by week. Median length of recovery was 17 days. Only 16.3% (299/1840) of patients recovered within one week, whereas 26.4% took longer than four weeks to recover. By 2 months postinjury, 6.7% of patients were still experiencing symptoms. Higher symptom scores at injury and initial visit were significantly associated with prolonged symptoms by week. Patients who presented to the clinic more than 2 weeks postinjury or who had 2 or more previous concussions showed increased risk for prolonged recovery. Females were at greater risk for prolonged recovery than males (odds ratio = 2.08, 95% confidence interval = 1.49-2.89). Age was not significantly associated with recovery length. High symptom scores at injury and initial visit, time to initial clinical presentation, presence of 2 or more previous concussions, and female sex are associated with prolonged concussion recovery. Further research should aim to establish objective measures of recovery, accounting for treatment received during the recovery. The median length of recovery is 17 days among pediatric sports-related concussion patients treated at concussion clinics. Only 16.3% of patients recovered within one week, whereas 26.4% took longer than 4 weeks to recover.

Prospective evaluation of pain, swelling, and disability from copperhead envenomation.

PubMed

Roth, Brett; Sharma, Kapil; Onisko, Nancy; Chen, Tiffany

2016-03-01

In light of the existing controversy regarding antivenin treatment for copperhead envenomation, a more detailed analysis of the disability from this species is needed. Our objective was to prospectively determine the duration of pain, swelling, and functional disability, i.e., residual venom effects, in patients with copperhead envenomation. Patients with venomous snakebite reported to the North Texas Poison Center between April 2009 and November 2011 were assessed. Patients with confirmed envenomations were contacted by a specialist in poison information. Day zero was the day of the bite and verbal phone consent for study enrollment was obtained at that time. The patient (or their guardian) was contacted by phone daily thereafter, and asked to rate their pain, edema/swelling, and disability using the modified DASH and LEFS scales. Patients were followed to resolution of all symptoms or return to baseline. About 104 cases of venomous snakebite were followed; of which 17 were excluded due to being a dry bites (5) or for having insufficient data during follow-up (11) or due to coagulopathy (1). Overall, residual venom effects from copperhead bites for most patients last between 7 and 13 days. Median time to complete pain resolution was 7 days (mean = 10.7 days). Median length of time to resolution of swelling was 10 days (mean = 13 days) and median length of time to resolution of functional disability was 9 days (mean = 12.2 days). Residual venom effects from copperhead envenomation in this study had a slightly shorter duration than some other studies. Data are skewed due to outliers where residual venom effects lasted for up to 89 days. Initial reoccurrence of some symptoms may be seen. Antivenom (AV) is currently being used for a large percentage of patients with copperhead envenomation. Finally, no differences in duration of venom effects were seen based on age or location of bite. Our study suggests that residual venom effects from copperhead species persist for between 10 and 13 days but may persist for months. Future studies are necessary to identify risk factors for severe/prolonged injury and to define the benefit of AV in patients with copperhead envenomation.

Alkalosis in Critically Ill Patients with Severe Sepsis and Septic Shock

PubMed Central

Jazrawi, Allan; Miller, Jan; Baigi, Amir; Chew, Michelle

2017-01-01

Introduction Although metabolic alkalosis is a common occurrence in intensive care units (ICUs), no study has evaluated its prevalence or outcomes in patients with severe sepsis or septic shock. Methods This is a retrospective cohort study of critically ill patients suffering from severe sepsis and septic shock admitted to the ICUs of Halmstad and Varberg County hospitals. From 910 patient records, 627 patients met the inclusion criteria. We investigated the relationship between metabolic alkalosis and mortality. Further, we studied the relationship between metabolic alkalosis and ICU length of stay (LOS). Results Metabolic alkalosis was associated with decreased 30-day and 12-month mortalities. This effect was however lost when a multivariate analysis was conducted, correcting for age, gender, pH on admission, base excess (BE) on admission, Simplified Acute Physiology Score III (SAPS III) and acute kidney injury (AKI). We then analyzed for any dose-response effect between the severity of metabolic alkalosis and mortality and found no relationship. Bivariate analysis showed that metabolic alkalosis had a significant effect on the length of ICU stay. When adjusting for age, sex, pH at admission, BE at admission, SAPS III and AKI in a multivariate analysis, metabolic alkalosis significantly contributed to prolonged ICU length of stay. In two separate sensitivity analyses pure metabolic alkalosis and late metabolic alkalosis (time of onset >48 hours) were the only significant predictor of increased ICU length of stay. Conclusion Metabolic alkalosis did not have any effect on 30-day and 12-month mortalities after adjusting for age, sex, SAPS III-score, pH and BE on admission and AKI in a multivariate analysis. The presence of metabolic alkalosis was independently associated with an increased ICU length of stay. PMID:28045915

Weather, day length and physical activity in older adults: Cross-sectional results from the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk Cohort.

PubMed

Wu, Yu-Tzu; Luben, Robert; Wareham, Nicholas; Griffin, Simon; Jones, Andy P

2017-01-01

A wide range of environmental factors have been related to active ageing, but few studies have explored the impact of weather and day length on physical activity in older adults. We investigate the cross-sectional association between weather conditions, day length and activity in older adults using a population-based cohort in England, the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk study. Physical activity was measured objectively over 7 days using an accelerometer and this was used to calculate daily total physical activity (counts per minute), daily minutes of sedentary behaviour and light, moderate and vigorous physical activity (LMVPA). Day length and two types of weather conditions, precipitation and temperature, were obtained from a local weather station. The association between these variables and physical activity was examined by multilevel first-order autoregressive modelling. After adjusting for individual factors, short day length and poor weather conditions, including high precipitation and low temperatures, were associated with up to 10% lower average physical activity (p<0.01) and 8 minutes less time spent in LMVPA but 15 minutes more sedentary time, compared to the best conditions. Day length and weather conditions appear to be an important factor related to active ageing. Future work should focus on developing potential interventions to reduce their impact on physical activity behaviours in older adults.

Axial deformity correction in children via distraction osteogenesis.

PubMed

Antoci, Valentin; Ono, Craig M; Antoci, Valentin; Raney, Ellen M

2006-08-01

We performed a retrospective analysis of the results of 62 tibial and 54 femoral lengthenings in 88 consecutive patients. The patients mean age was 13.5 years and mean follow-up was four years. There was a significant difference between metaphyseal (27+/-1.2 days/cm) and diaphyseal (39.4+/-1.7 days/cm), tibial (34+/-1.7 days/cm) and femoral (31+/-1.4 days/cm) lengthening (P<0.05), but no significant difference among the lengthening indexes when treating one-, two-, or three-dimensional deformities, congenital (34+/-2.4 days/cm) and acquired (32+/-1.0 days/cm) limb length discrepancy (LLD) (P>0.05). The lengthening index was 33+/-1.1 days/cm, distraction regenerate length 6+/-0.4 cm, and lengthening percentage 21+/-2.1. The scatter plots of new regenerate length against time and the scatter plots of neurological complication, residual deformities, broken pins, joint contractures, and hypertension rate against lengthening percentage showed a positive linear relationship (r=0.8). We found the correlations between quantitative and qualitative parameters that should help to predict the treatment outcomes. Lengthening index depends on the amount of length gained. Higher length of new bone regenerate leads to a decrease in lengthening index. Expected gain in bone length can aid in estimating the duration of treatment. The lengthening percentage correlates very well with the complication rate and can be used to predict the complication rate.

Lepidium meyenii (Maca) reversed the lead acetate induced -- damage on reproductive function in male rats.

PubMed

Rubio, Julio; Riqueros, Marissa I; Gasco, Manuel; Yucra, Sandra; Miranda, Sara; Gonzales, Gustavo F

2006-07-01

Rats were treated with 0, 8, 16 and 24 mg/kg of lead acetate (LA) (i.p.) for 35 days with or without Maca. Maca was co-administrated orally from day 18 to day 35. The lengths of stages of the seminiferous epithelium were assessed by transillumination. Also, sex organ weights, testicular and epididymal sperm count, sperm motility, daily sperm production, sperm transit rate and serum testosterone levels were measured. Lead acetate treatment resulted in a dose-response reduction of lengths of stages VIII and IX-XI, and serum testosterone levels. However, rats treated with 8 and 16 mg/kg but not 24 mg/kg of lead acetate showed a low number of testicular spermatids, low daily sperm production (DSP) and low epididymal sperm count. Administration of Maca to rats treated with lead acetate resulted in higher lengths of stages VIII and IX-XI with respect to lead acetate-treated rats. Moreover, treatment with Maca to lead acetate-treated rats resulted in lengths of stages VIII and IX-XI similar to the control group. Maca administration also reduced the deleterious effect on DSP caused by lead acetate treatment. Maca prevented LA-induced spermatogenic disruption in rats and it may become in a potential treatment of male infertility associated with lead exposure.

Fertility of the male alpaca: effect of daily consecutive breeding.

PubMed

Bravo, P W; Solis, P; Ordoñez, C; Alarcon, V

1997-04-01

The fertility of the male alpaca under different frequencies of daily consecutive matings was evaluated. Fifteen adult male Huacaya alpacas were divided randomly into three groups of five each to breed lactating female alpacas. The schedule of daily matings was two, four and six consecutive breeding per group and for nine consecutive days. Ovulation was determined by progesterone at seven days after breeding. Pregnancy was determined by ultrasonography at 15 and 30 days after breeding. Two hundred and eighty females were bred with some males not fulfilling their schedule of breeding. There were differences (P < 0.05) in the fertility rate of males breeding two and four times daily (76%) in contrast to 59% for males breeding six times. There were also differences (P < 0.05) in the fertility of individual males. Length of copulation was affected (P < 0.05) by schedule of matings, day of breeding and male. Ovulation was independent of length of copulation. Overall, it seems the fertility of the male alpaca is affected significantly when consecutive matings are over four times a day and for nine consecutive days.

Impact of a critical pathway on postoperative length of stay and outcomes after infrainguinal bypass.

PubMed

Stanley, A C; Barry, M; Scott, T E; LaMorte, W W; Woodson, J; Menzoian, J O

1998-06-01

To determine the effect of a critical pathway on postoperative length of stay and outcomes after infrainguinal bypass. A critical pathway for care of patients after infrainguinal bypass was introduced in December 1995 to coordinate postoperative care at our institution. We compared care of 67 consecutively treated patients before institution of the pathway with care of 69 consecutively treated patients with the critical pathway in place. Data collection was done by means of chart review. Univariate analyses were used to identify differences between prepathway and postpathway patients and to identify factors influencing postoperative length of stay. Multivariate analysis was used to identify factors that influenced length of stay and to examine the effect of use of the pathway after adjusting for other factors. Patients on the pathway were similar to prepathway controls with respect to comorbid illnesses, vascular risk factors, indications for surgical treatment, type of conduit, and type of operation. Factors associated with longer postoperative stays included distal anastomoses to tibial rather than popliteal vessels (p = 0.02), preexisting cardiac disease (p = 0.005), postoperative complications (p = 0.0003), lower preoperative hematocrit (p = 0.01), and elevated preoperative creatinine level (p = 0.006). Overall, pathway patients had somewhat shorter postoperative lengths of stay (median value 7 days; range 2 to 29 days) than prepathway patients (median value 6 days; range 2 to 35; p = 0.01), and the two groups had similar frequencies of postoperative complications, readmission, and 6-month mortality. However, patients on the pathway were more likely to be discharged to an intermediate-care facility rather than directly home. After 12 patients with extraordinarily prolonged postoperative stays were excluded, multivariate analysis indicated that pathway patients had significantly shorter postoperative stays (p = 0.001). However, the difference was not significant if patients with extraordinarily long postoperative stays were included in the analysis (p = 0.28). Use of a critical pathway was associated with a modest decrease in postoperative length of stay for most patients. This was accomplished without an adverse effect on readmission, complication, or mortality rates. However, the decrease in stay may have been achieved primarily by discharging more patients to intermediate-care facilities. The pathway did not appear to have any effect when the subset of patients with extraordinarily long stays because of complex medical problems was included.

The C4 Model Grass Setaria Is a Short Day Plant with Secondary Long Day Genetic Regulation

PubMed Central

Doust, Andrew N.; Mauro-Herrera, Margarita; Hodge, John G.; Stromski, Jessica

2017-01-01

The effect of photoperiod (day:night ratio) on flowering time was investigated in the wild species, Setaria viridis, and in a set of recombinant inbred lines (RILs) derived from a cross between foxtail millet (S. italica) and its wild ancestor green foxtail (S. viridis). Photoperiods totaled 24 h, with three trials of 8:16, 12:12 and 16:8 light:dark hour regimes for the RIL population, and these plus 10:14 and 14:10 for the experiments with S. viridis alone. The response of S. viridis to light intensity as well as photoperiod was assessed by duplicating photoperiods at two light intensities (300 and 600 μmol.m-2.s-1). In general, day lengths longer than 12 h delayed flowering time, although flowering time was also delayed in shorter day-lengths relative to the 12 h trial, even when daily flux in high intensity conditions exceeded that of the low intensity 12 h trial. Cluster analysis showed that the effect of photoperiod on flowering time differed between sets of RILs, with some being almost photoperiod insensitive and others being delayed with respect to the population as a whole in either short (8 or 12 h light) or long (16 h light) photoperiods. QTL results reveal a similar picture, with several major QTL colocalizing between the 8 and 12 h light trials, but with a partially different set of QTL identified in the 16 h trial. Major candidate genes for these QTL include several members of the PEBP protein family that includes Flowering Locus T (FT) homologs such as OsHd3a, OsRFT1, and ZCN8/12. Thus, Setaria is a short day plant (flowering quickest in short day conditions) whose flowering is delayed by long day lengths in a manner consistent with the responses of most other members of the grass family. However, the QTL results suggest that flowering time under long day conditions uses additional genetic pathways to those used under short day conditions. PMID:28729868

The C4 Model Grass Setaria Is a Short Day Plant with Secondary Long Day Genetic Regulation.

PubMed

Doust, Andrew N; Mauro-Herrera, Margarita; Hodge, John G; Stromski, Jessica

2017-01-01

The effect of photoperiod (day:night ratio) on flowering time was investigated in the wild species, Setaria viridis , and in a set of recombinant inbred lines (RILs) derived from a cross between foxtail millet ( S. italica ) and its wild ancestor green foxtail ( S. viridis ). Photoperiods totaled 24 h, with three trials of 8:16, 12:12 and 16:8 light:dark hour regimes for the RIL population, and these plus 10:14 and 14:10 for the experiments with S. viridis alone. The response of S. viridis to light intensity as well as photoperiod was assessed by duplicating photoperiods at two light intensities (300 and 600 μmol.m -2 .s -1 ). In general, day lengths longer than 12 h delayed flowering time, although flowering time was also delayed in shorter day-lengths relative to the 12 h trial, even when daily flux in high intensity conditions exceeded that of the low intensity 12 h trial. Cluster analysis showed that the effect of photoperiod on flowering time differed between sets of RILs, with some being almost photoperiod insensitive and others being delayed with respect to the population as a whole in either short (8 or 12 h light) or long (16 h light) photoperiods. QTL results reveal a similar picture, with several major QTL colocalizing between the 8 and 12 h light trials, but with a partially different set of QTL identified in the 16 h trial. Major candidate genes for these QTL include several members of the PEBP protein family that includes Flowering Locus T (FT) homologs such as OsHd3a, OsRFT1, and ZCN8/12. Thus, Setaria is a short day plant (flowering quickest in short day conditions) whose flowering is delayed by long day lengths in a manner consistent with the responses of most other members of the grass family. However, the QTL results suggest that flowering time under long day conditions uses additional genetic pathways to those used under short day conditions.

Visual plate waste in hospitalized patients: length of stay and diet order.

PubMed

Kandiah, Jay; Stinnett, Lydia; Lutton, Dale

2006-10-01

The purpose of this pilot research was to investigate the effect of diet order, sex, diagnosis, and length of stay on visual lunch plate waste in hospitalized patients. Information on 346 patients was collected using the computer program CBORD Diet Office. Visual plate waste during lunch was measured and analyzed for 4 consecutive days. Neither sex nor diagnosis at admittance was associated with visual plate waste. However, the odds of visual plate waste increased by 14.1% for every day a patient was admitted. In patients receiving a diabetic diet order, odds of visual plate waste decreased by 61.2%, indicating there was reduction in plate waste. Conversely, in patients receiving altered consistency diet orders, odds of visual plate waste increased by 344%, signifying a rise in plate waste. Due to an increase of visual plate waste associated with long length of stay and altered consistency diet orders, registered dietitians working in acute-care facilities need to develop strategies to create cost-effective, nutritionally balanced, altered consistency diets that would enhance patient acceptance and consumption of food.

Efficacy of a high-observation protocol in major head and neck cancer surgery: A prospective study.

PubMed

Barber, Brittany; Harris, Jeffrey; Shillington, Cameron; Rychlik, Shannon; Dort, Joseph; Meier, Michael; Estey, Angela; Elwi, Adam; Wickson, Patty; Buss, Michael; Zygun, David; Ansari, Kal; Biron, Vincent; O'Connell, Daniel; Seikaly, Hadi

2017-08-01

The purpose of this study was to optimize an existing clinical care pathway (CCP) for head and neck cancer with a high-observation protocol (HOP) and to determine the effect on length of intensive care unit (ICU) admission and length of stay in hospital (LOS). The HOP mandated initiation of spontaneous breathing trials before the conclusion of the surgery, weaning of sedation, and limiting mechanical ventilation. All patients with head and neck cancer undergoing primary surgery on the HOP were compared to a historical cohort regarding length of ICU admission, ICU readmissions, and LOS. Ninety-six and 52 patients were observed in "historical" and "HOP" cohorts. The length of ICU admission (1.9 vs 1.2 days; p = .021), LOS (20.3 vs 14.1 days; p = .020), and ICU readmissions (10.4% vs 1.9%; p = .013) were significantly decreased in the "HOP" cohort. Rapid weaning of sedation and limiting mechanical ventilation may contribute to a shorter length of ICU admission and LOS, as well as decreased ICU readmissions. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1689-1695, 2016. © 2017 Wiley Periodicals, Inc.

Estimating length of avian incubation and nestling stages in afrotropical forest birds from interval-censored nest records

USGS Publications Warehouse

Stanley, T.R.; Newmark, W.D.

2010-01-01

In the East Usambara Mountains in northeast Tanzania, research on the effects of forest fragmentation and disturbance on nest survival in understory birds resulted in the accumulation of 1,002 nest records between 2003 and 2008 for 8 poorly studied species. Because information on the length of the incubation and nestling stages in these species is nonexistent or sparse, our objectives in this study were (1) to estimate the length of the incubation and nestling stage and (2) to compute nest survival using these estimates in combination with calculated daily survival probability. Because our data were interval censored, we developed and applied two new statistical methods to estimate stage length. In the 8 species studied, the incubation stage lasted 9.6-21.8 days and the nestling stage 13.9-21.2 days. Combining these results with estimates of daily survival probability, we found that nest survival ranged from 6.0% to 12.5%. We conclude that our methodology for estimating stage lengths from interval-censored nest records is a reasonable and practical approach in the presence of interval-censored data. ?? 2010 The American Ornithologists' Union.

The toxicity and invasive effects of QDs on mung bean development

NASA Astrophysics Data System (ADS)

Zhai, Peng; Wang, Xiaomei; Wang, Ruhua; Huang, Xuan; Feng, Gang; Lin, Guimiao; Chen, Qiang; Xu, Gaixia; Chen, Danni

2014-09-01

Objective: Nowadays, the nanomaterials have been applied in every aspects of our life, including cosmetics, fresh-keeping, antisepsis and medicines. However, we know little about the toxic effects of nanoparticles towards plants. In this thesis, we synthesized quantum dots (QDs), and then toxicity and invasive effects of QDs for mung beans were investigated. Methods: We synthesised red CdTe QDs in water sphase with L-Cystein stabilizers, then prepared different concentration of QDs solution to cultivate mung bean plant, the radical length of mung beans was measured after four days every day, after 7 days, the distribution of QDs in mung bean plant was recorded under the microscopic. Results: The result showed the QDs inhibited the growth of mung beans, the higher the concentration of QDs was, the greater the inhibition effect was. After 7 days, the radicle average lengths of mung beans in different concentrations of QDs solution - blank 0.1μmol/L 0.2μmol/L 0.5 μmol/L 1 μmol/L - were 19.350+/- 0.427, 14.050+/- 0.879, 10.525+/- 0.554, 7.250+/- 0.522, 7.650+/- 0.229. The QDs mostly adhered onto the root surface and hairs. Conclusion: In conclusion, the QDs synthesized with L-cystein have effects on the growth of mung beans. However, it is necessary to do more experiments to confirm the mechanism of the toxicity effect of QDs on plants.

Improved functions and reduced length of stay after inpatient rehabilitation programs in older adults with stroke: A systematic review and meta-analysis of randomized controlled trials.

PubMed

Bindawas, Saad M; Vennu, Vishal; Moftah, Emad

2017-01-01

to examine the effects of inpatient rehabilitation programs on function and length of stay in older adults with strokeMETHODS: A total of five electronic databases were searched for relevant randomized controlled trials that examined the effects of inpatient rehabilitation programs on functional recovery, as measured by the functional independence measure and length of stay, which was measured in days. We included full-text articles written in English, and no time limit. The methodological quality and risk of bias were assessed using the Physiotherapy Evidence Database Scale and the Cochrane collaboration tools respectively. The effect sizes and confidence intervals were estimated using fixed-effect modelsRESULTS: Eight randomized controlled trials involving 1,910 patients with stroke were included in the meta-analysis showed that patients who participated in the inpatient rehabilitation programs had significantly (p less than 0.05) higher functional independence measure scores (effect size = 0.10; 95 percent confidence interval = 0.01, 0.22) and shorter length of stay (effect size = 0.14; 95 percent confidence interval = 0.03, 0.22). This systematic review provided evidence that inpatient rehabilitation programs have beneficial effects, improving functionality and reducing length of stay for older adults with stroke.

Comparison of Procalcitonin Guidance-Administered Antibiotics with Standard Guidelines on Antibiotic Therapy in Children with Lower Respiratory Tract Infections: A Retrospective Study in China

PubMed Central

Wu, Guo; Wu, Gao; Wu, Shuxie; Wu, Hanbin

2017-01-01

Objective To establish the efficacy of an algorithm based on the biomarker procalcitonin (PCT) to reduce antibiotic exposure in pediatric patients with lower respiratory tract infection (LRTI). Materials and Methods The clinical data of 357 patients (<14 years of age) who were discharged home with LRTI from January 1, 2010 to July 31, 2016 were analyzed. Antibiotic exposure, antibiotic prescription rate, length of hospital stay, and antibiotic-associated adverse effects were compared between the PCT group (n = 183) and the standard group (n = 174) using SAS 9.1.3 software. Results The overall adverse effect rates were similar in both the PCT and standard groups: 42 (22.95%) and 51 (29.31%), respectively. The length of hospital stay was not significantly different between the PCT (9.96 ± 5.81 days) and standard groups (10.58 ± 4.24 days) (difference: −0.62%; 95% CI: −1.68 to 0.43). Antibiotic prescribing rates were significantly different in the PCT group compared to the standard group: 54.64% versus 83.91% (difference: −29.26%; 95% CI: −38.31, −20.22; p = 0.23). Mean duration of antibiotic exposure in the PCT group (3.98 ± 2.17 days) was lower than the standard groups (6.66 ± 5.59 days) (difference: −2.68%; 95% CI: −3.21 to −2.16). Conclusion This study showed that PCT guidance of antibiotic treatment in children and adolescents with LRTI reduced the duration of antibiotic exposure and antibiotic prescribing rates, but did not affect the adverse effect rate and length of hospital stay. PMID:28578344

Dexmedetomidine for Refractory Adrenergic Crisis in Familial Dysautonomia

PubMed Central

Dillon, Ryan C.; Palma, Jose-Alberto; Spalink, Christy L.; Altshuler, Diana; Norcliffe-Kaufmann, Lucy; Fridman, David; Papadopoulos, John; Kaufmann, Horacio

2016-01-01

Objective Adrenergic crises are a cardinal feature of familial dysautonomia (FD). Traditionally, adrenergic crisis have been treated with the sympatholytic agent clonidine or with benzodiazepines, which can cause excessive sedation and respiratory depression. Dexmedetomidine is an α2A-adrenergic agonist with greater selectivity and shorter half-life than clonidine. We aimed to evaluate the preliminary effectiveness and safety of intravenous dexmedetomidine in the treatment of refractory adrenergic crisis in patients with FD. Methods Retrospective chart review of patients with genetically confirmed FD who received intravenous dexmedetomidine for refractory adrenergic crises. The primary outcome was preliminary effectiveness of dexmedetomidine defined as change in blood pressure (BP) and heart rate (HR) 1-hour after the initiation of dexmedetomidine. Secondary outcomes included incidence of adverse events related to dexmedetomidine, hospital and intensive care unit (ICU) length of stay, and hemodynamic parameters 12-hours after dexmedetomidine cessation. Results Nine patients over 14 admissions were included in the final analysis. At 1-hour after the initiation of dexmedetomidine, systolic BP decreased from 160±7 to 122±7 mmHg (p=0.0005), diastolic BP decreased from 103±6 to 65±8 (p=0.0003), and HR decreased from 112±4 to 100±5 bpm (p=0.0047). The median total adverse events during dexmedetomidine infusion was 1 per admission. Median hospital length of stay was 9 days (IQR, 3 – 11 days) and median ICU length of stay was 7 days (IQR, 3 – 11 days). Conclusions Intravenous dexmedetomidine is safe in patients with FD and appears to be effective to treat refractory adrenergic crisis. Dexmedetomidine may be considered in FD patients who do not respond to conventional clonidine and benzodiazepine pharmacotherapy. PMID:27752785

Toxic effects of boron on growth and antioxidant system parameters of maize (Zea mays L.) roots.

PubMed

Esim, Nevzat; Tiryaki, Deniz; Karadagoglu, Omer; Atici, Okkes

2013-10-01

The aim of this study was to investigate the possible oxidative stress and the antioxidant response, which were caused on maize by boron (B). For this, 11- and 15-day-old maize seedlings were subjected to 2 or 4 mM B in the form of boric acid (H₃BO₃) for 2 and/or 6 days. At the end of the treatment period, root length, hydrogen peroxide (H₂O₂) content, malondialdehyde (MDA) content and the antioxidant enzymes superoxide dismutase (SOD), peroxidase (POX) and catalase (CAT) were measured. The results revealed that root length of plants, activity of antioxidative enzymes such as SOD, POX and CAT and also H₂O₂ contents and MDA levels were seriously affected by excess B. These results suggested that the oxidative stress occurred due to the toxic effect of B.

Proceedings of the XXVI SLAC Summer Institute on Particle Physics: Gravity from the Hubble Length to the Planck Length

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

Deporcel, Lilian

2001-04-02

The XXVI SLAC Summer Institute on Particle Physics was held from August 3 to August 14, 1998. The topic, ''Gravity--from the Hubble Length to the Planck Length,'' brought together 179 physicists from 13 countries. The lectures in this volume cover the seven-day school portion of the Institute, which took us from the largest scales of the cosmos, to the Planck length at which gravity might be unified with the other forces of nature. Lectures by Robert Wagoner, Clifford Will, and Lynn Cominsky explored the embedding of gravity into general relativity and the confrontation of this idea with experiments in themore » laboratory and astrophysical settings. Avishai Deckel discussed observations and implications of the large-scale structure of the universe, and Tony Tyson presented the gravitational lensing effect and its use in the ongoing search for signatures of the unseen matter of the cosmos. The hunt for the wave nature of gravity was presented by Sam Finn and Peter Saulson, and Joe Polchinski showed us what gravity might look like in the quantum limit at the Planck scale. The lectures were followed by afternoon discussion sessions, where students could further pursue questions and topics with the day's lecturers. The Institute concluded with a three-day topical conference covering recent developments in theory and experiment from around the world of elementary particle physics and cosmology; its proceedings are also presented in this volume.« less

Cool night-time temperatures induce the expression of CONSTANS and FLOWERING LOCUS T to regulate flowering in Arabidopsis.

PubMed

Kinmonth-Schultz, Hannah A; Tong, Xinran; Lee, Jae; Song, Young Hun; Ito, Shogo; Kim, Soo-Hyung; Imaizumi, Takato

2016-07-01

Day length and ambient temperature are major stimuli controlling flowering time. To understand flowering mechanisms in more natural conditions, we explored the effect of daily light and temperature changes on Arabidopsis thaliana. Seedlings were exposed to different day/night temperature and day-length treatments to assess expression changes in flowering genes. Cooler temperature treatments increased CONSTANS (CO) transcript levels at night. Night-time CO induction was diminished in flowering bhlh (fbh)-quadruple mutants. FLOWERING LOCUS T (FT) transcript levels were reduced at dusk, but increased at the end of cooler nights. The dusk suppression, which was alleviated in short vegetative phase (svp) mutants, occurred particularly in younger seedlings, whereas the increase during the night continued over 2 wk. Cooler temperature treatments altered the levels of FLOWERING LOCUS M-β (FLM-β) and FLM-δ splice variants. FT levels correlated strongly with flowering time across treatments. Day/night temperature changes modulate photoperiodic flowering by changing FT accumulation patterns. Cooler night-time temperatures enhance FLOWERING BHLH (FBH)-dependent induction of CO and consequently increase CO protein. When plants are young, cooler temperatures suppress FT at dusk through SHORT VEGETATIVE PHASE (SVP) function, perhaps to suppress precocious flowering. Our results suggest day length and diurnal temperature changes combine to modulate FT and flowering time. © 2016 The Authors. New Phytologist © 2016 New Phytologist Trust.

Pavlovian conditioning of psychomotor stimulant-induced behaviours: has convenience led us astray?

PubMed

Martin-Iverson, M.T.; Fawcett, S.L.

1996-01-01

In order to classically condition the behavioural effects of psychomotor stimulants within a test context, rats were treated for 10 days with (+)-amphetamine (1.5mg/kg), (+)-4-propyl-9-hydroxynaphthoxazine (PHNO, 30µg/kg) or vehicle prior to a 1h placement into a test box. Conditioned behavioural effects were then measured in the previously drug-paired context after a vehicle injection (drug-free test day). Each rat was videotaped for the 1h test box exposure on days 1, 4, 7 and 10 of the drug conditioning trials, and on the drug-free test day. Eleven of 28 behaviours that were scored for frequency, duration and mean bout duration (bout length) were significantly influenced by at least one of the two drugs. Amphetamine predominantly increased bout lengths while PHNO predominantly increased bout frequency. Only two measures that were influenced by the drugs exhibited clear increases over controls in a manner consistent with a classical conditioning interpretation. Behavioural sensitization clearly occurred to some of the effects of amphetamine and PHNO, but these were not the same effects as those increased on the non-drug day testing for classical conditioning. Most behavioural effects of amphetamine and PHNO are not classically conditioned, and behavioural sensitization to these drugs, while perhaps context-specific, is not due to classical conditioning. Automated measures of behaviours have provided misleading evidence concerning the similarity among behavioural effects of stimulants, sensitization and effects of exposure to an environment previously paired with stimulants. Analysis of transitions between behaviours does not support the view that stimulants increase switching or response competition, or that behavioural reorganization is responsible for sensitization. Rather, it is suggested that stimulants selectively facilitate current stimulus-guided behaviours.

The Effect of Calf Gender on Milk Production in Seasonal Calving Cows and Its Impact on Genetic Evaluations

PubMed Central

Hess, Melanie K.; Hess, Andrew S.; Garrick, Dorian J.

2016-01-01

Gender of the calf whose birth initiates lactation could influence whole lactation milk yield of the dam due to hormonal influences on mammary gland development, or through calf gender effects on gestation length. Fetal gender could influence late lactation yields because cows become pregnant at peak lactation. The effects of calf gender sequences in parities 1–3 were assessed by separately fitting animal models to datasets from New Zealand comprising 274 000 Holstein Friesian and 85 000 Jersey cows, decreasing to 12 000 and 4 000 cows by parity 3. The lactation initiated by the birth of a female rather than a male calf was associated with a 0.33–1.1% (p≤0.05) higher milk yield. Female calf gender had carryover effects associated with higher milk yield in second lactations for Holstein Friesians (0.24%; p = 0.01) and third lactations for Jerseys (1.1%; p = 0.01). Cows giving birth to bull calves have 2 day longer gestations, which reduces lactation length in seasonal calving herds. Adding a covariate for lactation length to the animal model eroded some of these calf gender effects, such that calving a female led to higher milk yield only for second lactation Holstein Friesians (1.6%; p = 0.002). The interval centering method generates lower estimates of whole lactation yield when Wood’s lactation curves are shifted to the right by 2 days for male calves and this explained the higher yield in female calves when differences in lactation length were considered. Correlations of estimated breeding values between models including or excluding calf gender sequence were 1.00 for bulls or cows. Calf gender primarily influences milk yield through increased gestation length of male calves, and bias associated with the interval centering method used to estimate whole lactation milk yields. Including information on calf gender is unlikely to have an effect on selection response in New Zealand dairy cattle. PMID:26974166

The effects of consecutive night shifts and shift length on cognitive performance and sleepiness: a field study.

PubMed

Haidarimoghadam, Rashid; Kazemi, Reza; Motamedzadeh, Majid; Golmohamadi, Rostam; Soltanian, Alireza; Zoghipaydar, Mohamad Reza

2017-06-01

The aim of this study was to evaluate the effects of consecutive night shifts (CNS) and shift length on cognitive performance and sleepiness. This study evaluated the sleepiness and performance of 30 control room operators (CROs) working in 7 nights, 7 days, 7 days off (7N7D7O) and 30 CROs working in 4 nights, 7 days, 3 nights, 7 days off (4N7D3N7O) shift patterns in a petrochemical complex on the last night shift before swinging into the day shift. To assess cognitive performance, the n-back test, continuous performance test and simple reaction time test were employed. To assess sleepiness, the Karolinska sleepiness scale was used. Both schedules indicated that the correct responses and response times of working memory were reduced (p = 0.001), while intentional errors and sleepiness increased during the shift work (p = 0.001). CNS had a significant impact on reaction time and commission errors (p = 0.001). The main duty of CROs at a petrochemical plant is checking hazardous processes which require appropriate alertness and cognitive performance. As a result, planning for appropriate working hours and suitable number of CNS in a rotating shift system is a contribution to improving CRO performance and enhancing safety.

Anesthetic Sevoflurane Causes Rho-Dependent Filopodial Shortening in Mouse Neurons.

PubMed

Zimering, Jeffrey H; Dong, Yuanlin; Fang, Fang; Huang, Lining; Zhang, Yiying; Xie, Zhongcong

2016-01-01

Early postnatal anesthesia causes long-lasting learning and memory impairment in rodents, however, evidence for a specific neurotoxic effect on early synaptogenesis has not been demonstrated. Drebrin A is an actin binding protein whose localization in dendritic protrusions serves an important role in dendritic spine morphogenesis, and is a marker for early synaptogenesis. We therefore set out to investigate whether clinically-relevant concentrations of anesthetic sevoflurane, widely- used in infants and children, alters dendritic morphology in cultured fetal day 16 mouse hippocampal neurons. After 7 days in vitro, mouse hippocampal neurons were exposed to four hours of 3% sevoflurane in 95% air/5% CO2 or control condition (95% air/5% CO2). Neurons were fixed in 4% paraformaldehyde and stained with Alexa Fluor555-Phalloidin, and/or rabbit anti-mouse drebrin A/E antibodies which permitted subcellular localization of filamentous (F)-actin and/or drebrin immunoreactivity, respectively. Sevoflurane caused acute significant length-shortening in filopodia and thin dendritic spines in days-in-vitro 7 neurons, an effect which was completely rescued by co-incubating neurons with ten micromolar concentrations of the selective Rho kinase inhibitor Y27632. Filopodia and thin spine recovered in length two days after sevoflurane exposure. Yet cluster-type filopodia (a precursor to synaptic filopodia) were persistently significantly decreased in number on day-in-vitro 9, in part owing to preferential localization of drebrin immunoreactivity to dendritic shafts versus filopodial stalks. These data suggest that sevoflurane induces F-actin depolymerization leading to acute, reversible length-shortening in dendritic protrusions through a mechanism involving (in part) activation of RhoA/Rho kinase signaling and impairs localization of drebrin A to filopodia required for early excitatory synapse formation.

Use of Adult Day Care Centers: Do They Offset Utilization of Health Care Services?

ERIC Educational Resources Information Center

Iecovich, Esther; Biderman, Aya

2013-01-01

Purpose: Based on the medical offset effect, the goal of the study was to examine the extent to which users and nonusers of adult day care centers (ADCC) differ in frequency of use of out-patient health services (visits to specialists) and in-patient health services (number of hospital admissions, length of hospitalizations, and visits to…

Discussion of Yellow Starthistle Response to Irradiance, Photoperiod, and CO2

NASA Technical Reports Server (NTRS)

Bubenheim, David L.

2016-01-01

Yellow Starthistle (Centaurea solstitialis) is a native annual weed of Eurasia and since introduction into the US has become an invasive and noxious weed. It grows in a rosette habit during the vegetative state and usually bolts in summer to produce a large and branched flowering stem. Time to flowering in Yellow Starthistle has been attributed to photoperiod, nitrogen nutrition, temperature, and water stress. We executed a series of studies to investigate the role of light, both photoperiod and photosynthetic photon flux, on flowering and development in Yellow Starthistle. Treatments were presented in 4 ways: (1) Varying day length with constant photosynthetic photon flus (PPF) - providing increasing daily integrated Photosynthetic Photon (PP) exposure with longer day lengths, (2) Varying day length while adjusting PPF to maintain daily PP exposure for all treatments, (3) Extending photoperiod treatments beyond common 12-h photosynthetic period with low light levels to maintain both PPF and daily PP across all treatments; and (4) Reciprocal exchange of plant among photoperiod treatments. Yellow Starthistle appears to be a long-day plant with a critical day length requirement between 14-h and 16-h to induce transition from vegetative to floral stages in development. PPF and daily absorbed photons did not affect time to vegetative / floral stage transition, but did affect factors such as biomass accumulation and canopy parameters such as specific leaf mass. Reciprocal exchange of plants between floral inducing and inhibiting photoperiod treatments, starting at 2-weeks post germination, had no effect on to flower. Flowering was determined by photoperiod experienced during the first 2-weeks (or less) post germination. Yellow Starthistle net photosynthetic response to elevated atmospheric CO2 concentrations over a range of photosynthetically active radiation flux rates and temperatures will also be presented and discussed.

Discussion of Yellow Starthistle Response to Photosynthetic Irradiance, Photoperiod, and CO2

NASA Technical Reports Server (NTRS)

Bubenheim, David

2017-01-01

Yellow Starthistle (Centaurea solstitialis) is a native annual weed of Eurasia and since introduction into the United STates has become an invasive and noxious weed. It grows in a rosette habit during the vegetative state and usually bolts in summer to produce a large and branched flowering stem. Time to flowering in Yellow Starthistle has been attributed to photoperiod, nitrogen nutrition, temperature, and water stress. We executed a series of studies to investigate the role of light, both photoperiod and photosynthetic photon flux, on flowering and development in Yellow Starthistle. Treatments were presented in 4 ways: 1) varying day length with constant photosynthetic photon flus (PPF) providing increasing daily integrated Photosynthetic Photon (PP) exposure with longer day lengths 2) varying day length while adjusting PPF to maintain daily PP exposure for all treatments 3) extending photoperiod treatments beyond common 12-h photosynthetic period with low light levels to maintain both PPF and daily PP across all treatments4)reciprocal exchange of plant among photoperiod treatments Yellow Starthistle appears to be a long-day plant with a critical day length requirement between 14-h and 16-h to induce transition from vegetative to floral stages in development. PPF and daily absorbed photons did not affect time to vegetative floral stage transition, but did affect factors such as biomass accumulation and canopy parameters such as specific leaf mass. Reciprocal exchange of plants between floral inducing and inhibiting photoperiod treatments, starting at 2-weeks post germination, had no effect on to flower. Flowering was determined by photoperiod experienced during the first 2-weeks (or less) post germination.Yellow Starthistle net photosynthetic response to elevated atmospheric CO2 concentrations over a range of photosynthetically active radiation flux rates and temperatures will also be presented and discussed.

Impact of operative length on post-operative complications in meningioma surgery: a NSQIP analysis.

PubMed

Karhade, Aditya V; Fandino, Luis; Gupta, Saksham; Cote, David J; Iorgulescu, Julian B; Broekman, Marike L; Aglio, Linda S; Dunn, Ian F; Smith, Timothy R

2017-01-01

Many studies have implicated operative length as a predictor of post-operative complications, including venous thromboembolism [deep vein thrombosis (DVT) and pulmonary embolism (PE)]. We analyzed the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2014, to evaluate whether length of operation had a statistically significant effect on post-operative complications in patients undergoing surgical resection of meningioma. Patients were included for this study if they had a post-operative diagnosis of meningioma. Patient demographics, pre-operative comorbidities, and post-operative 30-day complications were analyzed. Of 3743 patients undergoing craniotomy for meningioma, 13.6 % experienced any complication. The most common complications and their median time to occurrence were urinary tract infection (2.6 %) at 10 days postoperatively (IQR 7-15), unplanned intubation (2.5 %) at 3 days (IQR 1-7), failure to wean from ventilator (2.4 %) at 2.0 days (IQR 2-4), and DVT (2.4 %) at 6 days (IQR 11-19). Postoperatively, 3.6 % developed VTE; 2.4 % developed DVT and 1.7 % developed PE. Multivariable analysis identified older age (third and upper quartile), obesity, preoperative ventilator dependence, preoperative steroid use, anemia, and longer operative time as significant risk factors for VTE. Separate multivariable logistic regression models demonstrated longer operative time as a significant risk factor for VTE, all complications, major complications, and minor complications. Meningioma resection is associated with various post-operative complications that increase patient morbidity and mortality risk. this large, multi-institutional patient sample, longer operative length was associated with increased risk for postoperative venous thromboembolisms, as well as major and minor complications.

The effect of photoperiod on life history and blood-feeding activity in Aedes albopictus and Aedes aegypti (Diptera: Culicidae).

PubMed

Costanzo, K S; Schelble, S; Jerz, K; Keenan, M

2015-06-01

Several studies have examined how climatic variables such as temperature and precipitation may affect life history traits in mosquitoes that are important to disease transmission. Despite its importance as a seasonal cue in nature, studies investigating the influence of photoperiod on such traits are relatively few. This study aims to investigate how photoperiod alters life history traits, survival, and blood-feeding activity in Aedes albopictus (Skuse) and Aedes aegypti (Linnaeus). We performed three experiments that tested the effects of day length on female survival, development time, adult size, fecundity, adult life span, and propensity to blood feed in Ae. albopictus and Ae. aegypti. Each experiment had three photoperiod treatments: 1) short-day (10L:14D), 2) control (12L:12D), and 3) long-day (14L:10D). Aedes albopictus adult females were consistently larger in size when reared in short-day conditions. Aedes aegypti adult females from short-day treatments lived longer and were more likely to take a blood meal compared to other treatments. We discuss how species-specific responses may reflect alternative strategies evolved to increase survival during unfavorable conditions. We review the potential impacts of these responses on seasonal transmission patterns, such as potentially increasing vectorial capacity of Ae. aegypti during periods of shorter day lengths. © 2015 The Society for Vector Ecology.

Weather, day length and physical activity in older adults: Cross-sectional results from the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk Cohort

PubMed Central

Wu, Yu-Tzu; Luben, Robert; Wareham, Nicholas; Griffin, Simon; Jones, Andy P.

2017-01-01

Background A wide range of environmental factors have been related to active ageing, but few studies have explored the impact of weather and day length on physical activity in older adults. We investigate the cross-sectional association between weather conditions, day length and activity in older adults using a population-based cohort in England, the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk study. Methods Physical activity was measured objectively over 7 days using an accelerometer and this was used to calculate daily total physical activity (counts per minute), daily minutes of sedentary behaviour and light, moderate and vigorous physical activity (LMVPA). Day length and two types of weather conditions, precipitation and temperature, were obtained from a local weather station. The association between these variables and physical activity was examined by multilevel first-order autoregressive modelling. Results After adjusting for individual factors, short day length and poor weather conditions, including high precipitation and low temperatures, were associated with up to 10% lower average physical activity (p<0.01) and 8 minutes less time spent in LMVPA but 15 minutes more sedentary time, compared to the best conditions. Conclusion Day length and weather conditions appear to be an important factor related to active ageing. Future work should focus on developing potential interventions to reduce their impact on physical activity behaviours in older adults. PMID:28562613

Chest tube management following pulmonary lobectomy: change of protocol results in fewer air leaks.

PubMed

Bertholet, Joost W M; Joosten, Joris J A; Keemers-Gels, Mariël E; van den Wildenberg, Frits J H; Barendregt, Wouter B

2011-01-01

Much controversy exists regarding the management of chest tubes following pulmonary lobectomy. The objective of this study was to analyse the effect of a new chest tube management protocol on clinical features, such as postoperative air leak, drain characteristics, 30-day postoperative complications and length of hospital stay. We retrospectively analysed 133 patients who underwent pulmonary lobectomy, from January 2005 to December 2008. A new chest tube protocol was introduced on 1 January 2007 and included placement of a single chest tube and early conversion to water seal. The chest tube was removed when air leak had resolved and (non-chylous) fluid drainage was <400 ml/day. The results of patients in the old (n=68) and the new protocol (n=65) were compared. In the new protocol group the median duration of air leak and duration of chest tube drainage declined significantly. Also the length of hospital stay decreased significantly to a median of eight days. The number of reinterventions and 30-day morbidity and mortality rates did not differ significantly. Our data suggest that placement of a single chest tube and early conversion to water seal decreases the duration of air leak and chest tube drainage and length of hospital stay.

Artificially extended photoperiod administered to pre-partum mares via blue light to a single eye: Observations on gestation length, foal birth weight and foal hair coat at birth.

PubMed

Nolan, Margaret B; Walsh, Caroline M; Duff, Noelle; McCrarren, Conor; Prendergast, Ralph L; Murphy, Barbara A

2017-09-15

In seasonally breeding animals, photoperiod perception is crucial for timing of important physiological events. In the horse, long day photoperiod influences the onset of ovulation and cyclicity, shedding of the heavier winter coat and the timing of parturition. In this compilation of studies, conducted across three breeding seasons and two countries, the impact of artificially extended day length was investigated on gestation length, foal birth weight and foal hair coat at birth. The light therapy was administered to pre-partum mares via mobile head worn masks which provided short wavelength blue light to a single eye. In Study 1, reductions in gestation lengths were observed following administration of artificially extended day length (124.8 ± 15.11 days) in the final months of pregnancy to a group of Thoroughbred mares compared to controls (P < 0.05; 339.7 ± 9.56 days vs 350.6 ± 9.13). Study 2 revealed that pre-partum exposure to artificially extended day length (104.6 ± 9.89 days) increased foal birth weight compared to controls (47.13 ± 2.93 kg vs 43.51 ± 6.14 kg; P < 0.05) in mares bred early in the year. In Study 3, artificially extended day length (87.53 ± 19.6 days) administered to pre-partum mares affected the coat condition of foals at birth with respect to hair weight (P < 0.0001) and hair length (P < 0.0001) compared to controls (0.34 ± 0.20 μg vs 0.59 ± 0.12 μg and 1.93 ± 0.56 cm vs 2.56 ± 0.32 cm, respectively). Collectively, these studies serve to highlight the influential role of the circa-annual changes in photoperiod length on the pre-partum mare for normal foetal development during the natural breeding season. It also emphasizes the potential that exists to improve breeding efficiency parameters by artificially simulating this important environmental cue in the latter stages of gestation against the backdrop of an economically driven early breeding season. Copyright © 2017 Elsevier Inc. All rights reserved.

Evolution of critical day length for diapause induction enables range expansion of Diorhabda carinulata, a biological control agent against tamarisk (Tamarix spp.)

PubMed Central

Bean, Dan W; Dalin, Peter; Dudley, Tom L

2012-01-01

In classical weed biological control, small collections of arthropods are made from one or a few sites in the native range of the target plant and are introduced to suppress the plant where it has become invasive, often across a wide geographic range. Ecological mismatches in the new range are likely, and success using the biocontrol agent may depend on postrelease evolution of beneficial life history traits. In this study, we measure the evolution of critical day length for diapause induction (day length at which 50% of the population enters dormancy), in a beetle (Diorhabda carinulata) introduced into North America from China to control an exotic shrub, Tamarix spp. Beetle populations were sampled from four sites in North America 7 years after introduction, and critical day length was shown to have declined, forming a cline over a latitudinal gradient At one field site, decreased critical day length was correlated with 16 additional days of reproductive activity, resulting in a closer match between beetle life history and the phenology of Tamarix. These findings indicate an enhanced efficacy and an increasingly wider range for D. carinulata in Tamarix control. PMID:22949926

Comparison of stethoscope bell and diaphragm, and of stethoscope tube length, for clinical blood pressure measurement.

PubMed

Liu, Chengyu; Griffiths, Clive; Murray, Alan; Zheng, Dingchang

2016-06-01

This study investigated the effect of stethoscope side and tube length on auscultatory blood pressure (BP) measurement. Thirty-two healthy participants were studied. For each participant, four measurements with different combinations of stethoscope characteristics (bell or diaphragm side, standard or short tube length) were each recorded at two repeat sessions, and eight Korotkoff sound recordings were played twice on separate days to one experienced listener to determine the systolic and diastolic BPs (SBP and DBP). Analysis of variance was carried out to study the measurement repeatability between the two repeat sessions and between the two BP determinations on separate days, as well as the effects of stethoscope side and tube length. There was no significant paired difference between the repeat sessions and between the repeat determinations for both SBP and DBP (all P-values>0.10, except the repeat session for SBP using short tube and diaphragm). The key result was that there was a small but significantly higher DBP on using the bell in comparison with the diaphragm (0.66 mmHg, P=0.007), and a significantly higher SBP on using the short tube in comparison with the standard length (0.77 mmHg, P=0.008). This study shows that stethoscope characteristics have only a small, although statistically significant, influence on clinical BP measurement. Although this helps understand the measurement technique and resolves questions in the published literature, the influence is not clinically significant.

Comparison of stethoscope bell and diaphragm, and of stethoscope tube length, for clinical blood pressure measurement

PubMed Central

Griffiths, Clive; Murray, Alan; Zheng, Dingchang

2016-01-01

Objective This study investigated the effect of stethoscope side and tube length on auscultatory blood pressure (BP) measurement. Methods Thirty-two healthy participants were studied. For each participant, four measurements with different combinations of stethoscope characteristics (bell or diaphragm side, standard or short tube length) were each recorded at two repeat sessions, and eight Korotkoff sound recordings were played twice on separate days to one experienced listener to determine the systolic and diastolic BPs (SBP and DBP). Analysis of variance was carried out to study the measurement repeatability between the two repeat sessions and between the two BP determinations on separate days, as well as the effects of stethoscope side and tube length. Results There was no significant paired difference between the repeat sessions and between the repeat determinations for both SBP and DBP (all P-values>0.10, except the repeat session for SBP using short tube and diaphragm). The key result was that there was a small but significantly higher DBP on using the bell in comparison with the diaphragm (0.66 mmHg, P=0.007), and a significantly higher SBP on using the short tube in comparison with the standard length (0.77 mmHg, P=0.008). Conclusion This study shows that stethoscope characteristics have only a small, although statistically significant, influence on clinical BP measurement. Although this helps understand the measurement technique and resolves questions in the published literature, the influence is not clinically significant. PMID:26741415

Does Day of Surgery Affect Hospital Length of Stay and Charges Following Minimally Invasive Transforaminal Lumbar Interbody Fusion?

PubMed

Hijji, Fady Y; Narain, Ankur S; Haws, Brittany E; Khechen, Benjamin; Kudaravalli, Krishna T; Yom, Kelly H; Singh, Kern

2018-06-01

Retrospective Cohort. To determine if an association exists between surgery day and length of stay or hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Length of inpatient stay after orthopedic procedures has been identified as a primary cost driver, and previous research has focused on determining risk factors for prolonged length of stay. In the arthroplasty literature, surgery performed later in the week has been identified as a predictor of increased length of stay. However, no such investigation has been performed for MIS TLIF. A surgical registry of patients undergoing MIS TLIF between 2008 and 2016 was retrospectively reviewed. Patients were grouped based on day of surgery, with groups including early surgery and late surgery. Day of surgery group was tested for an association with demographics and perioperative variables using the student t test or χ analysis. Day of surgery group was then tested for an association with direct hospital costs using multivariate linear regression. In total, 438 patients were analyzed. In total, 51.8% were in the early surgery group, and 48.2% were in the late surgery group. There were no differences in demographics between groups. There were no differences between groups with regard to operative time, intraoperative blood loss, length of stay, or discharge day. Finally, there were no differences in total hospital charges between early and late surgery groups (P=0.247). The specific day on which a MIS TLIF procedure occurs is not associated with differences in length of inpatient stay or total hospital costs. This suggests that the postoperative course after MIS TLIF procedures is not affected by the differences in hospital staffing that occurs on the weekend compared with weekdays.

The effect of Vitamin D and calcium plus Vitamin D on leg cramps in pregnant women: A randomized controlled trial.

PubMed

Mansouri, Ameneh; Mirghafourvand, Mojgan; Charandabi, Sakineh Mohammad Alizadeh; Najafi, Moslem

2017-01-01

This study intended to determine the effects of Vitamin D and calcium-Vitamin D in treating leg cramps in pregnant women. This study was conducted as a double-blind randomized controlled clinical trial on 126 participants, 18-35-year-old pregnant women with a minimum of two leg cramps per week who were referred to health-care centers in Tabriz-Iran in 2013. The participants were allocated to three 42 member groups using a randomized block design. For 42 days, the intervention groups took a 1000 unit Vitamin D pill or 300 mg calcium carbonate plus a 1000 unit Vitamin D pill, and the control group received a placebo pill every day. The participants were evaluated with regard to the frequency, length, and pain intensity of leg cramps during the week before and during the 3 rd and 6 th week of the intervention. The ANCOVA and repeated measurement test were used to analyze the data. Results showed that controlling for the effects before the intervention, calcium-Vitamin D, and Vitamin D supplements had no effect on the frequency, length, and pain intensity of leg cramps. The results of this study showed that the calcium-Vitamin D and the Vitamin D supplements have no effect on the frequency, length, and pain intensity of leg cramps during the 6 weeks of the study.

The effect of lactation length on greenhouse gas emissions from the national dairy herd.

PubMed

Wall, E; Coffey, M P; Pollott, G E

2012-11-01

Many governments have signed up to greenhouse gas emission (GHGE) reduction programmes under their national climate change obligations. Recently, it has been suggested that the use of extended lactations in dairy herds could result in reduced GHGE. Dairy GHGE were modelled on a national basis and the model was used to compare emissions from lactations of three different lengths (305, 370 and 440 days), and a current 'base' scenario on the basis of maintaining current milk production levels. In addition to comparing GHGE from the average 'National Herd' under these scenarios, results were used to investigate how accounting for lactations of different lengths might alter the estimation of emissions calculated from the National Inventory methodology currently recommended by Intergovernmental Panel on Climate Change. Data for the three lactation length scenarios were derived from nationally recorded dairy performance information and used in the GHGE model. Long lactations required fewer milking cows and replacements to maintain current milk yield levels than short ones, but GHGEs were found to rise from 1214 t of CO2 equivalent (CE)/farm per year for lactations of 305 days to 1371 t CE/farm per year for 440-day lactations. This apparent anomaly can be explained by the less efficient milk production (kg milk produced per kg cow weight) found in later lactation, a more pronounced effect in longer lactations. The sensitivity of the model to changes in replacement rate, persistency and level of milk yield was investigated. Changes in the replacement rate from 25% to 20% and in persistency by −10% to +20% resulted in very small changes in GHGE. Differences in GHGE due to the level of milk yield were much more dramatic with animals in the top 10% for yield, producing about 25% less GHGE/year than the average animal. National Inventory results were investigated using a more realistic spread of lactation lengths than recommended for such calculations using emissions calculated in the first part of the study. Current UK emission calculations based on the National Inventory were 329 Gg of methane per year from the dairy herd. Using the national distribution of lactation lengths, this was found to be an underestimate by about 10%. This work showed that the current rise in lactation length or a move towards calving every 18 months would increase GHGE by 7% to 14% compared with the current scenario, assuming the same milk yield in all models. Increased milk yield would have a much greater effect on reducing GHGE than changes to lactation length, replacement rate or persistency. National Inventory methodology appears to underestimate GHGE when the distribution of lactation lengths is considered and may need revising to provide more realistic figures.

Predictive value of cervical length measurement and fibronectin testing in threatened preterm labor.

PubMed

van Baaren, Gert-Jan; Vis, Jolande Y; Wilms, Femke F; Oudijk, Martijn A; Kwee, Anneke; Porath, Martina M; Oei, Guid; Scheepers, Hubertina C J; Spaanderman, Marc E A; Bloemenkamp, Kitty W M; Haak, Monique C; Bolte, Antoinette C; Bax, Caroline J; Cornette, Jérôme M J; Duvekot, Johannes J; Nij Bijvanck, Bas W A; van Eyck, Jim; Franssen, Maureen T M; Sollie, Krystyna M; Vandenbussche, Frank P H A; Woiski, Mallory; Grobman, William A; van der Post, Joris A M; Bossuyt, Patrick M M; Opmeer, Brent C; Mol, Ben W J

2014-06-01

To estimate the performance of combining cervical length measurement with fetal fibronectin testing in predicting delivery in women with symptoms of preterm labor. We conducted a prospective nationwide cohort study in all 10 perinatal centers in The Netherlands. Women with symptoms of preterm labor between 24 and 34 weeks of gestation with intact membranes were included. In all women, qualitative fibronectin testing (0.050-microgram/mL cutoff) and cervical length measurement were performed. Logistic regression was used to predict spontaneous preterm delivery within 7 days after testing. A risk less than 5%, corresponding to the risk for women with a cervical length of at least 25 mm, was considered as low risk. Between December 2009 and August 2012, 714 women were enrolled. Fibronectin results and cervical length were available for 665 women, of whom 80 (12%) delivered within 7 days. Women with a cervical length of at least 30 mm or with a cervical length between 15 and 30 mm with a negative fibronectin result were at low risk (less than 5%) of spontaneous delivery within 7 days. Fibronectin testing in case of a cervical length between 15 and 30 mm additionally classified 103 women (15% of the cohort) as low risk and 36 women (5% of the cohort) as high risk. Cervical length measurement, combined with fetal fibronectin testing in case of a cervical length between 15 and 30 mm, improves identification of women with a low risk to deliver spontaneously within 7 days. II.

The effect of metritis and subclinical hypocalcemia on uterine involution in dairy cows evaluated by sonomicrometry

PubMed Central

HEPPELMANN, Maike; KRACH, Karoline; KRUEGER, Lars; BENZ, Philipp; HERZOG, Kathrin; PIECHOTTA, Marion; HOEDEMAKER, Martina; BOLLWEIN, Heinrich

2015-01-01

The objective of this study was to examine the effects of metritis and subclinical hypocalcemia on reduction of uterine size in dairy cows using ultrasonography and sonomicrometry. Four piezoelectric crystals were implanted via laparotomy into the myometrium of the pregnant uterine horn of 12 pluriparous Holstein Friesian cows 3 weeks before the calculated calving date. Sonometric measurements were conducted daily from 2 days before parturition (= Day 0) until Day 14 after calving and then every other day until Day 28. Distances between adjacent crystals were expressed in relation to reference values obtained before calving. The diameter of the formerly pregnant uterine horn was measured using transrectal B-Mode sonography starting on Day 10. Cows were retrospectively divided into the following groups: cows without metritis (M–; n = 7), cows with metritis (M+; n = 5), cows with normocalcemia (SH–; Ca > 2.0 mmol/l on Days 1 to 3; n = 5) and cows with subclinical hypocalcemia (SH+; Ca < 2.0 mmol/l in at least one sample between Days 1 and 3; n = 7). Metritis did not affect (P > 0.05) sonometric measurements, but the diameter of the formerly pregnant horn was larger (P ≤ 0.05) between Days 15 and 21 in M+ cows than in M‒ cows. Reduction in uterine length in hypocalcemic cows was delayed (P ≤ 0.05) between Days 8 and 21 compared with normocalcemic cows, but the uterine horn diameter was not related to calcium status. In conclusion, both diseases affected reduction of uterine size until Day 28. Cows with metritis had a larger uterine diameter, possibly attributable to accumulation of lochia, and cows with subclinical hypocalcemia had delayed reduction of uterine length, presumably related to reduction of myometrial contractility. PMID:26400127

Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: a Systematic Review and Meta-analysis.

PubMed

Gillis, Chelsia; Buhler, Katherine; Bresee, Lauren; Carli, Francesco; Gramlich, Leah; Culos-Reed, Nicole; Sajobi, Tolulope T; Fenton, Tanis R

2018-05-08

Although there have been meta-analyses of the effects of exercise prehabilitation on patients undergoing colorectal surgery, little is known about the effects of nutrition-only (oral nutritional supplements and/or counseling) and multi-modal (oral nutritional supplements and/or counseling with exercise) prehabilitation on clinical outcomes and patient function after surgery. We performed a systemic review and meta-analysis to determine the individual and combined effects of nutrition-only and multi-modal prehabilitation, compared with no prehabilitation (control), on outcomes of patients undergoing colorectal resection. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, and ProQuest for cohort and randomized controlled studies of adults awaiting colorectal surgery who received at least 7 days of oral nutrition supplements and/or nutrition counselling with or without exercise. We performed a random effects meta-analysis to estimate the pooled risk ratio for categorical data and the weighted mean difference for continuous variables. The primary outcome was length of hospital stay; the secondary outcome was recovery of functional capacity, based on results of a 6-minute walk test. We identified 9 studies (5 randomized controlled studies and 4 cohort studies) comprising 914 patients undergoing colorectal surgery (438 received prehabilitation and 476 served as controls). Receipt of any prehabilitation significantly reduced days spent in hospital compared with controls (weighted mean difference of length of hospital stay, -2.2 days; 95% CI, -3.5 days to -0.9 days). Only 3 studies reported functional outcomes but could not be pooled due to methodological heterogeneity. In the individual studies, multimodal prehabilitation significantly improved results of the 6-minute walk test at 4 and 8 weeks after surgery compared with standard enhanced recovery pathway care, and at 8 weeks compared with standard enhanced recovery pathway care with added rehabilitation. The 4 observational studies had a high risk of bias. In a systematic review and meta-analysis, we found that nutritional prehabilitation alone, or when combined with an exercise program, significantly reduced length of hospital stay by 2 days in patients undergoing colorectal surgery. There is some evidence that multimodal prehabilitation accelerated the return to pre-surgery functional capacity. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Early intervention of negative pressure wound therapy using Vacuum-Assisted Closure in trauma patients: impact on hospital length of stay and cost.

PubMed

Kaplan, Mark; Daly, Darron; Stemkowski, Stephen

2009-03-01

The cost of treating complex traumatic wounds is substantial because of trauma severity, potential for infection, and delayed closure. Negative pressure wound therapy using reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum-Assisted Closure* (KCI Licensing, Inc, San Antonio, Texas) is an established, viable option for treating traumatic wounds. The authors used retrospective data to study the clinical and cost-effective benefits of using NPWT/ROCF early on day 1 or day 2 of treatment for traumatic wounds as compared with using it late (on day 3 or later). Hospital data records from trauma wound patients treated with NPWT/ROCF were retrospectively analyzed. Data were subdivided into 2 groups based on start of treatment. The group of patients treated on day 1 or 2 of their hospital stay was referred to as the early group, and that composed of patients treated on day 3 or later as the late group. Clinical and cost-effective metrics were compared between the 2 groups. For the early group, 518 patient records were included; 1000 records were reviewed for the late group. Early-group patients had fewer hospital inpatient days (10.6 vs 20.6 days; P < .0001), fewer treatment days (5.1 vs 6.0 days; P = .0498), shorter intensive care unit (ICU) stays (5.3 vs 12.4 days; P < .0001), and higher ICU admission rates (51.5 vs 44.5%; P = .0091) than the late group. Compared with late-group patients, early-group patients had lower total and variable costs per patient discharge ($43,956 vs $32,175; P < .0001 and $22,891 vs $15,805; P < .0001, respectively). Acute-care trauma wound patients receiving early NPWT/ROCF demonstrated significant reductions in length of stay, treatment days, and ICU stay, which resulted in significant reduced patient treatment costs. These results indicate that early intervention with NPWT/ROCF has potential clinical and cost-effective benefits for the treatment of traumatic wounds.

