[Unplanned extubation in ICU, and the relevance of non-dependent patient variables the quality of care].

PubMed

González-Castro, A; Peñasco, Y; Blanco, C; González-Fernández, C; Domínguez, M J; Rodríguez-Borregán, J C

2014-01-01

To evaluate, for a consecutive year, the magnitude of unplanned extubation, looking for non-dependent patient variables. Prospective, observational study of cases and controls in a mixed intensive care unit within in a tertiary hospital. Patients were considered cases with more than 24 hours who had an episode of unplanned extubation. Prospective collection of variables case as time of unplanned extubation (collection time), identification of the box where the patient was admitted, presence and type of physical restraint, development of ventilator-associated pneumonia (VAP) and death. There were 17 unplanned extubation in 15 patients, 1.21 unplanned extubation per 100 days of MV. The unplanned extubation had an inhomogeneous spatial distribution (number of boxes). The time distribution of cases compared with controls showed significant differences in time distribution (P=.02). The comparative analysis between cases and controls, showed increased mortality, increased length of ICU stay, longer hospital stay and increased risk for VAP when patients suffer an episode of unplanned extubation. Unplanned extubation occurs most frequently in a given time slot of the day, may play a role in the spatial location of the patient; occurs most often in patients who are in the process of weaning from mechanical ventilation, and develop greater VAP. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes.

PubMed

Oh, Lawrence J; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S Y; Francis, Ian C

2017-01-01

To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion ® phacoemulsification system (CPS) with the Infiniti ® phacoemulsification system (IPS). Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced ® tip ( n =207) or the IPS using the 30-degree Kelman ® tip ( n =205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS ( n =70) compared with IPS ( n =44) ( P =0.010). Surgical complications were not statistically different between the two subcohorts ( P =0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively ( P =0.033). CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

Chocolate consumption and risk of myocardial infarction: a prospective study and meta-analysis.

PubMed

Larsson, Susanna C; Åkesson, Agneta; Gigante, Bruna; Wolk, Alicja

2016-07-01

To examine whether chocolate consumption is associated with a reduced risk of ischaemic heart disease, we used data from a prospective study of Swedish adults and we performed a meta-analysis of available prospective data. The Swedish prospective study included 67 640 women and men from the Cohort of Swedish Men and the Swedish Mammography Cohort who had completed a food-frequency questionnaire and were free of cardiovascular disease at baseline. Myocardial infarction (MI) cases were ascertained through linkage with the Swedish National Patient and Cause of Death Registers. PubMed and EMBASE databases were searched from inception until 4 February 2016 to identify prospective studies on chocolate consumption and risk of ischaemic heart disease. The results from eligible studies were combined using a random-effects model. During follow-up (1998-2010), 4417 MI cases were ascertained in the Swedish study. Chocolate consumption was inversely associated with MI risk. Compared with non-consumers, the multivariable relative risk for those who consumed ≥3-4 servings/week of chocolate was 0.87 (95% CI 0.77 to 0.98; p for trend =0.04). Five prospective studies on chocolate consumption and ischaemic heart disease were identified. Together with the Swedish study, the meta-analysis included six studies with a total of 6851 ischaemic heart disease cases. The overall relative risk for the highest versus lowest category of chocolate consumption was 0.90 (95% CI 0.82 to 0.97), with little heterogeneity among studies (I(2)=24.3%). Chocolate consumption is associated with lower risk of MI and ischaemic heart disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Shifts in geographic distribution and antimicrobial resistance during a prolonged typhoid fever outbreak--Bundibugyo and Kasese Districts, Uganda, 2009-2011.

PubMed

Walters, Maroya Spalding; Routh, Janell; Mikoleit, Matthew; Kadivane, Samuel; Ouma, Caroline; Mubiru, Denis; Mbusa, Ben; Murangi, Amos; Ejoku, Emmanuel; Rwantangle, Absalom; Kule, Uziah; Lule, John; Garrett, Nancy; Halpin, Jessica; Maxwell, Nikki; Kagirita, Atek; Mulabya, Fred; Makumbi, Issa; Freeman, Molly; Joyce, Kevin; Hill, Vince; Downing, Robert; Mintz, Eric

2014-03-01

Salmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo. A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and ≥1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or non-responsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009-December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1-December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates. Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future.

Shifts in Geographic Distribution and Antimicrobial Resistance during a Prolonged Typhoid Fever Outbreak — Bundibugyo and Kasese Districts, Uganda, 2009–2011

PubMed Central

Walters, Maroya Spalding; Routh, Janell; Mikoleit, Matthew; Kadivane, Samuel; Ouma, Caroline; Mubiru, Denis; Mbusa, Ben; Murangi, Amos; Ejoku, Emmanuel; Rwantangle, Absalom; Kule, Uziah; Lule, John; Garrett, Nancy; Halpin, Jessica; Maxwell, Nikki; Kagirita, Atek; Mulabya, Fred; Makumbi, Issa; Freeman, Molly; Joyce, Kevin; Hill, Vince; Downing, Robert; Mintz, Eric

2014-01-01

Background Salmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo. Methodology/Principal Findings A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and ≥1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or non-responsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009–December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1–December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates. Conclusions/Significance Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future. PMID:24603860

Cigarette smoking as a risk factor for type 2 diabetes in women compared with men: a systematic review and meta-analysis of prospective cohort studies.