Brief hyperopic defocus or form deprivation have varying effects on eye growth and ocular rhythms depending on the time-of-day of exposure.

PubMed

Nickla, Debora L; Jordan, Kelsey; Yang, Jane; Totonelly, Kristen

2017-08-01

It is generally accepted that myopic defocus is a more potent signal to the emmetropization system than hyperopic defocus: one hour per day of myopic defocus cancels out 11 h of hyperopic defocus. However, we have recently shown that the potency of brief episodes of myopic defocus at inhibiting eye growth depends on the time of day of exposure. We here ask if this will also be true of the responses to brief periods of hyperopic defocus: may integration of the signal depend on time of day? If so, are the rhythms in axial length and choroidal thickness altered? Hyperopic defocus: Birds had one eye exposed to hyperopic defocus by the wearing of -10D lenses for 2 or 6 h at one of 3 times of day for 5 days: Morning (7 am - 9 am: n = 13; 7 am - 1 pm: n = 6), Mid-day (12 pm - 2 pm: n = 20; 10 am - 4 pm: n = 8), or Evening (7 pm - 9 pm: n = 12; 2 pm - 8 pm: n = 11). A separate group wore monocular lenses continually as a control (n = 12). Form deprivation: Birds wore a diffuser over one eye for 2 h at one of 3 times of day for 5 days: Morning (n = 12); Mid-day (n = 19) or Evening (n = 6). For all groups, ocular dimensions were measured using high-frequency A-scan ultrasonography at noon on the first day, under inhalation anesthesia. On day 5, eye dimensions were re-measured at 12 pm, and refractive errors were measured using a Hartinger's refractometer. A subset of birds in the 2-h lens group (morning, n = 8; mid-day, n = 8; evening, n = 6), and the deprivation group (n = 6 per time point), were also measured at 6 pm, 12 am, 6 am and 12 pm on the last day of exposure, to obtain the parameters of the diurnal rhythms in axial length and choroidal thickness. The effects of 2 h of defocus depended on time of day of exposure: it stimulated eye growth when exposure was in the morning and inhibited it when it was at mid-day (change in vitreous chamber, X-C; ANOVA p < 0.0005; 120 μm vs -77 μm/5d, respectively; t-tests: p = 0.001; p = 0.01; post-hoc tests: p = 0.002). For mid-day, experimental eyes were more hyperopic (1.4 D; p < 0.0001). Similar to 2 h defocus, 6 h exposures at mid-day inhibited growth and produced hyperopia (X-C: -167 μm; t-test p = 0.005; RE: 1.8 D; p = 0.03). The effects of 2 h of FD were similar to those of hyperopic defocus in inhibiting growth for mid-day exposures, but FD inhibited growth for the morning exposures as well (Axial length: X-C: Morning: -122 μm; mid-day: -92 μm; ttests p = 0.006 and p = 0.016 respectively). Experimental eyes were more hyperopic (1.8 D; 1.0 D; p < 0.05). The rhythms in axial length were altered for the morning exposures in both conditions. Form deprivation in the morning, which caused inhibition, caused the phases of the two rhythms to shift toward one another (peaks at 6:00 am and 10:45 am for choroid and axial length respectively). Our findings imply that the retinal "integrator", and/or scleral growth regulator exhibit diurnal rhythms. Furthermore, they suggest that reading activities early in the day may be contraindicated in school children at risk of becoming myopic. Copyright © 2017 Elsevier Ltd. All rights reserved.

Predictors of thirty-day readmission among hospitalized family medicine patients.

PubMed

Garrison, Gregory M; Mansukhani, Meghna P; Bohn, Bradley

2013-01-01

Hospital readmissions within 30 days of initial discharge occur frequently. In studies of elderly patients receiving Medicare, readmissions have been associated with poor-quality inpatient care, ineffective hospital-to-home transitions, patient characteristics, disease burden, and socioeconomic status. Among adult family medicine patients spanning a wide age range, we hypothesize that previous hospitalizations, length of stay, number of discharge medications, medical comorbidities, and patient demographics are associated with a greater risk of hospital readmission within 30 days. A retrospective case-control study of 276 family medicine inpatients was conducted to determine the factors associated with 30-day readmission. Bivariate statistics were computed and a multivariate analysis using logistic regression was performed to determine the independent effects of each factor. Patients readmitted within 30 days had more hospitalizations, more emergency department visits, longer hospital stays, more comorbidities, and more discharge medications and were less likely to be married. Multivariate logistic regression found that hospitalization within the previous 12 months (odds ratio, 2.71) and long hospital stays (odds ratio, 2.16) were associated with 30-day readmission; being married (odds ratio, 0.54) had a protective effect. This study demonstrates that factors previously found to be associated with 30-day readmission among elderly patients receiving Medicare also apply to family medicine patients of all ages. It also demonstrates prior hospitalizations, length of stay, and marital status are useful proxies for many more complicated factors, such as disease burden, medical complexity, and social issues, that influence hospital readmission.

Second hand tobacco smoke adversely affects the bone of immature rats.

PubMed

Rosa, Rodrigo César; Pereira, Sângela Cunha; Cardoso, Fabrizio Antônio Gomide; Caetano, Abadio Gonçalves; Santiago, Hildemberg Agostinho Rocha de; Volpon, José Batista

2017-12-01

To evaluate the influence of secondhand cigarette smoke exposure on longitudinal growth of the tibia of growing rats and some parameters of bone quality. Forty female rats were randomly divided into four groups: control: rats were sham exposed; 30 days: rats were exposed to tobacco smoke for 30 days; 45 days: rats were exposed to tobacco smoke for 45 days; and 60 days: rats were exposed to tobacco smoke for 60 days. Blood samples were collected to evaluate the levels of cotinine and alkaline phosphatase. Both tibias were dissected and weighed; the lengths were measured, and the bones were then stored in a freezer for analysis of bone mineral content and mechanical resistance (maximal load and stiffness). Exposure of rats to tobacco smoke significantly compromised bone health, suggesting that the harmful effects may be time dependent. Harmful effects on bone growth were detected and were more pronounced at 60-day follow-ups with a 41.8% reduction in alkaline phosphatase levels (p<0.01) and a decrease of 11.25% in tibia length (p<0.001). Furthermore, a 41.5% decrease in bone mineral density was observed (p<0.001), leading to a 42.8% reduction in maximum strength (p<0.001) and a 56.7% reduction in stiffness (p<0.001). Second hand cigarette smoke exposure in rats affected bones that were weaker, deforming them and making them osteopenic. Additionally, the long bone was shorter, suggesting interference with growth. Such events seem to be related to time of exposure.

A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws.

PubMed

Patel, Neha A; Bly, Randall A; Adams, Seth; Carlin, Kristen; Parikh, Sanjay R; Dahl, John P; Manning, Scott

2018-02-01

Postoperative calcium management is challenging following pediatric thyroidectomy given potential limitations in self-reporting symptoms and compliance with phlebotomy. A protocol was created at our tertiary children's institution utilizing intraoperative parathyroid hormone (PTH) levels to guide electrolyte management during hospitalization. The objective of this study was to determine the effect of a new thyroidectomy postoperative management protocol on two primary outcomes: (1) the number of postoperative calcium blood draws and (2) the length of hospital stay. Institutional review board approved retrospective study (2010-2016). Consecutive pediatric total thyroidectomy and completion thyroidectomy ± neck dissection cases from 1/1/2010 through 8/5/2016 at a single tertiary children's institution were retrospectively reviewed before and after initiation of a new management protocol. All cases after 2/1/2014 comprised the experimental group (post-protocol implementation). The pre-protocol control group consisted of cases prior to 2/1/2014. Multivariable linear and Poisson regression models were used to compare the control and experimental groups for outcome measure of number of calcium lab draws and hospital length of stay. 53 patients were included (n = 23, control group; n = 30 experimental group). The median age was 15 years. 41 patients (77.4%) were female. Postoperative calcium draws decreased from a mean of 5.2 to 3.6 per day post-protocol implementation (Rate Ratio = 0.70, p < .001), adjusting for covariates. The mean number of total inpatient calcium draws before protocol initiation was 13.3 (±13.20) compared to 7.2 (±4.25) in the post-protocol implementation group. Length of stay was 2.1 days in the control group and 1.8 days post-protocol implementation (p = .29). Patients who underwent concurrent neck dissection had a longer mean length of stay of 2.32 days compared to 1.66 days in those patients who did not undergo a neck dissection (p = .02). Hypocalcemia was also associated with a longer mean length of stay of 2.41 days compared to 1.60 days in patients who did not develop hypocalcemia (p < .01). The number of calcium blood draws was significantly reduced after introduction of a standardized protocol based on intraoperative PTH levels. The hospital length of stay did not change. Adoption of a standardized postoperative protocol based on intraoperative PTH levels may reduce the number of blood draws in children undergoing thyroidectomy. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluation of renal nerve morphological changes and norepinephrine levels following treatment with novel bipolar radiofrequency delivery systems in a porcine model

PubMed Central

Cohen-Mazor, Meital; Mathur, Prabodh; Stanley, James R.L.; Mendelsohn, Farrell O.; Lee, Henry; Baird, Rose; Zani, Brett G.; Markham, Peter M.; Rocha-Singh, Krishna

2014-01-01

Objective: To evaluate the safety and effectiveness of different bipolar radiofrequency system algorithms in interrupting the renal sympathetic nerves and reducing renal norepinephrine in a healthy porcine model. Methods: A porcine model (N = 46) was used to investigate renal norepinephrine levels and changes to renal artery tissues and nerves following percutaneous renal denervation with radiofrequency bipolar electrodes mounted on a balloon catheter. Parameters of the radiofrequency system (i.e. electrode length and energy delivery algorithm), and the effects of single and longitudinal treatments along the artery were studied with a 7-day model in which swine received unilateral radiofrequency treatments. Additional sets of animals were used to examine norepinephrine and histological changes 28 days following bilateral percutaneous radiofrequency treatment or surgical denervation; untreated swine were used for comparison of renal norepinephrine levels. Results: Seven days postprocedure, norepinephrine concentrations decreased proportionally to electrode length, with 81, 60 and 38% reductions (vs. contralateral control) using 16, 4 and 2-mm electrodes, respectively. Applying a temperature-control algorithm with the 4-mm electrodes increased efficacy, with a mean 89.5% norepinephrine reduction following a 30-s treatment at 68°C. Applying this treatment along the entire artery length affected more nerves vs. a single treatment, resulting in superior norepinephrine reduction 28 days following bilateral treatment. Conclusion: Percutaneous renal artery application of bipolar radiofrequency energy demonstrated safety and resulted in a significant renal norepinephrine content reduction and renal nerve injury compared with untreated controls in porcine models. PMID:24875181

Effect of breast milk on hospital costs and length of stay among very low-birth-weight infants in the NICU.

PubMed

Parker, Leslie A; Krueger, Charlene; Sullivan, Sandra; Kelechi, Teresa; Mueller, Martina

2012-08-01

Care of the very low-birth-weight (VLBW) infant is associated with prolonged hospitalization and increased hospital costs. Specific complications of prematurity, including necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and feeding intolerance, contribute to increased cost and length of hospitalization in this population. The provision of breast milk to VLBW infants has been associated with decreased incidence of NEC and LOS as well as fewer days required to achieve full enteral feedings. The purpose of this study was to determine the impact of breast milk on length of hospitalization and hospital costs among VLBW infants in the neonatal intensive care unit (NICU). A total of 80 infants weighing less than 1500 g, born prior to 32 weeks' gestation and who remained in the home hospital until discharge. This descriptive comparative study examined cost of hospitalization and length of stay between 2 groups of VLBW premature infants fed either exclusively formula (n = 40) or at least 50% breast milk (n = 40) during their hospitalization. A retrospective chart review was used to collect information concerning patient demographics, discharge information, and nutritional variables. Information regarding hospital costs was obtained from the hospital's patient accounting office. Independent t tests were used to compare demographic data, length of hospitalization, and cost of care between the 2 groups. No statistically significant differences in length of stay or cost of care were found between infants fed at least 50% breast milk and those who were exclusively formula fed. Descriptive data concerning length of stay and cost of care for VLBW infants and those infants weighing less than 1000 g are presented. This article presents a descriptive comparative study on the effect of providing at least 50% breast milk feedings compared with formula feeding on days to discharge and cost of hospitalization in VLBW infants in the NICU. It also provides information concerning cost of care and length of stay in VLBW and infants weighing less than 1000 g.

Quarantine for pandemic influenza control at the borders of small island nations.

PubMed

Nishiura, Hiroshi; Wilson, Nick; Baker, Michael G

2009-03-11

Although border quarantine is included in many influenza pandemic plans, detailed guidelines have yet to be formulated, including considerations for the optimal quarantine length. Motivated by the situation of small island nations, which will probably experience the introduction of pandemic influenza via just one airport, we examined the potential effectiveness of quarantine as a border control measure. Analysing the detailed epidemiologic characteristics of influenza, the effectiveness of quarantine at the borders of islands was modelled as the relative reduction of the risk of releasing infectious individuals into the community, explicitly accounting for the presence of asymptomatic infected individuals. The potential benefit of adding the use of rapid diagnostic testing to the quarantine process was also considered. We predict that 95% and 99% effectiveness in preventing the release of infectious individuals into the community could be achieved with quarantine periods of longer than 4.7 and 8.6 days, respectively. If rapid diagnostic testing is combined with quarantine, the lengths of quarantine to achieve 95% and 99% effectiveness could be shortened to 2.6 and 5.7 days, respectively. Sensitivity analysis revealed that quarantine alone for 8.7 days or quarantine for 5.7 days combined with using rapid diagnostic testing could prevent secondary transmissions caused by the released infectious individuals for a plausible range of prevalence at the source country (up to 10%) and for a modest number of incoming travellers (up to 8000 individuals). Quarantine at the borders of island nations could contribute substantially to preventing the arrival of pandemic influenza (or at least delaying the arrival date). For small island nations we recommend consideration of quarantine alone for 9 days or quarantine for 6 days combined with using rapid diagnostic testing (if available).

Quarantine for pandemic influenza control at the borders of small island nations

PubMed Central

2009-01-01

Background Although border quarantine is included in many influenza pandemic plans, detailed guidelines have yet to be formulated, including considerations for the optimal quarantine length. Motivated by the situation of small island nations, which will probably experience the introduction of pandemic influenza via just one airport, we examined the potential effectiveness of quarantine as a border control measure. Methods Analysing the detailed epidemiologic characteristics of influenza, the effectiveness of quarantine at the borders of islands was modelled as the relative reduction of the risk of releasing infectious individuals into the community, explicitly accounting for the presence of asymptomatic infected individuals. The potential benefit of adding the use of rapid diagnostic testing to the quarantine process was also considered. Results We predict that 95% and 99% effectiveness in preventing the release of infectious individuals into the community could be achieved with quarantine periods of longer than 4.7 and 8.6 days, respectively. If rapid diagnostic testing is combined with quarantine, the lengths of quarantine to achieve 95% and 99% effectiveness could be shortened to 2.6 and 5.7 days, respectively. Sensitivity analysis revealed that quarantine alone for 8.7 days or quarantine for 5.7 days combined with using rapid diagnostic testing could prevent secondary transmissions caused by the released infectious individuals for a plausible range of prevalence at the source country (up to 10%) and for a modest number of incoming travellers (up to 8000 individuals). Conclusion Quarantine at the borders of island nations could contribute substantially to preventing the arrival of pandemic influenza (or at least delaying the arrival date). For small island nations we recommend consideration of quarantine alone for 9 days or quarantine for 6 days combined with using rapid diagnostic testing (if available). PMID:19284571

Estimation of Extra Length of Stay Attributable to Hospital-Acquired Infections in Adult ICUs Using a Time-Dependent Multistate Model.

PubMed

Ohannessian, Robin; Gustin, Marie-Paule; Bénet, Thomas; Gerbier-Colomban, Solweig; Girard, Raphaele; Argaud, Laurent; Rimmelé, Thomas; Guerin, Claude; Bohé, Julien; Piriou, Vincent; Vanhems, Philippe

2018-04-10

The objective of the study was to estimate the length of stay of patients with hospital-acquired infections hospitalized in ICUs using a multistate model. Active prospective surveillance of hospital-acquired infection from January 1, 1995, to December 31, 2012. Twelve ICUs at the University of Lyon hospital (France). Adult patients age greater than or equal to 18 years old and hospitalized greater than or equal to 2 days were included in the surveillance. All hospital-acquired infections (pneumonia, bacteremia, and urinary tract infection) occurring during ICU stay were collected. None. The competitive risks of in-hospital death, transfer, or discharge were considered in estimating the change in length of stay due to infection(s), using a multistate model, time of infection onset. Thirty-three thousand four-hundred forty-nine patients were involved, with an overall hospital-acquired infection attack rate of 15.5% (n = 5,176). Mean length of stay was 27.4 (± 18.3) days in patients with hospital-acquired infection and 7.3 (± 7.6) days in patients without hospital-acquired infection. A multistate model-estimated mean found an increase in length of stay by 5.0 days (95% CI, 4.6-5.4 d). The extra length of stay increased with the number of infected site and was higher for patients discharged alive from ICU. No increased length of stay was found for patients presenting late-onset hospital-acquired infection, more than the 25th day after admission. An increase length of stay of 5 days attributable to hospital-acquired infection in the ICU was estimated using a multistate model in a prospective surveillance study in France. The dose-response relationship between the number of hospitalacquired infection and length of stay and the impact of early-stage hospital-acquired infection may strengthen attention for clinicians to focus interventions on early preventions of hospital-acquired infection in ICU.

Suppression of follicular rupture with meloxicam, a cyclooxygenase-2 inhibitor: potential for emergency contraception.

PubMed

Jesam, Cristián; Salvatierra, Ana María; Schwartz, Jill L; Croxatto, Horacio B

2010-02-01

There is evidence that cyclooxygenase-2 (COX-2) inhibitors can prevent or delay follicular rupture. COX-2 inhibitors, such as meloxicam, may offer advantages over emergency contraception with levonorgestrel, such as extending the therapeutic window for up to 24 h. We assessed the effect of meloxicam administered in the late follicular phase upon ovulation in women. This was a single center, double blind, crossover study designed to assess the effects in 27 eligible women (18-40 years old, surgically sterilized with regular menstrual cycles) of meloxicam, 15 or 30 mg/day, administered orally for five consecutive days during the late follicular phase, starting when the leading follicle reached 18 mm diameter. Volunteers underwent two treatment cycles separated by one resting cycle, with randomization to dose sequence. Main outcomes were follicular rupture; serum LH, progesterone and estradiol (E2) levels; and incidence of adverse events. Twenty-two volunteers completed the study. There were no differences between meloxicam doses in menstrual cycle length. Dysfunctional ovulation was observed in 11/22 (50%) cycles treated with 15 mg/day and 20/22 (90.9%) cycles with 30 mg/day (P = 0.0068). All women had normal luteal phase progesterone levels; mean maximal values +/- SEM were 42 +/- 4.1 and 46.8 +/- 2.6 nmol/l for 15 and 30 mg/day groups, respectively. There were no serious adverse events, and no changes in LH and E2 levels or in cycle length. Meloxicam 30 mg given for five consecutive days in the late follicular phase is safe, effective and may be an alternative form of emergency contraception.

Impact of Private Health Insurance on Lengths of Hospitalization and Healthcare Expenditure in India: Evidences from a Quasi-Experiment Study.

PubMed

Vellakkal, Sukumar

2013-01-01

The health insurers administer retrospectively package rates for various inpatient procedures as a provider payment mechanism to empanelled hospitals in Indian healthcare market. This study analyzed the impact of private health insurance on healthcare utilization in terms of both lengths of hospitalization and per-day hospitalization expenditure in Indian healthcare market where package rates are retrospectively defined as healthcare provider payment mechanism. The claim records of 94443 insured individuals and the hospitalisation data of 32665 uninsured individuals were used. By applying stepwise and propensity score matching method, the sample of uninsured individual was matched with insured and 'average treatment effect on treated' (ATT) was estimated. Overall, the strategies of hospitals, insured and insurers for maximizing their utility were competing with each other. However, two aligning co-operative strategies between insurer and hospitals were significant with dominant role of hospitals. The hospitals maximize their utility by providing high cost healthcare in par with pre-defined package rates but align with the interest of insurers by reducing the number (length) of hospitalisation days. The empirical results show that private health insurance coverage leads to i) reduction in length of hospitalization, and ii) increase in per day hospital (health) expenditure. It is necessary to regulate and develop a competent healthcare market in the country with proper monitoring mechanism on healthcare utilization and benchmarks for pricing and provision of healthcare services.

Response and recovery of the macrophytes Elodea canadensis and Myriophyllum spicatum following a pulse exposure to the herbicide iofensulfuron-sodium in outdoor stream mesocosms.

PubMed

Wieczorek, Matthias V; Bakanov, Nikita; Lagadic, Laurent; Bruns, Eric; Schulz, Ralf

2017-04-01

Interest in stream mesocosms has recently revived for higher tier aquatic macrophyte risk assessment of plant protection products mainly because 1) the highest predicted environmental concentrations for the assessment of effects are frequently derived from stream scenarios, and 2) they allow an effect assessment using stream-typical pulse exposures. Therefore, the present stream mesocosm study used an herbicide pulse exposure and evaluated the responses of Elodea canadensis and Myriophyllum spicatum. Macrophytes were exposed for 24 h to 1 μg/L, 3 μg/L, 10 μg/L, and 30 μg/L of the herbicide iofensulfuron-sodium with a subsequent recovery period of 42 d. Biological endpoints were growth rates of the main, side, and total shoot length, the shoot number, the maximum root length, and the dry weight. The total shoot length was identified as the most sensitive endpoint; the growth rate of the total shoot length was inhibited by up to 66% and 45% in M. spicatum and E. canadensis, respectively. The lowest no observed effect concentrations (NOECs) were observed at day 7 and/or day 14 after herbicide treatment and were 1 μg/L for M. spicatum and 3 μg/L for E. canadensis. The no-observed-ecologically-adverse-effect concentrations (NOEAECs) were 10 μg/L and 30 μg/L for M. spicatum and E. canadensis, respectively. Such or similar mesocosm designs are useful to simulate typical stream exposures and estimate herbicide effects on aquatic macrophytes in stream systems. Environ Toxicol Chem 2017;36:1090-1100. © 2016 SETAC. © 2016 SETAC.

Effects of climate change on phenological trends and seed cotton yields in oasis of arid regions.

PubMed

Huang, Jian; Ji, Feng

2015-07-01

Understanding the effects of climatic change on phenological phases of cotton (Gossypium hirsutum L.) in oasis of arid regions may help optimize management schemes to increase productivity. This study assessed the impacts of climatic changes on the phenological phases and productivity of spring cotton. The results showed that climatic warming led the dates of sowing seed, seeding emergence, three-leaf, five-leaf, budding, anthesis, full bloom, cleft boll, boll-opening, boll-opening filling, and stop-growing become earlier by 24.42, 26.19, 24.75, 23.28, 22.62, 15.75, 14.58, 5.37, 2.85, 8.04, and 2.16 days during the period of 1981-2010, respectively. The growth period lengths from sowing seed to seeding emergence and from boll-opening to boll-opening filling were shortened by 1.76 and 5.19 days, respectively. The other growth period lengths were prolonged by 2-9.71 days. The whole growth period length was prolonged by 22.26 days. The stop-growing date was delayed by 2.49-3.46 days for every 1 °C rise in minimum, maximum, and mean temperatures; however, other development dates emerged earlier by 2.17-4.76 days. Rising temperatures during the stage from seeding emergence to three-leaf reduced seed cotton yields. However, rising temperatures increased seed cotton yields in the two stages from anthesis to cleft boll and from boll-opening filling to the stop-growing. Increasing accumulated temperatures (AT) had different impacts on different development stages. During the vegetative phase, rising AT led to reduced seed cotton yields, but rising AT during reproductive stage increased seed cotton yields. In conclusion, climatic warming helpfully obtained more seed cotton yields in oasis of arid regions in northwest China. Changing the sowing date is another way to enhance yields for climate change in the future.

Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

PubMed

Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A

2013-11-01

In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P < .001). Non-VA care was completely eliminated for patients undergoing total hip and knee replacement at the Richard L. Roudebush Veterans Affairs Medical Center, producing an estimated return on investment of $1 million annually when compared with baseline cost and volumes. In addition, the volume of total joint replacements at this center increased during the data collection period. The success of the Joint Replacement Program demonstrates that VA-TAMMCS is an effective tool for Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.

A case-control study on the clinical impact of ventilator associated tracheobronchitis in adult patients who did not develop ventilator associated pneumonia.

PubMed

Cantón-Bulnes, María Luisa; González-García, María Ascensión; García-Sánchez, Manuela; Arenzana-Seisdedos, Ángel; Garnacho-Montero, José

2018-02-05

The main objective was to determine whether ventilator-associated tracheobronchitis (VAT) is related to increased length of ICU stay. Secondary endpoints included prolongation of hospital stay, as well as, ICU and hospital mortality. A retrospective matched case-control study. Each case was matched with a control for duration of ventilation (± 2 days until development of ventilator-associated tracheobronchitis), disease severity (Acute Physiology and Chronic Health Evaluation II) at admission ± 3, diagnostic category and age ±10 years. Critically ill adults admitted to a polyvalent 30-beds ICU with the diagnosis of VAT in the period 2013-2016. We identified 76 cases of VAT admitted to our ICU during the study period. No adequate controls were found for 3 patients with VAT. There were no significant differences in demographic characteristics, reasons for admission and comorbidities. Patients with VAT had a longer ICU length of stay, median 22 days (14-35), compared to controls, median 15 days (8-27), p=.02. Ventilator days were also significantly increased in VAT patients, median 18 (9-28) versus 9 days (5-16), p=.03. There was no significant difference in total hospital length of stay 40 (28-61) vs. 35days (23-54), p=.32; ICU mortality (20.5 vs. 31.5% p=.13) and hospital mortality (30.1 vs. 43.8% p=.09). We performed a subanalysis of patients with microbiologically proven VAT receiving adequate antimicrobial treatment and did not observe significant differences between cases and the corresponding controls. VAT is associated with increased length of intensive care unit stay and longer duration of mechanical ventilation. This effect disappears when patients receive appropriate empirical treatment. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Centrifugation effects on estrous cycle, mating success and pregnancy outcome in rats

NASA Astrophysics Data System (ADS)

Ronca, April E.; Rushing, Linda; Tou, Janet; Wade, Charles E.; Baer, Lisa A.

2005-08-01

We analyzed the effects of 2-g centrifugation on estrous cycling, mating success and pregnancy outcome in rats. Sexually mature female and male rats were assigned to either 2-g centrifuge or non-centrifuge conditions, and to non-breeding or breeding conditions. In non-breeding females, estrous cycles were analyzed by examining vaginal cytology before and for 35 days during centrifugation. Breeding females were time-mated following 7 days of adaptation to centrifugation. Following adaptation to centrifugation, estrous cycle duration over a five-cycle period was similar in centrifuged and non-centrifuged females. Identical numbers of centrifuged and non-centrifuged females conceived, however centrifuged females took four-times longer than controls to achieve conception. Births occurred at the normal gestational length. Pup birth weight and postnatal survival were p<0.05 reduced in centrifuged as compared to non-centrifuged groups. In conclusion, 2-g centrifugation had no effect on estrus cycle length or the probably of becoming pregnant but delayed conception and diminished pregnancy outcome.

Centrifugation Effects on Estrous Cycling, Mating Success and Pregnancy Outcome in Rats

NASA Technical Reports Server (NTRS)

Ronca, April E.; Rushing, Linda S.; Tou, Janet; Wade, Charles E.; Baer, Lisa A.

2005-01-01

We analyzed the effects of 2-g centrifugation on estrous cycling, mating success and pregnancy outcome in rats. Sexually mature female and male rats were assigned to either 2-g centrifuge or non-centrifuge conditions, and to non-breeding or breeding conditions. In non-breeding females, estrous cycles were analyzed by examining vaginal cytology before and for 35 days during centrifugation. Breeding females were time-mated following 7 days of adaptation to centrifugation. Following adaptation to centrifugation, estrous cycle duration over a five-cycle period was similar in centrifuged and non-centrifuged females. Identical numbers of centrifuged and non-centrifuged females conceived, however centrifuged females took four-times longer than controls to achieve conception. Births occurred at the normal gestational length. Pup birth weight and postnatal survival were p<0.05 reduced in centrifuged as compared to non-centrifuged groups. In conclusion, 2-g centrifugation had no effect on estrous cycle length or the probably of becoming pregnant but delayed conception and diminished pregnancy outcome.

Effects of microgravityon the structural organization of Brassica rapa photosynthetic appartus

NASA Astrophysics Data System (ADS)

Adamchuk, N.; Kordyum, E.; Guikema, J.

Leaf mesophyll cells of 13- and 15-day old Brassica rapa plants grown on board the space shuttle Columbia (STS-87) and in the ground control have been investigated using the methods of light and electron microscopy. 13-day old plants were fixed on orbit and 15-day old plants were fixed after landing. It was shown the essential differences in leaf mesophyll quantitative anatomical and ultrastructural characteristics between spaceflight and ground control variants. Both the volume of palisade parenchyma cells and a number of chloroplasts in those cells increased in spaceflight samples. Simultaneusly, a chloroplast size decreased together with increasing of a relative volume of stromal thylakoids, starch grains and plastoglobuli. It was also noted increasing of stromal thylakoid length. In the same time, both a total length of thylakoids in granae and the grana number diminished in space flight. In addition, the interthylakoid space could be expended and the thylakoid length was more variable in chloroplast granae on microgravity, that correlated with a shrinkage of thylakoids in granal stacks. The obtained data a er discussed with the questions on both the photosynthetic apparatus sensitivity to gravity and its adaptive possibility to microgravity.

Effects of block length on the enzymatic degradation and erosion of oxazoline linked poly-epsilon-caprolactone.

PubMed

Pulkkinen, Mika; Malin, Minna; Tarvainen, Tommy; Saarimäki, Tiina; Seppälä, Jukka; Järvinen, Kristiina

2007-06-01

The aim of the study was to develop enzyme sensitive polymers for pharmaceutical applications. Thus, 2,2'-bis(2-oxazoline)-linked poly-epsilon-caprolactone (PCL-O) polymers were synthesized by using epsilon-caprolactone precursors with different molecular weights (M(n): 1500, 3900, 7500 and 12,000g/mol), and the effects of PCL block length on enzymatic degradation and erosion (weight loss) of PCL-O films were studied. Solvent cast PCL and PCL-O films were incubated (22 days) in the presence of pancreatin (1%, pH 7.5), with and without enzyme inhibitors. In the absence of enzyme inhibitors, surface erosion of the PCL-O films occurred during incubation, and the erosion of the PCL-O films increased in parallel with a decrease in the PCL block length. The presence of the lipase inhibitors, paraoxon-ethyl and tetrahydrolipstatin delayed the weight loss of the PCL-O films. These results indicate that lipase was mainly responsible for the enzymatic erosion of the PCL-O films. In comparison, practically no weight loss of the PCL or the PCL-O films was observed in phosphate buffer (pH 7.4) (28 days incubation). The results demonstrate that the studied epsilon-caprolactone based poly(ester-amide)s are enzyme sensitive polymers whose erosion rate can be controlled by the PCL block length.

Day-of-Surgery Mobilization Reduces the Length of Stay After Elective Hip Arthroplasty.

PubMed

Okamoto, Taro; Ridley, Ryan J; Edmondston, Stephen J; Visser, Mariet; Headford, Julie; Yates, Piers J

2016-10-01

To determine the effect of mobilization on the day of surgery on the readiness for discharge and length of stay after elective total hip arthroplasty (THA). We devised a randomized control trial with concealed allocation and intention-to-treat analysis. Overall, 126 patients who underwent THA and met the criteria for mobilization on the day of surgery were randomly allocated into 2 groups; the intervention group was mobilized on the day of surgery, n = 58 and the control group was mobilized on the day after surgery, n = 68. Apart from timing of mobilization, both groups received the same postoperative management. The primary outcome measures were length of hospital stay and time to readiness for discharge. The early mobilization group was ready for discharge 63 hours (standard deviation [SD] = 15 hours) after surgery, compared to 70 hours (SD = 18 hours) for the control group (P = .03, 95% CI, 0.7-12.8). There was no significant difference in hospital stay in the early mobilization group (77 hours [SD = 30 hours]), compared to the control group (87 hours [SD = 35 hours]; P = .11, 95% CI, -2.1 to 21.6). Despite this at any point in time after the surgery, the intervention group was 1.8 times (P = .003, 95% CI, = 1.2-2.7) more likely to have been discharged. Mobilization on the day of THA surgery significantly increases the probability of discharge at any singular point in time compared with mobilization on the day after surgery and decreases the time to readiness for discharge. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Perioperative risk factors for mortality and length of hospitalization in mares with dystocia undergoing general anesthesia: A retrospective study

PubMed Central

Rioja, Eva; Cernicchiaro, Natalia; Costa, Maria Carolina; Valverde, Alexander

2012-01-01

This study investigated associations between perioperative factors and probability of death and length of hospitalization of mares with dystocia that survived following general anesthesia. Demographics and perioperative characteristics from 65 mares were reviewed retrospectively and used in a risk factor analysis. Mortality rate was 21.5% during the first 24 h post-anesthesia. The mean ± standard deviation number of days of hospitalization of surviving mares was 6.3 ± 5.4 d. Several factors were found in the univariable analysis to be significantly associated (P < 0.1) with increased probability of perianesthetic death, including: low preoperative total protein, high temperature and severe dehydration on presentation, prolonged dystocia, intraoperative hypotension, and drugs used during recovery. Type of delivery and day of the week the surgery was performed were significantly associated with length of hospitalization in the multivariable mixed effects model. The study identified some risk factors that may allow clinicians to better estimate the probability of mortality and morbidity in these mares. PMID:23115362

A mechanical stretch induces contractile activation in unstimulated developing rat skeletal muscle in vitro

PubMed Central

Mutungi, Gabriel; Edman, K A P; Ranatunga, K W

2003-01-01

The effects of a stretch-release cycle (≈25 % of the resting muscle fibre length, Lo) on both tension and [Ca2+]i in small, unstimulated, intact muscle fibre bundles isolated from adult and neonatal rats were investigated at 20 °C. The results show that the effects of the length change depended on the age of the rats. Thus, the length change produced three effects in the neonatal rat muscle fibre bundles, but only a single effect in the adult ones. In the neonatal fibre bundles, the length change led to an increase in resting muscle tension and to a transient increase in [Ca2+]i. The stretch-release cycle was then followed by a twitch-like tension response. In the adult fibre bundles, only the increase in resting tension was seen and both the transient increase in [Ca2+]i and the stretch-induced twitch-like tension response were absent. The amplitude of the twitch-like tension response was affected by both 2,3-butanedione monoxime and sarcomere length in the same manner as active twitch tension, suggesting that it arose from actively cycling crossbridges. It was also reversibly abolished by 25 mM K+, 1 μM tetrodotoxin and 1.5 mM lidocaine (lignocaine), and was significantly depressed (P < 0.001) by lowering [Ca2+]o. These findings suggest that a rapid stretch in neonatal rats induces a propagated impulse that leads to an increase in [Ca2+]i, and that abolishing the action potential abolishes the stretch-induced twitch-like tension response. In 5- to 7-day-old rats, the twitch-like tension response was ≈50 % of the isometric twitch. It then decreased progressively with age and was virtually absent by the time the rats were 21 days old. Interestingly, this is the same period over which rat muscles differentiate from their neonatal to their adult types. PMID:12813148

Effect of Aspirin on Development of ARDS in At-Risk Patients Presenting to the Emergency Department: The LIPS-A Randomized Clinical Trial.

PubMed

Kor, Daryl J; Carter, Rickey E; Park, Pauline K; Festic, Emir; Banner-Goodspeed, Valerie M; Hinds, Richard; Talmor, Daniel; Gajic, Ognjen; Ware, Lorraine B; Gong, Michelle Ng

2016-06-14

Management of acute respiratory distress syndrome (ARDS) remains largely supportive. Whether early intervention can prevent development of ARDS remains unclear. To evaluate the efficacy and safety of early aspirin administration for the prevention of ARDS. A multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 16 US academic hospitals. Between January 2, 2012, and November 17, 2014, 7673 patients at risk for ARDS (Lung Injury Prediction Score ≥4) in the emergency department were screened and 400 were randomized. Ten patients were excluded, leaving 390 in the final modified intention-to-treat analysis cohort. Administration of aspirin, 325-mg loading dose followed by 81 mg/d (n = 195) or placebo (n = 195) within 24 hours of emergency department presentation and continued to hospital day 7, discharge, or death. The primary outcome was the development of ARDS by study day 7. Secondary measures included ventilator-free days, hospital and intensive care unit length of stay, 28-day and 1-year survival, and change in serum biomarkers associated with ARDS. A final α level of .0737 (α = .10 overall) was required for statistical significance of the primary outcome. Among 390 analyzed patients (median age, 57 years; 187 [48%] women), the median (IQR) hospital length of stay was 6 3-10) days. Administration of aspirin, compared with placebo, did not significantly reduce the incidence of ARDS at 7 days (10.3% vs 8.7%, respectively; odds ratio, 1.24 [92.6% CI, 0.67 to 2.31], P = .53). No significant differences were seen in secondary outcomes: ventilator-free to day 28, mean (SD), 24.9 (7.4) days vs 25.2 (7.0) days (mean [90% CI] difference, -0.26 [-1.46 to 0.94] days; P = .72); ICU length of stay, mean (SD), 5.2 (7.0) days vs 5.4 (7.0) days (mean [90% CI] difference, -0.16 [-1.75 to 1.43] days; P = .87); hospital length of stay, mean (SD), 8.8 (10.3) days vs 9.0 (9.9) days (mean [90% CI] difference, -0.27 [-1.96 to 1.42] days; P = .79); or 28-day survival, 90% vs 90% (hazard ratio [90% CI], 1.03 [0.60 to 1.79]; P = .92) or 1-year survival, 73% vs 75% (hazard ratio [90% CI], 1.06 [0.75 to 1.50]; P = .79). Bleeding-related adverse events were infrequent in both groups (aspirin vs placebo, 5.6% vs 2.6%; odds ratio [90% CI], 2.27 [0.92 to 5.61]; P = .13). Among 390 analyzed patients (median age, 57 years; 187 [48%] women), median (IQR) hospital length of stay was 6 (3-10) days. Administration of aspirin, compared with placebo, did not significantly reduce the incidence of ARDS at 7 days (OR, 1.24; 92.6%CI, 0.67-2.31). No significant differences were seen in secondary outcomes or adverse events. [table: see text] Among at-risk patients presenting to the ED, the use of aspirin compared with placebo did not reduce the risk of ARDS at 7 days. The findings of this phase 2b trial do not support continuation to a larger phase 3 trial. clinicaltrials.gov Identifier: NCT01504867.

Effects of climate change on spring wheat phenophase and water requirement in Heihe River basin, China

NASA Astrophysics Data System (ADS)

Han, Dongmei; Yan, Denghua; Xu, Xinyi; Gao, Yu

2017-02-01

Climate change has significantly altered the temperature rhythm which is a key factor for the growth and phenophase of the crop. And temperature change further affects crop water requirement and irrigation system. In the north-west of China, one of the most important crop production bases is Heihe River basin where the observed phenological data is scarce. This study thus first adopted accumulated temperature threshold (ATT) method to define the phenological stages of the crop, and analysed the effect of climate change on phenological stages and water requirement of the crop during growing season. The results indicated the ATT was available for the determination of spring wheat phenological stages. The start dates of all phenological stages became earlier and the growing season length (days) was reduced by 7 days under climate change. During the growing season, water requirement without consideration of phenophase change has been increased by 26.1 mm, while that with consideration of phenophase change was featured in the decrease of water requirement by 50 mm. When temperature increased by 1°C on average, the changes were featured in the 2 days early start date of growing season, 2 days decrease of growing season length, and the 1.4 mm increase of water requirement, respectively.

Determinants of gestation length in Thoroughbred mares on German stud farms.

PubMed

Ewert, Mareike; Lüders, Imke; Böröcz, Jozsef; Uphaus, Hubert; Distl, Ottmar; Sieme, Harald

2018-04-01

The aim of the present study was to analyze the effects of stallion and mare, their ages, and maternal lineage on the gestation length (GL) in Thoroughbreds. In addition, additive genetic effects of the dam, stallion and fetus were analyzed. Data were taken from 1993 through 2009, and included 16,226 pregnancies from 5959 Th oroughbred mares mated with 290 different stallions. All analyses were performed using linear mixed models. The GL ranged from 306 to 390 days, with a mean length of 347.0 ± 14.4 days. Mating of mares with stallions aged 17 years and older resulted in a significantly longer GL compared to younger stallions. Furthermore, the GL significantly increased with the increasing age of the mares, and the GL was longer with male foals. The month and year of breeding, as well as the mare´s breeding history (parity and reproductive status) also affected GL. The mare and stallion themselves explained 18% and 4% of the variance in GL. Coefficients of inbreeding of mares and foals had no significant effect on GL. The heritability for the GL was 0.17 for the dam and 0.006 for the fetus, whereas an additive genetic paternal effect was not estimable. The relative proportions among the additive genetic and permanent environmental contributions of the dam were 76.5% and 23.5%. A maternal lineage effect was not obvious. Copyright © 2018 Elsevier B.V. All rights reserved.

Prescribed hypocaloric nutrition support for critically-ill adults.

PubMed

Perman, Mario I; Ciapponi, Agustín; Franco, Juan Va; Loudet, Cecilia; Crivelli, Adriana; Garrote, Virginia; Perman, Gastón

2018-06-04

There are controversies about the amount of calories and the type of nutritional support that should be given to critically-ill people. Several authors advocate the potential benefits of hypocaloric nutrition support, but the evidence is inconclusive. To assess the effects of prescribed hypocaloric nutrition support in comparison with standard nutrition support for critically-ill adults SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, Embase and LILACS (from inception to 20 June 2017) with a specific strategy for each database. We also assessed three websites, conference proceedings and reference lists, and contacted leaders in the field and the pharmaceutical industry for undetected/unpublished studies. There was no restriction by date, language or publication status. We included randomized and quasi-randomized controlled trials comparing hypocaloric nutrition support to normo- or hypercaloric nutrition support or no nutrition support (e.g. fasting) in adults hospitalized in intensive care units (ICUs). We used standard methodological procedures expected by Cochrane. We meta-analysed data for comparisons in which clinical heterogeneity was low. We conducted prespecified subgroup and sensitivity analyses, and post hoc analyses, including meta-regression. Our primary outcomes were: mortality (death occurred during the ICU and hospital stay, or 28- to 30-day all-cause mortality); length of stay (days stayed in the ICU and in the hospital); and Infectious complications. Secondary outcomes included: length of mechanical ventilation. We assessed the quality of evidence with GRADE. We identified 15 trials, with a total of 3129 ICU participants from university-associated hospitals in the USA, Colombia, Saudi Arabia, Canada, Greece, Germany and Iran. There are two ongoing studies. Participants suffered from medical and surgical conditions, with a variety of inclusion criteria. Four studies used parenteral nutrition and nine studies used only enteral nutrition; it was unclear whether the remaining two used parenteral nutrition. Most of them could not achieve the proposed caloric targets, resulting in small differences in the administered calories between intervention and control groups. Most studies were funded by the US government or non-governmental associations, but three studies received funding from industry. Five studies did not specify their funding sources.The included studies suffered from important clinical and statistical heterogeneity. This heterogeneity did not allow us to report pooled estimates of the primary and secondary outcomes, so we have described them narratively.When comparing hypocaloric nutrition support with a control nutrition support, for hospital mortality (9 studies, 1775 participants), the risk ratios ranged from 0.23 to 5.54; for ICU mortality (4 studies, 1291 participants) the risk ratios ranged from 0.81 to 5.54, and for mortality at 30 days (7 studies, 2611 participants) the risk ratios ranged from 0.79 to 3.00. Most of these estimates included the null value. The quality of the evidence was very low due to unclear or high risk of bias, inconsistency and imprecision.Participants who received hypocaloric nutrition support compared to control nutrition support had a range of mean hospital lengths of stay of 15.70 days lower to 10.70 days higher (10 studies, 1677 participants), a range of mean ICU lengths of stay 11.00 days lower to 5.40 days higher (11 studies, 2942 participants) and a range of mean lengths of mechanical ventilation of 13.20 days lower to 8.36 days higher (12 studies, 3000 participants). The quality of the evidence for this outcome was very low due to unclear or high risk of bias in most studies, inconsistency and imprecision.The risk ratios for infectious complications (10 studies, 2804 participants) of each individual study ranged from 0.54 to 2.54. The quality of the evidence for this outcome was very low due to unclear or high risk of bias, inconsistency and imprecisionWe were not able to explain the causes of the observed heterogeneity using subgroup and sensitivity analyses or meta-regression. The included studies had substantial clinical heterogeneity. We found very low-quality evidence about the effects of prescribed hypocaloric nutrition support on mortality in hospital, in the ICU and at 30 days, as well as in length of hospital and ICU stay, infectious complications and the length of mechanical ventilation. For these outcomes there is uncertainty about the effects of prescribed hypocaloric nutrition, since the range of estimates includes both appreciable benefits and harms.Given these limitations, results must be interpreted with caution in the clinical field, considering the unclear balance of the risks and harms of this intervention. Future research addressing the clinical heterogeneity of participants and interventions, study limitations and sample size could clarify the effects of this intervention.

Host selection and gonotrophic cycle length of Anopheles punctimacula in southern Mexico.

PubMed

Ulloa, Armando; Gonzalez-Cerón, Lilia; Rodríguez, Mario H

2006-12-01

The host preference, survival rates, and length of the gonotrophic cycle of Anopheles punctimacula was investigated in southern México. Mosquitoes were collected in 15-day separate experiments during the rainy and dry seasons. Daily changes in the parous-nulliparous ratio were recorded and the gonotrophic cycle length was estimated by a time series analysis. Anopheles punctimacula was most abundant during the dry season and preferred animals to humans. The daily survival rate in mosquitoes collected in animal traps was 0.96 (parity rate = 0.86; gonotrophic cycle = 4 days). The length of gonotrophic cycle of 4 days was estimated on the base of a high correlation coefficient value appearing every 4 days. The minimum time estimated for developing mature eggs after blood feeding was 72 h. The proportion of mosquitoes living enough to transmit Plasmodium vivax malaria during the dry season was 0.35.

Day versus night laparoscopic cholecystectomy for acute cholecystitis: A comparison of outcomes and cost.

PubMed

Siada, Sammy S; Schaetzel, Shaina S; Chen, Allen K; Hoang, Huy D; Wilder, Fatima G; Dirks, Rachel C; Kaups, Krista L; Davis, James W

2017-12-01

Recent studies have suggested higher complication and conversion to open rates for nighttime laparoscopic cholecystectomy (LC) and recommend against the practice. We hypothesize that patients undergoing night LC for acute cholecystitis have decreased hospital length of stay and cost with no difference in complication and conversion rates. A retrospective review of patients with acute cholecystitis who underwent LC from October 2011 through June 2015 was performed. Complication rates, length of stay, and cost of hospitalization were compared between patients undergoing day cholecystectomy and night cholecystectomy. Complication rates and costs did not differ between the day and night groups. Length of stay was shorter in the night group (2.4 vs 2.8 days, p = 0.002). Performing LC for acute cholecystitis during night-time hours does not increase risk of complications and decreases length of stay. Copyright © 2017 Elsevier Inc. All rights reserved.

Influence of Photoperiod on Hormones, Behavior, and Immune Function

PubMed Central

Walton, James C.; Weil, Zachary M.; Nelson, Randy J.

2011-01-01

Photoperiodism is the ability of plants and animals to measure environmental day length to ascertain time of year. Central to the evolution of photoperiodism in animals is the adaptive distribution of energetically challenging activities across the year to optimize reproductive fitness while balancing the energetic tradeoffs necessary for seasonally- appropriate survival strategies. The ability to accurately predict future events requires endogenous mechanisms to permit physiological anticipation of annual conditions. Day length provides a virtually noise free environmental signal to monitor and accurately predict time of the year. In mammals, melatonin provides the hormonal signal transducing day length. Duration of pineal melatonin is inversely related to day length and its secretion drives enduring changes in many physiological systems, including the HPA, HPG, and brain-gut axes, the autonomic nervous system, and the immune system. Thus, melatonin is the fulcrum mediating redistribution of energetic investment among physiological processes to maximize fitness and survival. PMID:21156187

Northern Drosophila montana flies show variation both within and between cline populations in the critical day length evoking reproductive diapause.

PubMed

Lankinen, Pekka; Tyukmaeva, Venera I; Hoikkala, Anneli

2013-08-01

Reproductive diapause, and its correct timing, plays an important role in the life cycle of many insect species living in a seasonally varying environment at high latitudes. In the present paper we have documented variation in the critical day length (CDL) for adult reproductive diapause and the steepness of photoperiodic response curves (PPRCs) in seven clinal populations of Drosophila montana in Finland between the latitudes 61 and 67°N, paying special attention to variation in these traits within and between cline populations. The isofemale lines representing these populations showed a sharp transition from 0% to 100% in females' diapause incidence in the shortening day lengths, indicated by steep PPRCs. The mean CDL showed a clear latitudinal cline decreasing by 1.6h from North to South regardless of the age of the lines, variation within the populations (i.e. among lines) in this trait being up to 3h. The steepness of the PPRCs correlated with the age of the line and this trait showed no clear latitudinal cline. Further studies on a large number of lines from one D. montana population confirmed that while maintaining the flies in diapause preventing conditions in the laboratory has no effect on CDL, older lines had steeper PPRCs. High variation in CDL within and between D. montana cline populations is likely to be heritable and provide a good potential for the evolution of photoperiodic responses. Information on genetic variation in life-history traits, such as diapause, is of utmost importance for predicting the ability of insects to survive in seasonally changing environmental conditions and to respond to long term changes in the length of the growing period e.g. by postponing the timing of diapause towards shorter day length and later calendar date. Copyright © 2013 Elsevier Ltd. All rights reserved.

Second hand tobacco smoke adversely affects the bone of immature rats

PubMed Central

Rosa, Rodrigo César; Pereira, Sângela Cunha; Cardoso, Fabrizio Antônio Gomide; Caetano, Abadio Gonçalves; de Santiago, Hildemberg Agostinho Rocha; Volpon, José Batista

2017-01-01

OBJECTIVES: To evaluate the influence of secondhand cigarette smoke exposure on longitudinal growth of the tibia of growing rats and some parameters of bone quality. METHODS: Forty female rats were randomly divided into four groups: control: rats were sham exposed; 30 days: rats were exposed to tobacco smoke for 30 days; 45 days: rats were exposed to tobacco smoke for 45 days; and 60 days: rats were exposed to tobacco smoke for 60 days. Blood samples were collected to evaluate the levels of cotinine and alkaline phosphatase. Both tibias were dissected and weighed; the lengths were measured, and the bones were then stored in a freezer for analysis of bone mineral content and mechanical resistance (maximal load and stiffness). RESULTS: Exposure of rats to tobacco smoke significantly compromised bone health, suggesting that the harmful effects may be time dependent. Harmful effects on bone growth were detected and were more pronounced at 60-day follow-ups with a 41.8% reduction in alkaline phosphatase levels (p<0.01) and a decrease of 11.25% in tibia length (p<0.001). Furthermore, a 41.5% decrease in bone mineral density was observed (p<0.001), leading to a 42.8% reduction in maximum strength (p<0.001) and a 56.7% reduction in stiffness (p<0.001). CONCLUSION: Second hand cigarette smoke exposure in rats affected bones that were weaker, deforming them and making them osteopenic. Additionally, the long bone was shorter, suggesting interference with growth. Such events seem to be related to time of exposure. PMID:29319726

COST-EFFECTIVENESS OF EARLY NUTRITIONAL THERAPY IN MALNOURISHED ADULT PATIENTS IN A HIGH COMPLEXITY HOSPITAL.

PubMed

Giraldo Giraldo, Nubia Amparo; Vásquez Velásquez, Johanna; Roldán Cano, Paula Andrea; Ospina Astudillo, Carolina; Sosa Cardona, Yuliet Paulina

2015-12-01

hospital malnutrition is a frequent worldwide problem and its potential issues related include increased complications, length of stay, mortality, and healthcare costs. the aim of this study was to establish the cost-effectiveness of early nutritional therapy for malnourished patients in a high complexity hospital. this analytical study with economic assessment included 227 adult hospitalised and malnourished according to the Subjective Global Assessment. The cohort prospective received Early Nutrition Therapy (ENT), whereas the cohort retrospective received Delayed Nutrition Therapy (DNT). The measures of cost-effectiveness included costs by: length of stay, complications and discharge condition. the cohorts were similar in demographic and clinical characteristics, except that the median age, for the ENT was 61 years (interquartile range [IQR]: 48-71) and for the DNT was 55 years (IQR: 44-67) (p = 0.024). The median length of stay was lower in the ENT (11 days, IQR: 7-17) than in the DNT (18 days, IQR: 10-28) (p < 0.001). The cost per patient discharged alive was US $ 10,261.55 in the ENT and US $ 15,553.11 in the DNT (p=0.043); the cost per patient with complications was US $ 13,663.90 in the ENT and US $ 17,860.32 in the DNT (p= 0.058). ENT increased the likelihood of being discharged alive, RR adjusted=0.31; 95% confidence interval (CI): 0.1; 0.6; (p<0.001) and decreased the likelihood of complications RR crude=0.8; 95% CI: 0.6; 0.9; (p=0.006). early nutritional therapy for malnourished adult patients appears to be cost-effective because it can reduce the length of stay, complications, mortality and associated costs. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

The financial impact of heparin-induced thrombocytopenia.

PubMed

Smythe, Maureen A; Koerber, John M; Fitzgerald, Maureen; Mattson, Joan C

2008-09-01

Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that increases patient morbidity and mortality. The financial impact of HIT to an institution is thought to be significant. The objective of this study was to evaluate the financial impact of HIT. A case-control study was employed. Case patients were identified as newly diagnosed HIT patients. Control subjects were matched by diagnosis-related group, primary diagnosis code, primary procedure code, and hospital admission date. The financial/decision support database of the hospital was queried to identify the matched control subjects, total cost, and reimbursement. The determination of financial impact included the total profit or (total loss) and the backfill effect (ie, the lost operating margin resulting from increased length of stay). Length of stay and mortality were compared. Data from 22 case patients and 255 control subjects were analyzed. On average, HIT case patients incurred a financial loss of $14,387 per patient and an increase in length of stay of 14.5 days. When confining the analysis to only Medicare case patients (n = 17) and Medicare control subjects, case patients incurred a financial loss of $20,170 per case and an increase in length of stay of 15.8 days. Depending on the occupancy rate of the institution, additional financial loss could result from the backfill effect. Mortality was not significantly affected. For an institution that sees 50 new cases of HIT per year, the projected annual financial impact ranges from approximately $700,000 to $1 million. Institutions with high bed occupancy rates may see an additional loss from the backfill effect.

Mitigation of Atmospheric Effects on Imaging Systems

DTIC Science & Technology

2004-03-31

focal length. The imaging system had two cameras: an Electrim camera sensitive in the visible (0.6 µ m) waveband and an Amber QWIP infrared camera...sensitive in the 9–micron region. The Amber QWIP infrared camera had 256x256 pixels, pixel pitch 38 mµ , focal length of 1.8 m, FOV of 5.4 x5.4 mr...each day. Unfortunately, signals from the different read ports of the Electrim camera picked up noise on their way to the digitizer, and this resulted

Explaining the variation in the shear force of lamb meat using sarcomere length, the rate of rigor onset and pH.

PubMed

Hopkins, D L; Toohey, E S; Lamb, T A; Kerr, M J; van de Ven, R; Refshauge, G

2011-08-01

The temperature when the pH=6.0 (temp@pH6) impacts on the tenderness and eating quality of sheep meat. Due to the expense, sarcomere length is not routinely measured as a variable to explain variation in shear force, but whether measures such as temp@pH6 are as useful a parameter needs to be established. Measures of rigor onset in 261 carcases, including the temp@pH6, were evaluated in this study for their ability to explain some of the variation in shear force. The results show that for 1 day aged product combinations of the temp@pH6, the pH at 18 °C and the pH at 24 h provided a larger reduction (almost double) in total shear force variation than sarcomere length alone, with pH at 24 h being the single best measure. For 5 day aged product, pH at 18 °C was the single best measure. Inclusion of sarcomere length did represent some improvement, but the marginal increase would not be cost effective. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Predicting Recovery Potential for Individual Stroke Patients Increases Rehabilitation Efficiency.

PubMed

Stinear, Cathy M; Byblow, Winston D; Ackerley, Suzanne J; Barber, P Alan; Smith, Marie-Claire

2017-04-01

Several clinical measures and biomarkers are associated with motor recovery after stroke, but none are used to guide rehabilitation for individual patients. The objective of this study was to evaluate the implementation of upper limb predictions in stroke rehabilitation, by combining clinical measures and biomarkers using the Predict Recovery Potential (PREP) algorithm. Predictions were provided for patients in the implementation group (n=110) and withheld from the comparison group (n=82). Predictions guided rehabilitation therapy focus for patients in the implementation group. The effects of predictive information on clinical practice (length of stay, therapist confidence, therapy content, and dose) were evaluated. Clinical outcomes (upper limb function, impairment and use, independence, and quality of life) were measured 3 and 6 months poststroke. The primary clinical practice outcome was inpatient length of stay. The primary clinical outcome was Action Research Arm Test score 3 months poststroke. Length of stay was 1 week shorter for the implementation group (11 days; 95% confidence interval, 9-13 days) than the comparison group (17 days; 95% confidence interval, 14-21 days; P =0.001), controlling for upper limb impairment, age, sex, and comorbidities. Therapists were more confident ( P =0.004) and modified therapy content according to predictions for the implementation group ( P <0.05). The algorithm correctly predicted the primary clinical outcome for 80% of patients in both groups. There were no adverse effects of algorithm implementation on patient outcomes at 3 or 6 months poststroke. PREP algorithm predictions modify therapy content and increase rehabilitation efficiency after stroke without compromising clinical outcome. URL: http://anzctr.org.au. Unique identifier: ACTRN12611000755932. © 2017 American Heart Association, Inc.

Study on some risk factors and effects of bovine ketosis on dairy cows from the Galicia region (Spain).

PubMed

Viña, C; Fouz, R; Camino, F; Sanjuán, M L; Yus, E; Diéguez, F J

2017-10-01

The study was designed to determine the relation between β-hydroxybutyrate (BHB) concentrations in milk from dairy cows after calving and the length of the previous lactation, the dry period and the 305-day normalized production, and to assess the influence of BHB concentrations on culling and test-day milk productions and somatic cell counts (SCC) throughout the lactation that followed the BHB measurement. The data used in the study were obtained from 59 187 cows in the Galicia region (Spain). BHB determination was performed using Fourier-transformed infrared spectrometry from the milk samples collected from each cow on the first post-partum test day. For statistical analysis, the following methods were applied: (i) ordinal regression to assess the effect of the length of the previous lactation, the dry period and the 305-day normalized milk production on milk BHB, (ii) a Cox model to estimate the influence of the BHB concentration on risk of culling (overall and for a variety of reasons) and (iii) linear regression to assess the link between BHB and the milk yield and SCC obtained from each of the tests day performed throughout lactation. The probability of having higher BHB concentrations increased when the length of the previous lactation (p = 0.006), the dry period (p = 0.003) and the 305-day normalized milk yield (p = 0.005) increased. However, the slight increase observed (especially for the case of the dry period and the 305-day milk yield) would not justify that measures be implemented to reduce these traits. Higher concentrations of BHB led to an increased risk of culling due to 'death' (p ≤ 0.001) and 'urgent slaughter' (p ≤ 0.002) (both causes of involuntary culling). It also led to a reduction in milk production (p < 0.001) and an increase in SCC (p < 0.001) in the post-partum; from that moment onward (including peak lactation), there were no differences in those two parameters depending on the BHB levels. Journal of Animal Physiology and Animal Nutrition © 2016 Blackwell Verlag GmbH.

An Analysis of the Relationship Between the Heat Index and Arrivals in the Emergency Department

PubMed Central

Levy, Matthew; Broccoli, Morgan; Cole, Gai; Jenkins, J Lee; Klein, Eili Y.

2015-01-01

Background: Heatwaves are one of the most deadly weather-related events in the United States and account for more deaths annually than hurricanes, tornadoes, floods, and earthquakes combined. However, there are few statistically rigorous studies of the effect of heatwaves on emergency department (ED) arrivals. A better understanding of this relationship can help hospitals plan better and provide better care for patients during these types of events. Methods: A retrospective review of all ED patient arrivals that occurred from April 15 through August 15 for the years 2008 through 2013 was performed. Daily patient arrival data were combined with weather data (temperature and humidity) to examine the potential relationships between the heat index and ED arrivals as well as the length of time patients spend in the ED using generalized additive models. In particular the effect the 2012 heat wave that swept across the United States, and which was hypothesized to increase arrivals was examined. Results: While there was no relationship found between the heat index and arrivals on a single day, a non-linear relationship was found between the mean three-day heat index and the number of daily arrivals. As the mean three-day heat index initially increased, the number of arrivals significantly declined. However, as the heat index continued to increase, the number of arrivals increased. It was estimated that there was approximately a 2% increase in arrivals when the mean heat index for three days approached 100°F. This relationship was strongest for adults aged 18-64, as well as for patients arriving with lower acuity. Additionally, a positive relationship was noted between the mean three-day heat index and the length of stay (LOS) for patients in the ED, but no relationship was found for the time from which a patient was first seen to when a disposition decision was made. No significant relationship was found for the effect of the 2012 heat wave on ED arrivals, though it did have an effect on patient LOS. Conclusion: A single hot day has only a limited effect on ED arrivals, but continued hot weather has a cumulative effect. When the heat index is high (~90°F) for a number of days in a row, this curtails peoples activities, but if the heat index is very hot (~100°F) this likely results in an exacerbation of underlying conditions as well as heat-related events that drives an increase in ED arrivals. Periods of high heat also affects the length of stay of patients either by complicating care or by making it more difficult to discharge patients. PMID:26579329

Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection.

PubMed

Stephen, Antonia E; Berger, David L

2003-03-01

Patient care pathways have been developed for operative procedures with documented improvements in length of stay and cost without compromising outcome. The average hospital stay after colonic resection is 5 to 10 days. This study describes a clinical pathway for colon resections and examines patient outcome before and after institution of the pathway. One hundred thirty-eight patients underwent elective colon resections at our institution by a single surgeon before (n = 52) and after (n = 86) introduction of a clinical pathway. Length of stay, postoperative complications, readmissions, and cost per patient were compared between the 2 groups. Mean total length of stay (+/- standard deviation [SD]) was less in the postclinical pathway patients (3.7 +/- 1.5 days) compared to preclinical pathway patients (6.6 +/- 3.3 days) (P <.001). When adjusted for age, sex, diagnosis, and type of operation, the difference in length of stay remains statistically significant (P <.001). There was 1 readmission in the prepathway group and 8 readmissions in the postpathway group. When the readmissions were added to the original admissions, the mean length of stay in the postpathway patients was 4.2 +/- 2.8 days and in the prepathway patients was 6.9 +/- 4.1 days (P <.001). The average cost per patient (+/- standard error of the mean), with readmission costs added, was 9310 +/- 5170 US dollars in the prepathway group and 7070 +/- 3670 US dollars in the postpathway group (P =.002). The institution of a clinical pathway for elective, open colon resections can be done safely with improvements in cost and length of stay.

Pediatric sports-related lower extremity fractures: hospital length of stay and charges: what is the role of the primary payer?

PubMed

Gao, Yubo; Johnston, Richard C; Karam, Matthew

2010-01-01

The purposes of this study were (a) to evaluate the distribution by primary payer (public vs. private) of U.S. pediatric patients aged 5-18 years who were hospitalized with a sports-related lower extremity fracture and (b) to discern the adjusted mean hospital length of stay and mean charge per day by payer type. Children who were aged 5 to 18 years and had diagnoses of lower extremity fracture and sports-related injury in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database were included. Lower extremity fractures are defined as International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under Section "Injury and Poisoning (800-999)," while sports-related external cause of injury codes (E-codes) are E886.0, E917.0, and E917.5. Differences in hospital length of stay and cost per day by payer type were assessed via adjusted least square mean analysis. The adjusted mean hospital length of stay was 20% higher for patients with a public payer (2.50 days) versus a private payer (2.08 days). The adjusted mean charge per day differed about 10% by payer type (public, US$7,900; private, US$8,794). Further research is required to identify factors that are associated with different length of stay and mean charge per day by payer type, and explore whether observed differences in hospital length of stay are the result of private payers enhancing patient care, thereby discharging patients in a more efficient manner.

Impact of a hospitalist system on length of stay and cost for children with common conditions.

PubMed

Srivastava, Rajendu; Landrigan, Christopher P; Ross-Degnan, Dennis; Soumerai, Stephen B; Homer, Charles J; Goldmann, Donald A; Muret-Wagstaff, Sharon

2007-08-01

This study examined mechanisms of efficiency in a managed care hospitalist system on length of stay and total costs for common pediatric conditions. We conducted a retrospective cohort study (October 1993 to July 1998) of patients in a not-for-profit staff model (HMO 1) and a non-staff-model (HMO 2) managed care organization at a freestanding children's hospital. HMO 1 introduced a hospitalist system for patients in October 1996. Patients were included if they had 1 of 3 common diagnoses: asthma, dehydration, or viral illness. Linear regression models examining length-of-stay-specific costs for prehospitalist and posthospitalist systems were built. Distribution of length of stay for each diagnosis before and after the system change in both study groups was calculated. Interrupted time series analysis tested whether changes in the trends of length of stay and total costs occurred after implementation of the hospitalist system by HMO1 (HMO 2 as comparison group) for all 3 diagnoses combined. A total of 1970 patients with 1 of the 3 study conditions were cared for in HMO 1, and 1001 in HMO 2. After the hospitalist system was introduced in HMO 1, length of stay was reduced by 0.23 days (13%) for asthma and 0.19 days (11%) for dehydration; there was no difference for patients with viral illness. The largest relative reduction in length of stay occurred in patients with a shorter length of stay whose hospitalizations were reduced from 2 days to 1 day. This shift resulted in an average cost-per-case reduction of $105.51 (9.3%) for patients with asthma and $86.22 (7.8%) for patients with dehydration. During the same period, length of stay and total cost rose in HMO 2. Introduction of a hospitalist system in one health maintenance organization resulted in earlier discharges and reduced costs for children with asthma and dehydration compared with another one, with the largest reductions occurring in reducing some 2-day hospitalizations to 1 day. These findings suggest that hospitalists can increase efficiency and reduce costs for children with common pediatric conditions.

Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation.

PubMed

Echevarria, Carlos; Gray, Joanne; Hartley, Tom; Steer, John; Miller, Jonathan; Simpson, A John; Gibson, G John; Bourke, Stephen C

2018-04-21

Previous models of Hospital at Home (HAH) for COPD exacerbation (ECOPD) were limited by the lack of a reliable prognostic score to guide patient selection. Approximately 50% of hospitalised patients have a low mortality risk by DECAF, thus are potentially suitable. In a non-inferiority randomised controlled trial, 118 patients admitted with a low-risk ECOPD (DECAF 0 or 1) were recruited to HAH or usual care (UC). The primary outcome was health and social costs at 90 days. Mean 90-day costs were £1016 lower in HAH, but the one-sided 95% CI crossed the non-inferiority limit of £150 (CI -2343 to 312). Savings were primarily due to reduced hospital bed days: HAH=1 (IQR 1-7), UC=5 (IQR 2-12) (P=0.001). Length of stay during the index admission in UC was only 3 days, which was 2 days shorter than expected. Based on quality-adjusted life years, the probability of HAH being cost-effective was 90%. There was one death within 90 days in each arm, readmission rates were similar and 90% of patients preferred HAH for subsequent ECOPD. HAH selected by low-risk DECAF score was safe, clinically effective, cost-effective, and preferred by most patients. Compared with earlier models, selection is simpler and approximately twice as many patients are eligible. The introduction of DECAF was associated with a fall in UC length of stay without adverse outcome, supporting use of DECAF to direct early discharge. Registered prospectively ISRCTN 29082260. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Partial correction of the dwarf phenotype by non-viral transfer of the growth hormone gene in mice: Treatment age is critical.

PubMed

Higuti, Eliza; Cecchi, Cláudia R; Oliveira, Nélio A J; Lima, Eliana R; Vieira, Daniel P; Aagaard, Lars; Jensen, Thomas G; Jorge, Alexander A L; Bartolini, Paolo; Peroni, Cibele N

2016-02-01

Non-viral transfer of the growth hormone gene to different muscles of immunodeficient dwarf (lit/scid) mice is under study with the objective of improving phenotypic correction via this particular gene therapy approach. Plasmid DNA was administered into the exposed quadriceps or non-exposed tibialis cranialis muscle of lit/scid mice followed by electroporation, monitoring several growth parameters. In a 6-month bioassay, 50μg DNA were injected three times into the quadriceps muscle of 80-day old mice. A 50% weight increase, with a catch-up growth of 21%, together with a 16% increase for nose-to-tail and tail lengths (catch-up=19-21%) and a 24-28% increase for femur length (catch-up=53-60%), were obtained. mIGF1 serum levels were ~7-fold higher than the basal levels for untreated mice, but still ~2-fold lower than in non-dwarf scid mice. Since treatment age was found to be particularly important in a second bioassay utilizing 40-day old mice, these pubertal mice were compared in a third bioassay with adult (80-day old) mice, all treated twice with 50μg DNA injected into each tibialis cranialis muscle, via a less invasive approach. mIGF1 concentrations at the same level as co-aged scid mice were obtained 15days after administration in pubertal mice. Catch-up growth, based on femur length (77%), nose-to-tail (36%) and tail length (39%) increases was 40 to 95% higher than those obtained upon treating adult mice. These data pave the way for the development of more effective pre-clinical assays in pubertal dwarf mice for the treatment of GH deficiency via plasmid-DNA muscular administration. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Impact of topical application of autologous platelet-rich gel on medical expenditure and length of stay in hospitals in diabetic patients with refractory cutaneous ulcers].

PubMed

Li, Lan; Wang, Chun; Wang, Yan; He, Li-Ping; Yang, Yan-Zhi; Chen, Li-Hong; Chen, Da-Wei; Li, Xiu-Jun; Ran, Xing-Wu

2012-09-01

To evaluate the potential financial benefit of topical application of autologous platelet-rich gel (APG) in treating diabetic refractory cutaneous ulcers. A single-center prospective randomized controlled trial was undertaken, with 117 patients with proven diabetic refractory cutaneous ulcers participating in the study. The patients who gave informed consents were randomly assigned into standard care group (n = 58) or standard care plus topical application of APG treatment group (n = 59). The outcome of healing and the medical expenditur and length of stay in the patients were compared between the two groups. The APG-treated group had better healing outcomes than the standard-treated group. The APG-treated group had 84.750 (50/59) complete healing and 98.31% improvement, higher than the 68.97% (40/58) and 75.86%, respectively, in the standard-treated group (P = 0.026). The median length for healing in the APG-treated patients was 36 days, shorter than the 45 days in the standard-treated patients (P = 0.012). The total medical expenditure and length of stay in hospitals were not significantly different between APG-treated patients [yen 38223 (23070-57398); 57 (41-94) days] and standard-treated patients [yen 35070 (24436-53649); 58 (31.75-58.50) days) (P = 0.455 and 0.301 respectively). Spendings on items such as medicine, artificial treatment, materials, interventional operation, surgical procedures, laboratory tests and other auxiliary examination, accommodations, meals, nursing care and debridement and dressing change were similar between the two groups (P > 0.05). There is an advantage for the topical application of APG on diabetic refractory cutaneous ulcers in terms of the healing outcomes. APG is a cost-effective choice for patients with diabetic refractory cutaneous ulcers.

Roughness Length as a Measure of the Effects of a Vegetative Windbreak

NASA Astrophysics Data System (ADS)

Kenny, W.; Maurer, K.; Bohrer, G.

2012-12-01

Vegetative windbreaks are often used as barriers to block the dispersion of particulate matter, particularly around agricultural facilities. Windbreaks and narrow forest strips alter the wind pattern and affect dispersion of particles and aerosols that are carried across. Our observations during two field campaigns, conducted near animal feeding lots where large flumes of dust are advected across edge-of-field windbreaks, suggest that sensible heat flux greatly affects the interaction between the flow and the windbreak. We used measurements at multiple heights upwind and downwind of the windbreak to calculate the background roughness length and the effective roughness length of the windbreak. While the flow is not fully adjusted at the wake of the windbreak, we use measurements at different times of the day as a sensitivity analysis to the strength of the buoyancy term within the theoretical surface similarity equation that includes the effects of the wind break. Clearly, calculated roughness length downwind of the windbreak is much greater than upwind of the windbreak, but as SHF increases, the difference in roughness length across the windbreak decreases indicating a decrease in the overall effect of the windbreak on flow. Our findings indicate that as SHF increases, windbreaks may not be able to play much of a role in affecting the dispersion of particulate matter, as the overall effects of windbreaks diminish.

[High-dosed gestagen therapy of the metastatic mammary carcinoma (author's transl)].

PubMed

Firusian, N; Becher, R

1981-12-01

Thirty patients with histologically proven metastatic mammary carcinoma were treated, after exhaustion of hormonal and cytostatic therapeutic means, with high-dosed medroxyprogesterone acetate (MPA) during a ten-day induction phase with 1000 mg MPAi.m. per day and then with 600 mg oral MPA per day. In eleven patients a complete or partial remission was achieved. The median period of remission comprised ten months. A positive relationship was found between the response to high-dosed MPA therapy and the length of free intervals. Side effects were tolerable.

Atmospheric gradients from very long baseline interferometry observations

NASA Technical Reports Server (NTRS)

Macmillan, D. S.

1995-01-01

Azimuthal asymmetries in the atmospheric refractive index can lead to errors in estimated vertical and horizontal station coordinates. Daily average gradient effects can be as large as 50 mm of delay at a 7 deg elevation. To model gradients, the constrained estimation of gradient paramters was added to the standard VLBI solution procedure. Here the analysis of two sets of data is summarized: the set of all geodetic VLBI experiments from 1990-1993 and a series of 12 state-of-the-art R&D experiments run on consecutive days in January 1994. In both cases, when the gradient parameters are estimated, the overall fit of the geodetic solution is improved at greater than the 99% confidence level. Repeatabilities of baseline lengths ranging up to 11,000 km are improved by 1 to 8 mm in a root-sum-square sense. This varies from about 20% to 40% of the total baseline length scatter without gradient modeling for the 1990-1993 series and 40% to 50% for the January series. Gradients estimated independently for each day as a piecewise linear function are mostly continuous from day to day within their formal uncertainties.

Night-time activity forecast by season and weather in a longitudinal design - natural light effects on three years' rest-activity cycles in nursing home residents with dementia.

PubMed

Wahnschaffe, Amely; Nowozin, Claudia; Rath, Andreas; Floessner, Theresa; Appelhoff, Stefan; Münch, Mirjam; Kunz, Dieter

2017-12-01

Backround: Night-time agitation is a frequent symptom of dementia. It often causes nursing home admission and has been linked to circadian rhythm disturbances. A positive influence of light interventions on night-time agitation was shown in several studies. The aim of our study was to investigate whether there is a long-term association between regional weather data (as indicator for daylight availability) and 24-hour variations of motor activity. Motor activity of 20 elderly nursing home residents living with dementia was analyzed using recordings of continuously worn wrist activity monitors over a three-year period. The average recording duration was 479 ± 206 days per participant (mean ± SD). Regional cloud amount and day length data from the local weather station (latitude: 52°56'N) were included in the analysis to investigate their effects on several activity variables. Nocturnal rest, here defined as the five consecutive hours with the least motor activity during 24 hours (L5), was the most predictable activity variable per participant. There was a significant interaction of night-time activity with day length and cloud amount (F 1,1174 = 4.39; p = 0.036). Night-time activity was higher on cloudy short days than on clear short days (p = 0.007), and it was also higher on cloudy short days than on cloudy long days (p = 0.032). The need for sufficient zeitgeber (time cue) strength during winter time, especially when days are short and skies are cloudy, is crucial for elderly people living with dementia. Activity forecast by season and weather might be a valuable approach to anticipate adequately complementary use of electrical light and thereby foster lower night-time activity.

Cow characteristics and their association with udder health after different dry period lengths.

PubMed

van Hoeij, R J; Lam, T J G M; de Koning, D B; Steeneveld, W; Kemp, B; van Knegsel, A T M

2016-10-01

Shortening or omitting the dry period (DP) in dairy cows is of interest because of potential beneficial effects on energy balance and metabolic health. Reported effects of a short or omitted dry period on udder health are ambiguous. This study aimed to evaluate the effect of no DP (0d), a short DP (30d), or a conventional DP (60 d) on the occurrence of intramammary infections (IMI) during the precalving period and on somatic cell counts (SCC), elevations of SCC (SCC≥200,000 cells/mL), and clinical mastitis in the subsequent lactation. The study also aimed to analyze which prepartum cow characteristics are associated with udder health after different DP lengths. Holstein-Friesian dairy cows (n=167) were randomly assigned to a DP length (0, 30, or 60 d). Cows with a 0-d DP had a greater occurrence of chronic IMI and a lower occurrence of cured IMI during the precalving period than cows with a 30-d or 60-d DP. Postpartum average SCC for lactation was greater in cows with a 0-d DP than in cows with a 30-d or 60-d DP. The number of cows with at least 1 elevation of SCC, the number of elevations of SCC per affected cow, the number of cows treated for clinical mastitis, and the number of cases of mastitis per affected cow did not differ among DP lengths. Cow characteristics related to postpartum average SCC for lactation were DP length, parity, and the following interactions: DP length with prepartum elevation of SCC, DP length with fat- and protein-corrected milk (FPCM) reduction between 150 and 67d prepartum, DP length with parity and with average SCC for lactation, and last FPCM before the conventional drying-off day with average SCC for lactation. Cows with prepartum parity 1 had a lower occurrence of at least 1 elevation of SCC in subsequent lactation compared with cows with parity >2. Last SCC before the conventional drying-off day was positively associated with occurrence of clinical mastitis in the subsequent lactation. In this study, DP length was not a risk factor for either elevation of SCC or occurrence of clinical mastitis in the subsequent lactation. The identified cow characteristics could be used in a decision support model to optimize DP length for individual cows. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

[Where do we stand with benign prostatic hyperplasia day-case surgery: A laser effect?

PubMed

Gury, L; Robert, G; Bensadoun, H

2018-06-12

Despite its feasibility has been proven, Benign Prostatic Hyperplasia (BPH) day-case surgery remains uncommon. Our objective was to describe the evolution of BPH day-case surgery in France according to the surgical technique employed. We extracted data from the Information System of Medicalization Program (PMSI) including all of the hospital stays in France from 2010 to 2016. Patients belonging to the transurethral prostatectomy homogeneous group of patients (GHM 12C04) and having as a main diagnosis prostatic hyperplasia (N40) or benign prostatic tumor (D291) were included in the analysis. From March 2016, specific codes were introduced to differentiate laser surgery and other types of surgery: JGFE023 (resection without laser), JGFE365 (laser resection) and JGNE171 (laser vaporization). We described the rates of day case surgery and the average length of stay from 2010 to 2016. From March 2016 we could study the influence of laser surgery on day-case and length of stay. Regarding the all dataset analysis we found 328,781 hospital stays (318,549 patients) for BPH surgery, of which 2.7% (9047 hospital stays) were day-case. From 2010 to 2016, the lengths of stay decreased from 5.78 to 4.29 days. In the meantime, the number of day-case procedures increased from 14 patients (0.03%) to 3035 patients (5.63%). Regarding the last 9 months of 2016, we found 38,930 hospital stays including 5.4% (2104) day-cases. In total, 92.7% of day-case procedures had been performed with a laser technique, of which 47.9% (1008) were laser vaporization and 44.8% (944) were laser resection. There were only 7.1% (151.8%) of day-case procedures performed without laser. The exponential development of the day-case procedures seems to be linked with the advent of laser technology. This tendency is expected to increase in the coming years according to the spreading of laser surgery. 3. Crown Copyright © 2018. Published by Elsevier Masson SAS. All rights reserved.

Ultrasonographic measurement of fetal growth parameters over three successive pregnancies in a captive Malayan tapir (Tapirus indicus).

PubMed

Hoyer, M J; van Engeldorp Gastelaars, H M D

2014-01-01

This study was conducted to establish representative curves that allow evaluation of fetal growth and estimation of gestational age from measurement of fetal structures by ultrasound in Malayan tapirs (Tapirus indicus). Three pregnancies (i.e. 3 fetuses) were examined in one female Malayan tapir. Transabdominal ultrasonographic examination was performed without anesthesia from 79 ± 8 days to 281 ± 48 days (mean ± S.D.) post mating. To assess fetal growth attempts were made to measure biparietal diameter (BPD), head length (HL), thorax diameter A (TDA), thorax height A (THA), thorax diameter B (TDB), thorax height B (THB), abdomen diameter (AD), abdomen height (AH), humerus length (HUL) and Crown rump length (CRL). The value of each parameter as an estimator of gestational age was assessed by ease of observation and the length of time the parameter was measurable throughout gestation. The most precise predictors for gestational age in this study were BPD and CRL (weeks 10-20 of gestation), as well as AD and AH (weeks 14-43 of gestation). The parameters TDB, THB and HUL (weeks 15-41 of gestation) gave almost as good predictions. Fetal viability was assessed by identifying a fetal heartbeat and movement. All pregnancies resulted in normal deliveries and healthy offspring. The ultrasound examination was well tolerated by the female. The gestation lengths (399 ± 3 days) were within reported ranges. The serial transabdominal ultrasound, without the need for anesthesia, was an effective method to evaluate fetal growth, development and well being in a Malayan tapir. © 2014 Wiley Periodicals, Inc.

Maximum Likelihood Factor Analysis of the Effects of Chronic Centrifugation on the Structural Development of the Musculoskeletal System of the Rat

NASA Technical Reports Server (NTRS)

Amtmann, E.; Kimura, T.; Oyama, J.; Doden, E.; Potulski, M.

1979-01-01

At the age of 30 days female Sprague-Dawley rats were placed on a 3.66 m radius centrifuge and subsequently exposed almost continuously for 810 days to either 2.76 or 4.15 G. An age-matched control group of rats was raised near the centrifuge facility at earth gravity. Three further control groups of rats were obtained from the animal colony and sacrificed at the age of 34, 72 and 102 days. A total of 16 variables were simultaneously factor analyzed by maximum-likelihood extraction routine and the factor loadings presented after-rotation to simple structure by a varimax rotation routine. The variables include the G-load, age, body mass, femoral length and cross-sectional area, inner and outer radii, density and strength at the mid-length of the femur, dry weight of gluteus medius, semimenbranosus and triceps surae muscles. Factor analyses on A) all controls, B) all controls and the 2.76 G group, and C) all controls and centrifuged animals, produced highly similar loading structures of three common factors which accounted for 74%, 68% and 68%. respectively, of the total variance. The 3 factors were interpreted as: 1. An age and size factor which stimulates the growth in length and diameter and increases the density and strength of the femur. This factor is positively correlated with G-load but is also active in the control animals living at earth gravity. 2. A growth inhibition factor which acts on body size, femoral length and on both the outer and inner radius at mid-length of the femur. This factor is intensified by centrifugation.

Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study.

PubMed

Kuo, Yong-Fang; Goodwin, James S

2011-08-02

Hospitalist care has grown rapidly, in part because it is associated with decreased length of stay and hospital costs. No national studies examining the effect of hospitalist care on hospital costs or on medical utilization and costs after discharge have been done. To assess the relationship of hospitalist care with hospital length of stay, hospital charges, and medical utilization and Medicare costs after discharge. Population-based national cohort study. Hospital care of Medicare patients. A 5% national sample of enrollees in Medicare parts A and B with a primary care physician who were cared for by their primary care physician or a hospitalist during medical hospitalizations from 2001 to 2006. Length of stay, hospital charges, discharge location and physician visits, emergency department visits, rehospitalization, and Medicare spending within 30 days after discharge. In propensity score analysis, hospital length of stay was 0.64 day less among patients receiving hospitalist care. Hospital charges were $282 lower, whereas Medicare costs in the 30 days after discharge were $332 higher (P < 0.001 for both). Patients cared for by hospitalists were less likely to be discharged to home (odds ratio, 0.82 [95% CI, 0.78 to 0.86]) and were more likely to have emergency department visits (odds ratio, 1.18 [CI, 1.12 to 1.24]) and readmissions (odds ratio, 1.08 [CI, 1.02 to 1.14]) after discharge. They also had fewer visits with their primary care physician and more nursing facility visits after discharge. Observational studies are subject to selection bias. Decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge. National Institute on Aging and National Cancer Institute.

Enteral tube feeding of patients with acute stroke: when does the risk of diarrhoea increase?

PubMed

Arevalo-Manso, J J; Martinez-Sanchez, P; Juarez-Martin, B; Fuentes, B; Ruiz-Ares, G; Sanz-Cuesta, B E; Parrilla-Novo, P; Diez-Tejedor, E

2014-12-01

We aimed to evaluate the relationship between the length of time acute stroke patients underwent enteral tube feeding (ETF) and episodes of diarrhoea, and to investigate the temporal cut-off point at which diarrhoea risk increases. An observational, retrospective study was conducted on patients with acute stroke admitted to a Stroke Centre. Patients undergoing ETF (ETF group) and those not undergoing ETF (control group) were analysed and matched by age and stroke severity. Data regarding demographic and clinical variables were recorded. The analysis was conducted using a receiver operating characteristic (ROC) curve and multivariate analyses. A total of 130 inpatients was included (age 75.08 ± 11.53 years, 56.2% men). The ETF group had higher diarrhoea frequency (27.7% vs 6.2%, P = 0.001). The length of time on ETF was associated with diarrhoea development (odds ratio (OR), 1.12 increment per day; 95% confidence interval (CI) 1.05-1.18; P < 0.001), after adjusting for confounders. The ROC curve showed 7 days on ETF as a cut-off point for diarrhoea risk. Seven days or more on ETF was independently associated with diarrhoea (OR, 6.26; 95% CI 1.66-23.62; P = 0.007), whereas less than 7 days was not when compared with the control group (OR, 0.38; 95% CI 0.04-3.91; P = 0.413). The length of time on ETF is associated with diarrhoea development in patients with acute stroke, demonstrating a temporal cut-off point. Seven days or longer on ETF is related to the occurrence of diarrhoea, whereas less than 7 days on ETF does not show this effect. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Randomized controlled trial of 3 days fasting and oral senna, combined with mannitol and simethicone, before capsule endoscopy.

PubMed

Chen, Hong-Bin; Lian-Xiang, Peng; Yue, Huang; Chun, Huang; Shu-Ping, Xiao; Rong-Pang, Lin; Xiao-Zong, Wang; Xiao-Lin, Li

2017-10-01

The approach to small bowel preparation before capsule endoscopy (CE) is still suboptimal. One hundred eighty patients were randomly allocated to 3 groups. Patients in Group A took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In Group B the same preparation was taken at 20:00 on the day before, and at 05:00 on the day of CE; in addition, 20 mL oral simethicone was taken 30 minutes before CE. Group C was treated identically to Group B, except that the patients fasted for 3 days and took 3 g senna orally 3 times daily before CE. The length of bowel containing green luminal contents was assessed by ImageJ software and bowel cleanliness was evaluated by computed assessment of the cleansing score. Cleansing of the whole small bowel and the distal small bowel were significantly different between the 3 groups (χ = 22.470, P = .000; χ = 17.029, P = .000, respectively). There were also significant differences between the 3 groups in the length of small bowel and specifically the length of the distal small bowel containing green luminal contents (χ = 12.390, P = .000, χ = 15.141, P = .000, respectively), but not with regard to the proximal small bowel (χ = 0.678, P = .509). Three days fasting and oral senna, combined with 20% mannitol and simethicone, before CE, can reduce the effects of bile on the small bowel and improve small bowel cleansing, especially in the distal small intestine.

Pulmonary and pleural responses in Fischer 344 rats following short-term inhalation of a synthetic vitreous fiber. I. Quantitation of lung and pleural fiber burdens.

PubMed

Gelzleichter, T R; Bermudez, E; Mangum, J B; Wong, B A; Everitt, J I; Moss, O R

1996-03-01

The pleura is an important target tissue of fiber-induced disease, although it is not known whether fibers must be in direct contact with pleural cells to exert pathologic effects. In the present study, we determined the kinetics of fiber movement into pleural tissues of rats following inhalation of RCF-1, a ceramic fiber previously shown to induce neoplasms in the lung and pleura of rats. Male Fischer 344 rats were exposed by nose-only inhalation to RCF-1 at 89 mg/m3 (2645 WHO fibers/cc), 6 hr/day for 5 consecutive days. On Days 5 and 32, thoracic tissues were analyzed to determine pulmonary and pleural fiber burdens. Mean fiber counts were 22 x 10(6)/lung (25 x 10(3)/pleura) at Day 5 and 18 x 10(6)/lung (16 x 10(3)/pleura) at Day 32. Similar geometric mean lengths (GML) and diameters (GMD) of pulmonary fiber burdens were observed at both time points. Values were 5 microns for GML (geometric standard deviation GSD approximately 2.3) and 0.3 micron for GMD (GSD approximately 1.9), with correlations between length and diameter (tau) of 0.2-0.3. Size distributions of pleural fiber burdens at both time points were approximately 1.5 microns GML (GSD approximately 2.0) and 0.09 micron GMD (GSD approximately 1.5; tau approximately 0.2-0.5). Few fibers longer than 5 microns were observed at either time point. These findings demonstrate that fibers can rapidly translocate to pleural tissues. However, only short, thin (< 5 microns in length) fibers could be detected over the 32-day time course of the experiment.

Meteorology and the physical activity of the elderly: the Nakanojo Study

NASA Astrophysics Data System (ADS)

Togo, Fumiharu; Watanabe, Eiji; Park, Hyuntae; Shephard, Roy J.; Aoyagi, Yukitoshi

2005-11-01

Seasonal changes in ambient temperature and day length are thought to modify habitual physical activity. However, relationships between such environmental factors and the daily physical activity of older populations remain unclear. The present study thus examined associations between meteorological variables and the number of steps taken per day by elderly Japanese. Continuous pedometer counts over a 450-day period were collected from 41 healthy subjects (age 71±4 years), none of whom engaged in any specific occupational activity or exercise programs. An electronic physical activity monitor was attached to a belt worn on the left side of the body throughout the day. Daily values for mean ambient temperature, duration of bright sunshine, mean wind speed, mean relative humidity, and precipitation were obtained from local meteorological stations. The day length was calculated from times of sunrise and sunset. Based on the entire group of 41 subjects (ensemble average), a subject’s step count per day decreased exponentially with increasing precipitation (r2=0.19, P<0.05). On days when precipitation was <1 mm, the step count increased with the mean ambient temperature over the range of 2 to 17°C, but decreased over the range 17 29°C. The daily step count also tended to increase with day length, but the regression coefficient of determination attributable to step count and mean ambient temperature (r2=0.32, P<0.05) exceeded that linking the step count and day length (r2=0.13, P<0.05). The influence of other meteorological factors was small (r2≤0.03) and of little practical significance. On days when precipitation is <1 mm, physical activity is associated more strongly with ambient temperature than with day length, duration of bright sunshine, wind speed, or relative humidity. Our findings have practical implications for health promotion efforts designed to increase the physical activity of elderly people consistently in the face of seasonal variations in environmental conditions.

The prevalence and impact of prescription controlled substance use among injured patients at a Level I trauma center.

PubMed

Cannon, Robert; Bozeman, Matthew; Miller, Keith Roy; Smith, Jason Wayne; Harbrecht, Brian; Franklin, Glen; Benns, Matthew

2014-01-01

There has been increasing attention focused on the epidemic of prescription drug use in the United States, but little is known about its effects in trauma. The purpose of this study was to define the prevalence of prescription controlled substance use among trauma patients and determine its effects on outcome. A retrospective review of all patients admitted to a Level 1 trauma center from January 1, 2011, to December 31, 2011, was performed. Patients dying within 24 hours or without home medication reconciliations were excluded. Data review included preexisting benzodiazepine or narcotic use, sex, age, mechanism of injury, Injury Severity Scores (ISSs), intensive care unit (ICU) and overall length of stay, ventilator days, and overall cost. SAS version 9.3 was used for the analysis, and p ≤ 0.05 was considered significant. A total of 1,700 patients met inclusion criteria. Of these, 340 (20.0%) were on prescription narcotics and/or benzodiazepines at the time of admission. Patients in the narcotic/benzodiazepine group were significantly older (48 years vs. 43 years) and more likely to be women (43.7% vs. 28.9%). There was no difference in mechanism, ISS, or the presence of head injury between groups. Both ICU length of stay (3.3 days vs. 2.1 days) and total length of stay (7.8 days vs. 6.1 days) were significantly longer in patients on outpatient narcotics and/or benzodiazepines. Excluding severely injured patients, the need for mechanical ventilation was also increased among outpatient controlled substance users (15.8% vs. 11.0%). There is a substantial prevalence of preexisting controlled substance use (20%) among patients at our Level 1 trauma center. Preexisting controlled substance use is associated with longer total hospital and ICU stays. Among mildly to moderately injured patients, preinjury controlled substance is also associated with the need for mechanical ventilation. Prognostic study, level III.

Maternal telomere length inheritance in the king penguin.

PubMed

Reichert, S; Rojas, E R; Zahn, S; Robin, J-P; Criscuolo, F; Massemin, S

2015-01-01

Telomeres are emerging as a biomarker for ageing and survival, and are likely important in shaping life-history trade-offs. In particular, telomere length with which one starts in life has been linked to lifelong survival, suggesting that early telomere dynamics are somehow related to life-history trajectories. This result highlights the importance of determining the extent to which telomere length is inherited, as a crucial factor determining early life telomere length. Given the scarcity of species for which telomere length inheritance has been studied, it is pressing to assess the generality of telomere length inheritance patterns. Further, information on how this pattern changes over the course of growth in individuals living under natural conditions should provide some insight on the extent to which environmental constraints also shape telomere dynamics. To fill this gap partly, we followed telomere inheritance in a population of king penguins (Aptenodytes patagonicus). We tested for paternal and maternal influence on chick initial telomere length (10 days old after hatching), and how these relationships changed with chick age (at 70, 200 and 300 days old). Based on a correlative approach, offspring telomere length was positively associated with maternal telomere length early in life (at 10 days old). However, this relationship was not significant at older ages. These data suggest that telomere length in birds is maternally inherited. Nonetheless, the influence of environmental conditions during growth remained an important factor shaping telomere length, as the maternal link disappeared with chicks' age.

Comparative effects of constant versus fluctuating thermal regimens on yellow perch growth, feed conversion and survival

USDA-ARS?s Scientific Manuscript database

The effects of fluctuating or constant thermal regimens on growth, mortality, and feed conversion were determined for juvenile yellow perch (Perca flavescens). Yellow perch averaging 156mm total length and 43g body weight were held in replicate 288L circular tanks for 129 days under: 1) a diel therm...

Anesthesia Technique and Mortality after Total Hip or Knee Arthroplasty: A Retrospective, Propensity Score-matched Cohort Study.

PubMed

Perlas, Anahi; Chan, Vincent W S; Beattie, Scott

2016-10-01

This propensity score-matched cohort study evaluates the effect of anesthetic technique on a 30-day mortality after total hip or knee arthroplasty. All patients who had hip or knee arthroplasty between January 1, 2003, and December 31, 2014, were evaluated. The principal exposure was spinal versus general anesthesia. The primary outcome was 30-day mortality. Secondary outcomes were (1) perioperative myocardial infarction; (2) a composite of major adverse cardiac events that includes cardiac arrest, myocardial infarction, or newly diagnosed arrhythmia; (3) pulmonary embolism; (4) major blood loss; (5) hospital length of stay; and (6) operating room procedure time. A propensity score-matched-pair analysis was performed using a nonparsimonious logistic regression model of regional anesthetic use. We identified 10,868 patients, of whom 8,553 had spinal anesthesia and 2,315 had general anesthesia. Ninety-two percent (n = 2,135) of the patients who had general anesthesia were matched to similar patients who did not have general anesthesia. In the matched cohort, the 30-day mortality rate was 0.19% (n = 4) in the spinal anesthesia group and 0.8% (n = 17) in the general anesthesia group (risk ratio, 0.42; 95% CI, 0.21 to 0.83; P = 0.0045). Spinal anesthesia was also associated with a shorter hospital length of stay (5.7 vs. 6.6 days; P < 0.001). The results of this observational, propensity score-matched cohort study suggest a strong association between spinal anesthesia and lower 30-day mortality, as well as a shorter hospital length of stay, after elective joint replacement surgery.

Perception of photoperiod in individual buds of mature trees regulates leaf-out.

PubMed

Zohner, Constantin M; Renner, Susanne S

2015-12-01

Experimental data on the perception of day length and temperature in dormant temperate zone trees are surprisingly scarce. In order to investigate when and where these environmental signals are perceived, we carried out bagging experiments in which buds on branches of Fagus sylvatica, Aesculus hippocastanum and Picea abies trees were exposed to natural light increase or kept at constant 8-h days from December until June. Parallel experiments used twigs cut from the same trees, harvesting treated and control twigs seven times and then exposing them to 8- or 16-h days in a glasshouse. Under 8-h days, budburst in Fagus outdoors was delayed by 41 d and in Aesculus by 4 d; in Picea, day length had no effect. Buds on nearby branches reacted autonomously, and leaf primordia only reacted to light cues in late dormancy after accumulating warm days. Experiments applying different wavelength spectra and high-resolution spectrometry to buds indicate a phytochrome-mediated photoperiod control. By demonstrating local photoperiodic control of buds, revealing the time when these signals are perceived, and showing the interplay between photoperiod and chilling, this study contributes to improved modelling of the impact of climate warming on photosensitive species. © 2015 The Authors. New Phytologist © 2015 New Phytologist Trust.

Procalcitonin guidance in patients with lower respiratory tract infections: a systematic review and meta-analysis.

PubMed

Hey, Juliane; Thompson-Leduc, Philippe; Kirson, Noam Y; Zimmer, Louise; Wilkins, Dana; Rice, Bernie; Iankova, Irena; Krause, Alexander; Schonfeld, Sophie A; DeBrase, Christopher R; Bozzette, Samuel; Schuetz, Philipp

2018-05-01

Although effective for bacterial lower respiratory tract infections (LRTIs), antibiotic treatment is often incorrectly prescribed for non-bacterial LRTIs. Procalcitonin has emerged as a promising biomarker to diagnose bacterial infections and guide antibiotic treatment decisions. As part of a regulatory submission to the U.S. Food and Drug Administration, this systematic review and meta-analysis summarizes the effects of procalcitonin-guided antibiotic stewardship on antibiotic use and clinical outcomes in adult LRTI patients. PubMed and the Cochrane Database of Systematic Reviews were searched for English-language randomized controlled trials published between January 2004 and May 2016. Random and fixed effects meta-analyses were performed to study efficacy (initiation of antibiotics, antibiotic use) and safety (mortality, length of hospital stay). Eleven trials were retained, comprising 4090 patients. Procalcitonin-guided patients had lower odds of antibiotic initiation (odds ratio: 0.26; 95% confidence interval [CI]: 0.13-0.52) and shorter mean antibiotic use (weighted mean difference: -2.15 days; 95% CI: -3.30 to -0.99) compared to patients treated with standard care. Procalcitonin use had no adverse impact on mortality (relative risk: 0.94; 95% CI: 0.69-1.28) and length of hospital stay (weighted mean difference: -0.15 days; 95% CI: -0.60 to 0.30). Procalcitonin guidance reduces antibiotic initiation and use among adults with LRTIs with no apparent adverse impact on length of hospital stay or mortality.

The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea.

PubMed

Kim, Seung Ju; Park, Eun-Cheol; Kim, Sun Jung; Han, Kyu-Tae; Han, Euna; Jang, Sung-In; Kim, Tae Hyun

2016-02-01

The diagnosis-related group-based prospective payment programme was introduced in Korea in 1997 as a pilot programme to control health spending. In July 2013, the programme was implemented throughout the nation. The aim of our study is to evaluate the relationship between quality of care and market competition following the introduction of the new payment system in Korea. We conduct an observational analysis using National Health Insurance claim data from 2011 to 2014. We analyse data on readmission within 30 days, length of stay, and number of outpatient visits for 1742 hospitals and 821 912 cases. We use a generalized estimating equation model to evaluate readmission within 30 days and number of outpatient visits and a multi-level regression model to assess length of stay. Total readmission within 30 days is 10 727 (1.3%). High competition areas present a lower risk of readmission [odds ratio (OR): 0.95, P: 0.0277], a longer length of stay (1%, P < 0.0001), and an increased number of outpatient visits (Relative Risk: 1.11, P: 0.0011) as compared with moderate competition areas. Risk of readmission is higher in low competition areas as compared with moderate competition areas (OR: 1.21, P < 0.0001). The effects of the introduction of the new payment system differed by degree of market competition. Thus, evaluation about the effect of new payment system on hospital performance should be measured in combination with the degree of hospital market structure. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

THE EFFECT OF THE GROWTH HORMONE FROM THE ANTERIOR LOBE OF THE PITUITARY ON BONE UNDER CONDITIONS OF IRRADIATION (in Russian)

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

Ivanova, E.A.

1963-05-21

Young rats 3 to 4 days old were given an x-ray dose of 1000 r on the left hind leg. A daily dose of 200 gamma of growth hormone obtained from the pituitary of a bull was administered, until the animals were killed on the 36th, 41st, and 44th days after the irradiation. The length of the tibia in the left and right legs was determined by x rays. In the irradiated animals, the ratio of the length of the left tibia to the right tibia was about 0.50, and the introduction of growth hormone into the rat had onlymore » a slight effect on tibial growth. The bones were then fixed in a Zenkerformalin fluid, and cytological studies were carried out. These studies show that irradiation of the extremity of a four-day rat with an x-ray dose of 2000 r resulted in deep disturbances in the cartilage bone with subsequent arrest in the development of the bone. The introduction of growth hormone ameliorated the changes in bone structure, but did not result in normal bone development. (TTT)« less

Electroencephalographic studies of sleep

NASA Technical Reports Server (NTRS)

Webb, W. B.; Agnew, H. W., Jr.

1975-01-01

Various experimental studies on sleep are described. The following areas are discussed: (1) effect of altered day length on sleep, (2) effect of a partial loss of sleep on subsequent nocturnal sleep; (3) effect of rigid control over sleep-wake-up times; (4) sleep and wakefulness in a time-free environment; (5) distribution of spindles during a full night of sleep; and (6) effect on sleep and performance of swiftly changing shifts of work.

Effect of early nutritional intake on long-term growth and bone mineralization of former very low birth weight infants.

PubMed

Christmann, V; van der Putten, M E; Rodwell, L; Steiner, K; Gotthardt, M; van Goudoever, J B; van Heijst, A F J

2018-03-01

Preterm infants are at risk for impaired bone mineralization and growth in length later in life due to inadequate nutritional intake in the early postnatal period. To investigate whether increased nutritional supplementation of calcium, phosphate and protein in Very Low Birth Weight (VLBW) infants during the first 14days after birth was associated with improvement in length and bone development until 9-10years of age. Observational follow-up study of VLBW infants (birth weight<1500g or gestational age<32weeks) born in two consecutive years (eligible infants: 2004 n: 63 and 2005: n: 66). Cohort 2005 received higher intake of calcium, phosphate and protein with parenteral nutrition compared to Cohort 2004. Anthropometric data were collected during standard follow-up visits until five years, and additionally at 9-10years of age including measurements of bone mineral content, bone mineral density of the whole body and lumbar spine determined by dual-energy X-ray absorptiometry. Long-term growth trajectories of both cohorts were evaluated separately for participants born appropriate (AGA) and small for gestational age (SGA), stratified by gender. Multivariate linear regression was used to examine the effect of nutritional intake and clinical covariates on length and bone mineralization. Both cohorts achieved a catch-up in length to SDS within the normal range by 6months (length SDS: estimated mean (95% confidence interval (CI): 6months: Cohort 2004: -0.7 (-1.1, -0.3) Cohort 2005: -0.5 (-0.8, -0.2)). Bone mineral content and density were within the normal range and not different between the cohorts. SGA children achieved a catch-up in length at 5years with bone mineralization comparable to AGA children. Only for girls birth weight was significantly associated with length SDS (per gram: β 0.001; 95% CI (0.000, 0.003); p=0.03) There was no evidence of an association between early nutritional intake and bone mineralization. Children born as appropriate or small for gestational age preterm infants are able to catch up in length after the postnatal period, and achieve a normal length and bone mineralization at age nine-ten years. An improvement of calcium and phosphate intake during the first 14days after birth was not associated with improvement in length and bone development. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Hospital resource utilization and costs of inappropriate treatment of candidemia.

PubMed

Arnold, Heather M; Micek, Scott T; Shorr, Andrew F; Zilberberg, Marya D; Labelle, Andrew J; Kothari, Smita; Kollef, Marin H

2010-04-01

To evaluate the impact of inappropriate therapy--defined as delayed antifungal therapy beyond 24 hours from culture collection, inadequate antifungal dosage, or administration of an antifungal to which an isolate was considered resistant--on postculture hospital length of stay and costs, and to evaluate the relationship between modifiable risk factors, including failure to remove a central venous catheter, antifungal delay, and inadequate dosage, for an additive effect on hospital length of stay and costs. Single-center retrospective cohort study. 1250-bed academic medical center. One hundred sixty-seven consecutive adult patients admitted between January 2004 and May 2006 with culture-confirmed Candida bloodstream infections that occurred within 14 days of hospital admission and who received at least one dose of antifungal treatment. Patients were stratified according to appropriateness of antifungal therapy. Appropriate therapy was defined as initiation of an antifungal to which the isolated pathogen was sensitive in vitro within 24 hours of positive culture collection, in addition to receipt of an adequate dose as recommended by the Infectious Diseases Society of America and the antifungal package insert. Postculture length of stay was the primary outcome and hospital costs the secondary outcome. An evaluation of modifiable risk factors was performed separately. Data were analyzed for 167 patients (22 in the appropriate therapy group and 145 in the inappropriate therapy group). Postculture length of stay was shorter in the appropriate therapy group (mean 7 vs 10.4 days, p=0.037). This correlated with total hospital costs that were lower in the appropriate therapy group (mean $15,832 vs $33,021, p<0.001.) A graded increase in costs was noted with increasing number of modifiable risk factors (p=0.001). Inappropriate therapy for Candida bloodstream infection occurring within 14 days of hospitalization was associated with prolonged postculture length of stay and increased costs. A rise in costs, but not length of stay, was noted with increasing modifiable risk factors.

Florigen unmasked - exciting prospects for horticulture

USDA-ARS?s Scientific Manuscript database

The pioneer work of Garner and Allard, who coined the term “photoperiod” to describe the dramatic effects of day length on flowering of many plants, led to the widespread commercial use of photoperiod modification to control flowering in plants, particularly ornamentals. M.K. Chailakhyan suggested t...

Effects of curing type, silica fume fineness, and fiber length on the mechanical properties and impact resistance of UHPFRC

NASA Astrophysics Data System (ADS)

Arel, Hasan Şahan

The effects of silica fume fineness and fiber aspect ratio on the compressive strength and impact resistance of ultra high-performance fiber-reinforced concrete (UHPFRC) are investigated experimentally. To this end, UHPFRC mixtures are manufactured by combining silica fumes with different fineness (specific surface areas: 17,200, 20,000, and 27,600 m2/kg) and hooked-end steel fibers with various aspect ratios (lengths: 8, 13, and 16 mm). The samples are subjected to standard curing, steam curing, and hot-water curing. Compressive strength tests are conducted after 7-, 28-, 56-, and 90-day curing periods, and an impact resistance experiment is performed after the 90th day. A steam-cured mixture of silica fumes with a specific surface area of 27,600 m2/kg and 16-mm-long fibers produce better results than the other mixtures in terms of mechanical properties. Moreover, impact resistance increases with the fiber aspect ratio.

Ketogenic diet treatment for pediatric super-refractory status epilepticus.

PubMed

Appavu, Brian; Vanatta, Lisa; Condie, John; Kerrigan, John F; Jarrar, Randa

2016-10-01

We aimed to study whether ketogenic diet (KD) therapy leads to resolution of super-refractory status epilepticus in pediatric patients without significant harm. A retrospective review was performed at Phoenix Children's Hospital on patients with super-refractory status epilepticus undergoing ketogenic diet therapy from 2011 to 2015. Ten children with super-refractory status epilepticus, ages 2-16 years, were identified. 4/10 patients had immune mediated encephalitis, including Rasmussen encephalitis, anti-N-methyl-d-aspartate receptor encephalitis, and post-infectious mycoplasma encephalitis. Other etiologies included Lennox Gastaut Syndrome, non-ketotic hyperglycinemia, PCDH19 and GABRG2 genetic epilepsy, New Onset Refractory Status Epilepticus, and Febrile Infection-Related Epilepsy Syndrome. 4/10 patients' EEG features suggested focal with status epilepticus, and 6/10 suggested generalized with status epilepticus. Median hospital length was 61days and median ICU length was 27days. The median number of antiepileptic medications prior to diet initiation was 3.0 drugs, and the median after ketogenic diet treatment was 3.5 drugs. Median duration of status epilepticus prior to KD was 18days. 9/10 patients had resolution of super-refractory status epilepticus in a median of 7days after diet initiation. 8/9 patients were weaned off anesthesia within 15days of diet initiation, and within 1day of achieving ketonuria. 1/10 patients experienced side effects on the diet requiring supplementation. Most patients achieved resolution of status epilepticus on KD therapy, suggesting it could be an effective therapy that can be utilized early in the treatment of children with super refractory status epilepticus. Copyright © 2016. Published by Elsevier Ltd.

The effect of post-ovulatory insemination on the subsequent embryonic loss, oestrous cycle length and vaginal discharge in sows.

PubMed

Kaeoket, K; Tantasuparuk, W; Kunavongkrit, A

2005-10-01

The aim of present study was to study the effect of post-ovulatory insemination on the subsequent embryonic loss, oestrous cycle length and vaginal discharge in sows. Ten Large White multiparous sows were divided into two groups. Group A sows were inseminated once at 15 h after ovulation. Thereafter, they were ovariohysterectomized on day 11 (n = 5, first day of standing oestrus = day 1) and flushed for recovery of embryos. Group B sows were also inseminated once at 15 h after ovulation. They were further observed for return to oestrus and vaginal discharge (n = 5) after insemination. The endometrium tissues were biopsied from sows with vaginal discharge, embedded with paraffin, stained with haematoxylin and eosin and examined under light microscope. Only two embryos were observed in one of four sows from group A. All embryos had a spherical shape but differed in size (range 1-2 mm). In group B, only one sow had a regular return to oestrus (i.e. on day 23) and another sow had an irregular return to oestrus (i.e. on day 27). The other two sows in this group had shown vaginal discharge on days 20 and 38 after standing oestrus. For the number of leucocytes in the endometrium of sows with vaginal discharge, a large number of lymphocytes and plasma cells were observed in the connective tissue of the subepithelial layer. In conclusion, post-ovulatory insemination resulted in early embryonic loss, a subsequent prolonged oestrus interval and also vaginal discharge (i.e. endometritis) in sows.

Shorter sleep duration in early pregnancy is associated with birth length: a prospective cohort study in Wuhan, China.

PubMed

Wang, Weiye; Zhong, Chunrong; Zhang, Yu; Huang, Li; Chen, Xi; Zhou, Xuezhen; Chen, Renjuan; Li, Xiating; Xiao, Mei; Hao, Liping; Yang, Xuefeng; Yang, Nianhong; Wei, Sheng

2017-06-01

To examine the association between sleep duration in early pregnancy and fetal growth in a prospective cohort study of 3567 Chinese women. Pregnant women at 8-16 weeks of gestation were interviewed using a semi-quantitative questionnaire to assess sleep duration. Birth weight and birth length were measured by a midwife in the delivery room at birth; low birth weight (LBW) was defined as birth weight <2500 g and small for gestational age (SGA) was defined as <10th customized centile. The average age of participants was 28.21 ± 3.38 years old. The mean sleep duration was 8.39 ± 1.13 h/day. A total of 1290 women sleeping ≥9 h/day, 1563 sleeping 8 to <9 h/day, 550 sleeping 7 to <8 h/day, and 164 sleeping <7 h/day. Compared to the sleeping 8 to <9 h/day group, birth length and birth weight of the sleeping <7 h/day group decreased by 2.42 mm (95% CI: -4.27, -0.58, p = 0.010) and 42.70 g (95% CI: -103.02, 17.62, p = 0.165), respectively; and risk of LBW and SGA of the sleeping <7 h/day group increased by 83% (95% CI: 0.59, 5.73, p = 0.297) and 56% (95% CI: 0.84, 2.92, p = 0.159), respectively; birth length of the sleeping <7 h/day group was decreased more in male babies, and among mothers without a midday napping habit or with a history of abortion (all p for interaction <0.05). Shorter sleep duration in early pregnancy was associated with birth length. Our findings indicate that midday napping may be a protective factor for birth length among pregnant women with shorter sleep duration. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of cooling management on blood flow to the dominant follicle and estrous cycle length at heat stress.

PubMed

Honig, Hen; Ofer, Lior; Kaim, Moshe; Jacobi, Shamay; Shinder, Dima; Gershon, Eran

2016-07-15

The use of ultrasound imaging for the examination of reproductive organs has contributed substantially to the fertility management of dairy cows around the world. This method has many advantages such as noninvasiveness and immediate availability of information. Adding Doppler index to the ultrasound imaging examination, improved the estimation of blood volume and flow rate to the ovaries in general and to the dominant follicle in particular. The aim of this study was to examine changes in the blood flow to the dominant follicle and compare them to the follicular development throughout the cycle. We further set out to examine the effects of different types of cooling management during the summer on the changes in blood flow to the dominant follicle. For this purpose, 24 Israeli-Holstein dairy cows, under heat stress, were randomly assigned one of two groups: one was exposed to five cooling sessions per day (5CS) and the other to eight cooling sessions per day (8CS). Blood flow to the dominant follicle was measured daily using Doppler index throughout the estrous cycle. No differences in the preovulatory dominant follicle diameter were detected between the two cooling management regimens during the cycle. However, the length of the first follicular wave was significantly longer, whereas the second follicular wave was nonsignificantly shorter in the 5CS group as compared to the 8CS group. In addition, no difference in blood flow was found during the first 18 days of the cycle between the two groups. However, from Day 20 until ovulation a higher rate of blood flow was measured in the ovaries of cows cooled 8 times per day as compared to the 5CS group. No differences in progesterone levels were noted. Finally, the estrous cycle length was shorter in the 8CS group as compared to the 5CS group. Our data suggest that blood flow to the dominant follicle and estrous cycle length is affected by heat stress. Using the appropriate cooling management during heat stress can enhance the blood flow to the ovary and may contribute to improved fertility in dairy cows. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of saline drinking water on early gosling development

USGS Publications Warehouse

Stolley, D.S.; Bissonette, J.A.; Kadlec, J.A.; Coster, D.

1999-01-01

Relatively high levels of saline drinking water may adversely affect the growth, development, and survival of young waterfowl. Saline drinking water was suspect in the low survival rate of Canada goose (Branta canadensis) goslings at Fish Springs National Wildlife Refuge (FSNWR) in western Utah. Hence, we investigated the effects of saline drinking water on the survival and growth of captive, wild-strain goslings from day 1-28 following hatch. We compared survival and growth (as measured by body mass, wing length, and culmen length) between a control group on tap water with a mean specific conductivity of 650 ??S/cm, and 2 saline water treatments: (1) intermediate level (12,000 ??S/cm), and (2) high level (18,000 ??S/cm). Gosling mortality occurred only in the 18,000 ??S/cm treatment group (33%; n = 9). Slopes of regressions of mean body mass, wing length, and culmen length on age were different from each other (P < 0.05), except for culmen length for the intermediate and high treatment levels. We predict that free-ranging wild goslings will experience mortality at even lower salinity levels than captive goslings because of the combined effects of depressed growth and environmental stresses, including hot desert temperatures and variable food quality over summer.

Photoperiodic Regulation of the Orexigenic Effects of Ghrelin in Siberian Hamsters

PubMed Central

Bradley, Sean P.; Pattullo, Lucia M.; Patel, Priyesh N.; Prendergast, Brian J.

2010-01-01

Animals living in temperate climates with predictable seasonal changes in food availability may use seasonal information to engage different metabolic strategies. Siberian hamsters decrease costs of thermoregulation during winter by reducing food intake and body mass in response to decreasing or short day lengths (SD). These experiments examined whether SD reductions in food intake in hamsters is driven, at least in part, by altered behavioral responses to ghrelin, a gut-derived orexigenic peptide which induces food intake via NPY-dependent mechanisms. Relative to hamsters housed in long day (LD) photoperiods, SD hamsters consumed less food in response to i.p. treatment with ghrelin across a range of doses from 0.03 to 3 mg/kg. To determine whether changes in photoperiod alter behavioral responses ghrelin-induced activation of NPY neurons, c-Fos and NPY expression were quantified in the arcuate nucleus (ARC) via double-label fluorescent immunocytochemistry following i.p. treatment with 0.3 mg/kg ghrelin or saline. Ghrelin induced c-Fos immunoreactivity (-ir) in a greater proportion of NPY-ir neurons of LD relative to SD hamsters. In addition, following ghrelin treatment, a greater proportion of ARC c-Fos-ir neurons were identifiable as NPY-ir in LD relative to SD hamsters. Changes in day length markedly alter the behavioral response to ghrelin. The data also identify photoperiod-induced changes in the ability of ghrelin to activate ARC NPY neurons as a possible mechanism by which changes in day length alter food intake. PMID:20600050

Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence.

PubMed

Kadono, Yoshifumi; Nohara, Takahiro; Kawaguchi, Shohei; Naito, Renato; Urata, Satoko; Nakashima, Kazufumi; Iijima, Masashi; Shigehara, Kazuyoshi; Izumi, Kouji; Gabata, Toshifumi; Mizokami, Atsushi

2018-02-28

To assess the chronological changes in urinary incontinence and urethral function before and after radical prostatectomy (RP), and to compare the findings of pelvic magnetic resonance imaging (MRI) before and after RP to evaluate the anatomical changes. In total, 185 patients were evaluated with regard to the position of the distal end of the membranous urethra (DMU) on a mid-sagittal MRI slice and urethral sphincter function using the urethral pressure profilometry. The patients also underwent an abdominal leak point pressure test before RP and at 10 days and 12 months after RP. The results were then compared with the chronological changes in urinary incontinence. The MRI results showed that the DMU shifted proximally to an average distance of 4 mm at 10 days after RP and returned to the preoperative position at 12 months after RP. Urethral sphincter function also worsened 10 days after RP, with recovery after 12 months. The residual length of the urethral stump and urinary incontinence were significantly associated with the migration length of the DMU at 10 days after RP. The residual length of the urethral stump was a significant predictor of urinary incontinence after RP. This is the first study to elucidate that the slight vertical repositioning of the membranous urethra after RP causes chronological changes in urinary incontinence. A long urethral residual stump reduces urinary incontinence after RP. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Effects of varenicline versus transdermal nicotine replacement therapy on cigarette demand on quit day in individuals with substance use disorders.

PubMed

Murphy, Cara M; MacKillop, James; Martin, Rosemarie A; Tidey, Jennifer W; Colby, Suzanne M; Rohsenow, Damaris J

2017-08-01

Cigarette demand is a behavioral economic measure of the relative value of cigarettes. Decreasing the value of cigarette reinforcement may help with quitting smoking. This study aimed to evaluate the effects of initial use of varenicline (VAR) versus nicotine replacement therapy (NRT) on demand for cigarettes on quit day among smokers with substance use disorders (SUD) and to determine whether reduced demand was associated with subsequent abstinence from smoking at 1 and 3 months. Participants (N = 110) were randomized to double-blind, double-placebo conditions: VAR with placebo NRT or NRT with placebo capsules. The cigarette purchase task (CPT) was used to assess demand for cigarettes at baseline and on quit day, following a 1-week medication dose run-up/placebo capsule lead-in and first day use of the patch. Demand for cigarettes decreased from baseline to quit day without significant differences between medications. Reductions in CPT intensity (number of cigarettes that would be smoked if they were free) and CPT breakpoint (lowest price at which no cigarettes would be purchased) predicted greater likelihood of abstaining on quit day. Reduced intensity predicted length of abstinence at 1 and 3 months while reduced breakpoint predicted only 1 month length of abstinence. Initial therapeutic doses of VAR and NRT resulted in similar reductions in cigarette reinforcement. Larger initial reductions in demand on quit day were associated with early success with abstaining from cigarettes. Behavioral economic approaches may be useful for identifying individuals who benefit less from pharmacotherapy and may need additional treatment resources. https://clinicaltrials.gov/ct2/show/NCT00756275.

Effect of biotin supplementation on claw horn growth in young, clinically healthy cattle

PubMed Central

da Silva, Luiz Antônio Franco; Franco, Leandro Guimarães; Atayde, Ingrid Bueno; da Cunha, Paulo Henrique Jorge; de Moura, Maria Ivete; Goulart, Daniel Silva

2010-01-01

The effects of orally administered biotin supplementation on the growth of claw horn in young, clinically healthy cattle were analyzed. Twelve, 1-year-old Girolando cattle were randomly assigned to receive either 12.5 mg of diluted powdered biotin (GI) or a control treatment (GII) for 40 consecutive days. Cattle in the GI group showed an average hoof growth of 11.3 ± 0.72 mm, while those in GII had an average hoof growth of 7.2 ± 0.78 mm. The results confirmed the positive effect of biotin supplementation on the growth of angle and length of the dorsal hoof wall, hoof sole length, and on resistance to wearing, in young cattle extensively managed. PMID:20808571

Differential effects of black currant anthocyanins on diffuser- or negative lens-induced ocular elongation in chicks.

PubMed

Iida, Hiroyuki; Nakamura, Yuko; Matsumoto, Hitoshi; Kawahata, Keiko; Koga, Jinichiro; Katsumi, Osamu

2013-01-01

To compare the inhibitory effects of 4 different types of black currant anthocyanins (BCAs) on ocular elongation in 2 different chick myopia models. In the first model, diffusers were used to induce form vision deprivation. In the second model, negative (-8D) spherical lenses were used to create a defocused retinal image. Either the diffusers or the -8D lenses were placed on the right eyes of 8-day-old chicks for 4 days. Ocular biometric components were measured using an A-scan ultrasound instrument on the third day after application of either the diffusers or -8D lenses. Interocular differences (globe component dimensions of the right diffuser or eyes covered with -8D lenses minus those of the open left eyes) were considered to evaluate the effect of BCAs. The BCAs used were cyanidin-3-glucoside (C3G), cyanidin-3-rutinoside (C3R), delphinidin-3-rutinoside (D3R), and delphinidin-3-glucoside (D3G). Each anthocyanin was administered intravenously at a dose of 0.027 μmol/kg once a day for 3 days. Compared to the vehicle treatment, C3G and C3R treatments significantly reduced both differential increases (positive values of interocular differences) of the ocular axial length induced by diffusers or -8D lenses (diffusers; C3G, C3R, and control: 0.32±0.051 mm, P<0.05; 0.25±0.034 mm, P<0.01; and 0.52±0.047 mm, -8D lenses; C3G, C3R, and control: 0.25±0.049 mm, P<0.01; 0.17±0.049 mm, P<0.001; and 0.50±0.056 mm). In contrast, compared to vehicle treatment, D3R treatment significantly decreased the differential increases in the ocular axial length only in chicks with myopia induced by -8D lenses (D3R and control: 0.17±0.049 mm and 0.50±0.056 mm, P<0.001). D3G did not inhibit the differential increase in the ocular axial length induced by either diffusers or -8D lenses. This study showed that the 4 tested BCAs had different effects on the 2 different experimental models of myopia.

Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients.

PubMed

Tak, Hyo Jung; Ruhnke, Gregory W; Meltzer, David O

2013-07-08

Patient participation in medical decision making has been associated with improved patient satisfaction and health outcomes. However, there is little evidence concerning its effects on resource utilization. Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care. To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients. Survey study in an academic research setting. A survey that included questions about preferences to receive medical information and to participate in medical decision making was administered to all patients admitted to the University of Chicago Medical Center general internal medicine service between July 1, 2003, and August 31, 2011, and completed by 21,754 (69.6%) of admitted patients. The survey data were linked with administrative data, including length of stay and total hospitalization costs. We used generalized linear models to measure the association of patient preference for participation in decision making with length of stay and costs. The mean length of stay was 5.34 days, and the mean hospitalization costs were $14,576. While 96.3% of patients expressed a desire to receive information about their illnesses and treatment options, 71.1% of patients preferred to leave medical decision making to their physician. Preference to participate in decision making increased with educational level and with private health insurance. Compared with patients who had a strong desire to delegate decisions to their physician, patients who preferred to participate in decision making concerning their care had a 0.26-day (95% CI, 0.06-0.47 day) longer length of stay (P = .01) and $865 (95% CI, $155-$1575) higher total hospitalization costs (P = .02). Patient preference to participate in decision making concerning their care may be associated with increased resource utilization among hospitalized patients. Variation in patient preference to participate in medical decision making and its effects on costs and outcomes in the presence of varying physician incentives deserve further examination.

Biometry of the hypospadic penis after hormone therapy (testosterone and estrogen): A randomized, double-blind controlled trial.