PubMed

Yuan, Shuai; Xue, Hong-Liang; Yu, Hong-Jie; Huang, Yao; Tang, Bo-Wen; Yang, Xu-Hao; Li, Qing-Xiao; He, Qi-Qiang

2018-06-13

Few studies have investigated the effect of smoking on type 2 diabetes in women compared with men, even though several epidemiological studies provided a clear picture of the risk among the entire population. We systematically searched PubMed and Embase up to August 2017 for prospective studies that were stratified by sex with measures of the relative risk (RR) for type 2 diabetes and current smoking compared with non-smoking. The sex-specific RRs and their ratios (RRRs), comparing women with man, were pooled using random-effects models. Seventeen articles were identified including 20 prospective cohorts with 5 077 289 participants and 223 084 incident cases of type 2 diabetes. The pooled RRR suggested a similar risk of type 2 diabetes associated with smoking in women compared with men (RRR: 0.98, 95% confidence interval [CI]: 0.96-1.01). Furthermore, no significant sex difference in the RR was found between former smokers and those who had never smoked (RRR: 0.98, 95% CI: 0.92-1.04). The findings of this meta-analysis indicate that female smokers had similar risk of type 2 diabetes with male smokers.

Presurgical mapping of basal cell carcinoma or squamous cell carcinoma by confocal laser endomicroscopy compared to traditional micrographic surgery: a single-centre prospective feasibility study.

PubMed

Schulz, Alexandra; Daali, Samira; Javed, Mehreen; Fuchs, Paul Christian; Brockmann, Michael; Igressa, Alhadi; Charalampaki, Patra

2016-12-01

At present, no ideal diagnostic tools exist in the market to excise cancer tissue with the required safety margins and to achieve optimal aesthetic results using tissue-conserving techniques. In this prospective study, confocal laser endomicroscopy (CLE) and the traditional gold standard of magnifying glasses (MG) were compared regarding the boundaries of in vivo basal cell carcinoma and squamous cell carcinoma. Tumour diameters defined by both methods were measured and compared with those determined by histopathological examination. Nineteen patients were included in the study. The CLE technique was found to be superior to excisional margins based on MG only. Re-excision was required in 68% of the cases following excision based on MG evaluation, but only in 27% of the cases for whom excision margins were based on CLE. Our results are promising regarding the distinction between tumour and healthy surrounding tissue, and indicate that presurgical mapping of basal cell carcinoma and squamous cell carcinoma is possible. The tool itself should be developed further with special attention to early detection of skin cancer.

Treatment of Chronic Plantar Fasciitis with Noninvasive Interactive Neurostimulation: A Prospective Randomized Controlled Study.

PubMed

Razzano, Cristina; Carbone, Stefano; Mangone, Massimiliano; Iannotta, M Raffaella; Battaglia, Alessandro; Santilli, Valter

The initial treatment of plantar fasciitis should be conservative, with most cases responding to standard physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs), heel pads, and stretching. In cases of chronic refractory symptoms, more invasive treatment could be necessary. Noninvasive interactive neurostimulation (NIN) is a form of electric therapy that works by locating areas of lower skin impedance. The objective of the present prospective randomized controlled study was to evaluate whether the use of NIN for chronic plantar fasciitis could result in greater improvement in a foot functional score, lower levels of reported pain, reduced patient consumption of NSAIDs, and greater patient satisfaction compared with electric shockwave therapy in patients without a response to standard conservative treatment. The patients were randomized using random blocks to the NIN program (group 1) or electric shockwave therapy (group 2). The outcome measurements were the pain subscale of the validated Foot Function Index (PS-FFI), patient-reported subjective assessment of the level of pain using a standard visual analog scale, and daily intake of NSAID tablets (etoricoxib 60 mg). The study group was evaluated at baseline (time 0), week 4 (time 1), and week 12 (final follow-up point). Group 1 (55 patients) experienced significantly better results compared with group 2 (49 patients) in term of the PS-FFI score, visual analog scale score, and daily intake of etoricoxib 60 mg. NIN was an effective treatment of chronic resistant plantar fasciitis, with full patient satisfaction in >90% of cases. The present prospective randomized controlled study showed superior results for noninvasive neurostimulation compared with electric shockwave therapy, in terms of the functional score, pain improvement, and use of NSAIDs. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Medicare home health care patient case-mix before and after the Balanced Budget Act of 1997: effect on dual eligible beneficiaries.