PubMed

Paiva, Kelly Christina de Castro; Bastos, André Netto; Miana, Laura Pimenta; Barros, Eveline de Souza; Ramos, Plínio Santos; Miranda, Lara Meneguelli; Faria, Natália Maia; Avarese de Figueiredo, André; de Bessa, José; Netto, José Murillo B

2016-08-01

The use of preoperative hormonal stimulation before hypospadias surgery aims to increase penile size and achieve better surgical results; however, the rules are not clear in the literature. We evaluated the effects of topical testosterone and estrogen in the hypospadic penis regarding biometric measures, side effects, and serum hormonal levels. To our knowledge, this is the first study using estradiol prior to hypospadias surgery. Sixty-nine children with hypospadias were randomly divided into three study groups: a control group (CG) of 17 children given placebo cream; a testosterone group (TG) of 28 children who used 1% testosterone propionate; and an estradiol group (EG) of 24 children using 0.01% estradiol. All subjects applied the topical ointment on the entire penis, twice daily for 30 days before surgical correction. Biometric evaluation of the penis included penile length and diameter, glans diameter, distance from the urethral meatus to the tip, and the width of the urethral plate. These measurements as well as serum hormone level, and side effects were evaluated prior to hormone use, and 30 and 90 days after. After 30 days an increase in penile diameter and length and diameter of the glans were observed in TG (p < 0.05). The width of the urethral plate and distance from meatus to the tip increased in TG, although not significantly. The most frequent side effects were appearance of pubic hair and darkening of the genital skin, mainly in TG, but these were transient and disappeared after 90 days of treatment. No significant variations were seen in serum hormonal levels (Table). As in previous studies, an increase in penile length and diameter, and glans diameter was observed with the use of testosterone. Proximal urethral plate width and distance from the meatus to the tip of the penis had a tendency to increase also in TG. Estradiol did not change biometric measure of the penis. Few side effects occurred after both hormones, and any that did improved after 90 days follow-up and did not change hormone serum levels. Preoperative use of topical testosterone increases penile size, diameter of the penis and glans. The use of estradiol does not change penile biometry. Side effects occur mainly with the use of testosterone and are transient. No significant and persistent hormonal changes were observed. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

A Value-Based Analysis of Hemodynamic Support Strategies for High-Risk Heart Failure Patients Undergoing a Percutaneous Coronary Intervention

PubMed Central

Gregory, David; Scotti, Dennis J.; de Lissovoy, Gregory; Palacios, Igor; Dixon, Simon; Maini, Brijeshwar; O'Neill, William

2013-01-01

Background The economic burden of heart disease is heavy and growing. As advanced technologies for treating heart disease become available, decision makers need to be able to assess the relative value of such options against existing standards of care. Objectives To compare the clinical and economic benefits of a percutaneous ventricular assist device (pVAD) versus an intra-aortic balloon pump (IABP) observed during the 90-day duration of the PROTECT II clinical trial, and to supplement these findings with a simulation of the longer-term value of this technology through the use of a Markov model to estimate the incremental cost-effectiveness of a pVAD relative to an IABP, in terms of quality-adjusted life-years (QALYs). Methods Hospital bills were collected for patients enrolled in the PROTECT II trial who received hemodynamic support for high-risk percutaneous coronary intervention (PCI) provided by a pVAD (Impella 2.5) versus a conventional IABP during a 90-day episode of care (EOC). Length of stay, charges, and costs were analyzed for the index admissions, intensive care unit confinements, readmissions, and overall EOC. In addition, a probabilistic Markov model was used to project these parameters and their impact on a patient's quality of life for up to 10 years in relation to a pVAD versus an IABP. Results Hospital costs for the index admission were lower for the IABP compared with the pVAD ($33,684 vs $47,667; P <.001), whereas readmission length of stay and costs were lower for the pVAD versus the IABP (5 days vs 7 days; and $11,007 vs $21,834, respectively; P <.001). The total 90-day hospital charges were similar for the pVAD and the IABP ($172,564 vs $172,758, respectively; P = .785); however, the total 90-day EOC cost was lower for the IABP than for the pVAD ($44,032 vs $53,171, respectively; P <.001). The median hospital days for the entire EOC were 7 days for the pVAD versus 9 days for the IABP (P = .008). Critical care stays were considerably shorter for a pVAD than for an IABP on readmissions (3.88 days vs 7.00 days; P = .145). Reduction in major adverse cardiovascular and cerebrovascular events resulted in a projected gain of 0.26 QALYs over 10 years, yielding an incremental cost-effectiveness ratio of $39,389/QALY. Conclusions For high-risk patients with advanced heart failure undergoing PCI, the new pVAD reduced major adverse events, critical care and readmission length of stay, and readmission cost over the 90-day EOC, and was determined to be cost-effective over the long-term. These findings can assist decision makers in forming value-based judgments with regard to new hemodynamic support strategies. PMID:24991349

A value-based analysis of hemodynamic support strategies for high-risk heart failure patients undergoing a percutaneous coronary intervention.

PubMed

Gregory, David; Scotti, Dennis J; de Lissovoy, Gregory; Palacios, Igor; Dixon, Simon; Maini, Brijeshwar; O'Neill, William

2013-03-01

The economic burden of heart disease is heavy and growing. As advanced technologies for treating heart disease become available, decision makers need to be able to assess the relative value of such options against existing standards of care. To compare the clinical and economic benefits of a percutaneous ventricular assist device (pVAD) versus an intra-aortic balloon pump (IABP) observed during the 90-day duration of the PROTECT II clinical trial, and to supplement these findings with a simulation of the longer-term value of this technology through the use of a Markov model to estimate the incremental cost-effectiveness of a pVAD relative to an IABP, in terms of quality-adjusted life-years (QALYs). Hospital bills were collected for patients enrolled in the PROTECT II trial who received hemodynamic support for high-risk percutaneous coronary intervention (PCI) provided by a pVAD (Impella 2.5) versus a conventional IABP during a 90-day episode of care (EOC). Length of stay, charges, and costs were analyzed for the index admissions, intensive care unit confinements, readmissions, and overall EOC. In addition, a probabilistic Markov model was used to project these parameters and their impact on a patient's quality of life for up to 10 years in relation to a pVAD versus an IABP. Hospital costs for the index admission were lower for the IABP compared with the pVAD ($33,684 vs $47,667; P <.001), whereas readmission length of stay and costs were lower for the pVAD versus the IABP (5 days vs 7 days; and $11,007 vs $21,834, respectively; P <.001). The total 90-day hospital charges were similar for the pVAD and the IABP ($172,564 vs $172,758, respectively; P = .785); however, the total 90-day EOC cost was lower for the IABP than for the pVAD ($44,032 vs $53,171, respectively; P <.001). The median hospital days for the entire EOC were 7 days for the pVAD versus 9 days for the IABP (P = .008). Critical care stays were considerably shorter for a pVAD than for an IABP on readmissions (3.88 days vs 7.00 days; P = .145). Reduction in major adverse cardiovascular and cerebrovascular events resulted in a projected gain of 0.26 QALYs over 10 years, yielding an incremental cost-effectiveness ratio of $39,389/QALY. For high-risk patients with advanced heart failure undergoing PCI, the new pVAD reduced major adverse events, critical care and readmission length of stay, and readmission cost over the 90-day EOC, and was determined to be cost-effective over the long-term. These findings can assist decision makers in forming value-based judgments with regard to new hemodynamic support strategies.

The influence of preoperative nutritional status on the outcomes of an enhanced recovery after surgery (ERAS) programme for colorectal cancer surgery.

PubMed

Lohsiriwat, V

2014-11-01

The aim of the present study was to evaluate the effects of preoperative nutritional status on the short-term outcomes of an enhanced recovery after surgery (ERAS) programme for colorectal cancer surgery. This prospective observational study included 149 patients who underwent elective resection of colorectal cancer with ERAS from January 2011 to January 2014 in a university hospital. Subjective global assessment (SGA) was used to determine preoperative nutritional status. Primary outcomes included the length of postoperative stay, postoperative morbidity, gastrointestinal recovery, and 30-day readmission. The patients were divided into 3 groups according to the SGA classification. There were 96 patients (64.4 %) in SGA-A (well-nourished), 48 (32.2 %) in SGA-B (mild to moderately malnourished), and 5 (3.4 %) in SGA-C (severely malnourished). Patients in SGA-A had the median length of postoperative stay of 4 days (range 2-23), which was significantly shorter compared to SGA-B (5 days; range 2-16; p < 0.01) and SGA-C (7 days; range 4-17; p < 0.01). The overall complication rates of SGA-A, SGA-B, and SGA-C patients were 11, 31 % (adjusted OR 3.76; 95 % CI 1.36-10.36; p < 0.01) and 40 % (adjusted OR 2.15; 95 % CI 0.07-63.64; p = 0.66). Mean time to resumption of normal diet and time to first defecation were 1.6 ± 1.3 and 2.2 ± 0.9 days in SGA-A, 2.6 ± 1.7 and 3.1 ± 1.6 days in SGA-B (p < 0.01 compared to SGA-A) and 3.2 ± 2.4 days and 2.6 ± 1.5 days in SGA-C (p = 0.07 and p = 0.1 compared to SGA-A, respectively). No 30-day mortality occurred in any group. One patient in SGA-A (1 %), and 3 patients in SGA-B (6 %) had unplanned 30-day re-admission; p = 0.11. Within an ERAS programme for colorectal cancer surgery, malnourished patients were at risk for increased postoperative morbidity, delayed recovery of gastrointestinal function, and prolonged length of hospital stay.

Atypical antipsychotics, insulin resistance and weight; a meta-analysis of healthy volunteer studies.

PubMed

Burghardt, Kyle J; Seyoum, Berhane; Mallisho, Abdullah; Burghardt, Paul R; Kowluru, Renu A; Yi, Zhengping

2018-04-20

Atypical antipsychotics increase the risk of diabetes and cardiovascular disease through their side effects of insulin resistance and weight gain. The populations for which atypical antipsychotics are used carry a baseline risk of metabolic dysregulation prior to medication which has made it difficult to fully understand whether atypical antipsychotics cause insulin resistance and weight gain directly. The purpose of this work was to conduct a systematic review and meta-analysis of atypical antipsychotic trials in healthy volunteers to better understand their effects on insulin sensitivity and weight gain. Furthermore, we aimed to evaluate the occurrence of insulin resistance with or without weight gain and with treatment length by using subgroup and meta-regression techniques. Overall, the meta-analysis provides evidence that atypical antipsychotics decrease insulin sensitivity (standardized mean difference=-0.437, p<0.001) and increase weight (standardized mean difference=0.591, p<0.001) in healthy volunteers. It was found that decreases in insulin sensitivity were potentially dependent on treatment length but not weight gain. Decreases in insulin sensitivity occurred in multi-dose studies <13days while weight gain occurred in studies 14days and longer (max 28days). These findings provide preliminary evidence that atypical antipsychotics cause insulin resistance and weight gain directly, independent of psychiatric disease and may be associated with length of treatment. Further, well-designed studies to assess the co-occurrence of insulin resistance and weight gain and to understand the mechanisms and sequence by which they occur are required. Copyright © 2018 Elsevier Inc. All rights reserved.

[Methyl-containing diet of mothers affects the AGOUTI gene expression in the offspring of rats with various behavioral types].

PubMed

Prasolova, L A; Os'kina, I N; Pliusnina, I Z; Trut, L N

2009-05-01

The effects of selection of agouti rats (with genotype AAHH) on the tame and aggressive behavior and dietary methyl given to females from the eighth day of pregnancy to the fifth day after the birth of the offspring on the intensity of the agouti coat color in the offspring have been studied. The morphometric parameters of hair determining the darkness of the agouti color (the total length of guard hairs, the lengths of their eumelanin end and pheomelanin band, the ratio between the lengths of the eumelanin and pheomelanin portions of the hair, the total length of the awn hairs, and the relative length of their widened "lanceolate" upper end) have been compared. It has been found that selection of agouti rats for aggressive behavior is accompanied by darkening of the coat color compared to tame rats due to an increase in the ratio of the length of the black eumelanin end of the guard hairs to the length of the yellow pheomelanin band. Methyl-containing additives to the diet of females affect the intensity of the agouti coat color in the offsprings with both types of behavior, but to different extents. Aggressive offspring is more sensitive to the mother's methyl-containing diet: the percentage of animals that are darker than control rats is higher among aggressive animals than among tame ones due to a greater increase in the ratio between dark and light portions of hairs. The possible mechanisms of differences in the phenotypic modifications of coat color in control and experimental agouti rats with different types of behavior are discussed.

Effects of Exogenous Melatonin and Tryptophan on Fecal Shedding of E. Coli O157:H7 in Cattle

USDA-ARS?s Scientific Manuscript database

Fecal prevalence of Escherichia coli O157 in ruminants is highest in the summer decreasing to very low levels in the winter. We hypothesize that this seasonal variation is a result of physiological responses within the host animal to changing day-length. To determine the effects of melatonin (MEL) o...

Effects of Light Regimes on the Biomass and Morphological Characteristics of 2-Year-Old Cherrybark Oak Seedlings

Treesearch

Yanfei Guo; Michael G. Shelton

2004-01-01

We used modified shadehouses to simulate the complex light conditions within forest openings and tested the effects of time of direct light exposure, the ratio of direct light to day length, and daily photosynthetically active radiation on aboveground biomass and morphological characteristics of 2-year-old cherrybark oak (Quercus pagoda Raf.)...

Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team.

PubMed

Arana, Melissa; Harper, Licia; Qin, Huanying; Mabrey, Jay

The purpose of this quality improvement project was to determine whether an outcomes manager-led interprofessional team could reduce length of stay and direct cost without increasing 30-day readmission rates in the total joint arthroplasty patient population. The goal was to promote interprofessional relationships combined with collaborative practice to promote coordinated care with improved outcomes. Results from this project showed that length of stay (total hip arthroplasty [THA] reduced by 0.4 days and total knee arthroplasty [TKA] reduced by 0.6 days) and direct cost (THA reduced by $1,020 per case and TKA reduced by $539 per case) were significantly decreased whereas 30-day readmission rates of both populations were not significantly increased.

Temporal Evaluation of Cardiac Myocyte Hypertrophy and Hyperplasia in Male Rats Secondary to Chronic Volume Overload

PubMed Central

Du, Yan; Plante, Eric; Janicki, Joseph S.; Brower, Gregory L.

2010-01-01

The temporal myocardial remodeling induced by chronic ventricular volume overload in male rats was examined. Specifically, left ventricular (LV) cardiomyocyte length and width, sarcomere length, and number of nuclei were measured in male rats (n = 8 to 17) at 1, 3, 5, 7, 21, 35, and 56 days after creation of an infrarenal aortocaval fistula. In contrast to previously published reports of progressive increases in cardiomyocyte length and cross-sectional area at 5 days post-fistula and beyond in female hearts, cardiomyocyte length and width did not increase significantly in males during the first 35 days of volume overload. Furthermore, a significant decrease in cardiomyocyte length relative to age-matched controls, together with a reduced number of sarcomeres per cell, was noted in male hearts at 5 days post-fistula. There was a concurrent increase in the percentage of mononucleated cardiomyocytes from 11.6% to 18% at 5 days post-fistula. These initial differences could not be attributed to cardiomyocyte proliferation, and treatment with a microtubule stabilizing agent prevented them from occurring. The subsequent significant increase in LV weight without corresponding increases in cardiomyocyte dimensions is indicative of hyperplasia. Thus, these findings indicate hyperplasia resulting from cytokinesis of cardiomyocytes is a key mechanism, independent of hypertrophy, that contributes to the significant increase in LV mass in male hearts subjected to chronic volume overload. PMID:20651227

Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes.

PubMed

Levetan, C S; Salas, J R; Wilets, I F; Zumoff, B

1995-07-01

To determine whether consultation by an individual endocrinologist or by a multidisciplinary diabetes team (endocrinologist, diabetes nurse educator, and registered dietitian) can impact length of hospital stay of patients with diabetes. Hospital stays of consecutive patients with a principal diagnosis of diabetes were compared. Forty-three patients were seen by an individual endocrine consultant and 27 were managed by the internist alone. Thirty-four patients were seen in consultation by the diabetes team. All consultations were performed at the request of the primary physician. There were no statistically significant differences among groups with respect to age, duration of diabetes, admitting diagnosis, glucose levels, or concomitant acute or chronic illness. Average length of stay of diabetes-team patients was 3.6 +/- 1.7 days, 56% shorter than the value, 8.2 +/- 6.2 days, of patients in the no-consultation group (P < 0.0001), and 35% shorter than the value, 5.5 +/- 3.4 days, of patients who received a traditional individual endocrine consultation (P < 0.05). The length of stay correlated with time from admission to consultation (regression equation: y = 3.92 + [1.09 x time to consultation]; r = .55; P < 0.0001). The slope (1.09) indicates that each 1-day delay in consultation resulted in a 1-day increase in length of stay. Length of stay was lowest in patients who received diabetes-team consultation. Three million Americans are hospitalized annually with diabetes at a cost of $65 billion. A team approach to their inpatient care may reduce their hospital stays, resulting in considerable health and economic benefits.

Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study

PubMed Central

2010-01-01

Introduction Transfusion is a common treatment in pediatric intensive care units (PICUs). Studies in adults suggest that prolonged storage of red blood cell units is associated with worse clinical outcome. No prospective study has been conducted in children. Our objectives were to assess the clinical impact of the length of storage of red blood cell units on clinical outcome of critically ill children. Methods Prospective, observational study conducted in 30 North American centers, in consecutive patients aged <18 years with a stay ≥ 48 hours in a PICU. The primary outcome measure was the incidence of multiple organ dysfunction syndrome after transfusion. The secondary outcomes were 28-day mortality and PICU length of stay. Odds ratios were adjusted for gender, age, number of organ dysfunctions at admission, total number of transfusions, and total dose of transfusion, using a multiple logistic regression model. Results The median length of storage was 14 days in 296 patients with documented length of storage. For patients receiving blood stored ≥ 14 days, the adjusted odds ratio for an increased incidence of multiple organ dysfunction syndrome was 1.87 (95% CI 1.04;3.27, P = 0.03). There was also a significant difference in the total PICU length of stay (adjusted median difference +3.7 days, P < 0.001) and no significant change in mortality. Conclusions In critically ill children, transfusion of red blood cell units stored for ≥ 14 days is independently associated with an increased occurrence of multiple organ dysfunction syndrome and prolonged PICU stay. PMID:20377853

Effect of chronic centrifugation of the musculoskeletal system of the dog.

PubMed

Amtmann, E; Oyama, J; Fisher, G L

1976-04-21

Sixteen male Beagle dogs, 293 to 509 days old, were exposed almost continuously for 3 months to 2.0 G on a 7.9 meter radius centrifuge. The dogs were maintained on the centrifuge, by means of a specially designed automated waste disposal and life support system. As compared to the mean values of normal gravity controls, centrifuged dogs showed no differences in femur length; cross-sectional area, outer and inner radii at mid-shaft of the femur; dry weights of the biceps femoris, quadriceps femoris, and gastrocnemius muscles. It was shown by analysis of covariance that chronic centrifugation has no effect on the relationship between the length and the cross-sectional dimensions at mid-shaft of the femur. Photon absorptiometry, however, revealed significant mineral content increases averaging 1.5% at 3 sites, i.e., at the 1/4, 1/2 and 3/4 length of the femur.

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

Saavedra, J.A.; Palta, J.P.; Stang, E.J.

Uniconazole (UCZ) is an effective growth suppressant of the group of triazoles. Triazoles have been used as fungicides (inhibiting sterol biosynthesis) or plant growth regulators (inhibiting gibberellin biosynthesis). Some reports suggest that triazoles can help to alleviate some environmental stresses, including SO{sub 2}, drought, and low and high temperatures. Using soil drench or foliar spray procedure the authors investigated the influence of UCZ 95-500 mg L{sup {minus}1} on freezing tolerance of leaf tissue. Freezing tolerance was evaluated 1-10 days following UCZ treatment by using electrolyte leakage method. They also measured internode length, chlorophyll content, and the size of palisade layermore » on treated leaves. The highest UCZ rate (500 mg L{sup {minus}1}) did not cause injury to the plants. Chlorophyll content and length of palisade cells increased by 30 and 14%, respectively, in the treated leaves. The internode length was suppressed in 22% by UCZ. Thus UCZ was effective in dwarfing the plants. However, no dramatic effects were found on the freezing stress resistance in both potato species.« less

Cost-effectiveness analysis of an enteral nutrition protocol for children with common gastrointestinal diseases in China: good start but still a long way to go.

PubMed

Yang, Min; Chen, Pei-Yu; Gong, Si-Tang; Lyman, Beth; Geng, Lan-Lan; Liu, Li-Ying; Liang, Cui-Ping; Xu, Zhao-Hui; Li, Hui-Wen; Fang, Tie-Fu; Li, Ding-You

2014-11-01

A standard nutrition screening and enteral nutrition (EN) protocol was implemented in January 2012 in a tertiary children's center in China. The aims of the present study were to evaluate the cost-effectiveness of a standard EN protocol in hospitalized patients. A retrospective chart review was performed in the gastroenterology inpatient unit. We included all inpatient children requiring EN from January 1, 2010, to December 31, 2013, with common gastrointestinal (GI) diseases. Children from January 1, 2012, to December 31, 2013, served as the standard EN treatment group, and those from January 1, 2010, to December 31, 2011, were the control EN group. Pertinent patient information was collected. We also analyzed the length of hospital stay, cost of care, and in-hospital infection rates. The standard EN treatment group received more nasojejunal tube feedings. There was a tendency for the standard EN treatment group to receive more elemental and hydrolyzed protein formulas. Implementation of a standard EN protocol significantly reduced the time to initiate EN (32.38 ± 24.50 hours vs 18.76 ± 13.53 hours; P = .011) and the time to reach a targeted calorie goal (7.42 ± 3.98 days vs 5.06 ± 3.55 days; P = .023); length of hospital stay was shortened by 3.2 days after implementation of the standard EN protocol but did not reach statistical significance. However, the shortened length of hospital stay contributed to a significant reduction in the total cost of hospital care (13,164.12 ± 6722.95 Chinese yuan [CNY] vs 9814.96 ± 4592.91 CNY; P < .032). Implementation of a standard EN protocol resulted in early initiation of EN, shortened length of stay, and significantly reduced total cost of care in hospitalized children with common GI diseases. © 2014 American Society for Parenteral and Enteral Nutrition.

Exploring the relationship between age and tenure with length of disability

PubMed Central

Young, Amanda E.; Pransky, Glenn

2015-01-01

Background The aging of the workforce, coupled with the changing nature of career tenure has raised questions about the impact of these trends on work disability. This study aimed to determine if age and tenure interact in relating to work disability duration. Methods Relationships were investigated using random effects models with 239,359 work disability claims occurring between 2008 and 2012. Results A 17‐day difference in the predicted length of disability was observed from ages 25 to 65. Tenure moderated the relationship between age and length of disability. At younger ages, the length of disability decreased as tenure increased, but at older age, the length of disability increased as tenure increased. Discussion Results indicate that although there is a relationship between length of disability and tenure, age makes a greater unique contribution to explaining variance in length of disability. Future research is needed to better understand why specifically age shows a strong relationship with length of disability and why that relationship varies with age. Am. J. Ind. Med. 58:974–987, 2015. © 2015 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. PMID:26010587

Outcomes of an antimicrobial control program in a teaching hospital.

PubMed

Gentry, C A; Greenfield, R A; Slater, L N; Wack, M; Huycke, M M

2000-02-01

The clinical outcomes and cost-effectiveness of an antimicrobial control program (ACP) were studied. The impact of an ACP in a teaching hospital was analyzed by comparing clinical outcomes and intravenous antimicrobial costs over two two-year periods, the two years before the program and the first two years after the program's inception. Admission baseline data, length of stay, mortality, and readmission rates were gathered for each patient. Patients were identified by using the International Classification of Diseases. Multivariate logistic regression models were constructed for mortality and for lengths of stay of 12 or more days. The acquisition costs of intravenous antimicrobial agents for the second baseline year and the entire program period were tabulated and compared. The average daily inpatient census was determined. The ACP was associated with a 2.4-day decrease in length of stay and a reduction in mortality from 8.28% to 6.61%. Rates of readmission for infection within 30 days of discharge remained about the same. Inpatient pharmacy costs other than intravenous antimicrobials decreased an average of only 5.7% over the two program years, but the acquisition cost of intravenous antimicrobials for both program years yielded a total cost saving of $291,885, a reduction of 30.8%. The institution's average daily census fell 19% between the second baseline year and the second program year. An ACP directed by a clinical pharmacist trained in infectious diseases was associated with improvements in inpatient length of stay and mortality. The ACP decreased intravenous antimicrobial costs and facilitated the approval process for restricted and nonformulary antimicrobial agents.

Fall Colors, Temperature, and Day Length

ERIC Educational Resources Information Center

Burton, Stephen; Miller, Heather; Roossinck, Carrie

2007-01-01

Along with the bright hues of orange, red, and yellow, the season of fall represents significant changes, such as day length and temperature. These changes provide excellent opportunities for students to use science process skills to examine how abiotic factors such as weather and temperature impact organisms. In this article, the authors describe…

Spatial variation in the effects of size and age on reproductive dynamics of common coral trout Plectropomus leopardus.

PubMed

Carter, A B; Russ, G R; Tobin, A J; Williams, A J; Davies, C R; Mapstone, B D

2014-04-01

The effects of size and age on reproductive dynamics of common coral trout Plectropomus leopardus populations were compared between coral reefs open or closed (no-take marine reserves) to fishing and among four geographic regions of the Great Barrier Reef (GBR), Australia. The specific reproductive metrics investigated were the sex ratio, the proportion of vitellogenic females and the spawning fraction of local populations. Sex ratios became increasingly male biased with length and age, as expected for a protogyne, but were more male biased in southern regions of the GBR (Mackay and Storm Cay) than in northern regions (Lizard Island and Townsville) across all lengths and ages. The proportion of vitellogenic females also increased with length and age. Female P. leopardus were capable of daily spawning during the spawning season, but on average spawned every 4·3 days. Mature females spawned most frequently on Townsville reserve reefs (every 2·3 days) and Lizard Island fished reefs (every 3·2 days). Females on Mackay reefs open to fishing showed no evidence of spawning over 4 years of sampling, while females on reserve reefs spawned only once every 2-3 months. No effect of length on spawning frequency was detected. Spawning frequency increased with age on Lizard Island fished reefs, declined with age on Storm Cay fished reefs, and declined with age on reserve reefs in all regions. It is hypothesized that the variation in P. leopardus sex ratios and spawning frequency among GBR regions is primarily driven by water temperature, while no-take management zones influence spawning frequency depending on the region in which the reserve is located. Male bias and lack of spawning activity on southern GBR, where densities of adult P. leopardus are highest, suggest that recruits may be supplied from central or northern GBR. Significant regional variation in reproductive traits suggests that a regional approach to management of P. leopardus is appropriate and highlights the need for considering spatial variation in reproduction where reserves are used as fishery or conservation management tools. © 2014 The Fisheries Society of the British Isles.

Reducing liver transplant length of stay: a Lean Six Sigma approach.

PubMed

Toledo, Alexander H; Carroll, Tracy; Arnold, Emily; Tulu, Zeynep; Caffey, Tom; Kearns, Lauren E; Gerber, David A

2013-12-01

Organ transplant centers are under increasing scrutiny to maintain outcomes while controlling cost in a challenging population of patients. Throughout health care and transplant specifically, length of stay is used as a benchmark for both quality and resource utilization. To decrease our length of stay for liver transplant by using Lean Six Sigma methods. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method was used to systematically analyze our process from transplant listing to hospital discharge after transplant, identifying many factors affecting length of stay. Adult, single-organ, primary liver transplant recipients between July 2008 and June 2012 were included in the study. Recipients with living donors or fulminant liver failure were excluded. Multiple interventions, including a clinical pathway and enhanced communication, were implemented. Length of stay after liver transplant and readmission after liver transplant.R ESULTS: Median length of stay decreased significantly from 11 days before the intervention to 8 days after the intervention. Readmission rate did not change throughout the study. The improved length of stay was maintained for 24 months after the study. Using a Lean Six Sigma approach, we were able to significantly decrease the length of stay of liver transplant patients. These results brought our center's outcomes in accordance with our goal and industry benchmark of 8 days. Clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains.

Recidivism following mental health court exit: Between and within-group comparisons.

PubMed

Lowder, Evan M; Desmarais, Sarah L; Baucom, Daniel J

2016-04-01

Over the past decade, Mental Health Courts (MHCs) have spread rapidly across the U.S. These courts aim to reduce recidivism among adults with mental illnesses through diversion into community-based treatment. Extant research suggests that MHCs can be effective in reducing recidivism, but also demonstrates that effectiveness varies as a function of characteristics of the participants (e.g., criminal history) and the program (e.g., coercion). Less is known regarding the extent to which process-related factors (e.g., length of participation, time between referral and receipt of services) impact effectiveness. Prior research also is limited by a focus on recidivism during MHC as opposed to postexit. To address these knowledge gaps, we examined recidivism 1 year postexit for a group of MHC participants (n = 57) and offenders receiving treatment as usual (TAU; n = 40), total N = 97. We also investigated the influence of individual characteristics and process factors on changes in jail days 1 year preentry to 1 year postexit for MHC participants. Overall, results provide some evidence supporting the effectiveness of MHCs. MHC participants had significantly fewer jail days, but not charges or convictions, relative to TAU participants. Among MHC participants, graduation from the MHC, presence of co-occurring substance use, and longer length of MHC participation were associated with greater reductions in jail days. Other process factors were unrelated to reductions in recidivism. Findings suggest that MHCs may be particularly effective for high-risk participants and that time spent in a MHC has positive effects on recidivism, regardless of graduation status. (c) 2016 APA, all rights reserved).

Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report.

PubMed

Bueno, Javier; Burgos, Rosa; Redecillas, Susana; López, Manuel; Balsells, Joaquin

2018-01-01

We have recently demonstrated the feasibility of lengthening the duodenum in children with short bowel syndrome and a dilated duodenum. This procedure gains additional intestinal length in a challenging area of autologous gut reconstruction. Herein, we report the successful application of this technique in an adult with ultra-short bowel syndrome. A 25-year-old man with a history of mid-gut volvulus was referred to our center for intestinal transplant evaluation. Only a megaduodenum stump that reached as far as the third portion (30 cm of length) and the colon up to the hepatic flexure in the form of a mucous fistula was retained. A gastrostomy tube drained gastric and bilio-pancreatic secretions (output range: 2.5-4 liters/day). The time spent on parenteral nutrition (3 liters/day; 1500 calories/day) and I.V. fluid (1.5-2 liters/day) administration was 24 hours per day. The patient underwent duodenal lengthening and tapering with 7 sequential transverse applications (5 of 45 mm and 2 of 60 mm) of an endoscopic stapler on the anterior and posterior walls of the duodenum, respecting the pancreatic parenchyma and end-to-side duodeno-colonic anastomosis. The final duodenal length was 83 cm. The pre-lengthening citrulline level increased from 13.6 micromol/L to 21.6 micromol/L one year post-lengthening. After 24 month of follow-up, the time on a parenteral pump was shortened to 9 hours during the night. The volume and calorie requirements were also reduced by half. Duodenal lengthening may be effective as part of the autologous intestinal reconstruction armamentarium in adults with short bowel syndrome.

Healthcare Disparities in Outcomes of a Metropolitan Congenital Heart Surgery Center: The Effect of Clinical and Socioeconomic Factors.

PubMed

Peterson, Jennifer K; Catton, Kirsti G; Setty, Shaun P

2018-04-01

The purpose of this study is to identify the impact of demographic, socioeconomic, and clinical factors on congenital heart surgery outcomes. This retrospective cohort study included 234 congenital heart surgery patients from 2011 through 2015, in a racially/ethnically diverse metropolitan children's hospital. Outcomes included length of stay (LOS), age at first echocardiogram, length of mechanical ventilation, and incidence of complications. Compared to others, black children underwent their first echocardiogram at a later age (median 23 versus 2 days, p = 0.014) and were more likely to be diagnosed with congenital heart disease in the emergency room (p = 0.026). Hispanic children were more likely to have major non-cardiac congenital anomalies (p = 0.045). Increased LOS during elective admissions was associated with higher surgical complexity (STAT category 4 and 5 Estimate 3.905 days, p = 0.001), compared to STAT category 1, and number of complications (Estimate = 2.306 days per complication, p < 0.001). Increased LOS in non-elective admissions was associated with the number of complex chronic conditions (Estimate = 15.446 days, p = 0.045) and the number of complications (Estimate = 11.591 days per complication, p < 0.001). However, in multivariate analysis, race and ethnicity was not associated with increased LOS or age at first echocardiogram. In this diverse setting, race/ethnicity was not associated with increased LOS, age at first echocardiogram, length of ventilation, or complications. Surgical complexity, chronic conditions, and complications were associated with increased LOS. We discuss some interventions to reduce disparities in congenital heart surgery outcomes.

An intention to achieve better postnatal in-hospital-growth for preterm infants: adjustable protein fortification of human milk.

PubMed

Alan, Serdar; Atasay, Begum; Cakir, Ufuk; Yildiz, Duran; Kilic, Atila; Kahvecioglu, Dilek; Erdeve, Omer; Arsan, Saadet

2013-12-01

We assessed the effect of human milk (HM) fortification with extra protein supplement by an adjustable protein fortification method according to the weekly blood urea nitrogen (BUN) levels on growth in hospitalized preterm infants. A prospective observational intervention study in 58 preterms born ≤32 weeks of gestation and fed with breast milk was conducted. Preterms who were given a commercial HM fortifier which provides an additional protein of 0.8 g/3 scales according to the standard feeding strategy served as a historical control group. Infants who were given extra protein in addition to the HM fortifier with another commercial protein supplement which provides an additional protein of 2.2g/1 scale comprised the intervention group. Additional protein supplementation was adjusted according to BUN levels weekly in the intervention group. Weight gain velocities (g/kg/day), length, head circumferences (HC) gain velocities (mm/day) and daily growth indexes for weight, height and HC (percentage per day) were calculated. The median amount of daily enteral protein intake [4 (3.4-4.6) vs. 2.78 (2.1-3.1) g/kg/day, p < 0.0001] was significantly higher in the interventional group. Length (p = 0.008) and HC (p < 0.0001) gain velocities were significantly higher in the intervention group. Daily growth indexes for weight (2.2% vs. 1.8%, p = 0.026), for length (0.4% vs. 0.3%, p = 0.027) and for HC (0.48% vs. 0.36% per day, p = 0.003) were significantly higher in the intervention group. A higher protein intake by adjustable protein fortification method without energy or volume change leads to improved postnatal in-hospital-growth in very low birth weight infants. © 2013 Elsevier Ireland Ltd. All rights reserved.

Mutagenic effects of gamma rays on soybean (Glycine max L.) germination and seedlings

NASA Astrophysics Data System (ADS)

Kusmiyati, F.; Sutarno; Sas, M. G. A.; Herwibawa, B.

2018-01-01

Narrow genetic diversity is a main problem restricting the progress of soybean breeding. One way to improve genetic diversity of plant is through mutation. The purpose of this study was to investigate effect of different dose of gamma rays as induced mutagen on physiological, morphological, and anatomical markers during seed germination and seedling growth of soybean. Seeds of soybean cultivars Dering-1 were irradiated with 11 doses of gamma rays (0, 5, 10, 20, 40, 80, 160, 320, 640, 1280, and 2560 Gy [Gray]. The research design was arranged in a completely randomized block design in three replicates. Results showed that soybean seed exposed at high doses (640, 1280, and 2560 Gy) did not survive more than 20 days, the doses were then removed from anatomical evaluation. Higher doses of gamma rays siginificantly reduced germination percentage at the first count and final count, coefficient of germination velocity, germination rate index, germination index, seedling height and seedling root length, and significantly increased mean germination time, first day of germination, last day of germination, and time spread of germination. However, the effects of gamma rays were varies for density, width, and length of stomata. The LD50 obtained based on survival percentage was 314.78 Gy. It can be concluded that very low and low doses of gamma rays (5-320 Gy) might be used to study the improvement of soybean diversity.

How Can We Make Kindergarten More Effective for Children?

ERIC Educational Resources Information Center

Honig, Alice Sterling

The title question is discussed in six sections. Structural variables and issues are discussed in subsections concerning: the sex of child, the kindergarten program's day length, type, entrance age, group size, classroom aides and arrangements, and policies on promotion, failure, and retention. Interpersonal variables are explored in terms of…

Low temperature limits photoperiod control of smolting in atlantic salmon through endocrine mechanisms

USGS Publications Warehouse

McCormick, S.D.; Moriyama, S.

2000-01-01

We have examined the interaction of photoperiod and temperature in regulating the parr-smolt transformation and its endocrine control. Atlantic salmon juveniles were reared at a constant temperature of 10??C or ambient temperature (2??C from January to April followed by seasonal increase) under simulated natural day length. At 10??C, an increase in day length [16 h of light and 8 h of darkness (LD 16:8)] in February accelerated increases in gill Na+K+-ATPase activity, whereas fish at ambient temperature did not respond to increased day length. Increases in gill Na+K+-ATPase activity under both photoperiods occurred later at ambient temperature than at 10??C. Plasma growth hormone (GH), insulin-like growth factor, and thyroxine increased within 7 days of increased day length at 10??C and remained elevated for 5-9 wk; the same photoperiod treatment at 2??C resulted in much smaller increases of shorter duration. Plasma cortisol increased transiently 3 and 5 wk after LD 16:8 at 10??C and ambient temperature, respectively. Plasma thyroxine was consistently higher at ambient temperature than at 10??C. Plasma triiodothyronine was initially higher at 10??C than at ambient temperature, and there was no response to LD 16:8 under either temperature regimen. There was a strong correlation between gill Na+K+-ATPase activity and plasma GH; correlations were weaker with other hormones. The results provide evidence that low temperature limits the physiological response to increased day length and that GH, insulin-like growth factor I, cortisol, and thyroid hormones mediate the environmental control of the parr-smolt transformation.

Length of Stay for Mental and Behavioural Disorders Postpartum in Primiparous Mothers: A Cohort Study

PubMed Central

Xu, Fenglian; Austin, Marie-Paule; Reilly, Nicole; Hilder, Lisa; Sullivan, Elizabeth A

2014-01-01

Background: Previous research showed that there was a significant increase in psychiatric hospital admission of postpartum mothers. The aim of the current study is to describe the length of hospital stays and patient days for mental and behavioural disorders (MBD) of new mothers in the first year after birth. Method: This was a cohort study based on linked population data between the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC). The study population included primiparous mothers aged from 18 to 44 who gave birth between 1 July 2000 and 31 December 2005. The Kaplan–Meier method was used to describe the length of hospital stay for MBD. Results: For principal diagnoses of MBD, the entire length of hospital stay in the first year postpartum was 11.38 days (95% CI: 10.70–12.06) for mean and 6 days (95% CI: 5.87–6.13) for median. The length of hospital stay per admission was 8.47 days (95% CI: 8.03–8.90) for mean and 5 days (95% CI: 4.90–5.10) for median. There were 5,129 patient days of hospital stay per year for principal diagnoses of postpartum MBD in new mothers between 1 July 2000 and 31 December 2005 in NSW, Australia. Conclusions: MBD, especially unipolar depressions, adjustment disorders, acute psychotic episodes, and schizophrenia, or schizophrenia-like disorders during the first year after birth, placed a significant burden on hospital services due to long hospital stays and large number of admissions. PMID:24681554

Control of annual reproductive cycle in the subtropical house sparrow (Passer domesticus): evidence for conservation of photoperiodic control mechanisms in birds

PubMed Central

Trivedi, Amit K; Rani, Sangeeta; Kumar, Vinod

2006-01-01

Background In many birds, day length (=photoperiod) regulates reproductive cycle. The photoperiodic environment varies between different seasons and latitudes. As a consequence, species at different latitudes may have evolved separate photoperiodic strategies or modified them as per their adaptive need. We studied this using house sparrow as a model since it is found worldwide and is widely investigated. In particular, we examined whether photoperiodism in house sparrows (Passer domesticus) at 27°N, 81°E shared features with those exhibited by its conspecifics at high latitudes. Results Initial experiment described in the wild and captive conditions the gonad development and molt (only in captives) cycles over a 12-month period. Both male and female sparrows had similar seasonal cycles, linked with annual variations in day length; this suggested that seasonal reproduction in house sparrows was under the photoperiodic control. However, a slower testis and attenuated follicular growth among captives indicated that other (supplementary) factors are also involved in controlling the reproductive cycle. Next experiment examined if sparrows underwent seasonal variations in their response to stimulatory effects of long day lengths. When birds were transferred every month over a period of 1 year to 16 hours light:8 hours darkness (16L:8D) for 17–26 weeks, there was indeed a time-of-year effect on the growth-regression cycle of gonads. The final experiment investigated response of house sparrows to a variety of light-dark (LD) cycles. In the first set, sparrows were exposed for 31 weeks to photoperiods that were close to what they receive in between the period from sunrise to sunset at this latitude: 9L:15D (close to shortest day length in December), 12L:12D (equinox, in March and September) 15L:9D (close to longest day length in June). They underwent testicular growth and regression and molt in 12L and 15L photoperiods, but not in 9L photoperiod. In the second set, sparrows were exposed for 17 weeks to photoperiods with light periods extending to different duration of the daily photosensitivity rhythm (e.g. 2L:22D, 6L:18D, 10L:14D, 14L:10D, 18L:6D and 22L:2D). Interestingly, a slow and small testicular response occurred under 2L and 10L photoperiods; 6L:18D was non-inductive. On the other hand, 14L, 18L and 22L photoperiods produced testicular growth and subsequent regression response as is typical of a long day photostimulation. Conclusion Subtropical house sparrows exhibit photoperiodic responses similar to that is reported for its population living at high latitudes. This may suggest the conservation of the photoperiodic control mechanisms in birds evolved over a long period of time, as a physiological strategy in a temporally changing environment ensuring reproduction at the best suited time of the year. PMID:16923197

Assessing the effect of the relative atmospheric angular momentum (AAM) on length-of-day (LOD) variations under climate warming

NASA Astrophysics Data System (ADS)

Lehmann, E.; Hansen, F.; Ulbrich, U.; Nevir, P.; Leckebusch, G. C.

2009-04-01

While most studies on model-projected future climate warming discuss climatological quantities, this study investigates the response of the relative atmospheric angular momentum (AAM) to climate warming for the 21th century and discusses its possible effects on future length-of-day variations. Following the derivation of the dynamic relation between atmosphere and solid earth by Barnes et al. (Proc. Roy. Soc., 1985) this study relates the axial atmospheric excitation function X3 to changes in length-of-day that are proportional to variations in zonal winds. On interannual time scales changes in the relative AAM (ERA40 reanalyses) are well correlated with observed length-of-day (LOD, IERS EOP CO4) variability (r=0.75). The El Niño-Southern Oscillation (ENSO) is a prominent coupled ocean-atmosphere phenomenon to cause global climate variability on interannual time scales. Correspondingly, changes in observed LOD relate to ENSO due to observed strong wind anomalies. This study investigates the varying effect of AAM anomalies on observed LOD by relating AAM to variations to ENSO teleconnections (sea surface temperatures, SSTs) and the Pacific North America (PNA) oscillation for the 20th and 21st century. The differently strong effect of strong El Niño events (explained variance 71%-98%) on present time (1962-2000) observed LOD-AAM relation can be associated to variations in location and strength of jet streams in the upper troposphere. Correspondingly, the relation between AAM and SSTs in the NIÑO 3.4 region also varies between explained variances of 15% to 73%. Recent coupled ocean-atmosphere projections on future climate warming suggest changes in frequency and amplitude of ENSO events. Since changes in the relative AAM indicate shifts in large-scale atmospheric circulation patterns due to climate change, AAM - ENSO relations are assessed in coupled atmosphere-ocean (ECHAM5-OM1) climate warming projections (A1B) for the 21st century. A strong rise (+31%) in relative AAM is observed with major contributions in the upper troposphere where increased jet streams cause large AAM anomalies. Due to increasing westerly winds, an eastward shift can be observed during strong El Niño events for the Pacific and North America centers of the PNA while its southeast center is less pronounced and shifts to the West. As a result, the PNA region during strong 21th century El Niño events is closely located to the PNA region of mean atmospheric conditions of present time. Further analyses on the climate warming scenario (A1B) determined a total of 28 strong El Niño events suggesting a steady increase in ENSO events, magnitude and duration during the last decades of the 21st century. Rising Niño 3.4 SSTs exceed global increases by 15%. Correspondingly to present times, the AAM-SST relation also indicates a range of explained variances from 8% to 82%. Ongoing analyses on 21st century climate warming relate zonal wind anomalies in the upper troposphere to SST patterns of individual strong El Niños to estimate a possible effect of the relative AAM on length-of-day variations.

Accuracy of self-reported length of coma and posttraumatic amnesia in persons with medically verified traumatic brain injury.

PubMed

Sherer, Mark; Sander, Angelle M; Maestas, Kacey Little; Pastorek, Nicholas J; Nick, Todd G; Li, Jingyun

2015-04-01

To determine the accuracy of self-reported length of coma and posttraumatic amnesia (PTA) in persons with medically verified traumatic brain injury (TBI) and to investigate factors that affect self-report of length of coma and PTA duration. Prospective cohort study. Specialized rehabilitation center with inpatient and outpatient programs. Persons (N=242) with medically verified TBI who were identified from a registry of persons who had previously participated in TBI-related research. Not applicable. Self-reported length of coma and self-reported PTA duration. Review of medical records revealed that the mean medically documented length of coma and PTA duration was 6.9±12 and 19.2±22 days, respectively, and the mean self-reported length of coma and PTA duration was 16.7±22 and 106±194 days, respectively. The average discrepancy between self-report and medical record for length of coma and PTA duration was 8.2±21 and 64±176 days, respectively. Multivariable regression models revealed that time since injury, performance on cognitive tests, and medical record values were associated with self-reported values for both length of coma and PTA duration. In this investigation, persons with medically verified TBI showed poor accuracy in their self-report of length of coma and PTA duration. Discrepancies were large enough to affect injury severity classification. Caution should be exercised when considering self-report of length of coma and PTA duration. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Primary care visit length, quality, and satisfaction for standardized patients with depression.

PubMed

Geraghty, Estella M; Franks, Peter; Kravitz, Richard L

2007-12-01

The contribution of physician and organizational factors to visit length, quality, and satisfaction remains uncertain, in part, because of confounding by patient presentation. To determine associations among visit length, quality, and satisfaction when patient presentation is controlled. A factorial experiment using standardized patients to make primary care visits presenting with either major depression or adjustment disorder, and a musculoskeletal complaint. One hundred fifty-two primary care physicians, each seeing 2 standardized patients. Visit length was determined from surreptitiously obtained audiorecordings. Other key measures were derived from physician and standardized patient report. Mean visit length for 294 completed encounters was 22.3 minutes (range = 5.8-72.2, SD = 9.4). Key factors associated with visit length were: physician style (rho = 0.68 and 0.54 after multivariate adjustment), nonprofessional experience with depression (11% longer, 95% CI = 0-23%), practicing within an HMO (26% shorter, 95% CI = 61-90%), and greater practice volume (those working >9 half-day clinic sessions/week had 15% shorter visits than those working fewer than 6, 95% CI = 0-27%, and those seeing >12 patients/half-day had 27% shorter visits than those seeing <10 patients/half-day, 95% CI = 13-39%). Suicidal inquiry (a process-based quality-of-care measure for depression) was not associated with adjusted visit length. Satisfaction was linearly associated with visit length but not with suicide inquiry or follow-up interval. Despite experimental control for clinical presentation, wide variation in visit length persists, largely reflecting individual physician styles. Visit length is a significant determinant of standardized patient satisfaction.

Physician organization care management capabilities associated with effective inpatient utilization management: a fuzzy set qualitative comparative analysis.

PubMed

Sheehy, Thomas J; Thygeson, N Marcus

2014-12-03

We studied the relationship between physician organization (PO) care management capabilities and inpatient utilization in order to identify PO characteristics or capabilities associated with low inpatient bed-days per thousand. We used fuzzy-set qualitative comparative analysis (fsQCA) to conduct an exploratory comparative case series study. Data about PO capabilities were collected using structured interviews with medical directors at fourteen California POs that are delegated to provide inpatient utilization management (UM) for HMO members of a California health plan. Health plan acute hospital claims from 2011 were extracted from a reporting data warehouse and used to calculate inpatient utilization statistics. Supplementary analyses were conducted using Fisher's Exact Test and Student's T-test. POs with low inpatient bed-days per thousand minimized length of stay and surgical admissions by actively engaging in concurrent review, discharge planning, and surgical prior authorization, and by contracting directly with hospitalists to provide UM-related services. Disease and case management were associated with lower medical admissions and readmissions, respectively, but not lower bed-days per thousand. Care management methods focused on managing length of stay and elective surgical admissions are associated with low bed-days per thousand in high-risk California POs delegated for inpatient UM. Reducing medical admissions alone is insufficient to achieve low bed-days per thousand. California POs with high bed-days per thousand are not applying care management best practices.

Embryo-fetal development toxicity of honokiol microemulsion intravenously administered to pregnant rats.

PubMed

Zhang, Qianqian; Ye, Xiangfeng; Wang, Lingzhi; Peng, Bangjie; Zhang, Yingxue; Bao, Jie; Li, Wanfang; Wei, Jinfeng; Wang, Aiping; Jin, Hongtao; Chen, Shizhong

2016-02-01

The aim of this study was to evaluate the embryo-fetal development toxicity of honokiol microemulsion. The drug was intravenously injected to pregnant SD rats at dose levels of 0, 200, 600 and 2000 μg/kg/day from day 6-15 of gestation. All the pregnant animals were observed for body weights and any abnormal changes and subjected to caesarean-section on gestation day (GD) 20; all fetuses obtained from caesarean-section were assessed by external inspection, visceral and skeletal examinations. No treatment-related external alterations as well as visceral and skeletal malformations were observed in honokiol microemulsion groups. There was no significant difference in the body weight gain of the pregnant rats, average number of corpora lutea, and the gravid uterus weight in the honokiol microemulsion groups compared with the vehicle control group. However, at a dose level of 2000 μg/kg/day, there was embryo-fetal developmental toxicity observed, including a decrease in the body length and tail length of fetuses. In conclusion, the no-observed-adverse-effect level (NOAEL) of honokiol microemulsion is 600 μg/kg/day, 75 times above the therapeutic dosage and it has embryo-fetal toxicity at a dose level of 2000 μg/kg/day, which is approximately 250 times above the therapeutic dosage. Copyright © 2015 Elsevier Inc. All rights reserved.

Growth Retardation Of Chick Embryo Exposed To A Low Dose Of Electromagnetic Waves.

PubMed

Siddiqi, Najam; John C, Muthusami; Norrish, Mark; Heming, Thomas

2016-01-01

The objectives of this study were to explore the effects of low dose of the nonionizing (REW) emitted by a mobile phone on the development of chick embryo. one hundred and twenty chick fertilized eggs were equally divided into a control and an exposed group. Sixty fertilized eggs were placed in an egg incubator with a mobile phone (SAR US: 1.10W/kg (head) 0.47 W/kg body) in silent mode having vibration disable mode. Mobile was called for a total of 20 minutes in 24 hours. Twenty embryos each were sacrificed at day 5, 10 and 15, mortality, wet body weight, head to rump length, eye diameter and morphological changes were noted. The control group, 60 eggs were incubated in the same conditions, having removed the phone. No mortality was noted. The experimental group exposed to REW showed subcutaneous haemorrhagic areas and significant growth retardation at day 10 as evidence by smaller eye diameter, wet weight and CR length than the control group. There were no significant growth differences at either day 5 or at day 15. Electromagnetic waves emitted from mobile phones even though for a very short duration of 20 minutes per day have affected the growth of the chick embryo at day 10 of incubation, Hence exposure of these waves are not 100% safe.

Effects of a supplemental Spanish oral language program on sentence length, complexity, and grammaticality in Spanish-speaking children attending English-only preschools.

PubMed

Restrepo, M Adelaida; Castilla, Anny P; Schwanenflugel, Paula J; Neuharth-Pritchett, Stacey; Hamilton, Claire E; Arboleda, Alejandra

2010-01-01

The purpose of this study was to examine the effects of a supplemental Spanish language instruction program for children who spoke Spanish as their native language and were attending English-only preschool programs. Specifically, the study evaluated the program's effects on the children's Spanish sentence length in words, subordination index, and grammaticality of sentences. Forty-five Spanish-speaking children attending English-only prekindergarten classrooms were selected for study. Of those, 15 children received 30 min of Spanish instruction 5 days a week for 16 weeks. The program targeted 5-10 vocabulary words a week, dialogic book reading, phonemic awareness, and letter knowledge. The remaining 30 children participated in regular preschool English instruction. Students were evaluated before intervention, immediately after intervention, and 4 months following intervention. Repeated measures analyses of variance indicated that the children who received the small-group supplemental Spanish language instruction made significant gains in their Spanish sentence length in words and subordination index when compared to those receiving regular English-only classroom instruction. There were no differences in the children's grammaticality of sentences. The findings demonstrate that a daily short native language program has significant effects on sentence length in words and subordination index in English language learners who are attending English-only preschool programs.

Variations in the rotation of the earth

NASA Astrophysics Data System (ADS)

Carter, W. E.; Robertson, D. S.; Pettey, J. E.; Tapley, B. D.; Schutz, B. E.; Eanes, R. J.; Miao, L.

Variations in the earth's rotation (UTI) and length of day have been tracked at the submillisecond level by astronomical radio interferometry and laser ranging to the LAGEOS satellite. Three years of regular measurements reveal complex patterns of variations including UTI fluctuations as large as 5 milliseconds in a few weeks. Comparison of the observed changes in length of day with variations in the global atmospheric angular momentum indicates that the dominant cause of changes in the earth's spin rate, on time scales from a week to several years, is the exchange of angular momentum between the atmosphere and the mantle. The unusually intense El Nino of 1982-1983 was marked by a strong peak in the length of day.

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

Aleshin, S. S., E-mail: aless2001@mail.ru; Lobanov, A. E., E-mail: lobanov@phys.msu.ru; Kharlanov, O. G., E-mail: okharl@mail.ru

The effect of flavor day-night asymmetry is considered for solar neutrinos of energy about 1 MeV under the assumption that the electron-density distribution within the Earth is approximately piecewise continuous on the scale of the neutrino-oscillation length. In this approximation, the resulting asymmetry factor for beryllium neutrinos does not depend on the structure of the inner Earth's layers or on the properties of the detector used. Its numerical estimate is on the order of -4 Multiplication-Sign 10{sup -4}, which is far beyond the reach of present-day experiments.

Temporal Variation of the Rotation of the Solar Mean Magnetic Field

NASA Astrophysics Data System (ADS)

Xie, J. L.; Shi, X. J.; Xu, J. C.

2017-04-01

Based on continuous wavelet transformation analysis, the daily solar mean magnetic field (SMMF) from 1975 May 16 to 2014 July 31 is analyzed to reveal its rotational behavior. Both the recurrent plot in Bartels form and the continuous wavelet transformation analysis show the existence of rotational modulation in the variation of the daily SMMF. The dependence of the rotational cycle lengths on solar cycle phase is also studied, which indicates that the yearly mean rotational cycle lengths generally seem to be longer during the rising phase of solar cycles and shorter during the declining phase. The mean rotational cycle length for the rising phase of all of the solar cycles in the considered time is 28.28 ± 0.67 days, while for the declining phase it is 27.32 ± 0.64 days. The difference of the mean rotational cycle lengths between the rising phase and the declining phase is 0.96 days. The periodicity analysis, through the use of an auto-correlation function, indicates that the rotational cycle lengths have a significant period of about 10.1 years. Furthermore, the cross-correlation analysis indicates that there exists a phase difference between the rotational cycle lengths and solar activity.

Effects of reservoir hydrology on reproduction by largemouth bass and spotted bass in Normandy Reservoir, Tennessee

USGS Publications Warehouse

Sammons, S.M.; Dorsey, L.G.; Bettoli, P.W.; Fiss, F.C.

1999-01-01

Age-O largemouth bass Micropterus salmoides and spotted bass M. punctulatus were collected from Normandy Reservoir, Tennessee, 1992-1996, to evaluate effects of reservoir hydrology and hatching of shad Dorosoma spp. on hatching and first-year growth and survival of these two species. Fish were collected in cove rotenone samples in early August and electrofishing samples biweekly throughout the summer; hatch dates and age-specific growth for both species were determined from cove samples with sagittal otoliths. Hatching of both species ranged from early April to early June. Initiation of largemouth bass spawning, but not spotted bass spawning, was positively related to the first day water levels achieved full pool. Mean hatch dates of both species were positively related to the first day of full pool. Timing of spawning for both species was not related to water temperature, Largemouth bass exhibited bimodal length-frequency distributions by midsummer in two wet years and length frequencies were unimodal in dry years; spotted bass always formed unimodal length-frequency distributions. When largemouth bass exhibited bimodal length distributions, earlier hatched fish grew faster than later hatched fish. Spotted bass grew at similar rates, regardless of hatch date, every year except during 1992 when later hatched fish grew faster than earlier hatched fish. Weekly survival of largemouth bass in their first summer was positively related to reservoir water level. First-year growth of both species was not directly affected by the timing of threadfin shad D. petenense or gizzard shad D. cepedianum hatching.

Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial.

PubMed

St Peter, Shawn D; Tsao, Kuojen; Spilde, Troy L; Holcomb, George W; Sharp, Susan W; Murphy, J Patrick; Snyder, Charles L; Sharp, Ronald J; Andrews, Walter S; Ostlie, Daniel J

2008-06-01

Appendicitis is the most common emergency condition in children. Historically, a 3-drug regimen consisting of ampicillin, gentamicin, and clindamycin (AGC) has been used postoperatively for perforated appendicitis. A retrospective review at our institution has found single day dosing of ceftriaxone and metronidazole (CM) to be a more simple and cost-effective antibiotic strategy. Therefore, we performed a prospective, randomized trial to compare efficacy and cost-effectiveness of these 2 regimens. After internal review board approval (IRB no. 04 12-149), children found to have perforated appendicitis at appendectomy were randomized to either once daily dosing of CM (2 total doses per day) or standard dosing of AGC (11 total doses per day). Perforation was defined as an identifiable hole in the appendix. The operative approach (laparoscopic), length of antibiotic use, and criteria for discharge were standardized for the groups. Based on our retrospective analysis using length of postoperative hospitalization as a primary end point, a sample size of 100 patients was calculated for an alpha of .5 and a power of 0.82. One hundred patients underwent laparoscopic appendectomy for perforated appendicitis. On presentation, there were no differences in sex distribution, days of symptoms, temperature, or leukocyte count. There was no difference in abscess rate or wound infections between groups. The CM group resulted in significantly less antibiotic charges then the AGC group. Once daily dosing with the 2-drug regimen (CM) offers a more efficient, cost-effective antibiotic management in children with perforated appendicitis without compromising infection control when compared to a traditional 3-drug regimen.

Effect of progesterone supplementation in the first week post conception on embryo survival in beef heifers.

PubMed

Beltman, M E; Lonergan, P; Diskin, M G; Roche, J F; Crowe, M A

2009-04-15

Progesterone is essential for establishment and maintenance of pregnancy in mammals. The objective of this study was to examine the effect of elevating progesterone during the different physiological stages of early embryo development on embryo survival. Estrus was synchronized in cross-bred beef heifers (n=197, approximately 2-years old) and they were inseminated 12-18h after estrus onset (=Day 0). Inseminated heifers were randomly assigned to 1 of 3 treatments: (1) Control, n=69; (2) progesterone supplementation using a Controlled Internal Drug Release Device (CIDR) from Day 3 to 6.5, n=64; or (3) progesterone supplementation using a CIDR from Day 4.5 to 8, n=64. Body condition (BCS) and locomotion scores (scale of 1-5) were recorded for all animals. Animals with a locomotion score >/=4 (very lame) were excluded. Embryo survival rate was determined at slaughter on Day 25. Conceptus length and weight were recorded and the corpus luteum (CL) of all pregnant animals was dissected and weighed. Supplementation with exogenous progesterone increased (P<0.05) peripheral progesterone concentrations, but did not affect embryo survival rate compared with controls. Mean CL weight, conceptus length and conceptus weight were not different between treatments. There was a positive relationship (P<0.04) between the increase in progesterone concentrations from Days 3 to 6.5 and embryo survival rate in treated heifers and a similar trend existed between the increase from Days 4.5 to 8 (P<0.06). There was also a positive relationship (P<0.05) between the progesterone concentration on Day 6.5 and the embryo survival rate in treated heifers. A direct correlation was seen between locomotion score and embryo survival rate, with higher (P<0.05) early embryo survival rates in heifers with a lower locomotion score. In conclusion, supplementation with progesterone at different stages of early embryo development increased peripheral progesterone concentration and resulted in a positive association between changes in progesterone concentration during the early luteal phase and embryo survival rate. Supplementation with progesterone had no effect on either CL weight or conceptus size in pregnant animals. Lameness had a significant negative effect on early embryo survival.

Length of psychiatric hospitalization is correlated with CYP2D6 functional status in inpatients with major depressive disorder.

PubMed

Ruaño, Gualberto; Szarek, Bonnie L; Villagra, David; Gorowski, Krystyna; Kocherla, Mohan; Seip, Richard L; Goethe, John W; Schwartz, Harold I

2013-06-01

This study aimed to determine the effect of the CYP2D6 genotype on the length of hospitalization stay for patients treated for major depressive disorder. A total of 149 inpatients with a diagnosis of major depressive disorder at the Institute of Living, Hartford Hospital (CT, USA), were genotyped to detect altered alleles in the CYP2D6 gene. Prospectively defined drug metabolism indices (metabolic reserve, metabolic alteration and allele alteration) were determined quantitatively and assessed for their relationship to length of hospitalization stay. Hospital stay was significantly longer in deficient CYP2D6 metabolizers (metabolic reserve <2) compared with functional or suprafunctional metabolizers (metabolic reserve ≥2; 7.8 vs 5.7 days, respectively; p = 0.002). CYP2D6 enzymatic functional status significantly affected length of hospital stay, perhaps due to reduced efficacy or increased side effects of the medications metabolized by the CYP2D6 isoenzyme. Functional scoring of CYP2D6 alleles may have a substantial impact on the quality of care, patient satisfaction and the economics of psychiatric treatment.

[Clinic-internal and -external factors of length of hospital stay].

PubMed

Schariatzadeh, R; Imoberdorf, R; Ballmer, P E

2011-01-19

In the context of forthcoming initiation of Diagnosis Related Groups (DRG) in Switzerland, the objective of the study was to find factors having an impact on the inpatient's length of hospital stay. The study was performed on two general-medical wards of the Kantonsspital Winterthur, where all admitted patients were included in the study over two months. The various periods of diagnostic and therapeutic management of the patients and all diagnostic and therapeutic measures plus the arrangements after hospitalization were recorded. The determinants influencing the length of hospital stay were classified in clinic-internal or -external. 124 inpatients entered the study. 91 (73.4%) had a length of hospital stay without delay, whereas 33 (26.6%) patients had an extended length of hospital stay. The cumulative length of hospital stay of all patients was 1314 days, whereof 216 days (16.4%) were caused by delays. 67 days were caused by clinic-internal (5.1%) and 149 days by clinic-external factors (11.3%). Delays were substantially more generated by clinic-internal than -external factors. Clinic-internal factors were mainly weekends with interruption of the diagnostic and therapeutic procedures, dead times waiting for diagnostic results and waiting times for consultations. Clinic-external factors were caused by delayed transfer in nursing homes or rehabilitation institutions, waiting for family members for the backhaul and by indetermination of the patient. Also factors relating to the patients' characteristics had an influence on the length of hospital stay. Summing up, a substantial part of the length of hospital stay was caused by delays. However, the many different clinic-internal factors complicate solutions to lower the length of hospital stay. Moreover, factors that cannot be influenced such as waiting for microbiological results, contribute to extended length of hospital stay. Early scheduling of post-hospital arrangements may lower length of hospital stay. Moreover, when cantonal restriction falls away in 2012, patients may be transferred to rehabilitation institutions more rapidly. Also the insurance companies may possibly strengthen their organisation and thus may meet the costs more quickly.

Optimal bladder diary duration for patients with suprapontine neurogenic lower urinary tract dysfunction.

PubMed

Konstantinidis, Charalampos; Kratiras, Zisis; Samarinas, Michael; Skriapas, Konstantinos

2016-01-01

To identify the minimum bladder diary's length required to furnish reliable documentation of LUTS in a specific cohort of patients suffering from neurogenic urinary dysfunction secondary to suprapontine pathology. From January 2008 to January 2014, patients suffering from suprapontine pathology and LUTS were requested to prospectively complete a bladder diary form for 7 consecutive days. Micturitions per day, excreta per micturition, urgency and incontinence episodes and voided volume per day were evaluated from the completed diaries. We compared the averaged records of consecutive days (2-6 days) to the total 7 days records for each patient's diary, seeking the minimum diary's length that could provide records comparable to the 7 days average, the reference point in terms of reliability. From 285 subjects, 94 male and 69 female patients enrolled in the study. The records of day 1 were significantly different from the average of the 7 days records in every parameter, showing relatively small correlation and providing insuficiente documentation. Correlations gradually increased along the increase in diary's duration. According to our results a 3-day duration bladder diary is efficient and can provide results comparable to a 7 day length for four of our evaluated parameters. Regarding incontinence episodes, 3 days seems inadequate to furnish comparable results, showing a borderline difference. A 3-day diary can be used, as its reliability is efficient regarding number of micturition per day, excreta per micturition, episodes of urgency and voided volume per day. Copyright© by the International Brazilian Journal of Urology.

Circuit class or seven-day therapy for increasing intensity of rehabilitation after stroke: protocol of the CIRCIT trial.

PubMed

Hillier, Susan; English, Coralie; Crotty, Maria; Segal, Leonie; Bernhardt, Julie; Esterman, Adrian

2011-12-01

There is strong evidence for a dose-response relationship between physical therapy early after stroke and recovery of function. The optimal method of maximizing physical therapy within finite health care resources is unknown. To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery (seven-days per week therapy services or group circuit class therapy over five-days a week) to usual care for people receiving inpatient rehabilitation after stroke. Multicenter, three-armed randomized controlled trial with blinded assessment of outcomes. A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure (FIM) score within the moderate range (total 40-80 points or motor 38-62 points) will be randomized to receive one of three interventions: • usual care therapy over five-days a week • standard care therapy over seven-days a week, or • group circuit class therapy over five-days a week. Participants will receive the allocated intervention for the length of their hospital stay. Analysis will be by intention-to-treat. The primary outcome measure is walking ability (six-minute walk test) at four-week postintervention with three- and six-month follow-up. Economic analysis will include a costing analysis based on length of hospital stay and staffing/resource costs and a cost-utility analysis (incremental quality of life per incremental cost, relative to usual care). Secondary outcomes include walking speed and independence, ability to perform activities of daily living, arm function, quality of life and participant satisfaction. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

Estimating climate change effects on net primary production of rangelands in the United States

Treesearch

Matthew C. Reeves; Adam L. Moreno; Karen E. Bagne; Steven W. Running

2014-01-01

The potential effects of climate change on net primary productivity (NPP) of U.S. rangelands were evaluated using estimated climate regimes from the A1B, A2 and B2 global change scenarios imposed on the biogeochemical cycling model, Biome-BGC from 2001 to 2100. Temperature, precipitation, vapor pressure deficit, day length, solar radiation, CO2 enrichment and nitrogen...

Effects of habitat isolation on the recovery of fish assemblages in experimentally defaunated stream pools in Arkansas

Treesearch

David George Lonzarich; Melvin L. Warren; Mary Ruth Elger Lonzrich

1998-01-01

The authors removed fish from pools in two Arkansas streams to determine recolonization rates and the effects of isolation (i.e., riffle length, riffle depth, distance to large source pools, and location), pool area, and assemblage size on recovery. To determine pool-specific recovery rates, the authors repeatedly snorkeled 12 pools over a 40-day recovery period....

Life-cycle toxicity of bis(tributyltin) oxide to the sheepshead minnow (Cyprinodon variegatus).

PubMed

Manning, C S; Lytle, T F; Walker, W W; Lytle, J S

1999-08-01

The effects of tributyltin (TBT) to the life cycle of the estuarine fish Cyprinodon variegatus were examined in a 180-day flow-through exposure. The study was initiated with embryos less than 24 h postfertilization and monitored through hatch, maturation, growth, and reproduction under continuous exposure to mean measured TBT concentrations of 5.4, 3.2, 1.3, 0.66, and 0.41 microg TBT/L. Progeny isolated at the onset of reproduction by the parental generation (F0) were monitored for survival as embryos, survival as fry/juveniles, and growth 30 days postisolation. TBT, at a concentration of 5.4 microg/L, significantly reduced embryo survival of the F0 generation sheepshead minnows. By day 145 of the exposure, significant effects to the survival of this generation increased and included all test concentrations >/=0.66 microg/L. Survival of 0.66 microg/L was reduced 59% relative to control survival by termination of the F0 generation. Growth of F0 generation organisms as measured by standard length was significantly reduced only on day 90 at 3.2 microg/L, however no significant reductions of wet or dry weight related to treatment concentration were detected. Due to complete mortality of organisms exposed to 5.4 microg/L by study day 7, effects to fecundity and progeny were monitored at measured concentrations of 3.2, 1.3, 0.66, and 0.41 microg TBT/L. Fecundity, as measured by the production of viable eggs produced per female per day, was unaffected by any of the test treatments. All F1 generation embryos isolated from treatment chambers into 3.2 microg/L died. Survival, standard length, wet and dry weight of the F1 generation at the remaining treatment concentrations were unaffected. The results of this study indicate that exposure to TBT reduced survival of the F0 generation sheepshead minnow and establishes the lowest observed effect concentration (LOEC) as 0.66 microg TBT/L, and the no observed effect concentration (NOEC) as 0.41 microg TBT/L for this species.http://link.springer-ny. com/link/service/journals/00244/bibs/37n2p258.html

Exposure to non-ionizing electromagnetic fields emitted from mobile phones induced DNA damage in human ear canal hair follicle cells.

PubMed

Akdag, Mehmet; Dasdag, Suleyman; Canturk, Fazile; Akdag, Mehmet Zulkuf

2018-01-01

The aim of this study was to investigate effect of radiofrequency radiation (RFR) emitted from mobile phones on DNA damage in follicle cells of hair in the ear canal. The study was carried out on 56 men (age range: 30-60 years old)in four treatment groups with n = 14 in each group. The groups were defined as follows: people who did not use a mobile phone (Control), people use mobile phones for 0-30 min/day (second group), people use mobile phones for 30-60 min/day (third group) and people use mobile phones for more than 60 min/day (fourth group). Ear canal hair follicle cells taken from the subjects were analyzed by the Comet Assay to determine DNA damages. The Comet Assay parameters measured were head length, tail length, comet length, percentage of head DNA, tail DNA percentage, tail moment, and Olive tail moment. Results of the study showed that DNA damage indicators were higher in the RFR exposure groups than in the control subjects. In addition, DNA damage increased with the daily duration of exposure. In conclusion, RFR emitted from mobile phones has a potential to produce DNA damage in follicle cells of hair in the ear canal. Therefore, mobile phone users have to pay more attention when using wireless phones.

Mortality, Length of Stay, and Inpatient Charges for Heart Failure Patients at Public versus Private Hospitals in South Korea

PubMed Central

Kim, Sun Jung; Park, Eun-Cheol; Kim, Tae Hyun; Yoo, Ji Won

2015-01-01

Purpose This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea. Materials and Methods We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed. Results The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis. Conclusion We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending. PMID:25837196

Statistical models for estimating daily streamflow in Michigan

USGS Publications Warehouse

Holtschlag, D.J.; Salehi, Habib

1992-01-01

Statistical models for estimating daily streamflow were analyzed for 25 pairs of streamflow-gaging stations in Michigan. Stations were paired by randomly choosing a station operated in 1989 at which 10 or more years of continuous flow data had been collected and at which flow is virtually unregulated; a nearby station was chosen where flow characteristics are similar. Streamflow data from the 25 randomly selected stations were used as the response variables; streamflow data at the nearby stations were used to generate a set of explanatory variables. Ordinary-least squares regression (OLSR) equations, autoregressive integrated moving-average (ARIMA) equations, and transfer function-noise (TFN) equations were developed to estimate the log transform of flow for the 25 randomly selected stations. The precision of each type of equation was evaluated on the basis of the standard deviation of the estimation errors. OLSR equations produce one set of estimation errors; ARIMA and TFN models each produce l sets of estimation errors corresponding to the forecast lead. The lead-l forecast is the estimate of flow l days ahead of the most recent streamflow used as a response variable in the estimation. In this analysis, the standard deviation of lead l ARIMA and TFN forecast errors were generally lower than the standard deviation of OLSR errors for l < 2 days and l < 9 days, respectively. Composite estimates were computed as a weighted average of forecasts based on TFN equations and backcasts (forecasts of the reverse-ordered series) based on ARIMA equations. The standard deviation of composite errors varied throughout the length of the estimation interval and generally was at maximum near the center of the interval. For comparison with OLSR errors, the mean standard deviation of composite errors were computed for intervals of length 1 to 40 days. The mean standard deviation of length-l composite errors were generally less than the standard deviation of the OLSR errors for l < 32 days. In addition, the composite estimates ensure a gradual transition between periods of estimated and measured flows. Model performance among stations of differing model error magnitudes were compared by computing ratios of the mean standard deviation of the length l composite errors to the standard deviation of OLSR errors. The mean error ratio for the set of 25 selected stations was less than 1 for intervals l < 32 days. Considering the frequency characteristics of the length of intervals of estimated record in Michigan, the effective mean error ratio for intervals < 30 days was 0.52. Thus, for intervals of estimation of 1 month or less, the error of the composite estimate is substantially lower than error of the OLSR estimate.

Analysis of the Factors Affecting Surgical Success of Implants Placed in Iranian Warfare Victims

PubMed Central

Jafarian, Mohammad; Bayat, Mohammad; Pakravan, Amir-Hossein; Emadi, Naghmeh

2016-01-01

Objective The aim was to evaluate the survival time and success rates of dental implants in warfare victims and factors that affect implant success. Subjects and Methods This retrospective study involved 250 Iranian warfare victims who received dental implants from 2003 to 2013. Patients' demographic characteristics, as well as the brand, diameter, length, location and failure rate of the implants were retrieved from patients' dental records and radiographs. The associations between these data and the survival rate were analyzed. Statistical analysis was carried out with χ2 and log-rank tests. Results Overall, out of the 1,533 dental implants, 61 (4s%) failed. The maxillary canine area had the highest failure rate [9 of 132 implants (6.8s%)], while the mandibular incisor region had the least number of failures [3 of 147 implants (2.0s%)] and the longest survival time (approximately 3,182 days). Maxillary canine areas had the shortest survival (about 2,996 days). The longest survival time was observed in implants with 11 mm length (3,179.72 ± 30.139 days) and 3.75-4 mm diameter (3,131.161 ± 35.96 days), and the shortest survival was found in implants with 11.5 mm length (2,317.79 ± 18.71 days) and 6.5 mm diameter (2,241.45 ± 182.21 days). Moreover, implants with 10 mm length (10.7s%) and 5.5-6 mm diameter (22.2s%) had the highest failure rate; however, the least failure rate occurred when the implants were 11.5 mm in length (1.9s%) and 3-3.5 mm in diameter (3.1s%). Conclusions The brand, length and diameter of implants affected the survival time, failure rate and time to failure. The location of the implant was not statistically significant regarding the mentioned factors, although it has clinical significance. PMID:27322534

Infant head circumference growth is saltatory and coupled to length growth.

PubMed

Lampl, Michelle; Johnson, Michael L

2011-05-01

Rapid growth rates of head circumference and body size during infancy have been reported to predict developmental pathologies that emerge during childhood. This study investigated whether growth in head circumference was concordant with growth in body length. Forty infants (16 males) were followed between the ages of 2 days and 21 months for durations ranging from 4 to 21 months (2616 measurements). Longitudinal anthropometric measurements were assessed weekly (n=12), semi-weekly (n=24) and daily (n=4) during home visits. Individual head circumference growth was investigated for the presence of saltatory patterns. Coincident analysis tested the null hypothesis that head growth was randomly coupled to length growth. Head circumference growth during infancy is saltatory (p<0.05), characterized by median increments of 0.20 cm (95% confidence interval, 0.10-0.30 cm) in 24-h, separated by intervals of no growth ranging from 1 to 21 days. Daily assessments identified that head growth saltations were coupled to length growth saltations within a median time frame of 2 days (interquartile 0-4, range 1-8 days). Assessed at semi-weekly and weekly intervals, an average 82% (SD 0.13) of head growth saltations was non-randomly concordant with length growth (p≤0.006). Normal infant head circumference grows by intermittent, episodic saltations that are temporally coupled to growth in total body length by a process of integrated physiology that remains to be described. Copyright © 2011 Elsevier Ltd. All rights reserved.

Three-dimensional volumetric gray-scale uterine cervix histogram prediction of days to delivery in full term pregnancy.

PubMed

Kim, Ji Youn; Kim, Hai-Joong; Hahn, Meong Hi; Jeon, Hye Jin; Cho, Geum Joon; Hong, Sun Chul; Oh, Min Jeong

2013-09-01

Our aim was to figure out whether volumetric gray-scale histogram difference between anterior and posterior cervix can indicate the extent of cervical consistency. We collected data of 95 patients who were appropriate for vaginal delivery with 36th to 37th weeks of gestational age from September 2010 to October 2011 in the Department of Obstetrics and Gynecology, Korea University Ansan Hospital. Patients were excluded who had one of the followings: Cesarean section, labor induction, premature rupture of membrane. Thirty-four patients were finally enrolled. The patients underwent evaluation of the cervix through Bishop score, cervical length, cervical volume, three-dimensional (3D) cervical volumetric gray-scale histogram. The interval days from the cervix evaluation to the delivery day were counted. We compared to 3D cervical volumetric gray-scale histogram, Bishop score, cervical length, cervical volume with interval days from the evaluation of the cervix to the delivery. Gray-scale histogram difference between anterior and posterior cervix was significantly correlated to days to delivery. Its correlation coefficient (R) was 0.500 (P = 0.003). The cervical length was significantly related to the days to delivery. The correlation coefficient (R) and P-value between them were 0.421 and 0.013. However, anterior lip histogram, posterior lip histogram, total cervical volume, Bishop score were not associated with days to delivery (P >0.05). By using gray-scale histogram difference between anterior and posterior cervix and cervical length correlated with the days to delivery. These methods can be utilized to better help predict a cervical consistency.

The “jaundice hotline” for the rapid assessment of patients with jaundice

PubMed Central

Mitchell, Jonathan; Hussaini, Hyder; McGovern, Dermot; Farrow, Richard; Maskell, Giles; Dalton, Harry

2002-01-01

Problem Patients with jaundice require rapid diagnosis and treatment, yet such patients are often subject to delay. Design An open referral, rapid access jaundice clinic was established by reorganisation of existing services and without the need for significant extra resources. Background and setting A large general hospital in a largely rural and geographically isolated area. Key measures for improvement Waiting times for referral, consultation, diagnosis, and treatment, length of stay in hospital, and general practitioners' and patients' satisfaction with the service. Strategies for change Referrals were made through a 24 hour telephone answering machine and fax line. Initial assessment of patients was carried out by junior staff as part of their working week. Dedicated ultrasonography appointments were made available. Effects of change Of 107 patients seen in the first year of the service, 62 had biliary obstruction. The mean time between referral and consultation was 2.5 days. Patients who went on to endoscopic retrograde cholangiopancreatography waited 5.7 days on average. The mean length of stay in hospital in the 69 patients who were admitted was 6.1 days, compared with 11.5 days in 1996, as shown by audit data. Nearly all the 36 general practices (95%) and the 30 consecutive patients (97%) that were surveyed rated the service as above average or excellent. Lessons learnt An open referral, rapid access service for patients with jaundice can shorten time to diagnosis and treatment and length of stay in hospital. These improvements can occur through the reorganisation of existing services and with minimal extra cost. PMID:12142314

Residency times and patterns of movement of postbreeding dunlin on a subarctic staging area in Alaska

USGS Publications Warehouse

Warnock, Nils; Handel, Colleen M.; Gill, Robert E.; McCaffery, Brian J.

2013-01-01

Understanding how individuals use key resources is critical for effective conservation of a population. The Yukon-Kuskokwim Delta (YKD) in western Alaska is the most important postbreeding staging area for shorebirds in the subarctic North Pacific, yet little is known about movements of shorebirds there during the postbreeding period. To address this information gap, we studied residency times and patterns of movement of 17 adult and 17 juvenile radio-marked Dunlin (Calidris alpina) on the YKD between early August and early October 2005. Throughout this postbreeding period, during which Dunlin were molting, most birds were relocated within a 130 km radius of their capture site on the YKD, but three birds were relocated more than 600 km to the south at estuaries along the Alaska Peninsula. On average, juvenile Dunlin were relocated farther away from the banding site (median relocation distance = 36.3 km) than adult Dunlin (median relocation distance = 8.8 km). Post-capture, minimum lengths of stay by Dunlin on the YKD were not significantly different between juveniles (median = 19 days) and adults (median = 23 days), with some birds staging for more than 50 days. Body mass at time of capture was the best single variable explaining length of stay on the YKD, with average length of stay decreasing by 2.5 days per additional gram of body mass at time of capture. Conservation efforts for postbreeding shorebirds should consider patterns of resource use that may differ not only by age cohort but also by individual condition.

Serum heme oxygenase-1 levels in patients with primary dysmenorrhea.

PubMed

Aksoy, Ayse Nur; Laloglu, Esra; Ozkaya, Alev Lazoglu; Yilmaz, Emsal Pınar Topdagi

2017-04-01

Primary dysmenorrhea effects the life-quality of women negatively. The aim of this study was to evaluate heme oxygenase-1 (HO1) activity together with malondialdehyde (MDA) and nitric oxide (NO) levels in patients with primary dysmenorrhea. A total of 28 nulliparous women with the diagnosis of primary dysmenorrhea and 26 healthy controls were included in this study. On the first day of menstruation, all patients underwent ultrasound examination to exclude pelvic pathology and the visual analogue scale was applied to patients. Patient's visual analogue scale (VAS) scores, age, body mass index (BMI), menstrual cycle length (day), length of bleeding (day) were recorded. In the same day, fasting blood samples were taken from each patient for biochemical analysis. Serum MDA, NO and HO1 levels were found to be higher in women with primary dysmenorrhea compared to healthy controls (p = 0.012, p = 0.009, p < 0.001, respectively). There were no correlation among serum levels of HO1, NO and MDA, age, BMI, cycle length, pain score and menses duration in both groups. In Pearson's correlation analysis, positive correlation was found between HO1 levels with the NO levels (r = 0.316, p < 0.05) and VAS scores (r = 0.520, p < 0.01). Also, positive correlation was found between MDA levels and VAS scores (r = 0.327, p < 0.05). Serum HO1, NO and MDA levels increase in patients with primary dysmenorrhea. Antioxidant support might be helpful to reduce pain severity in primary dysmenorrhea.

A new agent for flap survival – Hippophae rhamnoides L. (sea buckthorn): An experimental study in rats

PubMed Central

Emsen, Ilteris Murat

2005-01-01

Hippophae rhamnoides L. (sea buckthorn) is a member of the Elaeagnaceae family, and is a temperate bush native to Europe and Asia. The antioxidant activity of H rhamnoides L. has been shown in vitro cell culture and animal studies. Different fractions of H rhamnoides L. fruits inhibit 2,2-azobis-(2,4 dimethylvaleronitrile) and ascorbate iron-induced lipid peroxidations in vitro. H rhamnoides L., as well as vitamin E, decrease the malondialdehyde content in hyperlipidemic rabbit serum-cultured smooth muscle cells. The aim of the present study was to investigate, in a rat model, the potential effect of H rhamnoides L. on survival of random pattern skin flaps. For this purpose, 30 Wistar Albino rats were used, and a McFarlane-type caudally based skin flap was created on the dorsum of the rat (2.5 cm × 8 cm). Rats were divided into three groups: one control (group A) and two treatment groups (groups B and C). H rhamnoides L. was administered orally to the experimental groups: group B received a single 15 mg/kg dose per day and group C received 15 mg/kg twice per day. The areas and lengths of flap necrosis were measured in each group. The extent of necrotic flap areas were evaluated as length and area of total flap area, and differences were studied by Student’s t tests. The areas and lengths of necrosis of skin flaps decreased depending on H rhamnoides L., but viability of the flaps treated with 15 mg/kg/day was not significantly different from the control group. The rats receiving H rhamnoides L. 15 mg/kg twice per day had the highest flap survival rate (P<0.001). In conclusion, H rhamnoides L. may have a dose-dependent effect to increase flap survival in random skin flaps. PMID:24227931

Development of Trypanosoma (M.) theileri in tabanids.

PubMed

Böse, R; Heister, N C

1993-01-01

Thus far the life cycle of Trypanosoma (Megatrypanum) theileri has not been studied. We collected tabanids during the mass hatching, when only few tabanids are infected with trypanosomes. Tabanids were caught immediately after attacking a bait cow to serve as controls or after they had been allowed to engorge on the Trypanosoma (M.) theileri-infected cow. Tabanids were kept in the laboratory and used to study the developmental cycle of T. (M.) theileri in the tabanid gut. From day 1 to day 10 the presumably unfed controls and the engorged tabanids were dissected and cytological smears made from the mid- and hindgut. In total 2.6% (1/38) of the controls and 39% (23/59) of the engorged tabanids were positive for trypanosomes in the 1991 season. From day 1 to day 4 after engorgement trypanosomes were found in the midgut. Epimastigotes with a length of 29 microm on day 1 after infection multiplied by inequal division to form smaller epimastigotes of 26 microm on day 3. On day 4 morphologically indistinguishable trypanosomes of 21 microm total length were found in both mid- and hindgut. From day 5 to day 10 trypanosomes were found only in the hindgut in which the transformation to metacyclics was demonstrated, i.e., epimastigotes transformed to amastigote stages of 5 microm in total length.

Assessing the cost effectiveness of robotics in urological surgery - a systematic review.

PubMed

Ahmed, Kamran; Ibrahim, Amel; Wang, Tim T; Khan, Nuzhath; Challacombe, Ben; Khan, Muhammed Shamim; Dasgupta, Prokar

2012-11-01

Although robotic technology is becoming increasingly popular for urological procedures, barriers to its widespread dissemination include cost and the lack of long term outcomes. This systematic review analyzed studies comparing the use of robotic with laparoscopic and open urological surgery. These three procedures were assessed for cost efficiency in the form of direct as well as indirect costs that could arise from length of surgery, hospital stay, complications, learning curve and postoperative outcomes. A systematic review was performed searching Medline, Embase and Web of Science databases. Two reviewers identified abstracts using online databases and independently reviewed full length papers suitable for inclusion in the study. Laparoscopic and robot assisted radical prostatectomy are superior with respect to reduced hospital stay (range 1-1.76 days and 1-5.5 days, respectively) and blood loss (range 482-780 mL and 227-234 mL, respectively) when compared with the open approach (range 2-8 days and 1015 mL). Robot assisted radical prostatectomy remains more expensive (total cost ranging from US $2000-$39,215) than both laparoscopic (range US $740-$29,771) and open radical prostatectomy (range US $1870-$31,518). This difference is due to the cost of robot purchase, maintenance and instruments. The reduced length of stay in hospital (range 1-1.5 days) and length of surgery (range 102-360 min) are unable to compensate for the excess costs. Robotic surgery may require a smaller learning curve (20-40 cases) although the evidence is inconclusive. Robotic surgery provides similar postoperative outcomes to laparoscopic surgery but a reduced learning curve. Although costs are currently high, increased competition from manufacturers and wider dissemination of the technology could drive down costs. Further trials are needed to evaluate long term outcomes in order to evaluate fully the value of all three procedures in urological surgery. © 2012 BJU INTERNATIONAL.

Time-course of neurodegeneration and memory impairment following the 4-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion in middle-aged rats.

PubMed

Pereira, Francine Martins; Ferreira, Emilene Dias Fiuza; de Oliveira, Rúbia Maria Weffort; Milani, Humberto

2012-04-15

The present work extends previous studies with the aim of developing the 4-vessel occlusion/internal carotid artery (4-VO/ICA) model of chronic cerebral hypoperfusion. The permanent occlusion of the vertebral arteries (VAs) and internal carotid arteries (ICAs) followed the sequence VA→ICA→ICA. The interstage interval (ISI, →), chronicity of 4-VO/ICA, and age of the animals may determine the success of the model with regard to neurohistological and behavioral outcomes. Using middle-aged rats, the present study evaluated (i) how brain damage evolves as the ISI is reduced and duration (i.e., "chronicity") of 4-VO/ICA is prolonged and (ii) how the duration of 4-VO/ICA affects retrograde memory performance. Male Wistar rats (12-15 months of age) were subjected to 4-VO/ICA with an ISI of 7, 5, 4, or 3 days, and hippocampal and cortical damage was examined 7, 30, and 90 days later. Using an ISI of 4 days, retrograde memory performance was assessed in the aversive radial maze after 4-VO/ICA with a duration of 7, 30, and 90 days. The severity of brain neurodegeneration and rate of mortality progressively increased as the ISI length decreased from 7 to 3 days, an effect that was not significantly altered by the chronicity of 4-VO/ICA. Permanent 4-VO/ICA effectively caused retrograde amnesia, an effect that worsened as the chronicity of 4-VO/ICA was prolonged. The findings confirm and expand the notion that permanent, 3-stage 4-VO/ICA effectively produces extensive neurodegeneration and persistent learning/memory impairment in middle-aged rats and that the ISI length, more than the chronicity of 4-VO/ICA, determines the final results. Copyright © 2012 Elsevier B.V. All rights reserved.

Nesting behavior of Palila, as assessed from video recordings

USGS Publications Warehouse

Laut, M.E.; Banko, P.C.; Gray, E.M.

2003-01-01

We quantified nesting behavior of Palila (Loxiodes bailleui), an endangered Hawaiian honeycreeper, by recording at nests during three breeding seasons using a black-and-white video camera connected to a Videocassette recorder. A total of seven nests was observed. We measured the following factors for daylight hours: percentage of time the female was on the nest (attendance), length of attendance bouts by the female, length of nest recesses, and adult provisioning rates. Comparisons were made between three stages of the 40-day nesting cycle: incubation (day 1-day 16), early nestling stage (day 17-day 30 [i.e., nestlings ??? 14 days old]), and late nestling stage (day 31-day 40 [i.e., nestlings > 14 days old]). Of seven nests observed, four fledged at least one nestling and three failed. One of these failed nests was filmed being depredated by a feral cat (Felis catus). Female nest attendance was near 82% during the incubation stage and decreased to 21% as nestlings aged. We did not detect a difference in attendance bout length between stages of the nesting cycle. Mean length of nest recesses increased from 4.5 min during the incubation stage to over 45 min during the late nestling stage. Mean number of nest recesses per hour ranged from 1.6 to 2.0. Food was delivered to nestlings by adults an average of 1.8 times per hour for the early nestling stage and 1.5 times per hour during the late nestling stage and did not change over time. Characterization of parental behavior by video had similarities to but also key differences from findings taken from blind observations. Results from this study will facilitate greater understanding of Palila reproductive strategies.

Day length unlikely to constrain climate-driven shifts in leaf-out times of northern woody plants

NASA Astrophysics Data System (ADS)

Zohner, Constantin M.; Benito, Blas M.; Svenning, Jens-Christian; Renner, Susanne S.

2016-12-01

The relative roles of temperature and day length in driving spring leaf unfolding are known for few species, limiting our ability to predict phenology under climate warming. Using experimental data, we assess the importance of photoperiod as a leaf-out regulator in 173 woody species from throughout the Northern Hemisphere, and we also infer the influence of winter duration, temperature seasonality, and inter-annual temperature variability. We combine results from climate- and light-controlled chambers with species’ native climate niches inferred from georeferenced occurrences and range maps. Of the 173 species, only 35% relied on spring photoperiod as a leaf-out signal. Contrary to previous suggestions, these species come from lower latitudes, whereas species from high latitudes with long winters leafed out independent of photoperiod. The strong effect of species’ geographic-climatic history on phenological strategies complicates the prediction of community-wide phenological change.

Effects of breastfeeding on weight loss and recovery of pregestational weight in adolescent and adult mothers.

PubMed

Sámano, Reyna; Martínez-Rojano, Hugo; Godínez Martínez, Estela; Sánchez Jiménez, Bernarda; Villeda Rodríguez, Gilda Paulina; Pérez Zamora, Julieta; Casanueva, Esther

2013-06-01

Exclusive breastfeeding (EBF) in adolescent mothers has been associated with greater postpartum maternal weight loss. To assess the associations between EBF and weight loss in adolescent and adult mothers and between EBF and weight and length gain of their children. A cohort of 68 adolescent mothers (15 to 19 years), 64 adult mothers (20 to 29 years), and their infants were studied. Anthropometric measurements were performed at 15, 90, 180, and 365 days postpartum in the mothers and children. EBF was defined as consumption of human milk without supplementation of any type (water, juice, nonhuman milk, or food) for 4 months. Sixty-five percent of mothers sustained EBF for 4 months. There were no significant differences in the weight or length of the infants of adolescent and adult mothers at 365 days postpartum. Among infants of adult mothers, there was a significant difference between the weight gain of those were exclusively breastfed and those who were not exclusively breastfed (6,498 +/- 1,060 vs 6,096 +/- 1,035 g, p < .050) at 365 days postpartum, according to the parameters for weight gain and length established by the World Health Organization (WHO). Among both adult and adolescent mothers, those who practiced EBF lost more weight than those who did not practice EBF (-2.9 kg, 95% interquartile range, -5.7 to 0.8 kg, vs -1.8 kg 95% interquartile range -2.8 to 2.2 kg; p = .004). Gestational weight gain, duration of EBF, and recovery menstruation explained 21% of the variance (F = 28.184, p = .001) in change in postpartum maternal weight (in kilograms) from 0 to 365 days postpartum in all mothers. Pregestational weight, duration of EBF, and maternal age were factors that explained 14% (F = 22.759, p = .001) of the change in the weight and length of the infants from 0 to 365 days of life. EBF in adolescent and adult mothers influences postpartum weight loss and provides adequate infant growth in accordance with the WHO 2006 standards.

Allelopathic effects of ragweed (Ambrosia artemisiifolia L.) on cultivated plants.

PubMed

Lehoczky, E; Gólya, G; Szabó, R; Szalai, A

2011-01-01

During the past years ragweed has been coming to the forefront of interest in Hungary and in other European countries as well because its serious health risk. Results of the 5th National Weed Survey has proven that ragweed is the most important weed species on Hungarian field lands, its coverage shows a rising tendency in cereals moreover it not only occurs in cultivated plants. Allelopathic effects of aqueous extracts derived from different parts of ragweed plants (air dried leafy stems, seeds) on the germination and growth of other cultivated plants [maize (Zea mays L.), winter wheat (Triticum aestivum L.), rye (Secale cereale L.), oat (Avena sativa L.)] were studied. The extracts made for the trials were prepared with distilled water. Petri dishes were used for the germination experiments and distilled water was used as a control treatment. The seven days long experiment was carried out within a Binder-type thermostat under dark conditions. The germination percentage was checked in every two days and the growth of sprouts was evaluated after a week counting the germinated seeds and measuring the length of the radicle and plumule. The measured data were statistically analysed and the effect of extracts on germinating and length of sprouts were assessed.

Costs of day hospital and community residential chemical dependency treatment.

PubMed

Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya; Witbrodt, Jane

2008-03-01

Patient placement criteria developed by the American Society of Addiction Medicine (ASAM) have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher levels of severity. A recent clinical trial found similar outcomes at social model residential treatment and clinically-oriented day hospital programs, but did not report on costs. This paper addresses whether the similar outcomes in the recent trial were delivered with comparable costs, overall and within gender and ethnicity stratum. This paper reports on clients not at environmental risk who participated in a randomized trial conducted in three metropolitan areas served by a large pre-paid health plan. Cost data were collected using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Costs per episode were calculated by multiplying DATCAP-derived program-specific costs by each client's length of stay. Differences in length of stay, and in per-episode costs, were compared between residential and day hospital subjects. Lengths of stay at residential treatment were significantly longer than at day hospital, in the sample overall and in disaggregated analyses. This difference was especially marked among non-Whites. The average cost per week was USD 575 per week at day hospital, versus USD 370 per week at the residential programs. However, because of the longer stays in residential, per-episode costs were significantly higher in the sample overall and among non-Whites (and marginally higher for men). These cost results must be considered in light of the null findings comparing outcomes between subjects randomized to residential versus day hospital programs. The longer stays in the sample overall and for non-White clients at residential programs came at higher costs but did not lead to better rates of abstinence. The short stays in day hospital among non-Whites call into question the attractiveness of day hospital for minority clients. Outcomes and costs at residential versus day hospital programs were similar for women and for Whites. For non-Whites, and marginally for men, a preference for residential care would appear to come at a higher cost. Lengths of stay in residential treatment were significantly longer than in day hospital, but costs per week were lower. Women and Whites appear to be equally well-served in residential and day hospital programs, with no significant cost differential. Provision of residential treatment for non-Whites may be more costly than day hospital, because their residential stays are likely to be 3 times longer than they would be if treated in day hospital. For men, residential care will be marginally more costly. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Residential treatment appears to represent a cost-effective alternative to day hospital for female and White clients with severe alcohol and drug problems who are not at environmental risk. The much shorter stays in day hospital than at residential among non-Whites highlight the need for research to better understand how to best meet the needs and preferences of non-White clients when considering both costs and outcomes.

Higher Physiotherapy Frequency Is Associated with Shorter Length of Stay and Greater Functional Recovery in Hospitalized Frail Older Adults: A Retrospective Observational Study.

PubMed

Hartley, P; Adamson, J; Cunningham, C; Embleton, G; Romero-Ortuno, R

2016-01-01

Extra physiotherapy has been associated with better outcomes in hospitalized patients, but this remains an under-researched area in geriatric medicine wards. We retrospectively studied the association between average physiotherapy frequency and outcomes in hospitalized geriatric patients. High frequency physiotherapy (HFP) was defined as ≥0.5 contacts/day. Of 358 eligible patients, 131 (36.6%) received low, and 227 (63.4%) HFP. Functional improvement (discharge versus admission) in the modified Rankin scale was greater in the HFP group (1.1 versus 0.7 points, P<0.001). The mean length of stay (LOS) of the HFP group was 6 days shorter (7 versus 13 days, P<0.001). After adjusting for age, gender, comorbidity (Charlson index), frailty (Clinical Frailty Scale), dementia and acute illness severity, HFP was an independent predictor of functional improvement, shorter LOS and likelihood of being discharged without a formal care package. Prospective research is needed to examine the effect of physiotherapy frequency and intensity in geriatric wards.

Examination of time series through randomly broken windows. [space observations from earth

NASA Technical Reports Server (NTRS)

Sturrock, P. A.

1980-01-01

The effect of irregular interruption of data collection (the breaking of the window function) on the spectrum determination of a time series is investigated. It is assumed that there is a uniform probability p that each interval of length tau, of the total interval of length T = tau, yields no data. For the linear case (Fourier transform) it is found that the noise to signal ratio has a (one sigma) value less than epsilon if N exceeds p(-1) (1-p) epsilon (-2). For the quadratic case, the same requirement is met by the less restrictive requirement that N exceed p(-1) (1-p) epsilon (-1). It appears that, if four observatories spaced around the Earth were to operate for 25 days, each for six hours a day (N = 100), and if the probability of cloud cover at any site on any day is 20% (p = 0.8), the r.m.s. noise to signal ratio is 0.25% for frequencies displaced from a sharp strong signal by 15 micro Hz. The noise to signal ratio drops off rapidly if the frequency offset exceeds 15 micro Hz.

Laparoscopic Heller myotomy for achalasia: changing trend toward "true" day-case procedure.

PubMed

Agrawal, Sanjay; Super, Paul

2008-12-01

Laparoscopic Heller myotomy is the most effective therapy for achalasia. All case series have reported a minimum length of stay of more than 1 day. "True" day-case laparoscopic Heller myotomy has not been reported, so far. The aim of this study was to review our results with laparoscopic Heller myotomy with respect to the length of stay following the procedure. All patients undergoing laparoscopic Heller myotomy between August 2000 and July 2007 under the care of one surgeon were included in the study. This was performed by incising 6 cm of distal esophageal musculature, extending to 2 cm below the gastroesophageal junction. The myotomy was covered by an anterior fundoplication. All patients were reviewed in the clinic at a median of 6 weeks after surgery and, thereafter, if necessary. Over the 7-year period, 24 consecutive patients with achalasia were treated in this manner. There were 13 women and 11 men, with an age range of 12-73 years. Intraoperative complications included mucosal perforation in 2 patients (sutured immediately) with no postoperative complications or conversion to open surgery. There were no deaths. The average length of stay was 1.9 days (range, 0-4). The last 2 patients were discharged on the same day, and the 5 previous to this were discharged within 23 hours of surgery. There were no adverse outcomes related to early discharge, and there were no readmissions. All patients reported good to excellent results with a relief of dysphagia on follow-up. Three patients (12%) developed recurrent dysphagia after an initial improvement, requiring dilatation only several months later. Based on our own experience, we believe that laparoscopic Heller myotomy with anterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia. It is well tolerated and can be considered a true day-case procedure.

The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation.

PubMed

Segal, Dale N; Wilson, Jacob M; Staley, Christopher; Michael, Keith W

2018-05-03

Vertebral compression fractures are the most common spine injury seen in elderly patients. Vertebral augmentation is considered a safe and effective treatment. The ability to predict outcomes based on comorbidities is lacking. The modified frailty index has been used to predict complications after orthopedic and surgical procedures. We hypothesized that despite a low rate of adverse outcomes, postoperative complications after kyphoplasty would be greater in patients who are frail. The National Surgical Quality Improvement Program database was queried for patients who underwent kyphoplasty between 2006 and 2015. Complication data including 30-day complications, life-threatening complications, reoperation and readmission rate, and length of stay data was recorded, and 5-item modified frailty index (5i-mFI) scores were calculated. Univariate and multivariate logistic regression analyses were then conducted to analyze frailty as a predictor of postoperative complications after kyphoplasty. In total, 2465 patients were identified (mean age = 73.98). As 5i-mFI increased from 0 to ≥2, the rate of overall complications increased nearly 3-fold from 3.7% to 10.4% (P < 0.001) and the rate of life-threatening complications increased from 0.8% to 2.4% (P = 0.042). In addition, 30-day readmission increased from 8.9% to 12.9% (P = 0.005), adverse hospital discharge increased from 7.6% to 25.6% (P < 0.001), and length of stay increased from 1.66 days to 3.75 days (P < 0.001). Frailty was associated with increased total complications, Clavien-Dindo IV complications, length of stay, and 30-day readmission rates. The 5i-mFI is a straightforward assessment tool that correlates with outcomes after kyphoplasty. It can be used to help clinicians predict adverse events and facilitate informed discussions with their patients. Copyright © 2018 Elsevier Inc. All rights reserved.

Randomized controlled trial of 3 days fasting and oral senna, combined with mannitol and simethicone, before capsule endoscopy

PubMed Central

Chen, Hong-bin; Lian-xiang, Peng; Yue, Huang; Chun, Huang; Shu-ping, Xiao; Rong-pang, Lin; Xiao-zong, Wang; Xiao-lin, Li

2017-01-01

Abstract Background and Study Aims: The approach to small bowel preparation before capsule endoscopy (CE) is still suboptimal. Patients and Methods: One hundred eighty patients were randomly allocated to 3 groups. Patients in Group A took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In Group B the same preparation was taken at 20:00 on the day before, and at 05:00 on the day of CE; in addition, 20 mL oral simethicone was taken 30 minutes before CE. Group C was treated identically to Group B, except that the patients fasted for 3 days and took 3 g senna orally 3 times daily before CE. The length of bowel containing green luminal contents was assessed by ImageJ software and bowel cleanliness was evaluated by computed assessment of the cleansing score. Results: Cleansing of the whole small bowel and the distal small bowel were significantly different between the 3 groups (χ2 = 22.470, P = .000; χ2 = 17.029, P = .000, respectively). There were also significant differences between the 3 groups in the length of small bowel and specifically the length of the distal small bowel containing green luminal contents (χ2 = 12.390, P = .000, χ2 = 15.141, P = .000, respectively), but not with regard to the proximal small bowel (χ2 = 0.678, P = .509). Conclusions: Three days fasting and oral senna, combined with 20% mannitol and simethicone, before CE, can reduce the effects of bile on the small bowel and improve small bowel cleansing, especially in the distal small intestine. PMID:29069003

[The effect of acupuncture and endogenous c-Fos, c-Jun on regeneration of neuronal dendrite of spared DRG in vitro following partial ganglionectomy].

PubMed

Wang, Te-wei; Wang, Ting-hua; Zhou, Xue; Zhang, Lian-shuang; Xu, Xin-yun

2007-09-01

To explore the effect of acupuncture, endogenous c-Fos and c-Jun on the regeneration of neuronal dendrite of spared dorsal root ganglion (DRG) in vitro following partial ganglionectomy. Five adult male cats were used in this experiment. Their bilateral L1-L5, L7-S2 DRG were removed, and L6 DRG were spared. Then unilaterally, two sets of acupoints (Zusanli(St. 36) and Xuanzhong(G. B. 39); Futu (St. 32) and Sanyinjiao (Sp. 6) located in the distribution area of spinal nerve L6) were electro-stimulated alternately 30 min everyday by electro-needling. Seven days after operation, bilateral L6 DRGs were taken out and were cultured respectively in vitro. Some cultured mediums of the acupuncture lateral wells were totally replaced by each corresponding antibody-cultured medium including respectively 100 ng/mL anti-c-Fos and anti-c-Jun antibody at the 24th hour and terminated after 7 days. The length of the neurite was measured by upside-down light microscopy. Then, cultured cells were stained by the immunohistochemistry ABC method. Data were analyzed by One-way ANOVA and q test. Immunocytochemical staining revealed that over 95% cells were NSE positive cells which were the typical neuron of DRG in vitro. On the 7th day, the average neurite length of the spared DRG group, the anti-c-Fos antibody and the anti-c-Jun antibody group were shorter than that of the acupuncture group (P < 0.05); the average neurite length of the two antibody groups were longer than that of the spared DRG group (P < 0.05). These results indicate that acupuncture, endogenous c-Fos and c-Jun probably promote regeneration of neuronal dendrite of spared DRG in vitro.

Improving the care of patients with cystic fibrosis (CF)

PubMed Central

Khan, Ahsan Aftab; Nash, Edward F; Whitehouse, Joanna; Rashid, Rifat

2017-01-01

Background The West Midlands Adult Cystic Fibrosis (CF) Centre based at Birmingham Heartlands Hospital provides care for adults with CF in the West Midlands. People with CF are prone to pulmonary exacerbations, which often require inpatient admission for intravenous antibiotics. We observed that the admission process was efficient during working hours (9:00–17:00, Monday–Friday) when the CF team are routinely available, but out-of-working hours, there were delays in these patients being clerked and receiving their first antibiotic dose. We were concerned that this was resulting in quality and potential safety issues by causing delays in starting treatment and prolonging hospital inpatient stays. We therefore undertook a quality improvement project (QIP) aimed at addressing these issues. An initial survey showed median time to clerk of 5 hours, with 60% of patients missing their first dose of antibiotics and mean length of stay of 16 days. Methods We applied the Plan-Do-Study-Act (PDSA) cycle approach, with the first PDSA cycle involving raising awareness of the issue through education to doctors, nurses and patients. Results This led to a reduction of median time to clerk from 5 to 2 hours with 23% of patients missing their first antibiotic dose and mean length of stay reducing to 14 days. The second cycle involved introducing an admissions checklist and displaying education posters around the hospital, resulting in median time to clerk remaining at 2 hours but only 20% of patients missing their first antibiotic dose and the mean length of stay remaining at 14 days. Conclusion This QIP has improved the out-of-hours admissions process for adults with CF in our centre. We plan to review the longer term effects of the project including sustainability, effects on clinical outcomes and patient satisfaction. PMID:28959778

The effect of simethicone on postoperative ileus in patients undergoing colorectal surgery (SPOT), a randomized controlled trial.

PubMed

Springer, Jeremy E; Elkheir, Shiraz; Eskicioglu, Cagla; Doumouras, Aristithes G; Kelly, Stephen; Yang, Ilun; Forbes, Shawn

2018-06-12

Postoperative ileus is a poorly understood multifactorial outcome following colorectal surgery that presents significant clinical challenges and contributes to increased morbidity, length of stay, and healthcare cost. To date, there are few pharmacological interventions that shorten the duration of postoperative ileus. This study is the first to evaluate the efficacy of simethicone in treating postoperative ileus symptoms in patients undergoing colorectal surgery. A multicenter, double-blinded, placebo controlled randomized controlled trial. This trial was conducted at two academic tertiary care centres in Ontario, Canada. 118 patients undergoing colorectal surgery. Patients were randomized to receive either a five-day course of oral simethicone (n = 58) or a placebo (n = 60). The primary outcome was time to first passage of flatus. Secondary outcomes included time to first bowel movement, postoperative length of stay, and postoperative pain. Statistical analyses were performed on an intention-to-treat basis. Statistical significance set at p = 0.05. The median time to first passage of flatus in simethicone arm was 25.2 h and 26.7 h in controls (P = 0.98). There were no significant differences in the median time to first bowel movement (simethicone = 41.1 h vs. control = 42.9 h, P = 0.91) or median length of hospital stay (simethicone = 4.5 days vs. control = 4.0 days, P = 0.63). This study failed to show a difference in return of gastrointestinal motility in patients receiving simethicone following colorectal surgery. Postoperative ileus remains a significant clinical and economic burden to the healthcare system and further research is needed to identify a reliable and effective method of treatment. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

[Length of stay in patients admitted for acute heart failure].

PubMed

Martín-Sánchez, Francisco Javier; Carbajosa, Virginia; Llorens, Pere; Herrero, Pablo; Jacob, Javier; Miró, Òscar; Fernández, Cristina; Bueno, Héctor; Calvo, Elpidio; Ribera Casado, José Manuel

2016-01-01

To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay≤7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p<0.001). A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Classroom Research: Implications for Mathematics and Science Instruction.

ERIC Educational Resources Information Center

Stallings, Jane A.

Presented is a review of findings from research of teaching in the 1970's. It is noted most research was directed toward identifying effective instructional strategies for low achievers, and may not generalize to high achievers. Information is related to student time on task, length of school day, academic time, allocation of time to specific…

How does active substance use at psychiatric admission impact suicide risk and hospital length-of-stay?

PubMed

Miller, Keith A; Hitschfeld, Mario J; Lineberry, Timothy W; Palmer, Brian A

2016-01-01

Despite their high prevalence, little is known about the effects of substance use disorders and active substance use on the suicide risk or length-of-stay of psychiatric inpatients. This study examines the relationship between active substance use at the time of psychiatric hospitalization and changes in suicide risk measures and length-of-stay. Admission and discharge ratings on the Suicide Status Form-II-R, diagnoses, and toxicology data from 2,333 unique psychiatric inpatients were examined. Data for patients using alcohol, tetrahydrocannabinol, methamphetamines, cocaine, benzodiazepines, opiates, barbiturates, phencyclidine, and multiple substances on admission were compared with data from 1,426 admissions without substance use. Patients with substance use by toxicology on admission had a 0.9 day shorter length-of-stay compared to toxicology-negative patients. During initial nurse evaluation on the inpatient unit, these patients reported lower suicide measures (i.e., suicidal ideation frequency, overall suicide risk, and wish-to-die). No significant between-group differences were seen at discharge. Patients admitted with a substance use disorder diagnosis had a 1.0 day shorter length-of-stay than those without, while those with a substance use disorder diagnosis and positive toxicology reported the lowest measures of suicidality on admission. These results remained independent of psychiatric diagnosis. For acute psychiatric inpatients, suicide risk is higher and length-of-stay is longer in patients with substance use disorders who are NOT acutely intoxicated compared with patients without a substance use disorder. Toxicology-positive patients are less suicidal on admission and improve faster than their toxicology-negative counterparts. This study gives support to the clinical observation that acutely intoxicated patients may stabilize quickly with regard to suicidal urges and need for inpatient care.

Trade-offs between global warming and day length on the start of the carbon uptake period in seasonally cold ecosystems

NASA Astrophysics Data System (ADS)

Wohlfahrt, Georg; Cremonese, Edoardo; Hammerle, Albin; Hörtnagl, Lukas; Galvagno, Marta; Gianelle, Damiano; Marcolla, Barbara; Cella, Umberto Morra

2013-12-01

is well established that warming leads to longer growing seasons in seasonally cold ecosystems. Whether this goes along with an increase in the net ecosystem carbon dioxide (CO2) uptake is much more controversial. We studied the effects of warming on the start of the carbon uptake period (CUP) of three mountain grasslands situated along an elevational gradient in the Alps. To this end, we used a simple empirical model of the net ecosystem CO2 exchange, calibrated, and forced with multiyear empirical data from each site. We show that reductions in the quantity and duration of daylight associated with earlier snowmelts were responsible for diminishing returns, in terms of carbon gain, from longer growing seasons caused by reductions in daytime photosynthetic uptake and increases in nighttime losses of CO2. This effect was less pronounced at high, compared to low, elevations, where the start of the CUP occurred closer to the summer solstice when changes in day length and incident radiation are minimal.

Models and Measurements of the Rotation of Mars

NASA Astrophysics Data System (ADS)

Folkner, W. M.; Konopliv, A. S.; Park, R. S.; Dehant, V. M. A.; Yseboodt, M.; Rivoldini, A.

2016-12-01

The rotation of Mars has been determined more accurately than for any other planet except Earth. This has been done using radio tracking data from spacecraft orbiting Mars or landed on Mars, starting with Mariner 9 in 1972 continuing through the present with several orbiters currently in operation. The Viking landers in 1976 provided the first clear measurements of variation in length of day. Mars Pathfinder combined with Viking lander provided the first estimate of the martian precession rate. The model for rigid Mars rotation developed by Reasenberg and King for Viking data analysis is accurate enough to fit the currently available measurements. With the InSight mission to be launched in 2018 and the ExoMars lander mission to be launched in 2020, nutation of Mars due to non-rigid effects are expected to be detectable, requiring improved models for the effects of the martian fluid core. We will present an overview of the current measurements sets, including comparisons of length-of-day variations from independent subsets, plans for the InSight and ExoMars missions, and summarize potential modeling improvements.

Efficacy of short-term versus long-term chest tube drainage following talc slurry pleurodesis in patients with malignant pleural effusions: a randomised trial.

PubMed

Goodman, Anna; Davies, Christopher W H

2006-10-01

Talc pleurodesis is commonly used in the palliative treatment of malignant pleural effusions but the shortest and most effective regime has not been determined. In particular, it is not clear when the intercostal drain should be removed following the insertion of sclerosant. We conducted a single-centre, randomised, open trial of drain removal at 24 h versus 72 h following talc slurry pleurodesis. The primary outcome measure was success of pleurodesis (no recurrence of effusion on chest radiograph at 1-month follow-up) and secondary outcome measures included length of hospital stay and mortality. We found no difference between recurrence of pleural effusion in those randomised to drain removal at 24 h and those randomised to drain removal at 72 h (p>0.5). However, length of stay was significantly reduced when the chest drain was removed at 24 h (4 days versus 8 days; p<0.01). Mortality did not differ between the two groups. We conclude that this shorter pleurodesis regime is safe and effective.

Tradeoffs between global warming and day length on the start of the carbon uptake period in seasonally cold ecosystems.

PubMed

Wohlfahrt, Georg; Cremonese, Edoardo; Hammerle, Albin; Hörtnagl, Lukas; Galvagno, Marta; Gianelle, Damiano; Marcolla, Barbara; di Cella, Umberto Morra

2013-12-16

It is well established that warming leads to longer growing seasons in seasonally cold ecosystems. Whether this goes along with an increase in the net ecosystem carbon dioxide (CO 2 ) uptake is much more controversial. We studied the effects of warming on the start of the carbon uptake period (CUP) of three mountain grasslands situated along an elevational gradient in the Alps. To this end we used a simple empirical model of the net ecosystem CO 2 exchange, calibrated and forced with multi-year empirical data from each site. We show that reductions in the quantity and duration of daylight associated with earlier snowmelts were responsible for diminishing returns, in terms of carbon gain, from longer growing seasons caused by reductions in daytime photosynthetic uptake and increases in nighttime losses of CO 2 . This effect was less pronounced at high, compared to low, elevations, where the start of the CUP occurred closer to the summer solstice when changes in day length and incident radiation are minimal.

Effect of type II diabetes mellitus on outcomes in patients with acute respiratory distress syndrome.

PubMed

Singla, Abhishek; Turner, Paul; Pendurthi, Madhu Kalyan; Agrawal, Vrinda; Modrykamien, Ariel

2014-02-01

The acute respiratory distress syndrome (ARDS) is a life-threatening condition, whereas the presence of diabetes has been shown to be protective in its development. We undertook this study to assess the association of type II diabetes mellitus with clinical outcomes in patients with ARDS. We retrospectively examined the medical records of consecutive series of patients with ARDS requiring mechanical ventilation from January 2008 to March 2011. Patients with type I diabetes were excluded from the study. Clinical outcomes such as ventilator-free days, mortality, length of stay in the hospital and intensive care unit (ICU), and reintubations were compared based on the presence of diabetes. Multivariate regression model was used to find if the presence of type II diabetes mellitus predicts ventilator-free days at day 28. Two hundred forty-nine patients with ARDS were admitted to the ICU during the study period. Fifty (20%) subjects had type II diabetes mellitus. Differences in ventilator-free days, in-hospital mortality, reintubation rate, and length of stay in the hospital or ICU were not statistically significant between diabetic and nondiabetic patients with ARDS. Acute Physiologic and Chronic Health Evaluation II, ICU specialty, use of vasopressors, and the need for reintubation were predictors of ventilator-free days at day 28. The presence of type II diabetes mellitus and its adjustment by body mass index did not show association with ventilator-free days at day 28. The presence of type II diabetes mellitus is not associated with clinical outcomes in ARDS, even when its presence is adjusted by body mass index. © 2013.

Gestational length in Carthusian broodmares: effects of breeding season, foal gender, age of mare, year of parturition, parity and sire.

PubMed

Satué, K; Felipe, M; Mota, J; Muñoz, A

2011-01-01

The length of gestation in Carthusian broodmares was calculated on the basis of 339 spontaneous full-term deliveries taking place in the 8-year period 1998-2005 from 158 broodmares and 29 stallions in a major farm of Spanish horses of Carthusian strain in southern Spain. Ultrasonography was used to determine follicular dehiscence, 1st day of pregnancy and to confirm conception in mares. Mean GL was 332.4 +/- 12.1 days, and a normal interval of 297-358 days was established for this breed. GL records were grouped on the basis of foal sex (colts or fillies), mating month (between November and January; February and April; May and July), age of the mare (4 to 7 years; 8 to 12 years; 13 to 17 years), breeding year, stallion and parity (primiparous vs. multiparous). GLs were 12.9 days shorter in mares mated between May and July than those mated between November and January and 15.3 days in mares mated between February and April (p < 0.001). Mares aged between 8-12 years had 5.3 days shorter GLs than those aged between 13-17 years (p < 0.05). Pregnancy was significantly 5.7 days longer when the mare gave birth to colts than fillies (p < 0.05). GL was 14.5 days longer in primiparous than in multiparous mares ( p < 0.001). No statistical differences in GL were found between the studied years. This study shows the influence of certain stallion on GL.

(abstract) Effect of Long Period Ocean Tides on the Earth's Rotation

NASA Technical Reports Server (NTRS)

Gross, R. S.; Chao, B. F.; Desai, S.

1996-01-01

The second-degree zonal tide raising potential, which is responsible for tidal changes in the Earth's rotation rate and length-of-day, is symmetric about the polar axis and hence can excite the Earth's polar motion only through its action upon nonaxisymmetric features of the Earth such as the oceans. Ocean tidal excitation of polar motion in the diurnal and semidiurnal tidal bands has been previously detected and extensively examined. Here, the detection of ocean tidal excitation of polar motion in the long-period tidal band, specifically at the Mf' (13.63-day) and Mf (13.66-day) tidal frequencies, is reported.

Associations of Nurse Staffing and Education With the Length of Stay of Surgical Patients.

PubMed

Cho, Eunhee; Park, Jeongyoung; Choi, Miyoung; Lee, Hye Sun; Kim, Eun-Young

2018-03-01

To examine the association of nurse staffing and education with the length of stay of surgical patients in acute care hospitals in South Korea. A cross-sectional survey design was used for a nurse survey in acute hospitals collected between 2008 and 2009. The survey data (N = 1,665) were linked with patient discharge data (N = 113,438) and hospital facility data from 58 hospitals with 100 or more beds in South Korea. The dependent variable was the length of stay, that is, the number of days a patient remained in the hospital. The independent variables were nurse staffing (number of patients per nurse) and nurses' education level (percentage of nurses with a bachelor of science in nursing [BSN] degree). A multilevel analysis was used to analyze the associations of nurse staffing and education level with the length of stay by controlling for both hospital and patient characteristics. The average proportion of nurses with a BSN in all the hospitals was 30.86%, while the average number of patients per nurse was 14.31. The median length of hospital stay for patients was about 7 days. The multilevel analysis showed that nurse staffing and nurse education level were significantly associated with the length of stay of surgical patients in acute care hospitals. A 10% increase in the average number of patients per nurse increased the length of stay by 0.284 days (p = .037). When the number of nurses with a BSN was increased by 1%, the length of stay decreased by 0.42 days (p = .025). Nurse staffing and nurses' education levels were significantly associated with the length of stay of surgical patients in South Korean hospitals. The findings from this study suggest that the South Korea healthcare system should develop appropriate strategies to improve the nurse staffing and education levels to ensure high-quality patient care in hospitals. Healthcare policymakers and nurse managers need to modify adequate nurse staffing and education levels in order to reduce the length of stay of patients. © 2017 Sigma Theta Tau International.

Emotions and family interactions in childhood: Associations with leukocyte telomere length emotions, family interactions, and telomere length.

PubMed

Robles, Theodore F; Carroll, Judith E; Bai, Sunhye; Reynolds, Bridget M; Esquivel, Stephanie; Repetti, Rena L

2016-01-01

Conceptualizations of links between stress and cellular aging in childhood suggest that accumulating stress predicts shorter leukocyte telomere length (LTL). At the same time, several models suggest that emotional reactivity to stressors may play a key role in predicting cellular aging. Using intensive repeated measures, we tested whether exposure or emotional "reactivity" to conflict and warmth in the family were related to LTL. Children (N=39; 30 target children and 9 siblings) between 8 and 13 years of age completed daily diary questionnaires for 56 consecutive days assessing daily warmth and conflict in the marital and the parent-child dyad, and daily positive and negative mood. To assess exposure to conflict and warmth, diary scale scores were averaged over the 56 days. Mood "reactivity" was operationalized by using multilevel modeling to generate estimates of the slope of warmth or conflict scores (marital and parent-child, separately) predicting same-day mood for each individual child. After diary collection, a blood sample was collected to determine LTL. Among children aged 8-13 years, a stronger association between negative mood and marital conflict, suggesting greater negative mood reactivity to marital conflict, was related to shorter LTL (B=-1.51, p<.01). A stronger association between positive mood and marital affection, suggesting positive mood reactivity, was related to longer LTL (B=1.15, p<.05). These effects were independent of exposure to family and marital conflict and warmth, and positive and negative mood over a two-month period. To our knowledge, these findings, although cross-sectional, represent the first evidence showing that link between children's affective responses and daily family interactions may have implications for telomere length. Copyright © 2015 Elsevier Ltd. All rights reserved.

How satisfied are mothers with 1-day hospital stays for routine delivery?

PubMed

Klingner, J M; Solberg, L I; Knudson-Schumacher, S; Carlson, R R; Huss, K L

1999-01-01

Payers and health plans are encouraging shorter hospital stays after routine vaginal delivery. To assess the satisfaction of mothers who had 1-day or 2-day stays after routine delivery. We mailed questionnaires to mothers 7 to 9 months after delivery. The self-administered survey contained questions about the mothers' satisfaction with the care they received, clinical complications, and the mothers' preparedness after discharge. A mixed-staff, network-model managed care plan in Minnesota that encourages but does not require 1-day hospital stays after routine delivery. All plan members who delivered a baby vaginally in the first quarter of 1995 (n = 1009). 56% of the mothers responded to the survey. Of these, 202 had 1-day stays and 292 had 2-day stays. Mothers with 1-day stays were more likely than mothers with 2-day stays to report that their length of stay was "too short" (75% vs. 37%; P < 0.001), and 81% of mothers with 1-day stays would want to stay longer if they had another child. The frequency of self-reported maternal or infant complications did not differ substantially between the two groups. More mothers with 1-day stays than mothers with 2-day stays received home health care visits (44% vs. 10%; P < 0.001). Although length of stay does not seem to be related to clinical outcomes after vaginal delivery, mothers with 1-day stays are less satisfied with their length of stay.

Simulative Global Warming Negatively Affects Cotton Fiber Length through Shortening Fiber Rapid Elongation Duration.

PubMed

Dai, Yanjiao; Yang, Jiashuo; Hu, Wei; Zahoor, Rizwan; Chen, Binglin; Zhao, Wenqing; Meng, Yali; Zhou, Zhiguo

2017-08-23

Global warming could possibly increase the air temperature by 1.8-4.0 °C in the coming decade. Cotton fiber is an essential raw material for the textile industry. Fiber length, which was found negatively related to the excessively high temperature, determines yarn quality to a great extent. To investigate the effects of global warming on cotton fiber length and its mechaism, cottons grown in artificially elevated temperature (34.6/30.5 °C, T day /T night ) and ambient temperature (31.6/27.3 °C) regions have been investigated. Becaused of the high sensitivities of enzymes V-ATPase, PEPC, and genes GhXTH1 and GhXTH2 during fiber elongation when responding to high temperature stress, the fiber rapid elongation duration (FRED) has been shortened, which led to a significant suppression on final fiber length. Through comprehensive analysis, T night had a great influence on fiber elongation, which means T n could be deemed as an ideal index for forecasting the degree of high temperature stress would happen to cotton fiber property in future. Therefore, we speculate the global warming would bring unfavorable effects on cotton fiber length, which needs to take actions in advance for minimizing the loss in cotton production.

Immediate effects of adding mental practice to physical practice on the gait of individuals with Parkinson's disease: Randomized clinical trial.

PubMed

Santiago, Lorenna Marques de Melo; de Oliveira, Daniel Antunes; de Macêdo Ferreira, Louise Gabriella Lopes; de Brito Pinto, Hyanne Yasmim; Spaniol, Ana Paula; de Lucena Trigueiro, Larissa Coutinho; Ribeiro, Tatiana Souza; de Sousa, Angélica Vieira Cavalcanti; Piemonte, Maria Elisa Pimentel; Lindquist, Ana Raquel Rodrigues

2015-01-01

Mental practice has shown benefits in the rehabilitation of neurological patients, however, there is no evidence of immediate effects on gait of individuals with Parkinson's disease. Determine the effects of mental practice activity added to physical practice on the gait of individuals with Idiopathic Parkinson's Disease (IPD). 20 patients classified with stage 2 and 3, according to the Hoehn and Yahr scale were randomized into 2 groups. The experimental group (N = 10) was submitted to a single session of mental practice and physical practice gait protocol and the control group (N = 10) only to physical practice. The primary outcomes were stride length and total stance and swing time. Secondary outcomes were hip range of motion, velocity and mobility. Subjects were reassessed 10 minutes, 1 day and 7 days after the end of the session. There was no statistically significant difference between the groups. An intragroup difference was observed in velocity, stride length, hip range of motion, and mobility, as well as total stance and swing time. These results were also observed on follow-ups. Mental practice did not have a greater effect on the gait of individuals with IPD than physical practice, after a single session.

Effect of immune-enhancing diets on the outcomes of patients after major burns

PubMed Central

Mahmoud, W.H..; Mostafa, W.; Abdel-Khalek, A.H.; Shalaby, H.

2014-01-01

Summary The use of immune-enhancing diets (IEDs) has been shown to be beneficial in some categories of critically ill patients. This study aimed to evaluate the effect of early enteral feeding supplemented with glutamine and omega-3 fatty acids, as immune-enhancing diets, on the outcomes of patients after major burns. Forty thermally injured adult patients with 30-50% total body surface area (TBSA) burns, including deep areas ranging from 5-20%, were randomized into a prospective, double-blind, controlled clinical trial. They were placed into two equal groups: group A (IED group), in which patients received early enteral feeding supplemented with glutamine and omega-3 fatty acids as immune-enhancing diets; and group B (control group), in which patients received early enteral feeding not supplemented with immune-enhancing diets. Laboratory assessment of serum albumin, serum C-reactive protein, total lymphocytic count and serum immunoglobulins (IgA, IgG and IgM) was performed at admission, and on days 4, 7 and 14. Finally, outcomes were assessed by monitoring the survival rate, the length of hospital stay and the incidence of infection. There were no significant differences between the IED and control group regarding age (28.7±5.32 versus 29.85±5.94), sex, weight, %TBSA (37.75±4.4 versus 38.3±4.84) and %burn depth (11.7±2.36 versus 10.7±2.036). The incidence of infection (2 versus 8) and the length of hospital stay (16.3±0.92 days versus 17.95±2.96 days) were decreased significantly in the IED group versus the control group. There was no significant difference between the survival rates in both groups as there was only one death in the control group. Thanks to IEDs, patient outcome was improved and infectious morbidity and length of hospital stay were reduced, but there was no effect on the survival rates following major burns. PMID:26336366

Rat limb unloading - Soleus histochemistry, ultrastructure, and electromyography

NASA Technical Reports Server (NTRS)

Riley, D. A.; Slocum, G. R.; Bain, J. L. W.; Sedlak, F. R.; Sowa, T. E.

1990-01-01

The effects of hindlimb unloading on rat-soleus histochemisty, ultrastructure, and electromyogram (EMG) activity were investigated. It was found that, after 14 days of tail suspension, the area of type I and type IIa muscle fibers decreased by 63 and 47 percent, respectively, mainly due to the degradation of subsarcolemmal mitochondria and myofibrils. After 10 days, 3 percent of type IIa fibers exhibited segmental necrosis. After four days, video monitoring revealed abnormal plantar flexion of the hindfeet, which shortened the soleus working range. The EMG activity shifted from tonic to phasic, and aggregate activity decreased drastically after only seven days. The results indictate that the pathological changes in the soleus resulted from unloaded contractions, reduced use, compromised blood flow, and shortened working length.

Trends of 30-day mortality and morbidities in endovascular repair of intact abdominal aortic aneurysm during the last decade.

PubMed

Yin, Kanhua; Locham, Satinderjit S; Schermerhorn, Marc L; Malas, Mahmoud B

2018-06-15

Significant research efforts have been made to improve the safety and efficacy of endovascular aneurysm repair (EVAR) in treating abdominal aortic aneurysm. This study aimed to examine the trends of perioperative outcomes of EVAR in the recent decade using a national validated database. Patients who underwent EVAR for intact abdominal aortic aneurysm between 2006 and 2015 were identified from the National Surgical Quality Improvement Program and divided into early (2006-2010) and late (2011-2015) periods. The primary outcome of the study was 30-day mortality. Secondary outcomes included operative time, length of hospital stay, and 30-day major complications (renal, cardiopulmonary, and wound infection). A total of 30,076 patients were identified, with 11,539 in the early period and 18,537 in the late period. The 30-day mortality was kept at a low level in both periods (1.2% vs 1.2%; P = .98), whereas both the mean operation time (155.5 ± 72.6 minutes vs 141.9 ± 73.7 minutes; P < .001) and length of hospital stay (3.24 ± 5.32 days vs 2.81 ± 4.30 days; P < .001) were decreased in the late period. The 30-day major complication rate was reduced by 19.6% (5.1% vs 4.1%; P < .0001), with decreased renal failure (1.4% vs 1.0%; P = .003), cardiopulmonary complications (2.2% vs 1.7%; P = .006), and wound complications (2.5% vs 1.8%; P < .001). All the decreasing trends of mortality, any 30-day complication, and each type of major complication were statistically significant. Being treated in the late period was independently associated with decreased 30-day major complications (odds ratio, 0.75; 95% confidence interval, 0.65-0.87; P < .001), and this effect was confirmed in the propensity score-matched cohort (odds ratio, 0.76; 95% confidence interval, 0.66-0.90; P < .001). Although the 30-day mortality remains similar, postoperative complications in EVAR have decreased significantly during the recent decade. The continuous improvement in endograft technology and surgical skills has resulted in decreased operative time, marked reduction in surgical complications, and shorter hospital length of stay after endovascular repair. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Impact of polymerase chain reaction results on patient management during a viral meningitis outbreak in Tropical North Queensland.

PubMed

Stonehouse, Vicki; Furyk, Jeremy; Norton, Robert

2012-02-01

Enterovirus is the most commonly isolated pathogen in viral meningitis. We report on the first outbreak of viral meningitis in Tropical Queensland and the effect of polymerase chain reaction (PCR) results on antibiotic use and hospital length of stay. Retrospective case series of consecutive patients presenting to the Townsville ED with viral meningitis were evaluated by examining hospital medical records. The study period was November 2008 to February 2009. Forty-three patients were available for full analysis of which 17 (40%) were female and 17 (40%) had a positive enteroviral PCR. Antibiotics were commenced on 37 (86%) of patients. There was no difference in hospital length of stay in patients with a negative versus positive PCR (2.52 vs 2.72 days, P = 0.68) or duration of antibiotic therapy (2.20 vs 1.94 days, P = 0.61). In our study a positive result on PCR was not associated with a shorter hospital length of stay or a shorter duration of antibiotic therapy. This contrasts with previous reports on this topic and requires further evaluation. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Influence of Day Length and Physical Activity on Sleep Patterns in Older Icelandic Men and Women

PubMed Central

Brychta, Robert J.; Arnardottir, Nanna Yr; Johannsson, Erlingur; Wright, Elizabeth C.; Eiriksdottir, Gudny; Gudnason, Vilmundur; Marinac, Catherine R.; Davis, Megan; Koster, Annemarie; Caserotti, Paolo; Sveinsson, Thorarinn; Harris, Tamara; Chen, Kong Y.

2016-01-01

Study Objectives: To identify cross-sectional and seasonal patterns of sleep and physical activity (PA) in community-dwelling, older Icelandic adults using accelerometers. Methods: A seven-day free-living protocol of 244 (110 female) adults aged 79.7 ± 4.9 years was conducted as part of a larger population-based longitudinal observational-cohort study in the greater Reykjavik area of Iceland. A subpopulation (n = 72) repeated the 7-day measurement during seasonal periods with greater (13.4 ± 1.4 h) and lesser (7.7 ± 1.8 h) daylight. Results: Cross-sectional analyses using multiple linear regression models revealed that day length was a significant independent predictor of sleep duration, mid-sleep, and rise time (all p < 0.05). However, the actual within-individual differences in sleep patterns of the repeaters were rather subtle between periods of longer and shorter day-lengths. Compared to women, men had a shorter sleep duration (462 ± 80 vs. 487 ± 68 minutes, p = 0.008), earlier rise time, and a greater number of awakenings per night (46.5 ± 18.3 vs. 40.2 ± 15.7, p = 0.007), but sleep efficiency and onset latency were similar between the two sexes. Daily PA was also similar between men and women and between periods of longer and shorter day-lengths. BMI, age, gender, and overall PA all contributed to the variations in sleep parameters using multiple regression analysis. Conclusions: The sleep and PA characteristics of this unique population revealed some gender differences, but there was limited variation in response to significant daylight changes which may be due to long-term adaptation. Citation: Brychta RJ, Arnardottir NY, Johannsson E, Wright EC, Eiriksdottir G, Gudnason V, Marinac CR, Davis M, Koster A, Caserotti P, Sveinsson T, Harris T, Chen KY. Influence of day length and physical activity on sleep patterns in older Icelandic men and women. J Clin Sleep Med 2016;12(2):203–213. PMID:26414978

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients

PubMed Central

Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm. Thomas

2017-01-01

Background Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. Objectives To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. Methods The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre–quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post–quality improvement program as well as the difference between the validation cohort and the post–quality improvement program, respectively. Results As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre–quality improvement program baseline cohort, and $4,896,758 versus the pre–quality improvement program in the validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved. Conclusion The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost. PMID:28975010

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients.

PubMed

Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas

2017-07-01

Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved. The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost.

Audit of co-management and critical care outreach for high risk postoperative patients (The POST audit).

PubMed

Story, D A; Shelton, A; Jones, D; Heland, M; Belomo, R

2013-11-01

Co-management and critical care outreach for high risk surgical patients have been proposed to decrease postoperative complications and mortality. We proposed that a clinical project with postoperative comanagement and critical care outreach, the Post Operative Surveillance Team: (POST), would be associated with decreased hospital length of stay. We conducted a retrospective before (control group) and after (POST group) audit of this hospital program. POST was staffed for four months in 2010 by two intensive care nurses and two senior registrars who conducted daily ward rounds for the first five postoperative days on high risk patients undergoing inpatient general or urological surgery. The primary endpoint was length of hospital stay and secondary endpoints were Medical Emergency Team (MET) calls, cardiac arrests and in-hospital mortality. There were 194 patients in the POST group and 1,185 in the control group. The length of stay in the POST group, median nine days (Inter-quartile range [IQR]: 5 to 17 days), was longer than the control group, median seven days (IQR: 4 to 13 days): difference two days longer (95.0% confidence interval [95.0% CI]: 1 to 3 days longer, P <0.001). There were no important differences in the proportion of patients having MET calls (16.0% POST versus. 13% control (P=0.25)) or mortality (2.1% POST versus 2.8% Control (P=0.82)). Our audit found that the POST service was not associated with reduced length of stay. Models of co-management, different to POST, or with different performance metrics, could be tested.

Increased hospital length of stay attributable to Clostridium difficile infection in patients with four co-morbidities: an analysis of hospital episode statistics in four European countries.

PubMed

Eckmann, Christian; Wasserman, Matthew; Latif, Faisal; Roberts, Graeme; Beriot-Mathiot, Axelle

2013-10-01

Hospital-onset Clostridium difficile infection (CDI) places a significant burden on health care systems throughout Europe, estimated at around €3 billion per annum. This burden is shared between national payers and hospitals that support additional bed days for patients diagnosed with CDI while in hospital or patients re-admitted from a previous hospitalisation. This study was performed to quantify additional hospital stay attributable to CDI in four countries, England, Germany, Spain, and The Netherlands, by analysing nationwide hospital-episode data. We focused upon patients at increased risk of CDI: with chronic obstructive pulmonary disease, heart failure, diabetes, or chronic kidney disease, and aged 50 years or over. Multivariate regression and propensity score matching models were developed to investigate the impact of CDI on additional length of hospital stay, controlling for confounding factors such as underlying disease severity. Patients in England had the longest additional hospital stay attributable to CDI at 16.09 days, followed by Germany at 15.47 days, Spain at 13.56 days, and The Netherlands at 12.58 days, derived using regression analysis. Propensity score matching indicated a higher attributable length of stay of 32.42 days in England, 15.31 days in Spain, and 18.64 days in The Netherlands. Outputs from this study consistently demonstrate that in European countries, for patients whose hospitalisation is complicated by CDI, the infection causes a statistically significant increase in hospital length of stay. This has implications for optimising resource allocation and budget setting at both the national and hospital level to ensure that levels of CDI-complicated hospitalisations are minimised.

Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients.

PubMed

Andrews, Peter J D; Avenell, Alison; Noble, David W; Campbell, Marion K; Croal, Bernard L; Simpson, William G; Vale, Luke D; Battison, Claire G; Jenkinson, David J; Cook, Jonathan A

2011-03-17

To determine whether inclusion of glutamine, selenium, or both in a standard isonitrogenous, isocaloric preparation of parenteral nutrition influenced new infections and mortality among critically ill patients. Randomised, double blinded, factorial, controlled trial. Level 2 and 3 (or combined) critical care units in Scotland. All 22 units were invited, and 10 participated. 502 adults in intensive care units and high dependency units for ≥ 48 hours, with gastrointestinal failure and requiring parenteral nutrition. Parenteral glutamine (20.2 g/day) or selenium (500 μg/day), or both, for up to seven days. Primary outcomes were participants with new infections in the first 14 days and mortality. An intention to treat analysis and a prespecified analysis of patients who received ≥ 5 days of the trial intervention are presented. Secondary outcomes included critical care unit and acute hospital lengths of stay, days of antibiotic use, and modified SOFA (Sepsis-related Organ Failure Assessment) score. Selenium supplementation did not significantly affect patients developing a new infection (126/251 v 139/251, odds ratio 0.81 (95% CI 0.57 to 1.15)), except for those who had received ≥ 5 days of supplementation (odds ratio 0.53 (0.30 to 0.93)). There was no overall effect of glutamine on new infections (134/250 v 131/252, odds ratio 1.07 (0.75 to 1.53)), even if patients received ≥ 5 days of supplementation (odds ratio 0.99 (0.56 to 1.75)). Six month mortality was not significantly different for selenium (107/251 v 114/251, odds ratio 0.89 (0.62 to 1.29)) or glutamine (115/250 v 106/252, 1.18 (0.82 to 1.70)). Length of stay, days of antibiotic use, and modified SOFA score were not significantly affected by selenium or glutamine supplementation. The primary (intention to treat) analysis showed no effect on new infections or on mortality when parenteral nutrition was supplemented with glutamine or selenium. Patients who received parenteral nutrition supplemented with selenium for ≥ 5 days did show a reduction in new infections. This finding requires confirmation. Trial registration Current Controlled Trials ISRCTN87144826.

Effects of treadmill training on functional recovery following peripheral nerve injury in rats

PubMed Central

Boeltz, Tiffany; Ireland, Meredith; Mathis, Kristin; Nicolini, Jennifer; Poplavski, Karen; Rose, Samuel J.; Wilson, Erin

2013-01-01

Exercise, in the form of moderate daily treadmill training following nerve transection and repair leads to enhanced axon regeneration, but its effect on functional recovery is less well known. Female rats were exercised by walking continuously, at a slow speed (10 m/min), for 1 h/day on a level treadmill, beginning 3 days after unilateral transection and surgical repair of the sciatic nerve, and conducted 5 days/wk for 2 wk. In Trained rats, both direct muscle responses to tibial nerve stimulation and H reflexes in soleus reappeared earlier and increased in amplitude more rapidly over time than in Untrained rats. The efficacy of the restored H reflex was greater in Trained rats than in Untrained controls. The reinnervated tibialis anterior and soleus were coactivated during treadmill locomotion in Untrained rats. In Trained animals, the pattern of activation of soleus, but not tibialis anterior, was not significantly different from that found in Intact rats. The overall length of the hindlimb during level and up- and downslope locomotion was conserved after nerve injury in both groups. This conservation was achieved by changes in limb orientation. Limb length was conserved effectively in all rats during downslope walking but only in Trained rats during level and upslope walking. Moderate daily exercise applied immediately after sciatic nerve transection is sufficient to promote axon regeneration, to restore muscle reflexes, and to improve the ability of rats to cope with different biomechanical demands of slope walking. PMID:23468390

Enhanced care for primary hip arthroplasty: factors affecting length of hospital stay.

PubMed

Panteli, Michalis; Habeeb, Shayma'u; McRoberts, John; Porteous, Matthew J

2014-04-01

Enhanced care in joint replacement requires identification and correction of the causes of delay in discharge while ensuring practice remains safe. We conducted prospective studies of factors delaying discharge following hip replacement in 2006 and 2010. Daily data were twice collected prospectively in 100 consecutive unselected primary cemented THR, by an independent observer. Reasons for delays in discharge and variation from the patient pathway were identified and addressed. The mean length of stay (LOS) in 2006 was 4.3 days and in 2010, 3.56 days (target for discharge 4 days). In 2006, 31 patients had a stay of more than 4 days, 17 due to inadequate physiotherapy provision, 10 for medical and 4 for other reasons. In 2010, 15 patients had a stay of more than 4 days, 1 patient had inadequate physiotherapy provision, in 7 cases discharge was delayed because of need for blood transfusion and 7 because of need for catheterisation. Women aged more than 70 with preoperative haemoglobin of <12 g/dL were at particularly high risk of requiring transfusion. Catheterisation was also identified as a factor causing significant increase in LOS. Patients going home in less than 4 days were more likely to have had their operation in the morning. Patient LOS is multifactorial and can be reduced by regular review of the care pathway to effect incremental changes that have a significant impact on reducing stay.

Building a model for day case hiatal surgery - Lessons learnt over a 10 year period in a high volume unit: A case series.

PubMed

Mistry, Pritesh; Zaman, Shafquat; Shapey, Iestyn; Daskalakis, Markos; Nijjar, Rajwinder; Richardson, Martin; Super, Paul; Singhal, Rishi

2018-06-01

Laparoscopic anti-reflux surgery has become the standard treatment for symptomatic gastro-oesophageal reflux disease refractory to medical therapy. Successful anti-reflux surgery involves safe, minimally invasive surgery, resulting in symptom resolution with minimal side effects. This study aims to assess the feasibility and safety of day case anti-reflux surgery focussing on peri- and post-operative outcomes as a measure of success. Data was collected from the hospital database from 2003 to 2012. Data collection included demographics, surgeon, mode of admission, length of stay and complications. Electronic records were independently scrutinised for all patients with a length of stay of more than two nights. 723 patients underwent laparoscopic fundoplication ± small hiatus hernia repair (<5 cm) with a day case rate of 67.1%. The 30 day readmission rate in these patients was 2.9% (21/723 patients). Nine patients had a failure of their initial laparoscopic fundoplication (defined as recurrence of symptoms). Three patients required a re-operation within 12 months of their initial procedure (re-operation rate = 0.41% (3/723 patients)). Laparoscopic hiatal surgery can be performed safely as a day case in high volume specialist centres with good outcomes. Raising the national standard for day case fundoplication promotes good practice and should be the model for future commissioning. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Correlation of normal-range FMR1 repeat length or genotypes and reproductive parameters.

PubMed

Maslow, Bat-Sheva L; Davis, Stephanie; Engmann, Lawrence; Nulsen, John C; Benadiva, Claudio A

2016-09-01

This study aims to ascertain whether the length of normal-ranged CGG repeats on the FMR1 gene correlates with abnormal reproductive parameters. We performed a retrospective, cross-sectional study of all FMR1 carrier screening performed as part of routine care at a large university-based fertility center from January 2011 to March 2014. Correlations were performed between normal-range FMR1 length and baseline serum anti-Müllerian hormone (AMH), cycle day 3 follicle stimulating hormone (FSH), ovarian volumes (OV), antral follicle counts (AFC), and incidence of diminished ovarian reserve (DOR), while controlling for the effect of age. Six hundred three FMR1 screening results were collected. One subject was found to be a pre-mutation carrier and was excluded from the study. Baseline serum AMH, cycle day 3 FSH, OV, and AFC data were collected for the 602 subjects with normal-ranged CGG repeats. No significant difference in median age was noted amongst any of the FMR1 repeat genotypes. No significant correlation or association was found between any allele length or genotype, with any of the reproductive parameters or with incidence of DOR at any age (p > 0.05). However, subjects who were less than 35 years old with low/low genotype were significantly more likely to have below average AMH levels compared to those with normal/normal genotype (RR 3.82; 95 % CI 1.38-10.56). This large study did not demonstrate any substantial association between normal-range FMR1 repeat lengths and reproductive parameters.

Evaluation of developmental toxicity of guaifenesin using pregnant female rats.

PubMed

Shabbir, Arham; Shamsi, Sadia; Shahzad, Muhammad; Butt, Hajra Ikram; Aamir, Khurram; Iqbal, Javed

2016-01-01

Guaifenesin possesses expectorant, muscle relaxant, and anticonvulsive properties. To the best of our knowledge, the promising data regarding the developmental toxicity of guaifenesin are scarce. The current study investigates the developmental toxic effects of guaifenesin in detail using female rats. Twenty-five dams were divided into five groups. Group 1 served as a control, while Group-2, -3, -4, and -5 were administered with 250, 350, 500, and 600 (mg/kg b.w.) doses of guaifenesin, respectively, starting from gestation day 6 to day 17. Half of the total recovered fetuses was subjected to morphologic and morphometric analysis, while other half was subjected to skeletal examination. A significant reduction in maternal weight, and food/water intake, was observed, however, no mortality and morbidity were observed. About 14 dead fetuses were found in Group-3 and -4 each, while 26 in Group 5. Morphological analysis revealed 21.2%, 45.4%, 67.2%, and 86.9% of total fetuses having hemorrhagic spots in Group-2, -3, -4, and -5, respectively. Dropping wrist/ankle and kinky tail were found in Group-4 and -5 only. Morphometric analysis showed a significant decline in fetal weight, full body length, skull length, forelimb length, hindlimb length, and tail length in all guaifenesin treated groups. Skeletal examination displayed that only Group 5 fetuses had increased intercostal space between 7(th) and 8(th) rib. We also observed improper development of carpals, metacarpals, tarsals, and metatarsals of the Group 5 fetuses. Guaifenesin showed a significant developmental toxicity at selected test doses; therefore, a careful use is suggested during pregnancy.

Evaluation of developmental toxicity of guaifenesin using pregnant female rats

PubMed Central

Shabbir, Arham; Shamsi, Sadia; Shahzad, Muhammad; Butt, Hajra Ikram; Aamir, Khurram; Iqbal, Javed

2016-01-01

Objectives: Guaifenesin possesses expectorant, muscle relaxant, and anticonvulsive properties. To the best of our knowledge, the promising data regarding the developmental toxicity of guaifenesin are scarce. The current study investigates the developmental toxic effects of guaifenesin in detail using female rats. Materials and Methods: Twenty-five dams were divided into five groups. Group 1 served as a control, while Group-2, -3, -4, and -5 were administered with 250, 350, 500, and 600 (mg/kg b.w.) doses of guaifenesin, respectively, starting from gestation day 6 to day 17. Half of the total recovered fetuses was subjected to morphologic and morphometric analysis, while other half was subjected to skeletal examination. Results: A significant reduction in maternal weight, and food/water intake, was observed, however, no mortality and morbidity were observed. About 14 dead fetuses were found in Group-3 and -4 each, while 26 in Group 5. Morphological analysis revealed 21.2%, 45.4%, 67.2%, and 86.9% of total fetuses having hemorrhagic spots in Group-2, -3, -4, and -5, respectively. Dropping wrist/ankle and kinky tail were found in Group-4 and -5 only. Morphometric analysis showed a significant decline in fetal weight, full body length, skull length, forelimb length, hindlimb length, and tail length in all guaifenesin treated groups. Skeletal examination displayed that only Group 5 fetuses had increased intercostal space between 7th and 8th rib. We also observed improper development of carpals, metacarpals, tarsals, and metatarsals of the Group 5 fetuses. Conclusion: Guaifenesin showed a significant developmental toxicity at selected test doses; therefore, a careful use is suggested during pregnancy. PMID:27298495

Platelet-rich plasma stimulates angiogenesis in mice which may promote hair growth.

PubMed

Cheng, Hanxiao; Zhang, Jufang; Li, Jinsheng; Jia, Ming; Wang, Yuyan; Shen, Haiyan

2017-10-11

Platelet-rich plasma (PRP) is an autologous concentration of human platelets in plasma. In this paper, we aimed to investigate the effect of PRP on hair growth. Platelet-rich plasma and platelet-poor plasma were prepared by sterile centrifugation and injected into shaved dorsal skin of mice (n = 10). Saline injection was used in the control group. The length of randomly plucked hairs was measured at 8, 13, 18 days after PRP injection. Histological examination was preformed to observe the histologic changes of skins. The immunohistochemistry analysis of CD31 was performed to detect the changes of hair length and formation of new vessels. At 13 and 18 days after the last injection, the hair length of mice in PRP group (4.24 ± 0.60 and 8.29 ± 0.48 mm, respectively) was significantly longer compared with the control group (3.70 ± 0.52 and 7.21 ± 0.64 mm, p < 0.05). No significant difference in the hair length was found between the PPP group and the control (p > 0.05). In addition, the number of CD31-positive vessel in the PRP group (9.90 ± 0.60) was more than that in the control group (8.60 ± 2.34, p < 0.05). Platelet-rich plasma might promote hair length growth and increase the number of hair follicles by inducing angiogenesis.

Utilization management affects health care practices at Walter Reed Army Medical Center: analytical methods applied to decrease length of stay and assign appropriate level of care.

PubMed

Phillips, J S; Hamm, C K; Pierce, J R; Kussman, M J

1999-12-01

The Department of Defense has embraced utilization management (UM) as an important tool to control and possibly decrease medical costs. Budgetary withholds have been taken by the Office of the Assistant Secretary of Defense (Health Affairs) to encourage the military services to implement UM programs. In response, Walter Reed Army Medical Center implemented a UM program along with other initiatives to effect changes in the delivery of inpatient care. This paper describes this UM program and other organizational initiatives, such as the introduction of new levels of care in an attempt to effect reductions in length of stay and unnecessary admissions. We demonstrate the use of a diversity of databases and analytical methods to quantify improved utilization and management of resources. The initiatives described significantly reduced hospital length of stay and inappropriate inpatient days. Without solid command and clinical leadership support and empowerment of the professional staffs, these significant changes and improvements could not have occurred.

Effect of methylphenidate on ICU and hospital length of stay in patients with severe and moderate traumatic brain injury.

PubMed

Moein, Houshang; Khalili, Hossein A; Keramatian, Kamyar

2006-09-01

Traumatic brain injury is one of the major causes of death and disability among young people. Methylphenidate, a neural stimulant and protective drug, which has been mainly used for childhood attention deficit/hyperactivity disorder, has shown some benefits in late psychosocial problems in patients with traumatic brain injury. Its effect on arousal and consciousness has been also revealed in the sub-acute phase of traumatic brain injury. We studied its effect on the acute phase of moderate and severe traumatic brain injury (TBI) in relation to the length of ICU and hospital admission. Severely and moderately TBI patients (according to inclusion and exclusion criteria) were randomized to treatment and control groups. The treatment group received methylphenidate 0.3mg/kg per dose PO BID by the second day of admission until the time of discharge, and the control group received a placebo. Admission information and daily Glasgow Coma Scale (GCS) were recorded. Medical, surgical, and discharge plans for patients were determined by the attending physician, blinded to the study. Forty patients with severe TBI (GCS = 5-8) and 40 moderately TBI patients (GCS = 9-12) were randomly divided into treatment and control groups on the day of admission. In the severely TBI patients, both hospital and ICU length of stay, on average, were shorter in the treatment group compared with the control group. In the moderately TBI patients while ICU stay was shorter in the treatment group, there was no significant reduction of the period of hospitalization. There were no significant differences between the treatment and control groups in terms of age, sex, post resuscitation GCS, or brain CT scan findings, in either severely or moderately TBI patients. Methylphenidate was associated with reductions in ICU and hospital length of stay by 23% in severely TBI patients (P = 0.06 for ICU and P = 0.029 for hospital stay time). However, in the moderately TBI patients who received methylphenidate, there was 26% fall (P = 0.05) only in ICU length of stay.

Maternal exposure to diluted diesel engine exhaust alters placental function and induces intergenerational effects in rabbits.

PubMed

Valentino, Sarah A; Tarrade, Anne; Aioun, Josiane; Mourier, Eve; Richard, Christophe; Dahirel, Michèle; Rousseau-Ralliard, Delphine; Fournier, Natalie; Aubrière, Marie-Christine; Lallemand, Marie-Sylvie; Camous, Sylvaine; Guinot, Marine; Charlier, Madia; Aujean, Etienne; Al Adhami, Hala; Fokkens, Paul H; Agier, Lydiane; Boere, John A; Cassee, Flemming R; Slama, Rémy; Chavatte-Palmer, Pascale

2016-07-26

Airborne pollution is a rising concern in urban areas. Epidemiological studies in humans and animal experiments using rodent models indicate that gestational exposure to airborne pollution, in particular diesel engine exhaust (DE), reduces birth weight, but effects depend on exposure duration, gestational window and nanoparticle (NP) concentration. Our aim was to evaluate the effects of gestational exposure to diluted DE on feto-placental development in a rabbit model. Pregnant females were exposed to diluted (1 mg/m(3)), filtered DE (NP diameter ≈ 69 nm) or clean air (controls) for 2 h/day, 5 days/week by nose-only exposure (total exposure: 20 days in a 31-day gestation). DE exposure induced early signs of growth retardation at mid gestation with decreased head length (p = 0.04) and umbilical pulse (p = 0.018). Near term, fetal head length (p = 0.029) and plasma insulin and IGF1 concentrations (p = 0.05 and p = 0.019) were reduced. Placental function was also affected, with reduced placental efficiency (fetal/placental weight) (p = 0.049), decreased placental blood flow (p = 0.009) and fetal vessel volume (p = 0.002). Non-aggregated and "fingerprint" NP were observed at various locations, in maternal blood space, in trophoblastic cells and in the fetal blood, demonstrating transplacental transfer. Adult female offspring were bred with control males. Although fetoplacental biometry was not affected near term, second generation fetal metabolism was modified by grand-dam exposure with decreased plasma cholesterol (p = 0.008) and increased triglyceride concentrations (p = 0.015). Repeated daily gestational exposure to DE at levels close to urban pollution can affect feto-placental development in the first and second generation.

Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.

PubMed

Grebla, Regina C; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A; Rahman, Momotazur; Trivedi, Amal N

2015-08-01

The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Waiving the Three-Day Rule: Admissions and Length-of-Stay at Hospitals and Skilled Nursing Facilities did not Increase

PubMed Central

Grebla, Regina C.; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A.; Rahman, Momotazur; Trivedl, Amal N.

2015-01-01

The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006–10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted. PMID:26240246

Revisiting the cost-effectiveness of universal cervical length screening: importance of progesterone efficacy.

PubMed

Jain, Siddharth; Kilgore, Meredith; Edwards, Rodney K; Owen, John

2016-07-01

Preterm birth (PTB) is a significant cause of neonatal morbidity and mortality. Studies have shown that vaginal progesterone therapy for women diagnosed with shortened cervical length can reduce the risk of PTB. However, published cost-effectiveness analyses of vaginal progesterone for short cervix have not considered an appropriate range of clinically important parameters. To evaluate the cost-effectiveness of universal cervical length screening in women without a history of spontaneous PTB, assuming that all women with shortened cervical length receive progesterone to reduce the likelihood of PTB. A decision analysis model was developed to compare universal screening and no-screening strategies. The primary outcome was the cost-effectiveness ratio of both the strategies, defined as the estimated patient cost per quality-adjusted life-year (QALY) realized by the children. One-way sensitivity analyses were performed by varying progesterone efficacy to prevent PTB. A probabilistic sensitivity analysis was performed to address uncertainties in model parameter estimates. In our base-case analysis, assuming that progesterone reduces the likelihood of PTB by 11%, the incremental cost-effectiveness ratio for screening was $158,000/QALY. Sensitivity analyses show that these results are highly sensitive to the presumed efficacy of progesterone to prevent PTB. In a 1-way sensitivity analysis, screening results in cost-saving if progesterone can reduce PTB by 36%. Additionally, for screening to be cost-effective at WTP=$60,000 in three clinical scenarios, progesterone therapy has to reduce PTB by 60%, 34% and 93%. Screening is never cost-saving in the worst-case scenario or when serial ultrasounds are employed, but could be cost-saving with a two-day hospitalization only if progesterone were 64% effective. Cervical length screening and treatment with progesterone is a not a dominant, cost-effective strategy unless progesterone is more effective than has been suggested by available data for US women. Until future trials demonstrate greater progesterone efficacy, and effectiveness studies confirm a benefit from screening and treatment, the cost-effectiveness of universal cervical length screening in the United States remains questionable. Copyright © 2016 Elsevier Inc. All rights reserved.

[Cloning and expressing of cyclophilin B gene from Schistosoma japonnicum and the analysis of immunoprotective effect].

PubMed

Peng, Jinbiao; Han, Hongxiao; Hong, Yang; Wang, Yan; Guo, Fanji; Shi, Yaojun; Fu, Zhiqiang; Liu, Jinming; Cheng, Guofeng; Lin, Jiaojiao

2010-03-01

The present study was intend to clone and express the cDNA encoding Cyclophilin B (CyPB) of Schistosoma japonicum, its preliminary biological function and further immunoprotective effect against schistosome infection in mice. RT-PCR technique was applied to amplify a full-length cDNA encoding protein Cyclophilin B (Sj CyPB) from schistosomula cDNA. The expression profiles of Sj CyPB were determined by Real-time PCR using the template cDNAs isolated from 7, 13, 18, 23, 32 and 42 days parasites. The cDNA containing the Open Reading Frame of CyPB was then subcloned into a pGEX-6P-1 vector and transformed into competent Escherichia coli BL21 for expressing. The recombinant protein was renaturated, purified and its antigenicity were detected by Western blotting, and the immunoprotective effect induced by recombinant Sj CyPB was evaluated in Balb/C mice. The cDNA containing the ORF of Sj CyPB was cloned with the length of 672 base pairs, encoding 223 amino acids. Real-time PCR analysis revealed that the gene had the highest expression in 18-day schistosomula, suggesting that Sj CyPB was schistosomula differentially expressed gene. The recombinant protein showed a good antigenicity detected by Western blotting. Animal experiment indicated that the vaccination of recombinant CyPB protein in mice led to 31.5% worm and 41.01% liver egg burden reduction, respectively, compared with those of the control. A full-length cDNA differentially expressed in schistosomula was obtained. The recombinant Sj CyPB protein could induce partial protection against schistosome infection.

Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis.

PubMed

de Groot, Jeanny J A; Ament, Stephanie M C; Maessen, José M C; Dejong, Cornelis H C; Kleijnen, Jos M P; Slangen, Brigitte F M

2016-04-01

Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and meta-analysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. Searches were conducted using Embase, Medline, CINAHL, and the Cochrane Library up to 27 June 2014. Reference lists were screened to identify additional studies. Studies were included if at least four individual items of an enhanced recovery pathway were described. Outcomes included length of hospital stay, complication rates, readmissions, and mortality. Quantitative analysis was limited to comparative studies. Effect sizes were presented as relative risks or as mean differences (MD) with 95% confidence intervals (CI). Thirty-one records, involving 16 observational studies, were included. Diversity in reported elements within studies was observed. Preoperative education, early oral intake, and early mobilization were included in all pathways. Five studies, with a high risk of bias, were eligible for quantitative analysis. Enhanced recovery pathways reduced primary (MD -1.57 days, 95% CI CI -2.94 to -0.20) and total (MD -3.05 days, 95% CI -4.87 to -1.23) length of hospital stay compared with traditional perioperative care, without an increase in complications, mortality or readmission rates. The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

The influence of post-acute rehabilitation length of stay on traumatic brain injury outcome: a retrospective exploratory study.

PubMed

Ashley, Jessica G; Ashley, Mark J; Masel, Brent E; Randle, Kevin; Kreber, Lisa A; Singh, Charan; Harrington, David; Griesbach, Grace S

2018-01-01

Data regarding length of stay (LOS) in a rehabilitation programme after traumatic brain injury (TBI) are limited. The goal of this study was to examine the effect of LOS and disability on outcome following TBI. Records from patients in a multidisciplinary rehabilitation programme at least 3 months after TBI were analysed retrospectively to study the influence of LOS on functional outcome at different levels of disability. Functional status was determined by the Mayo-Portland Adaptability Inventory (MPAI) and the Community Integration Questionnaire (CIQ). Patients were further grouped by time since injury of 3-12 months or over 1 year. Those with a mild and moderate disabilities and over 1 year chronicity showed improvements after 90 days of rehabilitation. Patients with a severe disability and over 1 year chronicity required at least 180 days to show improvements. Moderately and severely disabled patients with an injury chronicity of 3-12 months showed improvements in the MPAI after 90 days. However, further improvement was observed after 180 days in the severely disabled group. Results suggest that both, level of disability and injury chronicity, should be considered when determining LOS. Data also show an association between LOS and changes in the MPAI and CIQ.

Preemptive analgesia by using celecoxib combined with tramadol/APAP alleviates post-operative pain of patients undergoing total knee arthroplasty.

PubMed

Xu, Zhongwei; Zhang, Hua; Luo, Jiao; Zhou, Aiguo; Zhang, Jian

2017-09-01

This study was aimed to evaluate the efficacy of preemptive analgesia (PA) by using celecoxib combined with low-dose tramadol/acetaminophen (tramadol/APAP) in treating post-operative pain of patients undergoing unilateral total knee arthroplasty (TKA). A total of 132 patients scheduled for TKA were included in this study. Three-day pre-operative medication was administrated in PA group with subsequent effective intra- and post-operative multimodal analgesia, while control patients received multimodal analgesia without PA. Visual analog scale (VAS) was utilized to assess the pain intensity at rest and during movement. VAS scores of participants were recorded 3 days before surgery, 1 day, 3 days, 1 week, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Moreover, the length of hospital stay, expense of hospitalization, C-reactive protein (CRP) values during hospitalization, and complications during medication were also recorded. PA showed superiority over control at 3 weeks (P = 0.013) and 6 weeks (P = 0.046) in resting pain, and 1 week (P = 0.015), 3 weeks (P = 0.003), 6 weeks (P = 0.003) and 3 months (P = 0.012) postoperatively in movement pain. There was no statistically significant difference in the length of hospital stay, total expense, CRP values, as well as complications. Based on satisfactory intra- and post-operative analgesia, PA by 3-day administration of celecoxib and low-dose tramadol/APAP might be an effective and safe therapy regarding patients undergoing TKA in terms of alleviating post-operative pain.

Measuring sperm whales from their clicks: Stability of interpulse intervals and validation that they indicate whale length

NASA Astrophysics Data System (ADS)

Rhinelander, Marcus Q.; Dawson, Stephen M.

2004-04-01

Multiple pulses can often be distinguished in the clicks of sperm whales (Physeter macrocephalus). Norris and Harvey [in Animal Orientation and Navigation, NASA SP-262 (1972), pp. 397-417] proposed that this results from reflections within the head, and thus that interpulse interval (IPI) is an indicator of head length, and by extrapolation, total length. For this idea to hold, IPIs must be stable within individuals, but differ systematically among individuals of different size. IPI stability was examined in photographically identified individuals recorded repeatedly over different dives, days, and years. IPI variation among dives in a single day and days in a single year was statistically significant, although small in magnitude (it would change total length estimates by <3%). As expected, IPIs varied significantly among individuals. Most individuals showed significant increases in IPIs over several years, suggesting growth. Mean total lengths calculated from published IPI regressions were 13.1 to 16.1 m, longer than photogrammetric estimates of the same whales (12.3 to 15.3 m). These discrepancies probably arise from the paucity of large (12-16 m) whales in data used in published regressions. A new regression is offered for this size range.

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

Xie, J. L.; Shi, X. J.; Xu, J. C., E-mail: xiejinglan@ynao.ac.cn

Based on continuous wavelet transformation analysis, the daily solar mean magnetic field (SMMF) from 1975 May 16 to 2014 July 31 is analyzed to reveal its rotational behavior. Both the recurrent plot in Bartels form and the continuous wavelet transformation analysis show the existence of rotational modulation in the variation of the daily SMMF. The dependence of the rotational cycle lengths on solar cycle phase is also studied, which indicates that the yearly mean rotational cycle lengths generally seem to be longer during the rising phase of solar cycles and shorter during the declining phase. The mean rotational cycle lengthmore » for the rising phase of all of the solar cycles in the considered time is 28.28 ± 0.67 days, while for the declining phase it is 27.32 ± 0.64 days. The difference of the mean rotational cycle lengths between the rising phase and the declining phase is 0.96 days. The periodicity analysis, through the use of an auto-correlation function, indicates that the rotational cycle lengths have a significant period of about 10.1 years. Furthermore, the cross-correlation analysis indicates that there exists a phase difference between the rotational cycle lengths and solar activity.« less

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement.

PubMed

Samuel, Andre M; Webb, Matthew L; Lukasiewicz, Adam M; Basques, Bryce A; Bohl, Daniel D; Varthi, Arya G; Lane, Joseph M; Grauer, Jonathan N

2016-06-01

Medicare currently reimburses hospitals for inpatient admissions with "bundled" payments based on patient Diagnosis-related Groups (DRGs) regardless of true hospital costs. At present, DRG 536 (fractures of the hip and pelvis) includes a broad spectrum of patients with orthopaedic trauma, likely with varying inpatient resource utilization. With the growing incidence of fractures in the elderly, inadequate reimbursements from Medicare for certain patients with DRG 536 may lead to growing financial strain on healthcare institutions caring for these patients with higher costs. The purposes of the study were to determine whether (1) inpatient length of stay; (2) intensive care unit stay; and (3) ventilator time differ among subpopulations with Medicare DRG 536. A total of 56,683 patients, 65 years or older, with fractures of the hip or pelvis were identified in the 2011 and 2012 National Trauma Data Bank. This clinical registry contains data on trauma cases from more than 900 participating trauma centers, allowing analysis of resource utilization in centers across the United States. Patients were grouped in the following subgroups: hip fractures (n = 35,119), nonoperative pelvic fractures (n = 15,506), acetabulum fractures, operative and nonoperative, (n = 7670), and operative pelvic fractures (n = 682). Total inpatient length of stay, intensive care unit (ICU) stay, and ventilator time were compared across groups using multivariate analysis that controlled for hospital factors. After controlling for patient and hospital factors, difference in inpatient length of stay was -0.2 days for patients with nonoperative pelvis fractures compared with inpatient length of stay for patients with hip fractures (95% CI, -0.4 to -0.1 days; p = 0.001); 1.7 days for patient with acetabulum fractures (95% CI, 1.4-1.9 days; p < 0.001); and 7.7 days for patients with operative pelvic fractures (95% CI, 7.0-8.4 days; p < 0.001). The difference in ICU length of stay for patients with nonoperative pelvis fractures was 0.8 days compared with ICU length of stay for patients with hip fractures (95% CI, 0.7-0.9 days; p < 0.001); 1.9 days for patients with acetabulum fractures (95% CI, 1.8-2.1 days; p < 0.001); and 6.3 days for patients with operative pelvic fractures (95% CI, 5.9-6.7 days; p < 0.001). The difference in mechanical ventilation time for patients with nonoperative fractures was 0.5 days compared with ventilation time for patients with hip fractures (95% CI, 0.4-0.6 days; p < 0.001); 1.1 days for patients with acetabulum fractures (95% CI, 1.0-1.2 days; p < 0.001); and 3.9 days for patients with operative fractures (95% CI, 2.5-3.2 days; p < 0.001). In our current multitiered trauma system, certain centers will see higher proportions of patients with acetabulum and operative pelvic fractures. Because hospitals are reimbursed equally for these subgroups of Medicare DRG 536, centers that care for a greater proportion of patients with more-complex pelvic trauma will experience lower financial margins per trauma patient, limiting their potential for growth and investment compared with competing institutions that may not routinely see patients with high-energy trauma. Because of this, we believe reevaluation of this Medicare Prospective Payment System DRG is warranted. Level IV, economic and decision analysis.

[Length of lactational amenorrhea in an urban population of Temuco, Chile].

PubMed

Valdés, Patricio; Sierralta, Pablo; Ossa, Ximena; Barría, Angélica

2002-01-01

Studies done in Santiago, Chile show that menses return before the sixth month of puerperium in 50% of lactating women, even in those that continue with exclusive breast feeding. To study the length of lactational amenorrhea in a group of women living in Southern Chile. One hundred fourteen women giving exclusive breast feeding, were followed from the third postpartum month, to determine the length of lactational amenorrhea. Its relationship with general characteristics of the mothers and children and breast feeding pattern was also studied. Sixty six women (58%) recovered their menses before the 6th postpartum month and their length of lactational amenorrhea was 101 +/- 5 days. In the rest of the sample, the length was 277 +/- 10 days. No differences in characteristics of the mothers and children or breast feeding pattern, were observed between these two groups. A short lactational amenorrhea is common in the Chilean population. Clinical characteristics or pattern of breast feeding do not explain the length of LA in this population.

High-Frequency, Moderate-Intensity Training in Sedentary Middle-Aged Women.

ERIC Educational Resources Information Center

Johannessen, S.; And Others

1986-01-01

The effects of a five-day-a-week, moderate-intensity aerobic training program were studied in previously sedentary middle-aged women. After 10 weeks of graduated-length sessions of continuous exercise, the subjects showed a 20 percent improvement in maximal oxygen uptake but no change in body weight or composition. Results are discussed.…

Reduction in the critical dark length for flower induction during aging in the short-day plant Pharbitis nil var. Kidachi.

PubMed

Hasegawa, Hiroshi; Yamada, Mizuki; Iwase, Yuiko; Wada, Kaede C; Takeno, Kiyotoshi

2010-12-01

The stress-sensitive short-day plant Pharbitis nil var. Kidachi flowers under a 16-h light and 8-h dark regime and non-stress conditions when grown for long periods of time. Such flowering was found to occur from the third week, and the floral buds were formed from the eighth node of the main stem. When young plants were grafted onto aged plants, the scions were induced to flower early. This flower induction by grafting was more effective when older plants were used as rootstocks. Grafting experiments using a single leaf as a donor revealed that younger leaves are more responsive to flower induction, suggesting that this age-mediated flowering response is not induced by aging or senescence of individual leaves. Rather, the plant may obtain the ability to flower as the whole plant ages. Flowering does not occur under continuous light conditions. A night break given in the 8-h dark period inhibits flowering. These results suggest that 8-h dark conditions, which are normally considered to be long-day conditions, actually correspond to short-day conditions for this plant. The 8-h dark conditions caused early flowering more efficiently in older plants. The critical dark length determined by a single treatment was 12 h in 0-week-old plants and was reduced to 6 h in 2- and 4-week-old plants. These results suggest that the critical dark length becomes shorter when plants get older. The expression of PnFT1 and PnFT2, orthologs of the flowering gene flowering locus T, was analyzed by reverse transcription-polymerase chain reaction revealing that the expression of PnFT at the end of dark period is correlated with flowering.

Temporal properties of the myopic response to defocus in the guinea pig.

PubMed

Leotta, Amelia J; Bowrey, Hannah E; Zeng, Guang; McFadden, Sally A

2013-05-01

Hyperopic defocus induces myopia in all species tested and is believed to underlie the progression of human myopia. We determined the temporal properties of the effects of hyperopic defocus in a mammalian eye. In Experiment 1, the rise and decay time of the responses elicited by hyperopic defocus were calculated in 111 guinea pigs by giving repeated episodes of monocular -4 D lens wear (from 5 to 6 days of age for 12 days) interspersed with various dark intervals. In Experiment 2, the decay time constant was calculated in 152 guinea pigs when repeated periods of monocular -5 D lens-wear (from 4 days of age for 7 days) were interrupted with free viewing periods of different lengths. At the end of the lens-wear period, ocular parameters were measured and time constants were calculated relative to the maximum response induced by continuous lens wear. When hyperopic defocus was experienced with dark intervals between episodes, the time required to induce 50% of the maximum achievable myopia and ocular elongation was at most 30 min. Saturated 1 h episodes took at least 22 h for refractive error and 31 h for ocular length, to decay to 50% of the maximum response. However, the decay was an order of magnitude faster when hyperopic defocus episodes were interrupted with a daily free viewing period, with only 36 min required to reduce relative myopia and ocular elongation by 50%. Hyperopic defocus causes myopia with brief exposures and is very long lasting in the absence of competing signals. However, this myopic response rapidly decays if interrupted by periods of 'normal viewing' at least 30 min in length, wherein ocular growth appears to be guided preferentially by the least amount of hyperopic defocus experienced. Ophthalmic & Physiological Optics © 2013 The College of Optometrists.

Variation in the flowering gene SELF PRUNING 5G promotes day-neutrality and early yield in tomato.

PubMed

Soyk, Sebastian; Müller, Niels A; Park, Soon Ju; Schmalenbach, Inga; Jiang, Ke; Hayama, Ryosuke; Zhang, Lei; Van Eck, Joyce; Jiménez-Gómez, José M; Lippman, Zachary B

2017-01-01

Plants evolved so that their flowering is triggered by seasonal changes in day length. However, day-length sensitivity in crops limits their geographical range of cultivation, and thus modification of the photoperiod response was critical for their domestication. Here we show that loss of day-length-sensitive flowering in tomato was driven by the florigen paralog and flowering repressor SELF-PRUNING 5G (SP5G). SP5G expression is induced to high levels during long days in wild species, but not in cultivated tomato because of cis-regulatory variation. CRISPR/Cas9-engineered mutations in SP5G cause rapid flowering and enhance the compact determinate growth habit of field tomatoes, resulting in a quick burst of flower production that translates to an early yield. Our findings suggest that pre-existing variation in SP5G facilitated the expansion of cultivated tomato beyond its origin near the equator in South America, and they provide a compelling demonstration of the power of gene editing to rapidly improve yield traits in crop breeding.

The Benefit of Modified Rehabilitation and Minimally Invasive Techniques in Total Hip Replacement

PubMed Central

Lilikakis, Anastasios K; Gillespie, Beryl; Villar, Richard N

2008-01-01

INTRODUCTION We wished to assess if an intensive rehabilitation regimen alone, or one combined with modified anaesthetic and surgical techniques, can change the speed of rehabilitation or the length of hospital stay after total hip replacement. PATIENTS AND METHODS We compared 44 patients who had followed a traditional care pathway, with 38 patients who had rehabilitated under a new rehabilitation protocol, with 40 patients who had also received modified, minimally invasive techniques. The speed of rehabilitation was measured in terms of three specific milestones accomplished on the day after surgery. RESULTS We found a statistically significant improvement in the day after surgery each activity was possible. The length of hospital stay was reduced from 6.5 days to 5.4 days to 4.1 days, a difference which was also statistically significant. CONCLUSIONS The data support the view that a new rehabilitation protocol alone can reduce the length of hospital stay and hasten rehabilitation. The combination of modified anaesthetic and minimally invasive surgical techniques with the new rehabilitation regimen can further improve short-term outcome after total hip replacement. PMID:18634739

Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients.

PubMed

Auxiliadora-Martins, M; Menegueti, M G; Nicolini, E A; Alkmim-Teixeira, G C; Bellissimo-Rodrigues, F; Martins-Filho, O A; Basile-Filho, A

2012-12-01

Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population.

Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients

PubMed Central

Auxiliadora-Martins, M.; Menegueti, M.G.; Nicolini, E.A.; Alkmim-Teixeira, G.C.; Bellissimo-Rodrigues, F.; Martins-Filho, O.A.; Basile-Filho, A.

2012-01-01

Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population. PMID:23044627

Utility of High Temporal Resolution Observations for Heat Health Event Characterization

NASA Astrophysics Data System (ADS)

Palecki, M. A.

2017-12-01

Many heat health watch systems produce a binary on/off warning when conditions are predicted to exceed a given threshold during a day. Days with warnings and their mortality/morbidity statistics are analyzed relative to days not warned to determine the impacts of the event on human health, the effectiveness of warnings, and other statistics. The climate analyses of the heat waves or extreme temperature events are often performed with hourly or daily observations of air temperature, humidity, and other measured or derived variables, especially the maxima and minima of these data. However, since the beginning of the century, 5-minute observations are readily available for many weather and climate stations in the United States. NOAA National Centers for Environmental Information (NCEI) has been collecting 5-minute observations from the NOAA Automated Surface Observing System (ASOS) stations since 2000, and from the U.S. Climate Reference Network (USCRN) stations since 2005. This presentation will demonstrate the efficacy of utilizing 5-minute environmental observations to characterize heat waves by counting the length of time conditions exceed extreme thresholds based on individual and multiple variables and on derived variables such as the heat index. The length and depth of recovery periods between daytime heating periods will also be examined. The length of time under extreme conditions will influence health outcomes for those directly exposed. Longer periods of dangerous conditions also could increase the chances for poor health outcomes for those only exposed intermittently through cumulative impacts.

A randomized controlled trial comparing periodic mask CPAP with physiotherapy after abdominal surgery.

PubMed

Denehy, L; Carroll, S; Ntoumenopoulos, G; Jenkins, S

2001-01-01

Physiotherapists use a variety of techniques aimed at improving lung volumes and secretion clearance in patients after surgery. Periodic continuous positive airway pressure (PCPAP) is used to treat patients following elective upper abdominal surgery. However, the optimal method of application has not been identified, more specifically, the dosage of application of PCPAP. The present randomized controlled trial compared the effects of two dosages of PCPAP application and 'traditional' physiotherapy upon functional residual capacity (FRC), vital capacity (VC), oxyhaemoglobin saturation (SpO2), incidence of post-operative pulmonary complications and length of stay with a control group receiving 'traditional' physiotherapy only. Fifty-seven subjects were randomly allocated to one of three groups. All groups received 'traditional' physiotherapy twice daily for a minimum of three post-operative days. In addition, two groups received PCPAP for 15 or 30 minutes, four times per day, for three days. Fifty subjects (39 male; 11 female) completed the study. There were no significant differences in any variables between the three groups. The overall incidence of post-operative pulmonary complications was 22% in the control group, 11% and 6% in the PCPAP 15-minute and PCPAP 30-minute groups, respectively. Length of hospital stay was not significantly different between the groups but for subjects who developed post-operative pulmonary complications, the length of stay was significantly greater (Z = -2.32; p = 0.021). The addition of PCPAP to a traditional physiotherapy post-operative treatment regimen after upper abdominal surgery did not significantly affect physiological or clinical outcomes.

Length of psychiatric hospitalization is correlated with CYP2D6 functional status in inpatients with major depressive disorder

PubMed Central

Ruaño, Gualberto; Szarek, Bonnie L; Villagra, David; Gorowski, Krystyna; Kocherla, Mohan; Seip, Richard L; Goethe, John W; Schwartz, Harold I

2016-01-01

Aim This study aimed to determine the effect of the CYP2D6 genotype on the length of hospitalization stay for patients treated for major depressive disorder. Methods A total of 149 inpatients with a diagnosis of major depressive disorder at the Institute of Living, Hartford Hospital (CT, USA), were genotyped to detect altered alleles in the CYP2D6 gene. Prospectively defined drug metabolism indices (metabolic reserve, metabolic alteration and allele alteration) were determined quantitatively and assessed for their relationship to length of hospitalization stay. Results Hospital stay was significantly longer in deficient CYP2D6 metabolizers (metabolic reserve <2) compared with functional or suprafunctional metabolizers (metabolic reserve ≥2; 7.8 vs 5.7 days, respectively; p = 0.002). Conclusion CYP2D6 enzymatic functional status significantly affected length of hospital stay, perhaps due to reduced efficacy or increased side effects of the medications metabolized by the CYP2D6 isoenzyme. Functional scoring of CYP2D6 alleles may have a substantial impact on the quality of care, patient satisfaction and the economics of psychiatric treatment. PMID:23734807

Reducing pre-operative length of stay for enterocutaneous fistula repair with a multi-disciplinary approach.

PubMed

Chamberlain, Mark; Dwyer, Rebecca

2015-01-01

Pre-operative assessment of complex surgical patients can be a lengthy process, albeit essential to minimise complication rates. In a tertiary referral unit specialising in the surgical repair of entercutaneous fistulas, a baseline audit revealed an average in-patient length of stay of 30.1 days, mainly caused by poor co-ordination between specialities. After the introduction of a weekly multi-disciplinary team meeting and the formalisation of a patient pathway, this admission length was reduced to 5.7 days (p<0.01), resulting in significant savings to the department.

Effects of temperature and diet on length-weight relationship and condition factor of the juvenile Malabar blood snapper (Lutjanus malabaricus Bloch & Schneider, 1801).

PubMed

Mazumder, Sabuj Kanti; Das, Simon Kumar; Bakar, Yosni; Ghaffar, Mazlan Abd

2016-08-01

In this study we aimed to analyze the effects of water temperature and diet on the length-weight relationship and condition of juvenile Malabar blood snapper Lutjanus malabaricus over a 30-d experimental period. The experiment was conducted in the laboratory using a flow-through-sea-water system. The fish were subjected to four different temperatures (22, 26, 30, and 34 °C) and two diets (commercial pellet and natural shrimp). Fish were fed twice daily. L. malabaricus exhibited negative allometric growth (b<3) at the beginning of the experiment (Day 0) at all temperatures and both diets except for 22 °C fed with shrimp, which showed isometric growth (b=3). Conversely, at the end of the experiment (Day 30) fish showed isometric growth (b=3) at 30 °C fed with the pellet diet, indicating that the shape of the fish did not change with increasing weight and length, and a positive allometric growth (b>3) at 30 °C fed with shrimp diet, which indicated that fish weight increases faster than their length. The rest of the temperatures represented negative allometric growth (b<3) on both diet, meaning that fish became lighter with increasing size. The condition factors in the initial and final measurements were greater than 1, indicating the state of health of the fish, except for those fed on a pellet diet at 34 °C. However, the best condition was obtained at 30 °C on both diets. Nevertheless, diets did not have a significant effect on growth and condition of juvenile L. malabaricus. The data obtained from this study suggested culturing L. malabaricus at 30 °C and feeding on the pellet or shrimp diet, which will optimize the overall production and condition of this commercially important fish species.

Protective Effect of Daikenchuto on Dextran Sulfate Sodium-Induced Colitis in Mice

PubMed Central

Matsunaga, Takaharu; Yamamoto, Naoki; Kawasato, Ryo; Shirasawa, Tomohiro; Goto, Atsushi; Fujisawa, Koichi; Takami, Taro; Okamoto, Takeshi; Nishikawa, Jun; Sakaida, Isao

2017-01-01

Aim. To investigate the effect of daikenchuto (TJ-100; DKT) for ulcerative colitis (UC) model mouse and assess its anti-inflammatory mechanisms. Methods. We evaluated the effects of DKT on dextran sulfate sodium- (DSS-) induced experimental colitis. First, we assessed the short-term effects of DKT using two groups: 5% DSS group and 5% DSS with DKT group. Colon length; histological scores; and interleukin- (IL-) 10, IL-1β, and tumor necrosis factor-α mRNA expression profiles were analyzed using real-time PCR. Second, we assessed the long-term effects of DKT, by comparing survival time between 2% DSS and 2% DSS with DKT groups. Results. After 7 days, the colon lengths of DSS + DKT group were longer than those of the DSS group (mean values: 6.11 versus 5.69 cm, p < 0.05). Furthermore, compared to DSS group, the DSS + DKT group maintained significantly higher levels of serum hemoglobin (13.1 versus 10.7 g/dL, p < 0.05) and exhibited significantly higher expression levels of IL-10 (p < 0.05). The 2% DSS + DKT group exhibited significantly longer survival time than the 2% DSS group (70 versus 44 days, p < 0.01). Conclusion. Our results indicate that DKT prevented inflammation in the colon, indicating its potential as a new therapeutic agent for UC. PMID:28210268

Protective Effect of Daikenchuto on Dextran Sulfate Sodium-Induced Colitis in Mice.

PubMed

Matsunaga, Takaharu; Hashimoto, Shinichi; Yamamoto, Naoki; Kawasato, Ryo; Shirasawa, Tomohiro; Goto, Atsushi; Fujisawa, Koichi; Takami, Taro; Okamoto, Takeshi; Nishikawa, Jun; Sakaida, Isao

2017-01-01

Aim . To investigate the effect of daikenchuto (TJ-100; DKT) for ulcerative colitis (UC) model mouse and assess its anti-inflammatory mechanisms. Methods . We evaluated the effects of DKT on dextran sulfate sodium- (DSS-) induced experimental colitis. First, we assessed the short-term effects of DKT using two groups: 5% DSS group and 5% DSS with DKT group. Colon length; histological scores; and interleukin- (IL-) 10, IL-1 β , and tumor necrosis factor- α mRNA expression profiles were analyzed using real-time PCR. Second, we assessed the long-term effects of DKT, by comparing survival time between 2% DSS and 2% DSS with DKT groups. Results . After 7 days, the colon lengths of DSS + DKT group were longer than those of the DSS group (mean values: 6.11 versus 5.69 cm, p < 0.05). Furthermore, compared to DSS group, the DSS + DKT group maintained significantly higher levels of serum hemoglobin (13.1 versus 10.7 g/dL, p < 0.05) and exhibited significantly higher expression levels of IL-10 ( p < 0.05). The 2% DSS + DKT group exhibited significantly longer survival time than the 2% DSS group (70 versus 44 days, p < 0.01). Conclusion . Our results indicate that DKT prevented inflammation in the colon, indicating its potential as a new therapeutic agent for UC.

[The influence of vibration training in combination with general magnetotherapy on dynamics of performance efficiency in athletes].

PubMed

Mikheev, A A; Volchkova, O A; Voronitskiĭ, N E

2010-01-01

The objective of this study was to evaluate effects of a combined treatment including vibrostimulation and magnetotherapy on the working capacity of athletes. Participants of the study were 8 male judo wrestlers. It was shown that implementation of a specialized training program comprising seances of vibration loading and general magnetotherapy 40 and 60 min in duration respectively during 3 consecutive days produced marked beneficial effect on the hormonal status of the athletes. Specifically, the three-day long treatment resulted in a significant increase of blood cortisol and testosterone levels considered to be an objective sign of improved performance parameters in athletes engaged in strength and speed sports. The optimal length of vibration training during 3 days of specialized training is estimated at 20 to 40 minutes supplemented by general magnetotherapy for 60 minutes.

[Response of indica rice spikelet differentiation and degeneration to air temperature and solar radiation of different sowing dates].

PubMed

Wang, Ya Liang; Zhang, Yu Ping; Xiang, Jing; Wang, Lei; Chen, Hui Zhe; Zhang, Yi Kai; Zhang, Wen Qian; Zhu, De Feng

2017-11-01

In this study, three rice varieties, including three-line hybrid indica rice Wuyou308 and Tianyouhuazhan, and inbred indica rice Huanghuazhan were used to investigate the effects of air temperature and solar radiation on rice growth duration and spikelet differentiation and degeneration. Ten sowing-date treatments were conducted in this field experiment. The results showed that the growth duration of three indica rice varieties were more sensitive to air temperature than to day-length. With average temperature increase of 1 ℃, panicle initiation advanced 1.5 days, but the panicle growth duration had no significant correlation with the temperature and day-length. The number of spikelets and differentiated spikelets revealed significant differences among different sowing dates. Increases in average temperature, maximum temperature, minimum temperature, effective accumulated temperature, temperature gap and the solar radiation benefited dry matter accumulation and spikelet differentiation of all varieties. With increases of effective accumulated temperature, diurnal temperature gap and solar radiation by 50 ℃, 1 ℃, 50 MJ·m -2 during panicle initiation stage, the number of differentiated spikelets increased 10.5, 14.3, 17.1 respectively. The rate of degenerated spikelets had a quadratic correlation with air temperature, extreme high and low temperature aggravated spikelets degeneration, and low temperature stress made worse effect than high temperature stress. The rate of spikelet degeneration dramatically rose with the temperature falling below the critical temperature, the critical effective accumulated temperature, daily average temperature, daily maximum temperature and minimum temperature during panicle initiation were 550-600 ℃, 24.0-26.0 ℃, 32.0-34.0 ℃, 21.0-23.0 ℃, respectively. In practice, the natural condition of appropriate high temperature, large diurnal temperature gap and strong solar radiation were conducive to spikelet differentiation, and hindered the spikelet degeneration.

Length of stay and hospital costs associated with a pharmacodynamic-based clinical pathway for empiric antibiotic choice for ventilator-associated pneumonia.

PubMed

Nicasio, Anthony M; Eagye, Kathryn J; Kuti, Effie L; Nicolau, David P; Kuti, Joseph L

2010-05-01

To determine hospital costs associated with the use of a clinical pathway implemented in our intensive care units (ICUs) to optimize antibiotic regimen selection for patients with ventilator-associated pneumonia (VAP) compared with costs in a historical control group treated according to prescriber preference. Retrospective cost analysis from the hospital perspective. Single, tertiary-care medical center. One hundred sixty-six adults with VAP from the medical, surgical, and neurotrauma ICUs (73 historical control patients [2004-2005] and 93 patients given an empiric antibiotic clinical pathway for VAP [2006-2007]). The VAP clinical pathway consisted of an ICU-specific three-drug regimen that considered local minimum inhibitory concentration distributions and a pharmacodynamically optimized dosing strategy. Hospital cost data were collected and inflated to 2007 according to the consumer price index. The VAP-related length of treatment, hospitalization costs, and antibiotic costs were compared between groups. The median VAP length of treatment was 24 days (interquartile range [IQR] 13-35 days] and 11 days (IQR 7-17 days) for historical and clinical pathway groups, respectively (p<0.001). Daily hospital costs were similar for both cohorts over the first 7 days, after which costs declined significantly for patients treated with the clinical pathway (p<0.001). When controlling for baseline differences between groups and length of stay before development of VAP, patients treated with the clinical pathway had shorter lengths of ICU stay after VAP, shorter total hospital lengths of stay after VAP, and lower hospital costs after the treatment of VAP. Median total antibiotic costs for individual patients were similar between groups ($535 [IQR $261-998] vs $482 [IQR $222-985] clinical pathway vs control, p=0.45), and the proportion of VAP hospital resources consumed by antibiotics for both groups was low. Although aggressive dosing of more costly antibiotics was empirically prescribed using the clinical pathway, patients in this group exhibited a shorter duration of treatment, reduced hospital length of stay after VAP, and lower hospital costs without any significant increase in antibiotic expenditures.

A multicenter, randomized, controlled trial of osteopathic manipulative treatment on preterms.

PubMed

Cerritelli, Francesco; Pizzolorusso, Gianfranco; Renzetti, Cinzia; Cozzolino, Vincenzo; D'Orazio, Marianna; Lupacchini, Mariacristina; Marinelli, Benedetta; Accorsi, Alessandro; Lucci, Chiara; Lancellotti, Jenny; Ballabio, Silvia; Castelli, Carola; Molteni, Daniela; Besana, Roberto; Tubaldi, Lucia; Perri, Francesco Paolo; Fusilli, Paola; D'Incecco, Carmine; Barlafante, Gina

2015-01-01

Despite some preliminary evidence, it is still largely unknown whether osteopathic manipulative treatment improves preterm clinical outcomes. The present multi-center randomized single blind parallel group clinical trial enrolled newborns who met the criteria for gestational age between 29 and 37 weeks, without any congenital complication from 3 different public neonatal intensive care units. Preterm infants were randomly assigned to usual prenatal care (control group) or osteopathic manipulative treatment (study group). The primary outcome was the mean difference in length of hospital stay between groups. A total of 695 newborns were randomly assigned to either the study group (n= 352) or the control group (n=343). A statistical significant difference was observed between the two groups for the primary outcome (13.8 and 17.5 days for the study and control group respectively, p<0.001, effect size: 0.31). Multivariate analysis showed a reduction of the length of stay of 3.9 days (95% CI -5.5 to -2.3, p<0.001). Furthermore, there were significant reductions with treatment as compared to usual care in cost (difference between study and control group: 1,586.01€; 95% CI 1,087.18 to 6,277.28; p<0.001) but not in daily weight gain. There were no complications associated to the intervention. Osteopathic treatment reduced significantly the number of days of hospitalization and is cost-effective on a large cohort of preterm infants.

Effect of Enteral Nutrition and Synbiotics on Bacterial Infection Rates After Pylorus-preserving Pancreatoduodenectomy

PubMed Central

Rayes, Nada; Seehofer, Daniel; Theruvath, Tom; Mogl, Martina; Langrehr, Jan M.; Nüssler, Natascha C.; Bengmark, Stig; Neuhaus, Peter

2007-01-01

Objective: Patients undergoing pancreas resection carry several risk factors for nosocomial bacterial infections. Pre- and probiotics (synbiotics) are potentially useful for prevention of these infections. Summary Background Data: First trials in patients following major abdominal surgery including liver transplantation using one Lactobacillus (LAB) and one fiber showed significant reduction of infection rates and reduced length of antibiotic therapy compared with a control group. The present study was designed to analyze whether a combination of different LAB and fibers would further improve outcome. Methods: A prospective randomized monocentric double-blind trial was undertaken in 80 patients following pylorus-preserving pancreatoduodenectomy (PPPD). All patients received enteral nutrition immediately postoperatively. One group (A) received a composition of 4 LAB and 4 fibers, and another group (B) received placebo (fibers only) starting the day before surgery and continuing for 8 days. Thirty-day infection rate, length of hospital stay, duration of antibiotic therapy, noninfectious complications, and side effects were recorded. Results: The incidence of postoperative bacterial infections was significantly lower with LAB and fibers (12.5%) than with fibers only (40%). In addition, the duration of antibiotic therapy was significantly shorter in the latter group. Fibers and LAB were well tolerated. Conclusion: Early enteral nutrition supplemented with a mixture of LAB and fibers reduces bacterial infection rates and antibiotic therapy following PPPD. PMID:17592288

The relationship between telomere length and beekeeping among Malaysians.

PubMed

Nasir, Nurul Fatihah Mohamad; Kannan, Thirumulu Ponnuraj; Sulaiman, Siti Amrah; Shamsuddin, Shaharum; Azlina, Ahmad; Stangaciu, Stefan

2015-06-01

The belief that beekeepers live longer than anyone else is present since ages. However, no research has been done to explore the longevity of life in beekeepers. Here, we investigated the telomere length in 30 male beekeepers and 30 male non-beekeepers and associated them with the longevity of life using Southern analysis of terminal restriction fragments (TRFs) generated by Hinf I/Rsa I digestion of human genomic DNA using TeloTAGGG Telomere Length Assay. Interestingly, we found that the telomere length of male beekeepers was significantly longer than those of male non-beekeepers with a p value of less than 0.05, suggesting that beekeepers may have longer life compared to non-beekeepers. We further found that the consumption of bee products for a long period and frequent consumption of bee products per day are associated with telomere length. An increase of year in consuming bee products is associated with a mean increase in telomere length of 0.258 kbp. In addition, an increase in frequency of eating bee products per day was also associated with a mean increase of 2.66 kbp in telomere length. These results suggested that bee products might play some roles in telomere length maintenance.

Saccharomyces boulardii CNCM I-745 reduces the duration of diarrhoea, length of emergency care and hospital stay in children with acute diarrhoea.

PubMed

Dinleyici, E C; Kara, A; Dalgic, N; Kurugol, Z; Arica, V; Metin, O; Temur, E; Turel, O; Guven, S; Yasa, O; Bulut, S; Tanir, G; Yazar, A S; Karbuz, A; Sancar, M; Erguven, M; Akca, G; Eren, M; Ozen, M; Vandenplas, Y

2015-01-01

Evidence from the literature has shown that Saccharomyces boulardii provides a clinically significant benefit in the treatment of acute infectious diarrhoea in children. In this multicentre, randomised, prospective, controlled, single blind clinical trial performed in children with acute watery diarrhoea, we aimed to evaluate the impact of S. boulardii CNCM I-745 in hospitalised children, in children requiring emergency care unit (ECU) stay and in outpatient settings. The primary endpoint was the duration of diarrhoea (in hours). Secondary outcome measures were duration of hospitalisation and diarrhoea at the 3(rd) day of intervention. In the whole study group (363 children), the duration of diarrhoea was approximately 24 h shorter in the S. boulardii group (75.4±33.1 vs 99.8±32.5 h, P<0.001). The effect of S. boulardii (diarrhoea-free children) was observed starting at 48 h. After 72 h, only 27.3% of the children receiving probiotic still had watery diarrhoea, in contrast to 48.5% in the control group (P<0.001). The duration of diarrhoea was significantly reduced in the probiotic group in hospital, ECU and outpatient settings (P<0.001, P<0.01 and P<0.001, respectively). The percentage of diarrhoea-free children was significantly larger after 48 and 72 h in all settings. The mean length of hospital stay was shorter with more than 36 h difference in the S. boulardii group (4.60±1.72 vs 6.12±1.71 days, P<0.001). The mean length of ECU stay was shorter with more than 19 h difference in the probiotic group (1.20±0.4 vs 2.0±0.3 days, P<0.001). No adverse effects related to the probiotic were noted. Because treatment can shorten the duration of diarrhoea and reduce the length of ECU and hospital stay, there is likely a social and economic benefit of S. boulardii CNCM I-745 in adjunction to oral rehydration solution in acute infectious gastroenteritis in children.

Comparison of Birth-and Conception-Based Definitions of Postnatal Age in Developmental and Reproductive Rodent Toxicity Studies: lnfluence of Gestation Length on Measurements of Offspring Body Weight and Puberty in Controls

EPA Science Inventory

Most laboratories conducting developmental and reproductive toxicity studies in rodents assign age by defining postnatal day (PND) 0 or 1 as the day of birth (DOB); i.e., gestation length affects PND and the timing of postnatal measurements. Some laboratories, however, define age...

FTY720-loaded poly(DL-lactide-co-glycolide) electrospun scaffold significantly increases microvessel density over 7 days in streptozotocin-induced diabetic C57b16/J mice: preliminary results.

PubMed

Bowers, D T; Chhabra, P; Langman, L; Botchwey, E A; Brayman, K L

2011-11-01

Nanofiber scaffolds could improve islet transplant success by physically mimicking the shape of extracellular matrix and by acting as a drug-delivery vehicle. Scaffolds implanted in alternate transplant sites must be prevascularized or very quickly vascularized following transplantation to prevent hypoxia-induced islet necrosis. The local release of the S1P prodrug FTY720 induces diameter enlargement and increases in length density. The objective of this preliminary study was to evaluate length and diameter differences between diabetic and nondiabetic animals implanted with FTY720-containing electrospun scaffolds using intravital imaging of dorsal skinfold window chambers. Electrospun mats of randomly oriented fibers we created from polymer solutions of PLAGA (50:50 LA:GA) with and without FTY720 loaded at a ratio of 1:200 (FTY720:PLAGA by wt). The implanted fiber mats were 4 mm in diameter and ∼0.2 mm thick. Increases in length density and vessel diameter were assessed by automated analysis of images over 7 days in RAVE, a Matlab program. Image analysis of repeated measures of microvessel metrics demonstrated a significant increase in the length density from day 0 to day 7 in the moderately diabetic animals of this preliminary study (P < .05). Furthermore, significant differences in length density at day 0 and day 3 were found between recently STZ-induced moderately diabetic and nondiabetic animals in response to FTY720 local release (P < .05, Student t test). Driving the islet revascularization process using local release of factors, such as FTY720, from biodegradable polymers makes an attractive system for the improvement of islet transplant success. Preliminary study results suggest that a recently induced moderately diabetic state may potentiate the mechanism by which local release of FTY720 from polymer fibers increases length density of microvessels. Therefore, local release of S1P receptor-targeted drugs is under further investigation for improvement of transplanted islet function. Copyright © 2011. Published by Elsevier Inc.

Effect of Lepidium meyenii (maca) roots on spermatogenesis of male rats.

PubMed

Gonzales, G F; Ruiz, A; Gonzales, C; Villegas, L; Cordova, A

2001-09-01

To determine the effect of oral administration of an aqueous extract from the roots of Lepidium meyenii (maca) on spermatogenesis in adult male rats. Male rats received an aqueous extract of the root (66.7 mg in one mL) twice a day for 14 consecutive days. Treatment with Lepidium meyenii resulted in an increase in the weights of testis and epididymis but not the seminal vesicle weight. The length and frequency of stages IX-XIV seminiferous tubules, where mitosis occurred, were increased and stages I-VI were reduced in rats treated with Lepidium meyenii. The Lepidium meyenii root invigorates spermatogenesis in male rats by acting on its initial stages (IX-XIV).

Impact of chemotherapy on telomere-length in sporadic and familial breast cancer patients

PubMed Central

Benitez-Buelga, C.; Sanchez-Barroso, L.; Gallardo, M.; Apellániz-Ruiz, María; Inglada-Pérez, L.; Yanowski, K.; Carrillo, J.; Garcia-Estevez, L.; Calvo, I.; Perona, R.; Urioste, M.; Osorio, A.; Blasco, MA.; Rodriguez-Antona, C.; Benitez, J.

2015-01-01

Purpose Recently, we observed that telomeres of BRCA1/2 mutation carriers were shorter than those of controls or sporadic breast cancer patients, suggesting that mutations in these genes might be responsible for this event. Given the contradictory results reported in the literature, we tested whether other parameters, such as chemotherapy, could be modifying telomere-length. Methods We performed a cross-sectional study measuring leukocyte telomere-length of 266 sporadic breasts cancer patients treated with first-line chemotherapy, with a median follow up of 240 days. Additionally, we performed both cross-sectional and longitudinal studies in a series of 236 familial breast cancer patients that included affected and non-affected BRCA1/2 mutation carriers. We have measured in leukocytes from peripheral blood: The telomere-length, percentage of short telomeres (<3Kb), telomerase activity levels and the annual telomere shortening speed. Results In sporadic cases we found that chemotherapy exerts a transient telomere shortening effect (around 2 years) that varies depending on the drug combination. In familial cases, only patients receiving treatment were associated with telomere shortening but they recovered normal telomere-length after a period of two years. Conclusion Chemotherapy affects telomere-length and should be considered in the studies that correlate telomere-length with disease susceptibility. PMID:25528024

ON-Q infusion pump linked to increased hospital stay after total knee arthroplasty.

PubMed

O'Neil, Stephen; Danielson, Kristopher; Johnson, Kory; Matelic, Thomas

2018-06-01

The purpose of this study was to evaluate immediate postoperative pain control modalities after total knee arthroplasty at the author's specific institution and compare those modalities with patient satisfaction, rehabilitation status, and length of hospital stay. A retrospective chart review of 101 patients who underwent total knee arthroplasty from 2013 to 2016 was performed. Data was collected including the pain control modality, total pain medication consumption, physical therapy progress, length of hospital stay and Visual Analog Scores. Analysis was then performed using SAS proprietary software. Results were reported as statistically significant if p value was less than 0.05. Multiple variables proved to be statistically significant (p value <0.05) in this particular study. Patients who received Valium required more morphine equivalents on average and reported higher Visual Analog Scores (VAS). For those patients who received a lower extremity nerve block pre operatively, there was a decrease in morphine equivalents on postoperative day one and lower VAS. For those patients who received the continuous pain pump, ON-Q postoperatively, there was an average increase in length of hospital stay by one day and a decrease in ambulation on postoperative day one. Also, females required less overall pain medication on postoperative days two and three compared to their male counterparts. Finally, there was no statistically significant difference for those patients who received Lyrica (pregabalin) or NSAIDS for the parameters that were measured in this study. Postoperative pain control modalities after total knee arthroplasty are highly variable among physicians. This variability has allowed researchers to review each modality and compare and contrast the benefits with the potential adverse effects of these medications on total knee replacement outcomes. The data in this study suggests that the use of Valium is correlated with increased pain medication consumption and decreased patient satisfaction. Data from this study also reveals that patients who underwent preoperative nerve blocks experienced decreased pain on postoperative day one and greater patient satisfaction. The most notable contribution of this study was the discovery of the adverse effects of the continuous pain pump, ON-Q. Patients treated with this modality had decreased ambulation on postoperative day one and on average remained in the hospital one extra day, a variable that significantly increases the cost of a total knee arthroplasty for the hospital, the surgeon and the patient. Even though this data is significant, further studies should be performed to enhance our knowledge of postoperative pain control for these patients.

Randomised clinical trial: prucalopride, a colonic pro-motility agent, reduces the duration of post-operative ileus after elective gastrointestinal surgery.

PubMed

Gong, J; Xie, Z; Zhang, T; Gu, L; Yao, W; Guo, Z; Li, Y; Lu, N; Zhu, W; Li, N; Li, J

2016-04-01

Previous studies have shown that recovery of colonic transit is a major determinant of post-operative ileus and clinical recovery after gastrointestinal surgery. Prucalopride is a highly selective 5-hydroxytryptamine receptor-4 agonist with colonic pro-motility effects. To evaluate the effect and safety of prucalopride on post-operative ileus and surgical outcomes after elective gastrointestinal surgery. In this phase II randomised clinical trial, 110 patients undergoing elective gastrointestinal surgery were randomised to either oral prucalopride (2 mg/day) (n = 55) or placebo (n = 55). Intervention was started 24 h after surgery and stopped after defecation or maximally at 7 days. The primary outcome was time to defecation. Secondary outcomes included time to first passage of flatus, tolerance of solid food, nasogastric tube reinsertion, post-operative length of stay, hospital readmission, overall cost, time to walk independently, surgical complications and inflammatory parameters. Patients who received prucalopride had a shorter time to defecation (65.0 vs. 94.5 h, P = 0.001), passage of flatus (53.0 vs. 73.0 h, P < 0.001), and post-operative length of stay (7.0 vs. 8.0 days, P = 0.001) than controls. The number of patients with prolonged ileus (>5 days) (16.4% vs. 34.5%, P = 0.026) and the C-reactive protein level on post-operative day 5 (35.67 vs. 59.07 mg/L, P = 0.040) were lower in the prucalopride group. There was no significant difference in post-operative Clavien-Dindo grade III and IV complications (P = 0.606) between the groups. Prucalopride is a safe and effective treatment to reduce post-operative ileus and systemic inflammation without affecting post-operative complications in patients undergoing elective gastrointestinal surgery. ClinicalTrials.gov: NCT02004652. © 2016 John Wiley & Sons Ltd.

Growth of the conceptus from day 33 to 45 of pregnancy is minimally associated with concurrent hormonal or metabolic status in postpartum dairy cows.

PubMed

Stratman, T J; Moore, S G; Lamberson, W R; Keisler, D H; Poock, S E; Lucy, M C

2016-05-01

A hypothetical explanation for pregnancy loss in postpartum dairy cows is that the metabolic environment of the cow inhibits the growth of the conceptus and places the pregnancy at risk for loss. The objective of the current study, therefore, was to model the association between cow-level metabolic indicators and conceptus growth during early pregnancy (day 33-45 after AI) and to determine if an association (if present) is large enough to cause pregnancy loss. Metabolic indicators included milk production, changes in body weight and body condition score, parity, and concentrations of circulating hormones and metabolites (glucose, non-esterified fatty acids, growth hormone, IGF1, progesterone, and pregnancy-associated glycoproteins). One-hundred cows were enrolled. Cows that became pregnant with single conceptus pregnancies (n=53) weighed more (P<0.007) and had fewer uterine polymorphonuclear neutrophils (uterine health indicator; P<0.051) compared with cows that failed to become pregnant. The embryo and amniotic vesicle were measured by using ultrasound on day 33, 35, 38, 40, 42, and 45 of pregnancy. Most of the cow-level indicators that were included in the model of conceptus growth failed to achieve statistical significance. Day of pregnancy had the largest effect on conceptus growth (size and cross-sectional area of the embryo and amniotic vesicle; P<0.001). There were effects of sex of fetus (male fetuses larger than female), insulin (negative association), and body weigh change (positive association) on embryo length and cross-sectional area but these effects were small when compared with the range in conceptus length or area that we observed. The conclusion was that the capacity of the cow to become pregnant was associated with body weight and uterine health but we failed to find a large association with metabolic status on conceptus growth from day 33 to 45 of pregnancy in lactating dairy cows. Copyright © 2016 Elsevier B.V. All rights reserved.

[Determination of the mean length-of-service and mean daily exposure to lead of workers in battery manufacture].

PubMed

Stamova, N; Gŭlŭbova, V; Aleksieva, Ts

1986-01-01

The determination of the occupational risk at the working places by only comparing the lead concentrations determined in the air of the working environment and MAC is not sufficiently complete, if consideration is not given to the length of service of the workers in contact with that metal. The determination of the mean daily exposure is of great significance in that case as well as the number of the days during which the workers had been exposed to the noxious effect of lead. That is why, the application of the method of A. Kovacev et al., allowed the determination of the mean-length-of-service and mean daily exposure to lead of the workers from some leading occupations from an accumulator plant, being the base for prognostication of the personal risk number and the allowable length of service for the newly come to work workers in the respective accumulator production.

Variability and trends in dry day frequency and dry event length in the southwestern United States

USGS Publications Warehouse

McCabe, Gregory J.; Legates, David R.; Lins, Harry F.

2010-01-01

Daily precipitation from 22 National Weather Service first-order weather stations in the southwestern United States for water years 1951 through 2006 are used to examine variability and trends in the frequency of dry days and dry event length. Dry events with minimum thresholds of 10 and 20 consecutive days of precipitation with less than 2.54 mm are analyzed. For water years and cool seasons (October through March), most sites indicate negative trends in dry event length (i.e., dry event durations are becoming shorter). For the warm season (April through September), most sites also indicate negative trends; however, more sites indicate positive trends in dry event length for the warm season than for water years or cool seasons. The larger number of sites indicating positive trends in dry event length during the warm season is due to a series of dry warm seasons near the end of the 20th century and the beginning of the 21st century. Overall, a large portion of the variability in dry event length is attributable to variability of the El Niño–Southern Oscillation, especially for water years and cool seasons. Our results are consistent with analyses of trends in discharge for sites in the southwestern United States, an increased frequency in El Niño events, and positive trends in precipitation in the southwestern United States.

Influence of incubation temperature on hatching success, energy expenditure for embryonic development, and size and morphology of hatchlings in the oriental garden lizard, Calotes versicolor (Agamidae).

PubMed

Ji, Xiang; Qiu, Qing-Bo; Diong, Cheong-Hoong

2002-06-01

We incubated eggs of Calotes versicolor at four constant temperatures ranging from 24 degrees C to 33 degrees C to assess the effects of incubation temperature on hatching success, embryonic use of energy, and hatchling phenotypes that are likely to affect fitness. All viable eggs increased in mass throughout incubation due to absorption of water, and mass gain during incubation was dependent on initial egg mass and incubation temperature. The average duration of incubation at 24 degrees C, 27 degrees C, 30 degrees C, and 33 degrees C was 82.1 days, 60.5 days, 51.4 days, and 50.3 days, respectively. Incubation temperature affected hatching success, energy expenditure for embryonic development, and several hatchling traits examined, but it did not affect the sex ratio of hatchlings. Hatching success was lowest (3.4%) at 33 degrees C, but a higher incidence of deformed embryos was recorded from eggs incubated at this temperature compared to eggs incubated at lower temperatures. Most of the deformed embryos died at the last stage of incubation. Energy expenditure for embryonic development was, however, higher in eggs incubated at 33 degrees C than those similarly incubated at lower temperatures. A prolonged exposure of eggs of C. versicolor at 33 degrees C appears to have an adverse and presumably lethal effect on embryonic development. Hatching success at 24 degrees C was also low (43.3%), but hatchlings incubated at 24 degrees C did not differ in any of the examined traits from those incubated at two intermediate temperatures (27 degrees C and 30 degrees C). Hatchlings incubated at 33 degrees C were smaller (snout-vent length, SVL) than those incubated at lower incubation temperatures and had larger mass residuals (from the regression on SVL) as well as shorter head length, hindlimb length, tympanum diameter, and eye diameter relative to SVL. Hatchlings from 33 degrees C had significantly lower scores on the first axis of a principal component analysis representing mainly SVL-free head size (length and width) and fore- and hindlimb lengths, but they had significantly higher scores on the second axis mainly representing SVL-free wet body mass. Variation in the level of fluctuating asymmetry in eye diameter associated with incubation temperatures was quite high, and it was clearly consistent with the prediction that environmental stress associated with the highest incubation temperatures might produce the highest level of asymmetry. Newly emerged hatchlings exhibited sexual dimorphism in head width, with male hatchlings having larger head width than females. Copyright 2002 Wiley-Liss, Inc.

[Risk factors for nosocomial pneumonia in patients with abdominal surgery].

PubMed

Evaristo-Méndez, Gerardo; Rocha-Calderón, César Haydn

2016-01-01

The risk of post-operative pneumonia is a latent complication. A study was conducted to determine its risk factors in abdominal surgery. A cross-sectional study was performed that included analysing the variables of age and gender, chronic obstructive pulmonary disease and smoking, serum albumin, type of surgery and anaesthesia, emergency or elective surgery, incision site, duration of surgery, length of hospital stay, length of stay in the intensive care unit, and time on mechanical ventilation. The adjusted odds ratio for risk factors was obtained using multivariate logistic regression. The study included 91 (9.6%) patients with pneumonia and 851 (90.4%) without pneumonia. Age 60 years or over (OR=2.34), smoking (OR=9.48), chronic obstructive pulmonary disease (OR=3.52), emergency surgery (OR=2.48), general anaesthesia (OR=3.18), surgical time 120 minutes or over (OR=5.79), time in intensive care unit 7 days or over (OR=1.23), time on mechanical ventilation greater than or equal to 4 days (OR=5.93) and length of post-operative hospital stay of 15 days or over (OR=1.20), were observed as independent predictors for the development of postoperative pneumonia. Identifying risk factors for post-operative pneumonia may prevent their occurrence. The length in the intensive care unit of greater than or equal to 7 days (OR=1.23; 95% CI 1.07 - 1.42) and a length postoperative hospital stay of 15 days or more (OR=1.20; 95% CI 1.07 - 1.34) were the predictive factors most strongly associated with lung infection in this study. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Seismomorphogenesis: a novel approach to acclimatization of tissue culture regenerated plants.

PubMed

Sarmast, Mostafa Khoshhal; Salehi, Hassan; Khosh-Khui, Morteza

2014-12-01

Plantlets under in vitro conditions transferred to ex vivo conditions are exposed to biotic and abiotic stresses. Furthermore, in vitro regenerated plants are typically frail and sometimes difficult to handle subsequently increasing their risk to damage and disease; hence acclimatization of these plantlets is the most important step in tissue culture techniques. An experiment was conducted under in vitro conditions to study the effects of shaking duration (twice daily at 6:00 a.m. and 9:00 p.m. for 2, 4, 8, and 16 min at 250 rpm for 14 days) on Sansevieria trifasciata L. as a model plant. Results showed that shaking improved handling, total plant height, and leaf characteristics of the model plant. Forty-eight hours after 14 days of shaking treatments with increasing shaking time, leaf length decreased but proline content of leaf increased. However, 6 months after starting the experiment different results were observed. In explants that received 16 min of shaking treatment, leaf length and area and photosynthesis rate were increased compared with control plantlets. Six months after starting the experiment, control plantlets had 12.5 % mortality; however, no mortality was observed in other treated explants. The results demonstrated that shaking improved the explants' root length and number and as a simple, cost-effective, and non-chemical novel approach may be substituted for other prevalent acclimatization techniques used for tissue culture regenerated plantlets. Further studies with sensitive plants are needed to establish this hypothesis.

Production of Pycnidia and Conidia by Guignardia bidwellii, the Causal Agent of Grape Black Rot, as Affected by Temperature and Humidity.

PubMed

Onesti, G; González-Domínguez, E; Rossi, V

2017-02-01

Black rot, caused by the fungus Guignardia bidwellii, is a polycyclic disease affecting grape leaves and berries. In environmentally controlled experiments and in a 3-year field study, the effects of temperature and relative humidity (RH) were assessed on the following growth parameters of G. bidwellii: (i) formation of pycnidia and cirri in grape leaf lesions, (ii) production and germination of conidia, and (iii) length of the period between lesion appearance and pycnidia production. Pycnidia were produced between 5 and 35°C and at 90 to 100% RH but more pycnidia were produced between 20 and 30°C. No pycnidia were produced at RH < 90%. The first pycnidia were produced in approximately 2 days after lesion appearance at ≥20°C and in 8 days at 5°C; pycnidia continued to be produced on the same lesion for 5 to 16 days after lesion appearance, depending on the temperature. Models were developed to describe the effect of temperature and RH on pycnidia production, accounting for 95 and 97% of variability, respectively. Cirri were extruded only between 15 and 35°C and mainly at 100% RH. Field experiments confirmed that pycnidia are produced for several days on a leaf lesion and that the length of the period between lesion appearance and pycnidia production depends on temperature. Overall, the findings showed that production of conidia requires high humidity; under field conditions, some hours at high humidity, which usually occur at nighttime, rather than constant high humidity may be sufficient.

Photoperiod but not food restriction modulates innate immunity in an opportunistic breeder, Loxia curvirostra.

PubMed

Schultz, Elizabeth M; Hahn, Thomas P; Klasing, Kirk C

2017-02-15

An organism's investment in immune function often varies seasonally but understanding of how fluctuations in environmental conditions directly modulate investment remains limited. This experiment investigated how changes in photoperiod and food availability affect investment in constitutive innate immunity and the acute phase response induced by lipopolysaccharide (LPS) injections in captive red crossbills ( Loxia curvirostra ). Crossbills are reproductively flexible songbirds that specialize on an unpredictably available food resource and display temporal variation in immunity in the wild. Birds were separated into four treatments and exposed to long or short day lengths for 6 weeks before continuing on an ad libitum diet or experiencing a 20% food reduction for 10 days. Birds were un-injected or injected with LPS both before and after diet change. Innate immunity was quantified throughout the experiment to assess effects of photoperiod, food availability and their interactions on hemolysis-hemagglutination, haptoglobin, bacterial killing ability and leukocyte counts. Overall, increasing day length significantly increased both bacterial killing ability and leukocyte counts. Surprisingly, food restriction had little effect on the immune parameters, potentially owing to the 'low-cost' environment of captivity and suggesting that investment in innate immunity is prioritized and maintained whenever possible. LPS injections induced stereotypical sickness behaviors and increased bacterial killing ability in short day birds and complement activity (hemolysis) both before and after food restriction. These results demonstrate robust seasonal modulation of immune investment and an ability to maintain innate immunity in the face of limited resources in these temporally flexible songbirds. © 2017. Published by The Company of Biologists Ltd.

Improving Seasonal Crop Monitoring and Forecasting for Soybean and Corn in Iowa

NASA Astrophysics Data System (ADS)

Togliatti, K.; Archontoulis, S.; Dietzel, R.; VanLoocke, A.

2016-12-01

Accurately forecasting crop yield in advance of harvest could greatly benefit farmers, however few evaluations have been conducted to determine the effectiveness of forecasting methods. We tested one such method that used a combination of short-term weather forecasting from the Weather Research and Forecasting Model (WRF) to predict in season weather variables, such as, maximum and minimum temperature, precipitation and radiation at 4 different forecast lengths (2 weeks, 1 week, 3 days, and 0 days). This forecasted weather data along with the current and historic (previous 35 years) data from the Iowa Environmental Mesonet was combined to drive Agricultural Production Systems sIMulator (APSIM) simulations to forecast soybean and corn yields in 2015 and 2016. The goal of this study is to find the forecast length that reduces the variability of simulated yield predictions while also increasing the accuracy of those predictions. APSIM simulations of crop variables were evaluated against bi-weekly field measurements of phenology, biomass, and leaf area index from early and late planted soybean plots located at the Agricultural Engineering and Agronomy Research Farm in central Iowa as well as the Northwest Research Farm in northwestern Iowa. WRF model predictions were evaluated against observed weather data collected at the experimental fields. Maximum temperature was the most accurately predicted variable, followed by minimum temperature and radiation, and precipitation was least accurate according to RMSE values and the number of days that were forecasted within a 20% error of the observed weather. Our analysis indicated that for the majority of months in the growing season the 3 day forecast performed the best. The 1 week forecast came in second and the 2 week forecast was the least accurate for the majority of months. Preliminary results for yield indicate that the 2 week forecast is the least variable of the forecast lengths, however it also is the least accurate. The 3 day and 1 week forecast have a better accuracy, with an increase in variability.

Thyroid endocrine disruption and external body morphology of Zebrafish

USGS Publications Warehouse

Sharma, Prakash; Grabowski, Timothy B.; Patino, Reynaldo

2016-01-01

This study examined the effects thyroid-active compounds during early development on body morphology of Zebrafish (Danio rerio). Three-day postfertilization (dpf) larvae were exposed to goitrogen [methimazole (MZ, 0.15 mM)], combination of MZ (0.15 mM) and thyroxine (T4, 2 nM), T4 (2 nM), or control (reconstituted water) treatments until 33 dpf and subsequently maintained in reconstituted water until 45 dpf. Samples were taken at 33 and 45 dpf for multivariate analysis of geometric distances between selected homologous landmarks placed on digital images of fish, and for histological assessment of thyrocytes. Body mass, standard length, and pectoral fin length were separately measured on remaining fish at 45 dpf. Histological analysis confirmed the hypothyroid effect (increased thyrocyte height) of MZ and rescue effect of T4 co-administration. Geometric distance analysis showed that pectoral and pelvic fins shifted backward along the rostrocaudal axis under hypothyroid conditions at 45 dpf and that T4 co-treatment prevented this shift. Pectoral fin length at 45 dpf was reduced by exposure to MZ and rescued by co-administration of T4, but it was not associated with standard length. Methimazole caused a reduction in body mass and length at 45 dpf that could not be rescued by T4 co-administration, and non-thyroidal effects of MZ on body shape were also recognized at 33 and 45 dpf. Alterations in the length and position of paired fins caused by exposure to thyroid-disrupting chemicals during early development, as shown here for Zebrafish, could affect physical aspects of locomotion and consequently other important organismal functions such as foraging, predator avoidance, and ultimately survival and recruitment into the adult population. Results of this study also suggest the need to include rescue treatments in endocrine disruption studies that rely on goitrogens as reference for thyroid-mediated effects.

Thyroid endocrine disruption and external body morphology of Zebrafish.

PubMed

Sharma, Prakash; Grabowski, Timothy B; Patiño, Reynaldo

2016-01-15

This study examined the effects thyroid-active compounds during early development on body morphology of Zebrafish (Danio rerio). Three-day postfertilization (dpf) larvae were exposed to goitrogen [methimazole (MZ, 0.15mM)], combination of MZ (0.15mM) and thyroxine (T4, 2nM), T4 (2nM), or control (reconstituted water) treatments until 33dpf and subsequently maintained in reconstituted water until 45dpf. Samples were taken at 33 and 45dpf for multivariate analysis of geometric distances between selected homologous landmarks placed on digital images of fish, and for histological assessment of thyrocytes. Body mass, standard length, and pectoral fin length were separately measured on remaining fish at 45dpf. Histological analysis confirmed the hypothyroid effect (increased thyrocyte height) of MZ and rescue effect of T4 co-administration. Geometric distance analysis showed that pectoral and pelvic fins shifted backward along the rostrocaudal axis under hypothyroid conditions at 45dpf and that T4 co-treatment prevented this shift. Pectoral fin length at 45dpf was reduced by exposure to MZ and rescued by co-administration of T4, but it was not associated with standard length. Methimazole caused a reduction in body mass and length at 45dpf that could not be rescued by T4 co-administration, and non-thyroidal effects of MZ on body shape were also recognized at 33 and 45dpf. Alterations in the length and position of paired fins caused by exposure to thyroid-disrupting chemicals during early development, as shown here for Zebrafish, could affect physical aspects of locomotion and consequently other important organismal functions such as foraging, predator avoidance, and ultimately survival and recruitment into the adult population. Results of this study also suggest the need to include rescue treatments in endocrine disruption studies that rely on goitrogens as reference for thyroid-mediated effects. Published by Elsevier Inc.

Small pelagics in a changing ocean: biological responses of sardine early stages to warming

PubMed Central

Faleiro, Filipa; Pimentel, Marta; Pegado, Maria Rita; Bispo, Regina; Lopes, Ana Rita; Diniz, Mário S.; Rosa, Rui

2016-01-01

Small pelagic fishes are known to respond rapidly to changes in ocean climate. In this study, we evaluate the effects of future environmental warming (+2°C) during the early ontogeny of the European sardine, Sardina pilchardus. Warming reduced the survival of 30-day-old larvae by half. Length at hatching increased with temperature as expected, but no significant effect was observed on the length and growth at 30 days post-hatching. Warming did not significantly affect the thermal tolerance of sardine larvae, even though the mean lethal temperature increased by 1°C. In the warm conditions, sardine larvae showed signs of thermal stress, indicated by a pronounced increase in larval metabolism (Q10 = 7.9) and a 45% increase in the heat shock response. Lipid peroxidation was not significantly affected by the higher temperature, even though the mean value doubled. Warming did not affect the time larvae spent swimming, but decreased by 36% the frequency of prey attacks. Given the key role of these small pelagics in the trophic dynamics off the Western Iberian upwelling ecosystem, the negative effects of warming on the early stages may have important implications for fish recruitment and ecosystem structure. PMID:27293764

Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial.

PubMed

Thaut, M H; Leins, A K; Rice, R R; Argstatter, H; Kenyon, G P; McIntosh, G C; Bolay, H V; Fetter, M

2007-01-01

The effectiveness of 2 different types of gait training in stroke rehabilitation, rhythmic auditory stimulation (RAS) versus neurodevelopmental therapy (NDT)/Bobath- based training, was compared in 2 groups of hemiparetic stroke patients over a 3-week period of daily training (RAS group, n = 43; NDT/Bobath group =35). Mean entry date into the study was 21.3 days poststroke for the RAS group and 22.3 days for the control group. Patients entered the study as soon as they were able to complete 5 stride cycles with handheld assistance. Patients were closely equated by age, gender, and lesion site. Motor function in both groups was pre-assessed by the Barthel Index and the Fugl-Meyer Scales. Pre- to posttest measures showed a significant improvement in the RAS group for velocity (P = .006), stride length (P = .0001), cadence (P = .0001) and symmetry (P = .0049) over the NDT/Bobath group. Effect sizes for RAS over NDT/Bobath training were 13.1 m/min for velocity, 0.18 m for stride length, and 19 steps/min for cadence. The data show that after 3 weeks of gait training, RAS is an effective therapeutic method to enhance gait training in hemiparetic stroke rehabilitation. Gains were significantly higher for RAS compared to NDT/Bobath training.

Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer.

PubMed

Garth, A K; Newsome, C M; Simmance, N; Crowe, T C

2010-08-01

Malnutrition and its associated complications are a considerable issue for surgical patients with upper gastrointestinal and colorectal cancer. The present study aimed to determine whether specific perioperative nutritional practices and protocols are associated with improved patient outcomes in this group. Patients admitted for elective upper gastrointestinal or colorectal cancer surgery (n = 95) over a 19-month period underwent a medical history audit assessing weight changes, nutritional intake, biochemistry, post-operative complications and length of stay. A subset of patients (n = 25) underwent nutritional assessment by subjective global assessment prior to surgery in addition to assessment of post-operative medical outcomes, nutritional intake and timing of dietetic intervention. Mean (SD) length of stay for patients was 14.0 (12.2) days, with complication rates at 35%. Length of stay was significantly longer in patients who experienced significant preoperative weight loss compared to those who did not [17.0 (15.8) days versus 10.0 (6.8) days, respectively; P < 0.05]. Low albumin and post-operative weight loss were also predictive of increased length of stay. Of patients who underwent nutritional assessment, 32% were classified as mild-moderately malnourished and 16% severely malnourished. Malnourished patients were hospitalised twice as long as well-nourished patients [15.8 (12.8) days versus 7.6 (3.5) days; P < 0.05]. Time taken [6.9 (3.6) days] to achieve adequate nutrition post surgery was a factor in post-operative outcomes, with a positive correlation with length of stay (r = 0.493; P < 0.01), a negative correlation with post-operative weight change (r = -0.417; P < 0.05) and a greater risk of complications (52% versus 13%; P < 0.01). Malnutrition is prevalent among surgical patients with gastrointestinal cancer. Poor nutritional status coupled with delayed and inadequate post-operative nutrition practices are associated with worse clinical outcomes.

Evaluation of very long baseline interferometry atmospheric modeling improvements

NASA Technical Reports Server (NTRS)

Macmillan, D. S.; Ma, C.

1994-01-01

We determine the improvement in baseline length precision and accuracy using new atmospheric delay mapping functions and MTT by analyzing the NASA Crustal Dynamics Project research and development (R&D) experiments and the International Radio Interferometric Surveying (IRIS) A experiments. These mapping functions reduce baseline length scatter by about 20% below that using the CfA2.2 dry and Chao wet mapping functions. With the newer mapping functions, average station vertical scatter inferred from observed length precision (given by length repeatabilites) is 11.4 mm for the 1987-1990 monthly R&D series of experiments and 5.6 mm for the 3-week-long extended research and development experiment (ERDE) series. The inferred monthly R&D station vertical scatter is reduced by 2 mm or by 7 mm is a root-sum-square (rss) sense. Length repeatabilities are optimum when observations below a 7-8 deg elevation cutoff are removed from the geodetic solution. Analyses of IRIS-A data from 1984 through 1991 and the monthly R&D experiments both yielded a nonatmospheric unmodeled station vertical error or about 8 mm. In addition, analysis of the IRIS-A exeriments revealed systematic effects in the evolution of some baseline length measurements. The length rate of change has an apparent acceleration, and the length evolution has a quasi-annual signature. We show that the origin of these effects is unlikely to be related to atmospheric modeling errors. Rates of change of the transatlantic Westford-Wettzell and Richmond-Wettzell baseline lengths calculated from 1988 through 1991 agree with the NUVEL-1 plate motion model (Argus and Gordon, 1991) to within 1 mm/yr. Short-term (less than 90 days) variations of IRIS-A baseline length measurements contribute more than 90% of the observed scatter about a best fit line, and this short-term scatter has large variations on an annual time scale.

Reference standard of penile size and prevalence of buried penis in Japanese newborn male infants.

PubMed

Matsuo, Nobutake; Ishii, Tomohiro; Takayama, John I; Miwa, Masayuki; Hasegawa, Tomonobu

2014-01-01

The present study set forth the reference values for penile size and determined the prevalence of buried penis in Japanese full-term newborns. The stretched penile length was measured and the presence of buried penis was assessed at 1-7 days of age in 547 Japanese full-term newborn infants born between 2008 and 2012 in Tokyo. The stretched penile lengths were compared at 1-12 hours and 1-7 days of age in 63 infants and by two observers in 73 infants to estimate postnatal changes and interobserver variation, respectively. The mean stretched penile length was 3.06 cm (SD, 0.26; 95% confidence interval [CI], 3.04-3.08) and the mean ratio of penile length to body length was 6.24 × 100(-1) (SD, 0.55 × 100(-1)), both of which were significantly smaller than those in Caucasian newborn infants. Buried penis was identified in 20 of 547 infants (3.7%; 95% CI, 2.1-5.2%). The first measurements of penile length at 1-12 hours were significantly smaller than the next measurements at 1-7 days (95% CI of the difference, 0.22-0.34). The 95% CI for the limits of agreement in the penile lengths measured by the two observers was -0.58 to -0.40 for the lower limit and 0.33 to 0.51 for the upper limit. These findings indicate that the penile length should be assessed after 24 hours of age by the reference standard of the same ethnicity for identifying micropenis and that buried penis is not uncommon in Japanese full-term newborns.

Impacts of regular and random noise on the behaviour, growth and development of larval Atlantic cod (Gadus morhua)

PubMed Central

Nedelec, Sophie L.; Simpson, Stephen D.; Morley, Erica L.; Nedelec, Brendan; Radford, Andrew N.

2015-01-01

Anthropogenic noise impacts behaviour and physiology in many species, but responses could change with repeat exposures. As repeat exposures can vary in regularity, identifying regimes with less impact is important for regulation. We use a 16-day split-brood experiment to compare effects of regular and random acoustic noise (playbacks of recordings of ships), relative to ambient-noise controls, on behaviour, growth and development of larval Atlantic cod (Gadus morhua). Short-term noise caused startle responses in newly hatched fish, irrespective of rearing noise. Two days of both regular and random noise regimes reduced growth, while regular noise led to faster yolk sac use. After 16 days, growth in all three sound treatments converged, although fish exposed to regular noise had lower body width–length ratios. Larvae with lower body width–length ratios were easier to catch in a predator-avoidance experiment. Our results demonstrate that the timing of acoustic disturbances can impact survival-related measures during development. Much current work focuses on sound levels, but future studies should consider the role of noise regularity and its importance for noise management and mitigation measures. PMID:26468248

Effect of seasonal changes on fertility parameters of Holstein dairy cows in subtropical climate of Taiwan.

PubMed

Liu, Wen-Bor; Peh, Huo-Cheng; Wang, Chien-Kai; Mangwe, Mancoba Christopher; Chen, Chih-Feng; Chiang, Hsin-I

2018-06-01

The purpose of this retrospective study was to investigate the relationship between temperature-humidity index (THI), season, and conception rate (CR) of Holstein cows in central Taiwan. The mean performance and number of observations were statistically evaluated for various parameters, including age at first service, number of days open, gestation length, CR, and calving interval for different parities. The results indicate that the mean age at first service was 493.2 days; the gestation length was similar across all cows of different parities, ranging from 275.1 to 280.7 days. The overall CR of all inseminations was significantly lower in multiparous cows (47.26%±0.22%) than in heifers (57.14%±0.11%) (p<0.05). At THI>72 and during the hot season (from June to November), CRs for multiparous cows were significantly reduced compared to that for heifers, while the ratio remained unchanged among heifers for all seasons. To achieve a high CR, lactating cows should be bred in winter and spring (from December to May) from the start of the seasonal breeding program, whereas the heifer should be allowed to breed in summer and fall under the subtropical climate in Taiwan.

Impacts of regular and random noise on the behaviour, growth and development of larval Atlantic cod (Gadus morhua).

PubMed

Nedelec, Sophie L; Simpson, Stephen D; Morley, Erica L; Nedelec, Brendan; Radford, Andrew N

2015-10-22

Anthropogenic noise impacts behaviour and physiology in many species, but responses could change with repeat exposures. As repeat exposures can vary in regularity, identifying regimes with less impact is important for regulation. We use a 16-day split-brood experiment to compare effects of regular and random acoustic noise (playbacks of recordings of ships), relative to ambient-noise controls, on behaviour, growth and development of larval Atlantic cod (Gadus morhua). Short-term noise caused startle responses in newly hatched fish, irrespective of rearing noise. Two days of both regular and random noise regimes reduced growth, while regular noise led to faster yolk sac use. After 16 days, growth in all three sound treatments converged, although fish exposed to regular noise had lower body width-length ratios. Larvae with lower body width-length ratios were easier to catch in a predator-avoidance experiment. Our results demonstrate that the timing of acoustic disturbances can impact survival-related measures during development. Much current work focuses on sound levels, but future studies should consider the role of noise regularity and its importance for noise management and mitigation measures. © 2015 The Authors.

The Influence of Length of School Day on Grade 4 and Grade 5 Language Arts and Mathematics Performance in the State of New Jersey

ERIC Educational Resources Information Center

Plevier, Meghan M.

2016-01-01

The purpose of this relational, non-experimental, explanatory, cross sectional study with quantitative methods was to explain the influence of length of school day, if any, on Grade 4 and Grade 5 student achievement in Language Arts and Mathematics as measured by the high-stakes New Jersey standardized test entitled New Jersey Assessment of Skills…

Effect of Health Literacy on Research Follow-up

PubMed Central

Leak, Cardella; Goggins, Kathryn; Schildcrout, Jonathan S.; Theobald, Cecelia; Donato, Katharine M.; Bell, Susan P.; Schnelle, John; Kripalani, Sunil

2016-01-01

Previous research has not examined the effect of health literacy on research subjects' completion of scheduled research follow-up. This article evaluates patient factors associated with incomplete research follow-up at three time points after enrollment in a large, hospital-based prospective cohort study. Predictor variables included health literacy, age, race, gender, education, employment status, difficulty paying bills, hospital diagnosis, length of stay, self-reported global health status, depression, perceived health competence, medication adherence and healthcare system distrust. In a sample of 2042 patients, multivariable models demonstrated that lower health literacy and younger age were significantly associated with a lower likelihood of completing research follow-up interviews at 2-3 days, 30 days and 90 days after hospital discharge. Additionally, patients who had less education, were currently employed, and had moderate financial stress were less likely to complete 90-day follow-up. This study is the first to demonstrate that lower health literacy is a significant predictor of incomplete research follow-up. PMID:26513035

Dementia as a predictor of mortality in adult trauma patients.

PubMed

Jordan, Benjamin C; Brungardt, Joseph; Reyes, Jared; Helmer, Stephen D; Haan, James M

2018-01-01

The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls. A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Patients with dementia were matched with non-dementia patients and compared on mortality, ICU length of stay, and hospital length of stay. A total of 195 patients with dementia were matched to non-dementia controls. Comorbidities and complications (11.8% vs 12.4%) were comparable between both groups. Dementia patients spent fewer days on the ventilator (1 vs 4.5, P = 0.031). The length of ICU stay (2 days), hospital length of stay (3 days), and mortality (5.1%) were the same for both groups (P > 0.05). Dementia does not appear to increase the risk of mortality in trauma patients. Further studies should examine post-discharge outcomes in dementia patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Light, time, and the physiology of biotic response to rapid climate change in animals.

PubMed

Bradshaw, William E; Holzapfel, Christina M

2010-01-01

Examination of temperate and polar regions of Earth shows that the nonbiological world is exquisitely sensitive to the direct effects of temperature, whereas the biological world is largely organized by light. Herein, we discuss the use of day length by animals at physiological and genetic levels, beginning with a comparative experimental study that shows the preeminent role of light in determining fitness in seasonal environments. Typically, at seasonally appropriate times, light initiates a cascade of physiological events mediating the input and interpretation of day length to the output of specific hormones that ultimately determine whether animals prepare to develop, reproduce, hibernate, enter dormancy, or migrate. The mechanisms that form the basis of seasonal time keeping and their adjustment during climate change are reviewed at the physiological and genetic levels. Future avenues for research are proposed that span basic questions from how animals transition from dependency on tropical cues to temperate cues during range expansions, to more applied questions of species survival and conservation biology during periods of climatic stress.

Effects of tributyltin on metamorphosis and gonadal differentiation of Xenopus laevis at environmentally relevant concentrations.

PubMed

Shi, Huahong; Zhu, Pan; Guo, Suzhen

2014-05-01

Tributyltin (TBT), a well known endocrine disruptor, has high teratogenicity to embryos of amphibian (Xenopus tropicalis). An amphibian metamorphosis assay (AMA) and a complete AMA (CAMA) were conducted for TBT. In AMA, the body weight, the snout-to-vent length and the hind limb length of X. laevis tadpoles were decreased in tributyltin chloride (TBTCl; 12.5-200 ng/L) treatment groups after 7 days exposure. TBT greatly retarded the development of tadpoles, decreased the number of follicle and induced thyroid follicle cell hyperplasia after 19 days exposure. In CAMA, 10 and 100 ng/L TBTCl led to various malformations of gonad, including intersex, segmental aplasia and multiple ovary cavities of X. laevis following exposure from stages 46 to stage 66. The sex ratio was male-biased in TBT treatment groups. These results suggest that TBT delayed the metamorphosis, inhibited the growth of tadpoles and disrupted the gonadal differentiation of X. laevis at environmentally relevant concentrations.

Protective effect of an herbal preparation (HemoHIM) on radiation-induced intestinal injury in mice.

PubMed

Kim, Sung Ho; Lee, Hae June; Kim, Joong Sun; Moon, Changjong; Kim, Jong Choon; Park, Hae-Ran; Jung, Uhee; Jang, Jong Sik; Jo, Sung Kee

2009-12-01

The protective properties of an herbal preparation (HemoHIM) against intestinal damage were examined by evaluating its effects on jejunal crypt survival, morphological changes, and apoptosis in gamma-irradiated mice. The mice were whole-body irradiated with 12 Gy for the examination of jejunal crypt survival and any morphological changes and with 2 Gy for the detection of apoptosis and Ki-67 labeling. Irradiation was conducted using (60)Co gamma-rays. HemoHIM treatment was administered intraperitonially at a dosage of 50 mg/kg of body weight at 36 and 12 hours pre-irradiation and 30 minutes post-irradiation or orally at a dosage of 250 mg/kg of body weight/day for 7 or 11 days before necropsy. The HemoHIM-treated group displayed a significant increase in survival of jejunal crypts, when compared to the irradiation controls. HemoHIM treatment decreased intestinal morphological changes such as crypt depth, villus height, mucosal length, and basal lamina length of 10 enterocytes after irradiation. Furthermore, the administration of HemoHIM protected intestinal cells from irradiation-induced apoptosis. These results suggested that HemoHIM may be therapeutically useful to reduce intestinal injury following irradiation.

Measurement effects of seasonal and monthly variability on pedometer-determined data.

PubMed

Kang, Minsoo; Bassett, David R; Barreira, Tiago V; Tudor-Locke, Catrine; Ainsworth, Barbara E

2012-03-01

The seasonal and monthly variability of pedometer-determined physical activity and its effects on accurate measurement have not been examined. The purpose of the study was to reduce measurement error in step-count data by controlling a) the length of the measurement period and b) the season or month of the year in which sampling was conducted. Twenty-three middle-aged adults were instructed to wear a Yamax SW-200 pedometer over 365 consecutive days. The step-count measurement periods of various lengths (eg, 2, 3, 4, 5, 6, 7 days, etc.) were randomly selected 10 times for each season and month. To determine accurate estimates of yearly step-count measurement, mean absolute percentage error (MAPE) and bias were calculated. The year-round average was considered as a criterion measure. A smaller MAPE and bias represent a better estimate. Differences in MAPE and bias among seasons were trivial; however, they varied among different months. The months in which seasonal changes occur presented the highest MAPE and bias. Targeting the data collection during certain months (eg, May) may reduce pedometer measurement error and provide more accurate estimates of year-round averages.

Effects of rearing temperature and density on growth, survival and development of sea cucumber larvae, Apostichopus japonicus (Selenka)

NASA Astrophysics Data System (ADS)

Liu, Guangbin; Yang, Hongsheng; Liu, Shilin

2010-07-01

In laboratory conditions, effects of rearing temperature and stocking density were examined on hatching of fertilized egg and growth of auricularia larvae of Apostichopus japonicus respectively. Data series like larval length and density, metamorphic time, and survival rate of the larvae were recorded. Statistics showed that for A. japonicus, survival rate (from fertilized egg to late auricularia) decreased significantly with the increasing rearing temperature ( P<0.05). At different temperatures SGR was statistically significant as well ( P<0.05) from day 1, and maximal SGR was found on day 9 at 24°C (159.26±3.28). This study clearly indicated that at low temperature (<24°C), metamorphic rate was remarkably higher than at higher temperature (>26°C). Hatching rate was significantly different between 0.2-5 ind./ml groups and 20-50 ind./ml groups. Rearing larvae at the higher density had the smaller maximal-length, whereas needed longer time to complete metamorphosis. This study suggested that 21°C and 0.4 ind./ml can be used as the most suitable rearing temperature and stocking density for large -scale artificial breeding of A. japonicus’s larvae.

Hypothesis driven single cell dual oscillator mathematical model of circadian rhythms

PubMed Central

S, Shiju

2017-01-01

Molecular mechanisms responsible for 24 h circadian oscillations, entrainment to external cues, encoding of day length and the time-of-day effects have been well studied experimentally. However, it is still debated from the molecular network point of view whether each cell in suprachiasmatic nuclei harbors two molecular oscillators, where one tracks dawn and the other tracks dusk activities. A single cell dual morning and evening oscillator was proposed by Daan et al., based on the molecular network that has two sets of similar non-redundant per1/cry1 and per2/cry2 circadian genes and each can independently maintain their endogenous oscillations. Understanding of dual oscillator dynamics in a single cell at molecular level may provide insight about the circadian mechanisms that encodes day length variations and its response to external zeitgebers. We present here a realistic dual oscillator model of circadian rhythms based on the series of hypotheses proposed by Daan et al., in which they conjectured that the circadian genes per1/cry1 track dawn while per2/cry2 tracks dusk and they together constitute the morning and evening oscillators (dual oscillator). Their hypothesis also provides explanations about the encoding of day length in terms of molecular mechanisms of per/cry expression. We frame a minimal mathematical model with the assumption that per1 acts a morning oscillator and per2 acts as an evening oscillator and to support and interpret this assumption we fit the model to the experimental data of per1/per2 circadian temporal dynamics, phase response curves (PRC's), and entrainment phenomena under various light-dark conditions. We also capture different patterns of splitting phenomena by coupling two single cell dual oscillators with neuropeptides vasoactive intestinal polypeptide (VIP) and arginine vasopressin (AVP) as the coupling agents and provide interpretation for the occurrence of splitting in terms of ME oscillators, though they are not required to explain the morning and evening oscillators. The proposed dual oscillator model based on Daan's hypothesis supports per1 and per2 playing the role of morning and evening oscillators respectively and this may be the first step towards the understanding of the core molecular mechanism responsible for encoding the day length. PMID:28486525

Hypothesis driven single cell dual oscillator mathematical model of circadian rhythms.

PubMed

S, Shiju; Sriram, K

2017-01-01

Molecular mechanisms responsible for 24 h circadian oscillations, entrainment to external cues, encoding of day length and the time-of-day effects have been well studied experimentally. However, it is still debated from the molecular network point of view whether each cell in suprachiasmatic nuclei harbors two molecular oscillators, where one tracks dawn and the other tracks dusk activities. A single cell dual morning and evening oscillator was proposed by Daan et al., based on the molecular network that has two sets of similar non-redundant per1/cry1 and per2/cry2 circadian genes and each can independently maintain their endogenous oscillations. Understanding of dual oscillator dynamics in a single cell at molecular level may provide insight about the circadian mechanisms that encodes day length variations and its response to external zeitgebers. We present here a realistic dual oscillator model of circadian rhythms based on the series of hypotheses proposed by Daan et al., in which they conjectured that the circadian genes per1/cry1 track dawn while per2/cry2 tracks dusk and they together constitute the morning and evening oscillators (dual oscillator). Their hypothesis also provides explanations about the encoding of day length in terms of molecular mechanisms of per/cry expression. We frame a minimal mathematical model with the assumption that per1 acts a morning oscillator and per2 acts as an evening oscillator and to support and interpret this assumption we fit the model to the experimental data of per1/per2 circadian temporal dynamics, phase response curves (PRC's), and entrainment phenomena under various light-dark conditions. We also capture different patterns of splitting phenomena by coupling two single cell dual oscillators with neuropeptides vasoactive intestinal polypeptide (VIP) and arginine vasopressin (AVP) as the coupling agents and provide interpretation for the occurrence of splitting in terms of ME oscillators, though they are not required to explain the morning and evening oscillators. The proposed dual oscillator model based on Daan's hypothesis supports per1 and per2 playing the role of morning and evening oscillators respectively and this may be the first step towards the understanding of the core molecular mechanism responsible for encoding the day length.

To compare growth outcomes and cost-effectiveness of "Kangaroo ward care" with "intermediate intensive care" in stable extremely low birth weight infants: randomized control trial.

PubMed

Sharma, Deepak; Murki, Srinivas; Pratap, Oleti Tejo

2017-07-01

To compare growth outcome and cost-effectiveness of "Kangaroo ward care" (KWC) with "Intermediate intensive care" (IIC) in stable extremely low birth weight (ELBW) infants. This is secondary analysis of the study and we analyzed 62 ELBW infants, 33 were randomized to KWC and 29 to IIC once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to the Kangaroo ward immediately after randomization and in the IIC group received IIC care till they attain a weight of 1250 g before shifting to Kangaroo ward. The gain in weight (g/day), length (cm/week), and head circumference (cm/week) were comparable between the two groups. The mean weight, length, and head circumference were comparable at term gestational age. The infants in KWC group were shifted five days earlier to Kangaroo ward when compared to IIC group. The cost-effective analysis using "top-down" and "bottom-up" accounting method showed that there was significant reduction of hospital and parents expenditure in KWC group (p < 0.001) with approximate saving of 452 USD for each patient in the KWC group. Early shifting of ELBW infants for KWC is very efficacious and cost-effective intervention when compared to IIC. (CTRI/2014/05/004625).

Asthma length of stay in hospitals in London 2001-2006: demographic, diagnostic and temporal factors.

PubMed

Soyiri, Ireneous N; Reidpath, Daniel D; Sarran, Christophe

2011-01-01

Asthma is a condition of significant public health concern associated with morbidity, mortality and healthcare utilisation. This study identifies key determinants of length of stay (LOS) associated with asthma-related hospital admissions in London, and further explores their effects on individuals. Subjects were primarily diagnosed and admitted for asthma in London between 1(st) January 2001 and 31(st) December 2006. All repeated admissions were treated uniquely as independent cases. Negative binomial regression was used to model the effect(s) of demographic, temporal and diagnostic factors on the LOS, taking into account the cluster effect of each patient's hospital attendance in London. The median and mean asthma LOS over the period of study were 2 and 3 days respectively. Admissions increased over the years from 8,308 (2001) to 10,554 (2006), but LOS consistently declined within the same period. Younger individuals were more likely to be admitted than the elderly, but the latter significantly had higher LOS (p<0.001). Respiratory related secondary diagnoses, age, and gender of the patient as well as day of the week and year of admission were important predictors of LOS. Asthma LOS can be predicted by socio-demographic factors, temporal and clinical factors using count models on hospital admission data. The procedure can be a useful tool for planning and resource allocation in health service provision.

Evaluation of the Effectiveness of Two Morphine Protocols to Treat Neonatal Abstinence Syndrome in a Level II Nursery in a Community Hospital.

PubMed

DeAtley, Heather N; Burton, Amanda; Fraley, Michelle DeLuca; Haltom, Joan

2017-07-01

The authors sought to evaluate the impact on length of hospital stay and treatment duration of morphine after implementation of a change in the institutional protocol for managing neonatal abstinence syndrome (NAS) in an effort to improve patient outcomes. A single-center, retrospective chart review was conducted at a Level II nursery in a community hospital in Kentucky. Fifty-nine neonates born between January 1, 2014, and December 31, 2015, who were diagnosed with NAS and received morphine for treatment were included. The protocol 1 group consisted of 33 neonates who received an initial dose of morphine 0.04 mg/kg/dose administered orally every 4 hours (January 1-December 31, 2014), and the protocol 2 group consisted of 26 neonates who received an initial dose of morphine 0.06 mg/kg/dose administered orally every 3 hours (January 1-November 30, 2015), after a change in the protocol for managing NAS was implemented on January 1, 2015. Data were reviewed and compared between the two protocol groups to determine the impact that the dosage change had on length of hospital stay and morphine treatment duration. The average length of stay decreased by 7 days in the protocol 2 group compared with the protocol 1 group (21 vs 28.65 days). The average duration of treatment decreased by 7 days in the protocol 2 group compared with the protocol 1 group (18.3 vs 25.4 days). These differences between groups were not statistically significant, however, because the population size was not large enough to achieve adequate power. These results indicate that protocol 2 displayed the potential to decrease length of stay and duration of treatment compared with protocol 1 at this facility; however, balancing higher starting doses with the risk of oversedation will continue to challenge the health care team. Concern for oversedation when using the higher starting dose in protocol 2 has prompted further research (e.g., protocol 3, initial morphine 0.05 mg/kg/dose every 3 hrs). Continued research is also necessary with larger patient populations to enable generalizability to other institutions. © 2017 Pharmacotherapy Publications, Inc.

GROWTH AND BEHAVIOR OF LARVAL ZEBRAFISH Danio ...

EPA Pesticide Factsheets

Because Zebrafish (Danio rerio) have become a popular and important model for scientific research, the capability to rear larval zebrafish to adulthood is of great importance. Recently research examining the effects of diet (live versus processed) have been published. In the current study we examined whether the larvae can be reared on a processed diet alone, live food alone, or the combination while maintaining normal locomotor behavior, and acceptable survival, length and weight at 14 dpf in a static system. A 14 day feeding trial was conducted in glass crystallizing dishes containing 500 ml of 4 ppt Instant Ocean. On day 0 pdf 450 embryos were selected as potential study subjects and placed in a 26○C incubator on a 14:10 (light:dark) light cycle. At 4 dpf 120 normally developing embryos were selected per treatment and divided into 3 bowls of 40 embryos (for an n=3 per treatment; 9 bowls total). Treatment groups were: G (Gemma Micro 75 only), R (L-type marine rotifers (Brachionus plicatilis) only) or B (Gemma and rotifers). Growth (length), survival, water quality and rotifer density were monitored on days 5-14. On day 14, weight of larva in each bowl was measured and 8 larva per bowl were selected for use in locomotor testing. This behavior paradigm tests individual larval zebrafish under both light and dark conditions in a 24-well plate.After 14 dpf, survival among the groups was not different (92-98%). By days 7 -14 R and B larvae were ~2X longer

Selective breeding for susceptibility to myopia reveals a gene-environment interaction.

PubMed

Chen, Yen-Po; Hocking, Paul M; Wang, Ling; Povazay, Boris; Prashar, Ankush; To, Chi-Ho; Erichsen, Jonathan T; Feldkaemper, Marita; Hofer, Bernd; Drexler, Wolfgang; Schaeffel, Frank; Guggenheim, Jeremy A

2011-06-08

Purpose. To test whether the interanimal variability in susceptibility to visually induced myopia is genetically determined. Methods. Monocular deprivation of sharp vision (DSV) was induced in outbred White Leghorn chicks aged 4 days. After 4 days' DSV, myopia susceptibility was quantified by the relative changes in axial length and refraction. Chicks in the extreme tails of the distribution of susceptibility to DSV were kept and paired for breeding (high- and low-susceptibility lines). A second round of selection was then performed. The third generation of chicks, derived from the selected parents, was assessed after either monocular DSV (4 or 10 days) or lens wear. Results. After two rounds of selective breeding, the chicks from the high-susceptibility line developed approximately twice as much myopia in response to 4 days' DSV as did those from the low-susceptibility line (P < 0.001). All ocular component dimensions differed significantly (P < 0.001) between the two selected lines, both before treatment and in the responses of the treated eye. When DSV was conducted for 10 days, the relative changes in axial length and refractive error were still significantly different between the high and low lines (P < 0.001). The chicks bred for high or low susceptibility to DSV also showed significantly different responses to minus lens wear, but not to plus lens wear. Additive genetic effects explained ∼50% of the interanimal variability in response to DSV. Conclusions. Genes and environment interact to shape refractive development in chicks.

The effect of heat waves on dairy cow mortality.

PubMed

Vitali, A; Felici, A; Esposito, S; Bernabucci, U; Bertocchi, L; Maresca, C; Nardone, A; Lacetera, N

2015-07-01

This study investigated the mortality of dairy cows during heat waves. Mortality data (46,610 cases) referred to dairy cows older than 24mo that died on a farm from all causes from May 1 to September 30 during a 6-yr period (2002-2007). Weather data were obtained from 12 weather stations located in different areas of Italy. Heat waves were defined for each weather station as a period of at least 3 consecutive days, from May 1 to September 30 (2002-2007), when the daily maximum temperature exceeded the 90th percentile of the reference distribution (1971-2000). Summer days were classified as days in heat wave (HW) or not in heat wave (nHW). Days in HW were numbered to evaluate the relationship between mortality and length of the wave. Finally, the first 3 nHW days after the end of a heat wave were also considered to account for potential prolonged effects. The mortality risk was evaluated using a case-crossover design. A conditional logistic regression model was used to calculate odds ratio and 95% confidence interval for mortality recorded in HW compared with that recorded in nHW days pooled and stratified by duration of exposure, age of cows, and month of occurrence. Dairy cows mortality was greater during HW compared with nHW days. Furthermore, compared with nHW days, the risk of mortality continued to be higher during the 3 d after the end of HW. Mortality increased with the length of the HW. Considering deaths stratified by age, cows up to 28mo were not affected by HW, whereas all the other age categories of older cows (29-60, 61-96, and >96mo) showed a greater mortality when exposed to HW. The risk of death during HW was higher in early summer months. In particular, the highest risk of mortality was observed during June HW. Present results strongly support the implementation of adaptation strategies which may limit heat stress-related impairment of animal welfare and economic losses in dairy cow farm during HW. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Estimating physical activity in children: impact of pedometer wear time and metric.

PubMed

Laurson, Kelly R; Welk, Gregory J; Eisenmann, Joey C

2015-01-01

The purpose of this study was to provide a practical demonstration of the impact of monitoring frame and metric when assessing pedometer-determined physical activity (PA) in youth. Children (N = 1111) were asked to wear pedometers over a 7-day period during which time worn and steps were recorded each day. Varying data-exclusion criteria were used to demonstrate changes in estimates of PA. Steps were expressed using several metrics and criteria, and construct validity was demonstrated via correlations with adiposity. Meaningful fluctuations in average steps per day and percentage meeting PA recommendations were apparent when different criteria were used. Children who wore the pedometer longer appeared more active, with each minute the pedometer was worn each day accounting for an approximate increase of 11 and 8 steps for boys and girls, respectively (P < .05). Using more restrictive exclusion criteria led to stronger correlations between indices of steps per day, steps per minute, steps per leg length, steps per minute per leg length, and obesity. Wear time has a meaningful impact on estimates of PA. This should be considered when determining exclusion criteria and making comparisons between studies. Results also suggest that incorporating wear time per day and leg length into the metric may increase validity of PA estimates.

Soleus Fiber Force and Maximal Shortening Velocity After Non-Weight Bearing with Intermittent Activity

NASA Technical Reports Server (NTRS)

Widrick, Jeffrey J.; Bangart, Jill J.; Karhanek, Miloslav; Fitts, Robert H.

1996-01-01

This study examined the effectiveness of intermittent weight bearing (IWB) as a countermeasure to non-weight-bearing (NWB)-induced alterations in soleus type 1 fiber force (in mN), tension (P(sub o); force per fiber cross-sectional area in kN/sq m), and maximal unloaded shortening velocity (V(sub o), in fiber lengths/s). Adult rats were assigned to one of the following groups: normal weight bearing (WB), 14 days of hindlimb NWB (NWB group), and 14 days of hindlimb NWB with IWB treatments (IWB group). The IWB treatment consisted of four 10-min periods of standing WB each day. Single, chemically permeabilized soleus fiber segments were mounted between a force transducer and position motor and were studied at maximal Ca(2+) activation, after which type 1 fiber myosin heavy-chain composition was confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. NWB resulted in a loss in relative soleus mass (-45%), with type 1 fibers displaying reductions in diameter (-28%) and peak isometric force (-55%) and an increase in V(sub o) (+33%). In addition, NWB induced a 16% reduction in type 1 fiber P., a 41% reduction in type 1 fiber peak elastic modulus [E(sub o), defined as ((delta)force/(delta)length x (fiber length/fiber cross-sectional area] and a significant increase in the P(sub o)/E(sub o) ratio. In contrast to NWB, IWB reduced the loss of relative soleus mass (by 22%) and attenuated alterations in type 1 fiber diameter (by 36%), peak force (by 29%), and V(sub o)(by 48%) but had no significant effect on P(sub o), E(sub o) or P(sub o)/E(sub o). These results indicate that a modest restoration of WB activity during 14 days of NWB is sufficient to attenuate type 1 fiber atrophy and to partially restore type 1 peak isometric force and V(sub o) to WB levels. However, the NWB-induced reductions in P(sub o) and E(sub o) which we hypothesize to be due to a decline in the number and stiffness of cross bridges, respectively, are considerably less responsive to this countermeasure treatment.

Enhanced hip fracture management: use of statistical methods and dataset to evaluate a fractured neck of femur fast track pathway-pilot study.

PubMed

Gilchrist, Nigel; Dalzell, Kristian; Pearson, Scott; Hooper, Gary; Hoeben, Kit; Hickling, Jeremy; McKie, John; Yi, Ma; Chamberlain, Sandra; McCullough, Caroline; Gutenstein, Marc

2017-05-12

The increasing elderly population and subsequent rise in total hip fracture(s) in this group means more effective management strategies are necessary to improve efficiency. We have changed our patient care strategy from the emergency department (ED), acute orthopaedic wards, operating theatre, post-operation and rehabilitation, and called it Fracture Neck of Femur Fast Track Pathway. All clinical data and actions were captured, integrated and displayed on a weekly basis using 'signalfromnoise' (SFN) software. The initial four months analysis of this project showed significant improvement in patient flow within the hospitals. The overall length of stay was reduced by four days. Time in ED was reduced by 30 minutes, and the wait for rehabilitation reduced by three days. Overall time in rehabilitation reduced by 3-7 days depending on facility. On average, fast track patients spent 95 less hours in hospital, resulting in 631 bed days saved in this period, with projected savings of NZD700,000. No adverse effects were seen in mortality, readmission and functional improvement status. Fractured neck of femur has increasing clinical demand in a busy tertiary hospital. Length of stay, co-morbidities and waiting time for theatres are seen as major barriers to treatment for these conditions. Wait for rehabilitation can significantly lengthen hospital stay; also poor communication between the individual hospital management facets of this condition has been an ongoing issue. Lack of instant and available electronic information on this patient group has also been seen as a major barrier to improvement. This paper demonstrates how integration of service components that are involved in fractured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practice. This paper indicates that cooperation between health professionals and practitioners can significantly improve the length of stay and the time in which patients can be returned home. Full interdisciplinary involvement was the key to this approach. The use of electronic data capture and analysis can be used in many other health pathways within the health system.

Potential superiority of periarticular injection in analgesic effect and early mobilization ability over femoral nerve block following total knee arthroplasty.

PubMed

Fu, Huichao; Wang, Jiaxing; Zhang, Wen; Cheng, Tao; Zhang, Xianlong

2017-01-01

Pain management after total knee arthroplasty (TKA) should permit early knee mobilization with minimal pain. Periarticular injection (PAI) with local anaesthetics has been recently discussed as a protocol of pain control. The purpose of this review of the literature was to evaluate the efficacy of PAI in comparison with femoral nerve block (FNB). A literature search was performed in PubMed, EMBASE, the OVID database and the Cochrane Library databases. Risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included narcotic consumption, pain score, early mobilization ability, length of stay and adverse effects or events. Research identified 918 articles, of which six with a total of 284 knees, met the inclusion criteria and were eligible for the current study. Conflicting evidence was found in terms of narcotic consumption on the postoperative day 1 and early mobilization ability. Total narcotic consumption, pain score in the first 2 days after surgery, length of stay and adverse effects or events showed no difference between two groups. Lower pain score on the day of surgery was detected after PAI. When compared to continuous FNB, patients in PAI group showed a tendency to achieving better ability of early mobilization. In consideration of its relatively simple practice and its potential in analgesic effects or early mobilization ability, PAI had superiority to FNB in the management of pain control after TKA. Before PAI could be widely used in clinical practice after TKAs, further investigations would be necessary to confirm or refute our observed results and to unify the protocol of PAI. I.

Effects of polyunsaturated fatty acids supplementation on reproductive parameters associated with the performance of suckled beef cows.

PubMed

Fontes, P L P; Henry, D D; Ciriaco, F M; Oosthuizen, N; Cooke, R F; Mercadante, V R G; DiLorenzo, N; Lamb, G C

2018-06-21

To evaluate the effects of a polyunsaturated fatty acids (PUFA) supplement on reproductive parameters of suckled beef cows, two experiments were conducted. In Experiment (Exp.) 1, 60 primiparous cows were randomly assigned to one of two treatments: CTRL - 1.36 kg/day of corn gluten feed (CGF) and MEGR - 1.36 kg/day of CGF and 0.23 kg/day of calcium salts of soybean oil. Supplementation occurred from 30 days before fixed-time artificial insemination (TAI) until 7 days post-TAI. The expression of interferon-stimulated genes (ISG) was measured on days 18 and 21. Pregnancy rates were diagnosed on days 30 and 100. Treatment altered plasma fatty acid profile (P<0.05), however, did not change cow BW (P=0.52) or body condition score (BCS) (P=0.52). Treatment did not alter (P=0.12) pregnancy rates to TAI or final pregnancy rates (P=0.56). Treatments did not impact messenger RNA (mRNA) expression of the ISG OAS1 or MX2 on days 18 (P=0.67; P=0.96, respectively) or 21 (P=0.72; P=0.17, respectively). Length of gestation was greater (P=0.02) for MEGR, however, treatments did not alter calf birth weight (P=0.20). In Exp. two, 66 multiparous cows were assigned to one of two treatments: MEG - 0.65 kg/day of CGF+0.23 kg/day of calcium salts of palm oil and MEGR - 0.65 kg/day of CGF+0.23 kg/day of Ca salts of soybean oil. Cows were supplemented from 30 days prepartum to 30 days postpartum. On day 35 after TAI, pregnancy status, embryo crown-to-rump length (CRL), and plasma concentrations of pregnancy-specific protein-B (PSPB) were evaluated. Treatment altered plasma fatty acid profile (P<0.05). In addition, cows from the MEG treatment had greater BW (P<0.01) and BCS (P<0.01) than those in the MEGR treatment, as well as heavier calves at weaning (P=0.03). Treatment did not affect resumption of estrous cycle (P=0.29). There were no differences in pregnancy rates to TAI (P=0.87) or final pregnancy rates (P=0.29). No differences between treatments were detected on CRL (P=0.24) and plasma concentrations of PSPB (P=0.46). Birth weight (P=0.12) and calving distribution (P=0.52) were not altered. We concluded that PUFA supplementation altered plasma fatty acid profile, however, did not impact the remaining reproductive parameters evaluated.

Combined organizational and activational effects of short and long photoperiods on spatial and temporal memory in rats.

PubMed

MacDonald, Christopher J; Cheng, Ruey-Kuang; Williams, Christina L; Meck, Warren H

2007-02-22

The present study examined the effects of photoperiod on spatial and temporal memory in adult Sprague-Dawley rats that were conceived and reared in different day lengths, i.e., short day (SD-8:16 light/dark) and long day (LD-16:8 light/dark). Both male and female LD rats demonstrated increased spatial memory capacity as evidenced by a lower number of choices to criterion in a 12-arm radial maze task relative to the performance of SD rats. SD rats also demonstrated a distortion in the content of temporal memory as evidenced by a proportional rightward shift in the 20 and 60 s temporal criteria trained using the peak-interval procedure that is consistent with reduced cholinergic function. The conclusion is that both spatial and temporal memory are sensitive to photoperiod variation in laboratory rats in a manner similar to that previously observed for reproductive behaviour.

[The curative effects of different drugs on liver cell damage of rats induced by acute nickel carbonyl poisoning].

PubMed

Liu, Jing; Wang, Qiu-ying; Wang, Bei; Xuan, Xiao-qiang; Chen, Qiong; Xu, Dong-wei; Cheng, Ning

2011-02-01

To assess the curative effects of different drugs on liver cell damage of rats induced by acute nickel carbonyl poisoning. In present study 220 SD rats were divided into control group (10 rats), carbonyl nickel group (10 rats), 20 mg/kg methylprednisolone group (40 rats), 100 mg/kg DDC group (40 rats), 10 µmol/kg sodium selenite group (40 rats), 0.25 ml shenfuhuiyangtang group (40 rats) and 20 mg/kg methylprednisolone with 100 mg/kg DDC group (40 rats). All rats except for control group inhaled passively 250 mg/m(3) carbonyl nickel for 30 minutes. At 4h and 30h after exposure, the drugs were given intraperitoneally to the rats. On the 3rd and 7th days after exposure, the liver samples were taken from 10 rats each group. The DNA damage of liver cells was detected using comet assay, the ultrastructure changes in liver cells were examined under an electronmicroscope. Compared to carbonyl nickel group, the tail lengths of liver cells in 5 groups administrated at 4 h or 30 h and tested on the 3rd or 7th day after exposure decreased significantly (P < 0.05). Compared to the control group, the tail lengths of liver cells in sodium selenite and shenfuhuiyangtang groups administrated at 4h after exposure or sodium selenite, shenfuhuiyangtang and methylprednisolone with DDC groups administrated at 30h after exposure increased significantly (P < 0.05 or P < 0.01), when tested on the 3rd day after exposure. Except from methylprednisolone sub-group administrated at 4h and tested on the 7th day after exposure, the tail lengths of liver cells in other groups administrated at 4 h or 30 h and tested on the 7th day after exposure increased significantly (P < 0.05). Compared to carbonyl nickel group, the Olive moment of liver cells in 5 groups administrated at 4 h or 30 h tested on the 3rd or 7th day after exposure decreased significantly (P < 0.05 or P < 0.01). Compared to the control group, the Olive moment of liver cells in following groups (selenite and shenfuhuiyangtang groups administrated at 4 h or 30 h and tested on the 3rd or 7th day after exposure, DDC group administrated at 4 h or 30 h and tested on the 7th day after exposure, DDC group administrated at 30h and tested on the 3rd day after exposure, and methylprednisolone with DDC group administrated at 30 h and tested on the 7th day after exposure) increased significantly (P < 0.05 or P < 0.01). As compared with carbonyl nickel group, the ultrastructure observation indicated that the nucleus and other organelles of liver cells in methylprednisolone, DDC and methylprednisolone with DDC groups administrated at 4h and tested on the 3rd day were access to normal levels. The results of present study showed that methylprednisolone, DDC and methylprednisolone with DDC could improve obviously the repair of rat liver cell damage induced by acute carbonyl nickel poisoning, and the curative effects of early treatment were better than those of later treatment.

The effect of English language proficiency on length of stay and in-hospital mortality.

PubMed

John-Baptiste, Ava; Naglie, Gary; Tomlinson, George; Alibhai, Shabbir M H; Etchells, Edward; Cheung, Angela; Kapral, Moira; Gold, Wayne L; Abrams, Howard; Bacchus, Maria; Krahn, Murray

2004-03-01

In ambulatory care settings, patients with limited English proficiency receive lower quality of care. Limited information is available describing outcomes for inpatients. To investigate the effect of English proficiency on length of stay (LOS) and in-hospital mortality. Retrospective analysis of administrative data at 3 tertiary care teaching hospitals (University Health Network) in Toronto, Canada. Consecutive inpatient admissions from April 1993 to December 1999 were analyzed for LOS differences first by looking at 23 medical and surgical conditions (59,547 records) and then by a meta-analysis of 220 case mix groups (189,119 records). We performed a similar analysis for in-hospital mortality. LOS and odds of in-hospital death for limited English-proficient (LEP) patients relative to English-proficient (EP) patients. LEP patients stayed in hospital longer for 7 of 23 conditions (unstable coronary syndromes and chest pain, coronary artery bypass grafting, stroke, craniotomy procedures, diabetes mellitus, major intestinal and rectal procedures, and elective hip replacement), with LOS differences ranging from approximately 0.7 to 4.3 days. A meta-analysis using all admission data demonstrated that LEP patients stayed 6% (approximately 0.5 days) longer overall than EP patients (95% confidence interval, 0.04 to 0.07). LEP patients were not at increased risk of in-hospital death (relative odds, 1.0; 95% confidence interval, 0.9 to 1.1). Patients with limited English proficiency have longer hospital stays for some medical and surgical conditions. Limited English proficiency does not affect in-hospital mortality. The effect of communication barriers on outcomes of care in the inpatient setting requires further exploration, particularly for selected conditions in which length of stay is significantly prolonged.

Effect of surfactant chain length on drug release kinetics from microemulsion-laden contact lenses.

PubMed

Maulvi, Furqan A; Desai, Ankita R; Choksi, Harsh H; Patil, Rahul J; Ranch, Ketan M; Vyas, Bhavin A; Shah, Dinesh O

2017-05-30

The effect of surfactant chain lengths [sodium caprylate (C 8 ), Tween 20 (C 12 ), Tween 80 (C 18 )] and the molecular weight of block copolymers [Pluronic F68 and Pluronic F 127] were studied to determine the stability of the microemulsion and its effect on release kinetics from cyclosporine-loaded microemulsion-laden hydrogel contact lenses in this work. Globule size and dilution tests (transmittance) suggested that the stability of the microemulsion increases with increase in the carbon chain lengths of surfactants and the molecular weight of pluronics. The optical transmittance of direct drug-laden contact lenses [DL-100] was low due to the precipitation of hydrophobic drugs in the lenses, while in microemulsion-laden lenses, the transmittance was improved when stability of the microemulsion was achieved. The results of in vitro release kinetics revealed that drug release was sustained to a greater extent as the stability of microemulsion was improved as well. This was evident in batch PF127-T80, which showed sustained release for 15days in comparison to batch DL-100, which showed release up to 7days. An in vivo drug release study in rabbit tear fluid showed significant increase in mean residence time (MRT) and area under curve (AUC) with PF-127-T80 lenses (stable microemulsion) in comparison to PF-68-SC lenses (unstable microemulsion) and DL-100 lenses. This study revealed the correlation between the stability of microemulsion and the release kinetics of drugs from contact lenses. Thus, it was inferred that the stable microemulsion batches sustained the release of hydrophobic drugs, such as cyclosporine from contact lenses for an extended period of time without altering critical lens properties. Copyright © 2017 Elsevier B.V. All rights reserved.

Cannabis Use Has Negligible Effects Following Severe Traumatic Injury.

PubMed

AbdelFattah, Kareem R; Edwards, Courtney R; Cripps, Michael W; Minshall, Christian T; Phelan, Herb A; Minei, Joseph P; Eastman, Alexander L

Nearly half of all states have legalized medical marijuana or recreational-use marijuana. As more states move toward legalization, the effects on injured patients must be evaluated. This study sought to determine effects of cannabis positivity at the time of severe injury on hospital outcomes compared with individuals negative for illicit substances and those who were users of other illicit substances. A Level I trauma center performed a retrospective chart review covering subjects over a 2-year period with toxicology performed and an Injury Severity Score (ISS) of more than 16. These individuals were divided into the negative and positive toxicology groups, further divided into the marijuana-only, other drugs-only, and mixed-use groups. Differences in presenting characteristics, hospital length of stay, intensive care unit (ICU) stays, ventilator days, and death were compared. A total of 8,441 subjects presented during the study period; 2,134 (25%) of these had toxicology performed; 843 (40%) had an ISS of more than 16, with 347 having negative tests (NEG); 70 (8.3%) substance users tested positive only for marijuana (MO), 323 (38.3%) for other drugs-only, excluding marijuana (OD), and 103 (12.2%) subjects showed positivity for mixed-use (MU). The ISS was similar for all groups. No differences were identified in Glasgow Coma Scale (GCS), ventilator days, blood administration, or ICU/hospital length of stay when comparing the MO group with the NEG group. Significant differences occurred between the OD group and the NEG/MO/MU groups for GCS, ICU length of stay, and hospital charges. Cannabis users suffering from severe injury demonstrated no detrimental outcomes in this study compared with nondrug users.

Comparison of endoscopic and percutaneous drainage of symptomatic necrotic collections in acute necrotizing pancreatitis.

PubMed

Woo, Shanan; Walklin, Ryan; Ackermann, Travis; Lo, Sheng Wei; Shilton, Hamish; Pilgrim, Charles; Evans, Peter; Burnes, James; Croagh, Daniel

2018-05-10

Primary endoscopic and percutaneous drainage for pancreatic necrotic collections is increasingly used. We aim to compare the relative effectiveness of both modalities in reducing the duration and severity of illness by measuring their effects on systemic inflammatory response syndrome (SIRS). We retrospectively reviewed all cases of endoscopic and percutaneous drainage for pancreatic necrotic collections performed in 2011-2016 at two hospitals. We assessed the post-procedure length of hospital stay, reduction in C-reactive protein levels, resolution of SIRS, the complication rates, and the number of procedures required for resolution. Thirty-two patients were identified and 57 cases (36 endoscopic, 21 percutaneous) were included. There was no significant difference in C-reactive protein reduction between endoscopic and percutaneous drainage (69.5% vs 68.8%, P = 0.224). Resolution of SIRS was defined as the post-procedure normalization of white cell count (endoscopic vs percutaneous: 70.4% vs 64.3%, P = 0.477), temperature (endoscopic vs percutaneous: 93.3% vs 60.0%, P = 0.064), heart rate (endoscopic vs percutaneous: 56.0% vs 11.1%, P = 0.0234), and respiratory rate (endoscopic vs percutaneous: 83.3% vs 0.0%, P = 0.00339). Post-procedure length of hospital stay was 27 days with endoscopic drainage and 46 days with percutaneous drainage (P = 0.0183). Endoscopic drainage was associated with a shorter post-procedure length of hospital stay and a greater rate of normalization of SIRS parameters than percutaneous drainage, although only the effects on heart rate and respiratory rate reached statistical significance. Further studies are needed to establish which primary drainage modality is superior for pancreatic necrotic collections. © 2018 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.

PubMed

Perez, Katherine K; Olsen, Randall J; Musick, William L; Cernoch, Patricia L; Davis, James R; Peterson, Leif E; Musser, James M

2014-09-01

An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria. A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures. Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P < 0.001) and effective antibiotic therapy (89.7 h versus 32 h, P < 0.001). Patients in the pre-intervention period had increased duration of hospitalization compared to those in the intervention period (23.3 days versus 15.3 days, P = 0.0001) and longer intensive care unit length of stay (16 days versus 10.7 days, P = 0.008). Mortality among patients during the intervention period was lower (21% versus 8.9%, P = 0.01) and our study intervention remained a significant predictor of survival (OR, 0.3; 95% confidence interval [CI], 0.12-0.79) after multivariate logistic regression. Mean hospital costs for each inpatient survivor were reduced $26,298 in the intervention cohort resulting in an estimated annual cost savings of $2.4 million (P = 0.002). Integration of rapid identification and susceptibility techniques with antimicrobial stewardship resulted in significant improvements in clinical and financial outcomes for patients with bloodstream infections caused by antibiotic-resistant Gram-negatives. The intervention decreased hospital and intensive care unit length of stay, total hospital costs, and reduced all-cause 30-day mortality. Copyright © 2014. Published by Elsevier Ltd.

Methicillin-resistant Staphylococcus aureus prolongs intensive care unit stay in ventilator-associated pneumonia, despite initially appropriate antibiotic therapy.

PubMed

Shorr, Andrew F; Combes, Alain; Kollef, Marin H; Chastre, Jean

2006-03-01

To determine the impact of methicillin-resistant Staphylococcus aureus (MRSA) on length of stay in the intensive care unit (ICU) for patients with ventilator-associated pneumonia (VAP) and to control for the effect of initially inappropriate antibiotic treatment on outcomes by focusing only on persons who were given appropriate antibiotic therapy for their infection. Retrospective analysis of pooled, patient-level data from multiple clinical trials in VAP. Multiple ICUs in France. Persons with bronchoscopically confirmed VAP due to either MRSA or methicillin-susceptible S. aureus (MSSA) and who received initially appropriate antibiotic treatment. All persons with MRSA VAP received vancomycin (15 mg/kg intravenously, twice daily). None. We compared patients with MRSA VAP to persons with MSSA VAP. ICU length of stay represented the primary end point and ICU-free days served as a secondary end point. We recorded information regarding multiple confounders, including demographics, reasons for ICU admission and mechanical ventilation (MV), severity of illness at both ICU admission and time of diagnosis of VAP, and duration of mechanical ventilation before and following the onset of VAP. The final cohort included 107 patients, and one third of cases were due to MRSA. Despite receiving initially appropriate antibiotic treatment, median ICU length of stay was significantly longer for persons with MRSA infection (33 days vs. 22 days; p=.047). The median number of ICU-free days was concomitantly lower in MRSA VAP (0 days vs. 5 days; p=.011). Survival analysis employing a Cox proportional hazards model identified several predictors of remaining in the ICU: Pao2/Fio2 ratio at diagnosis of VAP, duration of MV before VAP, duration of MV after diagnosis of VAP, and reason for MV. Additionally, infection with MRSA as opposed MSSA doubled the probability of needing continued ICU care (hazard ratio, 2.08; 95% confidence interval, 1.09-3.95; p=.025). MRSA VAP independently prolongs the duration of ICU hospitalization, and in turn, increases overall costs, even for patients initially given appropriate antibiotic treatment. Confronting the adverse impact of MRSA will require efforts that address more than the initial antibiotic prescription.

Outcomes of Laparoscopic Colectomy in Younger and Older Patients: An Analysis of Nationwide Readmission Database.

PubMed

Mehta, Hemalkumar B; Hughes, Byron D; Sieloff, Eric; Sura, Sneha O; Shan, Yong; Adhikari, Deepak; Senagore, Anthony

2018-04-01

Prior studies report safety and effectiveness of laparoscopic colectomy in older patients. The study aimed to examine the impact of laparoscopic colectomy on 30-day readmissions, discharge destination, hospital length of stay, and cost in younger (19-65 years) and older adults (>65 years). We used the nationwide readmission database from 2013 to study adults undergoing elective colectomy. The outcomes were 30-day readmissions, discharge destination for the index hospitalization (routine, skilled nursing facility [SNF]/intermediate care facility [ICF], home healthcare), length of stay, and cost. Multivariable analyses were conducted to determine the association of laparoscopic colectomy on outcome; logistic regression for 30-day readmission, multinomial logistic regression for discharge destination, and linear regression for length of stay and cost. An interaction between age and colectomy approach was included, and all models controlled gender, income, insurance status, All Patients Refined Diagnosis Related Groups (APR-DRG), Elixhauser comorbidities, hospital bed size, ownership, and teaching status. Of 79,581 colectomies, 40.2% were laparoscopic. Laparoscopic colectomy was more frequent in younger patients (41.9% versus 38.5%, p < .0001). Regardless of age, patients undergoing laparoscopic colectomy were 20% less likely to be readmitted within 30 days (odds ratio [OR] 0.80, confidence interval [95% CI] 0.75-0.85). For postdischarge destination, laparoscopic colectomy offered higher benefits to younger patients (SNF/ICF: OR 0.42, 95% CI 0.36-0.49; home health: OR 0.32, 95% CI 0.30-0.35) than older patients (SNF/ICF: OR 0.50, 95% CI 0.47-0.54; home health: OR 0.59, 95% CI 0.55-0.62). Regardless of age, laparoscopic colectomy resulted in 1.46 days (p < .0001) shorter hospital stays compared to open colectomy. Laparoscopic colectomy had significantly lower cost compared to open approach, particularly in younger ($1,466) versus older ($632) patients. Laparoscopic colectomy is superior to an open approach, with fewer 30-day readmissions, fewer discharges to SNF/ICF or home health, shorter hospital stays, and less overall cost; younger patients benefit more than older patients.

Predictors of Failure in Infant Mandibular Distraction Osteogenesis.

PubMed

Hammoudeh, Jeffrey A; Fahradyan, Artur; Brady, Colin; Tsuha, Michaela; Azadgoli, Beina; Ward, Sally; Urata, Mark M

2018-03-15

Mandibular distraction osteogenesis (MDO) has been shown to be successful in treating upper airway obstruction caused by micrognathia in pediatric patients. The purpose of this study was to assess the success rate of MDO and possible predictors of failure. The records of all neonates and infants who underwent MDO from 2008 to 2015 were retrospectively reviewed. Procedural failure was defined as patient death or the need for tracheostomy postoperatively. Details of distraction, length of stay, and failures were captured and elucidated. Of the 82 patients, 47 (57.3%) were male; 46 (56.1%) had sporadic Pierre Robin sequence; 33 (40.3%) had syndromic Pierre Robin sequence; and 3 (3.7%) had micrognathia, not otherwise specified. The average distraction length was 27.5 mm (range, 15 to 30 mm; SD, 4.4 mm), the average age at operation was 63.3 days (range, 3 to 342 days; SD, 71.4 days), and the average length of post-MDO hospital stay was 43 days (range, 9 to 219 days; SD, 35 days) with an average follow-up period of 4.3 years (range, 1.1 to 9.6 years; SD, 2.6 years). There were 7 failures (8.5%) (5 tracheostomies and 2 deaths) resulting in a 91.5% success rate. Regression analysis showed that the predicted probability of the need for tracheostomy was 45% (P = .02) when the patient had a central nervous system (CNS) anomaly. The predicted probability of the need for tracheostomy and death combined was 99.6% when the patient had laryngomalacia and a CNS anomaly and was preoperatively intubated (P < .05). This review confirms that MDO is an effective method of treating the upper airway obstruction caused by micrognathia with a high success rate. In our sample the presence of CNS abnormalities, laryngomalacia, and preoperative intubation had a significant impact on the failure rate. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

30-Day Readmission After Spine Surgery: An Analysis of 1400 Consecutive Spine Surgery Patients.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Han, Jing L; Karikari, Isaac O; Cheng, Joseph; Bagley, Carlos A

2017-04-01

Retrospective cohort review. To identify the rates, causes, and risk factors for 30-day unplanned readmissions in after elective spine surgery at our institution. Early readmission after spine surgery is being used as a proxy for quality of care. One-fifth of patients are rehospitalized within 30 days after spine surgery. Nearly 60% of these readmissions are unplanned, which translates into billions of dollars in healthcare costs. A total of 1400 patients undergoing elective spine surgery at Duke University Hospital between 2008 and 2010 were included in the study. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient records were reviewed to determine the cause of readmission and the length of hospital stay. A total of 132 (9.4%) unplanned early readmissions were identified. The mean ± SD age was 58.6 ± 15.1 years. Lumbar decompression and fusion was the most common procedure The most common causes for readmission were infection or a concern for infection (34.8%) and pain (19.7%), and 26.5% of readmissions required a return to the operating room. The majority of patients that were readmitted presented to the emergency department from home (58.0%) whereas 25.2% were readmitted from a skilled nursing facility. The mean ± SD number of days from discharge to readmission was 9.8 ± 7.9 days and the average length of hospital stay for the readmissions was 7.5 days. This study suggests that infection and refractory pain were the most common primary reasons for unplanned readmission. Efforts at reducing unplanned early readmission after elective spine surgery should be focused on more effective post discharge care.

Effect of employment status on length of hospital stay, 30-day readmission and patient reported outcomes after spine surgery.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Fialkoff, Jared; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2017-03-01

Growing scrutiny has placed hospitals at the center of readmission prevention. The relationship between pre-operative employment status, length of hospital stays (LOS) and 30-day readmission rates after elective spine surgery remains unclear. The medical records of 360 patients (employed: n=174, unemployed: n=70, retired: n=40, disabled: n=76) undergoing elective spine surgery at a major academic medical center were reviewed. Patient demographics, comorbidities, and post-operative complication rates were recorded. All patients had comprehensive 1-year patient reported outcomes (PROs) measures. We hypothesized that employment status is associated with decreased LOS and decreased risk of 30-day readmission after elective spine surgery. All-cause readmissions within 30 days of discharge was the primary outcome variable. Baseline characteristics were similar in all cohorts. There was no difference in operative time, estimated blood loss (EBL), or number of fusion levels between all patient cohorts. There were no significant differences in peri-operative complication rates between patient cohorts. On average, the LOS was shorter for the employed compared to non-employed patients (4.89 vs. 5.26 days). The rate of 30-day readmission was 2-fold greater unemployed compared to employed patients (5.17% vs. 10%). At 1-year after surgery, employed patients were more likely to express functional improvement (change in ODI score) compared to unemployed patients (ODI: employed: 33.80 vs. unemployed: 41.93). Our study suggests that employment status may be associated with shorter duration of hospital stay, lower 30-day readmission rates and greater functional improvement. Future interventions to reduce unplanned hospital readmissions should consider pre-operative employment status.

Morphometric and immunohistochemical study of the rumen of red deer during prenatal development.

PubMed

Franco, A J; Masot, A J; Aguado, Ma C; Gómez, L; Redondo, E

2004-06-01

Abstract A detailed study of the ontogenesis of deer stomach has not been undertaken to date, and our aim was to sequence several histological phenomena that occur during the ontogenesis of one of the gastric compartments, the rumen. Histomorphometric and immunohistochemical analyses were carried out on 50 embryos and fetuses of deer from the initial stages of prenatal life until birth. For the purposes of testing, the animals were divided into five experimental groups: group I, 1.4-3.6 cm crown-rump length, 30-60 days, 1-25% of gestation; group II, 4.5-7.2 cm crown-rump length, 67-90 days, 25-35% of gestation; group III, 8-19 cm crown-rump length, 97-135 days, 35-50% of gestation; group IV, 21-33 cm crown-rump length, 142-191 days, 45-70% of gestation; and group V, 36-40 cm crown-rump length, 205-235 days, 75-100% of gestation. The rumen of the primitive gastric tube was observed at approximately 60 days. At 67 days the rumen consisted of three layers: internal or mucosal, middle or muscular, and external or serosal layer. The stratification of the epithelial layer was accompanied by changes in its structure with the appearance of ruminal pillars and papillae. The outline of the ruminal papillae began to appear at 142 days of prenatal development as evaginations of the basal zone toward the ruminal lumen, pulling with it in its configuration the stratum basale, the lamina propria and the submucosa. From the pluripotential blastemic tissue at 60 days we witnessed the histodifferentiation of the primitive tunica muscularis, composed of two layers of myoblasts with a defined arrangement. It was also from the pluripotential blastemic tissue, at 97 days, that the lamina propria and the submucosa were differentiated. The serosa showed continuity in growth as well as differentiation, already detected in the undifferentiated outline phase. The tegumentary mucosa of deer rumen was shown without secretory capacity in the initial embryonic phases; neutral mucopolysaccharides appeared from 67 days. The presence of neuroendocrine cells (non-neuronal enolase) in the ruminal wall of deer during development was not detected until 97 days. The glial cells were detected at 142 days for glial fibrillary acidic protein and at 67 days for vimentin. The immunodetection of neuropeptides vasointestinal peptide and neuropeptide Y progressively increased with gestation period, starting from 97 days. In terms of the structure of the rumen of the primitive gastric tube, our observations revealed that the deer is less precocious than small and large domestic ruminants. Thus its secretory capacity, detected by the presence of neutral mucopolysaccharides, and its neuroendocrine nature, determined by the presence of positive non-neuronal enolase cells, were evident in more advanced stages of prenatal development than those detected in the sheep, goat and cow.

Morphometric and immunohistochemical study of the rumen of red deer during prenatal development

PubMed Central

Franco, A J; Masot, A J; Aguado, MaC; Gómez, L; Redondo, E

2004-01-01

A detailed study of the ontogenesis of deer stomach has not been undertaken to date, and our aim was to sequence several histological phenomena that occur during the ontogenesis of one of the gastric compartments, the rumen. Histomorphometric and immunohistochemical analyses were carried out on 50 embryos and fetuses of deer from the initial stages of prenatal life until birth. For the purposes of testing, the animals were divided into five experimental groups: group I, 1.4–3.6 cm crown–rump length, 30–60 days, 1–25% of gestation; group II, 4.5–7.2 cm crown–rump length, 67–90 days, 25–35% of gestation; group III, 8–19 cm crown–rump length, 97–135 days, 35–50% of gestation; group IV, 21–33 cm crown–rump length, 142–191 days, 45–70% of gestation; and group V, 36–40 cm crown–rump length, 205–235 days, 75–100% of gestation. The rumen of the primitive gastric tube was observed at approximately 60 days. At 67 days the rumen consisted of three layers: internal or mucosal, middle or muscular, and external or serosal layer. The stratification of the epithelial layer was accompanied by changes in its structure with the appearance of ruminal pillars and papillae. The outline of the ruminal papillae began to appear at 142 days of prenatal development as evaginations of the basal zone toward the ruminal lumen, pulling with it in its configuration the stratum basale, the lamina propria and the submucosa. From the pluripotential blastemic tissue at 60 days we witnessed the histodifferentiation of the primitive tunica muscularis, composed of two layers of myoblasts with a defined arrangement. It was also from the pluripotential blastemic tissue, at 97 days, that the lamina propria and the submucosa were differentiated. The serosa showed continuity in growth as well as differentiation, already detected in the undifferentiated outline phase. The tegumentary mucosa of deer rumen was shown without secretory capacity in the initial embryonic phases; neutral mucopolysaccharides appeared from 67 days. The presence of neuroendocrine cells (non-neuronal enolase) in the ruminal wall of deer during development was not detected until 97 days. The glial cells were detected at 142 days for glial fibrillary acidic protein and at 67 days for vimentin. The immunodetection of neuropeptides vasointestinal peptide and neuropeptide Y progressively increased with gestation period, starting from 97 days. In terms of the structure of the rumen of the primitive gastric tube, our observations revealed that the deer is less precocious than small and large domestic ruminants. Thus its secretory capacity, detected by the presence of neutral mucopolysaccharides, and its neuroendocrine nature, determined by the presence of positive non-neuronal enolase cells, were evident in more advanced stages of prenatal development than those detected in the sheep, goat and cow. PMID:15198691

Day case hernia repair: weak evidence or practice gap?

PubMed

Scarfe, Anje; Duncan, Joanna; Ma, Ning; Cameron, Alun; Rankin, David; Karatassas, Alex; Fletcher, David; Watters, David; Maddern, Guy

2018-06-01

Analysis of a private insurer's administrative data set revealed significant variation in the length of hospital stay following hernia surgery. This review examined factors influencing the performance of day surgery for inguinal, femoral and umbilical hernia repair in adults. A systematic literature search was conducted in the PubMed, Embase and Cochrane Library databases to identify studies and clinical practice guidelines (CPGs) comparing same day hernia surgery to surgery followed by an overnight stay. Screening of studies by abstract and full text was completed by a single researcher and checked by a second. Studies were selected for inclusion based on a step-wise approach across three phases. Limited evidence from one systematic review, and three case series studies including 3213 patients found that same day hernia surgery was as safe and effective as an overnight stay. All identified CPGs recommended a same day procedure for most patients. Two case series studies reported that 3-8% of patients were ineligible for day procedures due to medical reasons; however, the characteristics of patients, in general, which are not suitable, have not been adequately investigated. Day surgery for groin hernia repair is safe and effective for most patients. However, evidence-based support is only one of many factors that may contribute to the uptake of day surgery in Australia. There is an opportunity for key stakeholders across the private healthcare system to deliver an equally effective but more sustainable and affordable hernia care by increasing the day surgery rates. © 2018 Royal Australasian College of Surgeons.

Identification of complications that have a significant effect on length of stay after spine surgery and predictive value of 90-day readmission rate.

PubMed

Yadla, Sanjay; Ghobrial, George M; Campbell, Peter G; Maltenfort, Mitchell G; Harrop, James S; Ratliff, John K; Sharan, Ashwini D

2015-12-01

Complications after spine surgery have an impact on overall outcome and health care expenditures. The increased cost of complications is due in part to associated prolonged hospital stays. The authors propose that certain complications have a greater impact on length of stay (LOS) than others and that those complications should be the focus of future targeted prevention efforts. They conducted a retrospective analysis of a prospectively maintained database to identify complications with the greatest impact on LOS as well as the predictive value of these complications with respect to 90-day readmission rates. Data on 249 patients undergoing spine surgery at Thomas Jefferson University from May to December 2008 were collected by a study auditor. Any complications occurring within 30 days of surgery were recorded as was overall LOS for each patient. Stepwise regression analysis was performed to determine whether specific complications had a statistically significant effect on LOS. For correlation, all readmissions within 90 days were recorded and organized by complication for comparison with those complications affecting LOS. The mean LOS for patients without postoperative complications was 6.9 days. Patients who developed pulmonary complications had an associated increase in LOS of 11.1 days (p < 0.005). The development of a urinary tract infection (UTI) was associated with an increase in LOS of 3.4 days (p = 0.002). A new neurological deficit was associated with an increase in LOS of 8.2 days (p = 0.004). Complications requiring return to the operating room (OR) showed a trend toward an increase in LOS of 4.7 days (p = 0.09), as did deep wound infections (3.3 days, p = 0.08). The most common reason for readmission was for wound drainage (n = 21; surgical drainage was required in 10 [4.01%] of these 21 cases). The most common diagnoses for readmission, in decreasing order of incidence, were categorized as hardware malpositioning (n = 4), fever (n = 4), pulmonary (n = 2), UTI (n = 2), and neurological deficit (n = 1). Complications affecting LOS were not found to be predictive of readmission (p = 0.029). Postoperative complications in patients who have undergone spine surgery are not uncommon and are associated with prolonged hospital stays. In the current cohort, the occurrence of pulmonary complications, UTI, and new neurological deficit had the greatest effect on overall LOS. Further study is required to determine the causative factors affecting readmission. These specific complications may be high-yield targets for cost reduction and/or prevention efforts.

Lenticular accommodation in relation to ametropia: the chick model.

PubMed

Choh, Vivian; Sivak, Jacob G

2005-03-04

Our goal was to determine whether experimentally induced ametropias have an effect on lenticular accommodation and spherical aberration. Form-deprivation myopia and hyperopia were induced in one eye of hatchling chicks by application of a translucent goggle and +15 D lens, respectively. After 7 days, eyes were enucleated and lenses were optically scanned prior to accommodation, during accommodation, and after accommodation. Accommodation was induced by electrical stimulation of the ciliary nerve. Lenticular focal lengths for form-deprived eyes were significantly shorter than for their controls and accommodation-associated changes in focal length were significantly smaller in myopic eyes compared to their controls. For eyes imposed with +15 D blur, focal lengths were longer than those for their controls and accommodative changes were greater. Spherical aberration of the lens increased with accommodation in both form-deprived and lens-treated birds, but induction of ametropia had no effect on lenticular spherical aberration in general. Nonmonotonicity from lenticular spherical aberration increased during accommodation but effects of refractive error were equivocal. The crystalline lens contributes to refractive error changes of the eye both in the case of myopia and hyperopia. These changes are likely attributable to global changes in the size and shape of the eye.

Quasi-Biennial Oscillation as the Result of Planetary Motion

NASA Astrophysics Data System (ADS)

Retejum, Alexey

QUASI-BIENNIAL OSCILLATION AS THE RESULT OF PLANETARY MOTION A.Ju.Retejum Lomonosov Moscow State University, aretejum@yandex.ru A remarkable phenomenon of quasi-biennial oscillation (QBO) attracts a growing attention for its unclear origin and possible global impact. A comprehensive theory of this phenomenon should answer the following questions: 1. Why does the phase change of the atmospheric circulation on average occur every 800 days? 2. When does the cycle length decreases or increases? 3. Wherefore the regular wind shift is observed in the equatorial stratosphere only? 4. What could cause a sudden reverse in zonal wind direction? 5. Why the generating impulse travels from the border between the atmosphere and outer space downwards without significant loss of power? 6. What is the reason of known differences in behavior patterns between west and east winds? 7. How do middle and upper latitudes respond to the remote signal? Unfortunately all the explanation of QBO that have been given so far, unable to meet the above criteria. The author proposes an alternative idea of the external forcing due to motion of Mars, Jupiter and Venus. This study is based on the QBO Index data at the 30-hPa Height for the 1979-2013 period (http://www.cpc.ncep.noaa.gov/data/indices/qbo.u30.index). Having in mind that the oscillation is symmetric about the Equator, where the Earth rotation speed is highest, one examined on the first stage relationships between the QBO manifestation and the length of day. A ten-year comparison of slow and fast spinning periods (1979-1983, 1991-1995 and 2000-2006, 2009-2011 respectively) reveals a significant difference in west and east winds strengths. The same picture can be observed if mean monthly data for March-April (the length of day maximum) and July (the length of day minimum) are collated. This is the answer to the question # 3. The exact answers to questions # 1 and # 2 give an analysis of the dependence of the wind reverse time on the moments of Mars, Jupiter and Venus conjunctions or opposition in geocentric ecliptical longitudes. Mars having the synodic period varies between 764 and 810 days plays a key role in this process of external regulation. The planets forcing fact is the answer to the question # 5. Sudden reverses in zonal wind direction coincide with the Earth’s changing rotation rate under the influence of other planets and the Sun. Winds shift to west usually occurs when the length of day is getting longer, and the globe’s spin-up produces an opposite effect. West and east winds exhibit different response to the forced irregularities of the forward rotation of the Earth. This finding helps answer to questions # 4 and # 6. Some signs of quasi-biennial modulation in northern regions might be considered as traces of the telecommunication factor. But processing of the data on sensitive indicators (zonal winds and heat flux at 60° as well as total ozone concentration) by means of the superposed epoch method provide evidences of the Martian control (the answer to questions # 7). The first proven effect of the planets impact on the Earth’s atmosphere is a result of conservation of angular momentum in the Solar system and interaction of the outer ether envelops of celestial bodies with forward and reverse rotation.

Recent Changes in Arctic Sea Ice Melt Onset, Freeze-Up, and Melt Season Length

NASA Technical Reports Server (NTRS)

Markus, Thorsten; Stroeve, Julienne C.; Miller, Jeffrey

2010-01-01

In order to explore changes and trends in the timing of Arctic sea ice melt onset and freeze-up and therefore melt season length, we developed a method that obtains this information directly from satellite passive microwave data, creating a consistent data set from 1979 through present. We furthermore distinguish between early melt (the first day of the year when melt is detected) and the first day of continuous melt. A similar distinction is made for the freeze-up. Using this method we analyze trends in melt onset and freeze-up for 10 different Arctic regions. In all regions except for the Sea of Okhotsk, which shows a very slight and statistically insignificant positive trend (O.4 days/decade), trends in melt onset are negative, i.e. towards earlier melt. The trends range from -1.0day/decade for the Bering Sea to -7.3 days/decade for the East Greenland Sea. Except for the Sea of Okhotsk all areas also show a trend towards later autumn freeze onset. The Chukchi/Beaufort Seas and Laptev/East Siberian Seas observe the strongest trends with 7 days/decade. For the entire Arctic, the melt season length has increased by about 20 days over the last 30 years. Largest trends of over 1O days/decade are seen for Hudson Bay, the East Greenland Sea the Laptev/East Siberian Seas, and the Chukchi/Beaufort Seas. Those trends are statistically significant a1 the 99% level.

Biopersistences of man-made vitreous fibers and crocidolite fibers in rat lungs following short-term exposures.

PubMed Central

Musselman, R P; Miiller, W C; Eastes, W; Hadley, J G; Kamstrup, O; Thevenaz, P; Hesterberg, T W

1994-01-01

Biopersistence of commercial man-made vitreous fibers (MMVF) and crocidolite were studied in Fischer 344 rats. MMVF used were size-selected to be rat-respirable, and rats were exposed nose-only 6 h/day for 5 days to gravimetric concentrations (30 mg/m3) of two fiber glass compositions--a rockwool, and a slagwool--or to 10 mg/m3 of long-fibered crocidolite, or to filtered air. Animals were sacrificed at 1 hr, 1, 5, 31, 90, 180, 270, 365, and 545 days after exposure stopped. Fibers were recovered from digested lung tissue to determine changes in concentrations (fibers/mg dry lung) and fiber retentions (expressed as percent of day 1 retention [PR]) for selected dimension categories. One-day average concentrations of lung-retained MMVF and crocidolite fibers, of diameter > or = 0.5 micron or > 20 microns in length, were nearly equal, permitting direct comparisons between MMVF and crocidolite. At 270 days average PR for MMVF > or = 0.5 micron in diameter were from 3 to 6 +/- 2% and 27 +/- 9% for crocidolite. For fibers > 20 microns, PR were 1 to 4 +/- 4% for MMVF and 37 +/- 20% for crocidolite. At 545 days, MMVF > 20 microns in length were at background level while concentration of crocidolite fibers > 20 microns in length remained at 2000 +/- 400 f/mg DL (dry lung), or 38 +/- 9% of day-1 retention. These results suggest strongly that MMVF dissolved or fractured in vivo whereas crocidolite fibers did not change. PMID:7882918

Developmental toxicity in white leghorn chickens following in ovo exposure to perfluorooctane sulfonate (PFOS)

USGS Publications Warehouse

Peden-Adams, M. M.; Stuckey, Joyce E.; Gaworecki, K.M.; Berger-Ritchie, J.; Bryant, K.; Jodice, P.G.; Scott, T.R.; Ferrario, J.B.; Guan, B.; Vigo, C.; Boone, J.S.; McGuinn, W.D.; DeWitt, J.C.; Keil, D.E.

2009-01-01

Studies show that perfluorinated compounds cause various toxicological effects; nevertheless, effects on immune function and developmental endpoints have not been addressed at length. This study examined the effects of perfluorooctane sulfonate (PFOS) in white leghorn hatchlings on various developmental, immunological, and clinical health parameters. In addition, serum PFOS concentrations were determined by LC/MS/MS. Embryonic day (ED) 0 eggs were injected with either safflower oil/10% DMSO (control, 0 mg/kg egg wt) or PFOS in safflower oil/10% DMSO at 1, 2.5, or 5 mg/kg egg wt, and the chicks were grown to post-hatch day (PHD) 14. Treatment with PFOS did not affect hatch rate. Following in ovo exposure chicks exhibited increases in spleen mass at all treatment levels, in liver mass at 2.5 and 5 mg/kg egg wt, and in body length (crown-rump length) at the 5 mg/kg treatment. Right wings were shorter in all treatments compared to control. Increases in the frequency of brain asymmetry were evident in all treatment groups. SRBC-specific immunoglobulin (IgM and IgY combined) titers were decreased significantly at all treatment levels, while plasma lysozyme activity was increased at all treatment levels. The PHA skin test response decreased in relation to increasing PFOS dose. Serum concentrations where significant immunological, morphological, and neurological effects were observed at the lowest dose (1 mg/kg egg wt) averaged 154 ng PFOS/g serum. These concentrations fall within environmental ranges reported in blood samples from wild caught avian species; thereby, verifying that the environmental egg concentrations used for the injections do indeed relate to serum levels in hatchlings that are also environmentally relevant. These data indicate that immune alterations and brain asymmetry can occur in birds following in ovo exposure to environmentally relevant concentrations of PFOS and demonstrates the need for further research on the developmental effects of perfluorinated compounds in various species. ?? 2009 Elsevier Inc.

Age determination enhanced by embryonic foot bud and foot plate measurements in relation to Carnegie stages, and the influence of maternal cigarette smoking.

PubMed

Lutterodt, M C; Rosendahl, M; Yding Andersen, C; Skouby, S O; Byskov, A G

2009-08-01

Reliable age determination of first-trimester human embryos and fetuses is an important parameter for clinical use and basic science. Age determination by ultrasound or morphometric parameters of embryos 4-6 weeks post conception (p.c.) have been questioned, and more accurate methods are required. Data on whether and how maternal smoking and alcohol consumption influence embryonic and fetal foot growth is also lacking. Embryonic tissue from 102 first-trimester legal abortions (aged 35-69 days p.c.) were collected. All women answered a questionnaire concerning smoking and drinking habits, and delivered a urine sample for cotinine analysis. Embryonic age was evaluated by vaginal ultrasound measurements and by post-termination foot length and compared with the Carnegie stages. Foot bud and foot plate were defined and measured as foot length in embryos aged 35-47 days p.c. (range 0.8-2.1 mm). In embryos and fetuses aged 41-69 days p.c., heel-toe length was measured (range 2.5-7.5 mm). We found a significant linear correlation between foot length and age. Morphology of the feet was compared visually with the Carnegie collection, and we found that the mean ages of the two collections correlated well. Foot length was independent of gender, Environmental Tobacco Smoke, maternal smoking and alcohol consumption. Foot length correlated linearly to embryonic and foetal age, and was unaffected by gender, ETS, maternal smoking and alcohol consumption.

Controlling inpatient psychiatric utilization through managed care.

PubMed

Wickizer, T M; Lessler, D; Travis, K M

1996-03-01

There is little current understanding of how managed care strategies affect hospital inpatient psychiatric care for mentally ill patients. This study examined one prominent form of managed care, utilization management, which reviews requests for psychiatric care and authorizes provision of care deemed appropriate and clinically necessary. The authors analyzed data on 2,265 utilization management reviews conducted during 1989-1992 for patients insured by a single large commercial insurance company. Three utilization management procedures were examined: preadmission review, continued-stay review, and case management. The performance indicators analyzed included percent of admission requests granted, number of days requested and approved, and number of treatment extensions granted. Utilization management initially approved inpatient psychiatric treatment for nearly all (98.8%) of the patients but authorized, on average, only one-third of the days requested (6.9 versus 19.0). On average, 23.5 (total) days of care were requested and 16.8 days were approved. Care for patients with alcohol or drug dependence diagnoses was more restricted than was care for other patients. These data suggest that managed care does restrict inpatient psychiatric care, primarily by managing length of stay. The fact that almost all patients were approved for the same initial length of stay implies adherence to strict treatment protocols that do not distinguish among different clinical or patient factors. There is a need for careful study of the effects of managed care on outcomes and quality of psychiatric care.

Decreased hospital length of stay associated with presentation of cases at morning report with librarian support

PubMed Central

Banks, Daniel E.; Shi, Runhua; Timm, Donna F.; Christopher, Kerri Ann; Duggar, David Charles; Comegys, Marianne; McLarty, Jerry

2007-01-01

Objective: The research sought to determine whether case discussion at residents' morning report (MR), accompanied by a computerized literature search and librarian support, affects hospital charges, length of stay (LOS), and thirty-day readmission rate. Methods: This case-control study, conducted from August 2004 to March 2005, compared outcomes for 105 cases presented at MR within 24 hours of admission to 19,210 potential matches, including cases presented at MR and cases not presented at MR. With matching criteria of patient age (± 5 years), identical primary diagnosis, and secondary diagnoses (within 3 additional diagnoses) using International Classification of Diseases (ICD-9) codes, 55 cases were matched to 136 controls. Statistical analyses included Student's t tests, chi-squared tests, and nonparametric methods. Results: LOS differed significantly between matched MR cases and controls (3 days vs. 5 days, P < 0.024). Median total hospital charges were $7,045 for the MR group and $10,663 for the control group. There was no difference in 30-day readmission rate between the 2 groups. Discussion/Conclusion: Presentation of a case at MR, followed by the timely dissemination of the results of an online literature review, resulted in a shortened LOS and lower hospital charges compared with controls. MR, in association with a computerized literature search guided by the librarians, was an effective means for introducing evidence-based medicine into patient care practices. PMID:17971885

Predictors for individual patient antibiotic treatment effect in hospitalized community-acquired pneumonia patients.

PubMed

Simonetti, A F; van Werkhoven, C H; Schweitzer, V A; Viasus, D; Carratalà, J; Postma, D F; Oosterheert, J J; Bonten, M J M

2017-10-01

Our objective was to identify clinical predictors of antibiotic treatment effects in hospitalized patients with community-acquired pneumonia (CAP) who were not in the intensive care unit (ICU). Post-hoc analysis of three prospective cohorts (from the Netherlands and Spain) of adult patients with CAP admitted to a non-ICU ward having received either β-lactam monotherapy, β-lactam + macrolide, or a fluoroquinolone-based therapy as empirical antibiotic treatment. We evaluated candidate clinical predictors of treatment effects in multiple mixed-effects models by including interactions of the predictors with empirical antibiotic choice and using 30-day mortality, ICU admission and length of hospital stay as outcomes. Among 8562 patients, empirical treatment was β-lactam in 4399 (51.4%), fluoroquinolone in 3373 (39.4%), and β-lactam + macrolide in 790 (9.2%). Older age (interaction OR 1.67, 95% CI 1.23-2.29, p 0.034) and current smoking (interaction OR 2.36, 95% CI 1.34-4.17, p 0.046) were associated with lower effectiveness of fluoroquinolone on 30-day mortality. Older age was also associated with lower effectiveness of β-lactam + macrolide on length of hospital stay (interaction effect ratio 1.14, 95% CI 1.06-1.22, p 0.008). Older age and smoking could influence the response to specific antibiotic regimens. The effect modification of age and smoking should be considered hypothesis generating to be evaluated in future trials. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Changes in diaphragm muscle collagen gene expression after acute unilateral denervation

NASA Technical Reports Server (NTRS)

Gosselin, L. E.; Sieck, G. C.; Aleff, R. A.; Martinez, D. A.; Vailas, A. C.

1995-01-01

The purpose of the present study was to examine the effects of acute (3 days) unilateral diaphragm denervation (DNV) on 1) levels of alpha 1(I) and alpha 1(III) procollagen mRNA; 2) collagen concentration [hydroxyproline (HYP)]; 3) amount of the nonreducible collagen cross-link hydroxylysylpyridinoline (HP); and 4) the passive force-length relationship of the muscle. The levels of alpha 1(I) and alpha 1(III) procollagen mRNA, HYP concentration, and amount of HP were measured in muscle segments from the midcostal region of DNV and intact (INT) hemidiaphragms of adult male Fischer 344 rats (250-300 g). The in vitro passive force-length relationship of DNV and INT hemidiaphragm was determined by lengthening and shortening the diaphragm muscle segments from 85 to 115% of optimal length at a constant velocity (0.6 optimal length/s). Three days after DNV, the level of alpha 1(I) procollagen mRNA was increased over 15-fold in the DNV hemidiaphragm compared with INT (P < 0.05), whereas the level of alpha 1(III) procollagen mRNA was increased by approximately sixfold in the DNV hemidiaphragm compared with INT (P < 0.05). Collagen (HYP) concentration did not differ between groups, averaging 8.7 and 8.9 micrograms/mg dry wt for the DNV and INT hemidiaphragms, respectively. In addition, there was no difference in the amount of the mature nonreducible collagen cross-link HP between the DNV and INT hemidiaphragms (0.66 vs. 0.76 mole HP/mole collagen, respectively). The amount of passive force developed during lengthening did not differ between DNV and INT hemidiaphragms. These data indicate that acute DNV of the hemidiaphragm is associated with an increase in the mRNA level of the two principal fibrillar collagen phenotypes in skeletal muscle. However, despite extensive muscle remodeling, the passive force-length relationship of the DNV hemidiaphragm is unaffected compared with the INT muscle.

Telomere elongation protects heart and lung tissue cells from fatal damage in rats exposed to severe hypoxia.

PubMed

Wang, Yaping; Zhao, Zhen; Zhu, Zhiyong; Li, Pingying; Li, Xiaolin; Xue, Xiaohong; Duo, Jie; Ma, Yingcai

2018-02-17

The effects of acute hypoxia at high altitude on the telomere length of the cells in the heart and lung tissues remain unclear. This study aimed to investigate the change in telomere length of rat heart and lung tissue cells in response to acute exposure to severe hypoxia and its role in hypoxia-induced damage to heart and lung tissues. Forty male Wistar rats (6-week old) were randomized into control group (n = 10) and hypoxia group (n = 30). Rats in control group were kept at an altitude of 1500 m, while rats in hypoxia group were exposed to simulated hypoxia with an altitude of 5000 m in a low-pressure oxygen chamber for 1, 3, and 7 days (n = 10). The left ventricular and right middle lobe tissues of each rat were collected for measurement of telomere length and reactive oxygen species (ROS) content, and the mRNA and protein levels of telomerase reverse transcriptase (TERT), hypoxia-inducible factor1α (HIF-1α), and hypoxia-inducible factor1α (HIF-2α). Increased exposure to hypoxia damaged rat heart and lung tissue cells and increased ROS production and telomere length. The mRNA and protein levels of TERT and HIF-1α were significantly higher in rats exposed to hypoxia and increased with prolonged exposure; mRNA and protein levels of HIF-2α increased only in rats exposed to hypoxia for 7 days. TERT was positively correlated with telomere length and the levels of HIF-1α but not HIF-2α. Acute exposure to severe hypoxia causes damage to heart and lung tissues due to the production of ROS but promotes telomere length and adaptive response by upregulating TERT and HIF-1α, which protect heart and lung tissue cells from fatal damage.

Late Quaternary glacier sensitivity to temperature and precipitation distribution in the Southern Alps of New Zealand

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

Ann V. Rowan; Simon H. Brocklehurst; David M. Schultz

2014-05-01

Glaciers respond to climate variations and leave geomorphic evidence that represents an important terrestrial paleoclimate record. However, the accuracy of paleoclimate reconstructions from glacial geology is limited by the challenge of representing mountain meteorology in numerical models. Precipitation is usually treated in a simple manner and yet represents difficult-to-characterize variables such as amount, distribution, and phase. Furthermore, precipitation distributions during a glacial probably differed from present-day interglacial patterns. We applied two models to investigate glacier sensitivity to temperature and precipitation in the eastern Southern Alps of New Zealand. A 2-D model was used to quantify variations in the length ofmore » the reconstructed glaciers resulting from plausible precipitation distributions compared to variations in length resulting from change in mean annual air temperature and precipitation amount. A 1-D model was used to quantify variations in length resulting from interannual climate variability. Assuming that present-day interglacial values represent precipitation distributions during the last glacial, a range of plausible present-day precipitation distributions resulted in uncertainty in the Last Glacial Maximum length of the Pukaki Glacier of 17.1?km (24%) and the Rakaia Glacier of 9.3?km (25%), corresponding to a 0.5°C difference in temperature. Smaller changes in glacier length resulted from a 50% decrease in precipitation amount from present-day values (-14% and -18%) and from a 50% increase in precipitation amount (5% and 9%). Our results demonstrate that precipitation distribution can produce considerable variation in simulated glacier extents and that reconstructions of paleoglaciers should include this uncertainty.« less

Improved Data Acquisition Methods for Uninterrupted Signal Monitoring and Ultra-Fast Plasma Diagnostics in LHD

NASA Astrophysics Data System (ADS)

Nakanishi, Hideya; Imazu, Setsuo; Ohsuna, Masaki; Kojima, Mamoru; Nonomura, Miki; Shoji, Mamoru; Emoto, Masahiko; Yoshida, Masanobu; Iwata, Chie; Miyake, Hitoshi; Nagayama, Yoshio; Kawahata, Kazuo

To deal with endless data streams acquired in LHD steady-state experiments, the LHD data acquisition system was designed with a simple concept that divides a long pulse into a consecutive series of 10-s “subshots”. Latest digitizers applying high-speed PCI-Express technology, however, output nonstop gigabyte per second data streams whose subshot intervals would be extremely long if 10-s rule was applied. These digitizers need shorter subshot intervals, less than 10-s long. In contrast, steady-state fusion plants need uninterrupted monitoring of the environment and device soundness. They adopt longer subshot lengths of either 10 min or 1 day. To cope with both uninterrupted monitoring and ultra-fast diagnostics, the ability to vary the subshot length according to the type of operation is required. In this study, a design modification that enables variable subshot lengths was implemented and its practical effectiveness in LHD was verified.