PubMed

Shih, Huai-Che; Temkin-Greener, Helena; Votava, Kathryn; Friedman, Bruce

2014-01-01

The Balanced Budget Act (BBA) of 1997 changed the payment system for Medicare home health care (HHC) from cost-based to prospective reimbursement. We used Medical Expenditure Panel Survey data to assess the impact of the BBA on Medicare HHC patient case-mix measured by the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) model. There was a significant increase in Medicare HHC patient case-mix between the pre-BBA and Prospective Payment System (PPS) periods. The increase in the standardized-predicted risk score from the Interim Payment System period to PPS was nearly 4 times greater for the dual eligibles (Medicare-Medicaid) than for the Medicare-only population. This significantly greater rise in the HHC resources required by dual eligibles as compared to nonduals could be due to a shift in HHC payers from Medicare only to Medicaid rather than be an actual increase in case-mix per se.

[The application of the prospective space-time statistic in early warning of infectious disease].

PubMed

Yin, Fei; Li, Xiao-Song; Feng, Zi-Jian; Ma, Jia-Qi

2007-06-01

To investigate the application of prospective space-time scan statistic in the early stage of detecting infectious disease outbreaks. The prospective space-time scan statistic was tested by mimicking daily prospective analyses of bacillary dysentery data of Chengdu city in 2005 (3212 cases in 102 towns and villages). And the results were compared with that of purely temporal scan statistic. The prospective space-time scan statistic could give specific messages both in spatial and temporal. The results of June indicated that the prospective space-time scan statistic could timely detect the outbreaks that started from the local site, and the early warning message was powerful (P = 0.007). When the merely temporal scan statistic for detecting the outbreak was sent two days later, and the signal was less powerful (P = 0.039). The prospective space-time scan statistic could make full use of the spatial and temporal information in infectious disease data and could timely and effectively detect the outbreaks that start from the local sites. The prospective space-time scan statistic could be an important tool for local and national CDC to set up early detection surveillance systems.

Snapshots of Student Thinking: An Exploration of Video Cases for Extending Prospective Teachers' Knowledge

ERIC Educational Resources Information Center

Pitts Bannister, Vanessa R.; Mariano, Gina J.

2013-01-01

The purpose of this article is to explore the relationships between prospective teachers' content knowledge, student understanding, and pedagogy using video cases. The emphasis was on the extent to which the participants utilized constructs of Technology Pedagogy And Content Knowledge. Ten prospective teachers viewed video cases of students…

Demographic Risk Factors for Vascular Lesions as Etiology of Intraventricular Hemorrhage in Prospectively Screened Cases

PubMed Central

Fam, Maged; Pang, Alice; Zeineddine, Hussein A.; Mayo, Steven; Stadnik, Agnieszka; Jesselson, Michael; Zhang, Lingjiao; Dlugash, Rachel; Ziai, Wendy; Hanley, Daniel; Awad, Issam A.

2017-01-01

Background Spontaneous intraventricular hemorrhage (IVH) is associated with high rates of morbidity and mortality despite critical care and other advances. An important step in clinical management is to confirm/rule out an underlying vascular lesion, which influences further treatment, potential for further bleeding and prognosis. Our aim is to compare demographic and clinical characteristics between IVH patients with and without an underlying vascular lesion, and among cohorts with different vascular lesions. Methods We analyzed prospectively collected data of IVH patients screened for eligibility as part of the Clot Lysis: Evaluation Accelerated Resolution of Intraventricular Hemorrhage-CLEAR Phase III clinical trial. The trial adopted a structured screening process to systematically exclude patients with an underlying vascular lesion as etiology of IVH. We collected age, sex, ethnicity and primary diagnosis on these cases and vascular lesions were categorized prospectively as aneurysm, vascular malformation (arteriovenous malformation, dural arteriovenous fistula, cavernoma), Moyamoya disease or other vascular lesion. We excluded cases < 18 or > 80 years of age. Baseline characteristics were compared between the CLEAR group (IVH screened without vascular lesion) and the group of IVH patients screened and excluded from CLEAR because of an identified vascular lesion. We further analyzed the differential demographic and clinical characteristics among subcohorts with different vascular lesions. Results 10,538 consecutive IVH cases were prospectively screened for the trial between 2011 and 2015. 496 cases (4.7%) screened negative for underlying vascular lesion, met the inclusion criteria and were enrolled in the trial (no vascular etiology group), and 1,205 cases (11.4%) were concurrently screened and excluded from the trial because of a demonstrated underlying vascular lesion (vascular etiology group). Cases with vascular lesion were less likely to be older than 45 years of age (OR 0.28 CI 0.20–0.40), African-American (OR 0.23 CI 0.18–0.31) or male (OR 0.48 CI 0.38–0.60), and more likely to present with primary IVH (OR 1.85 CI 1.37–2.51) compared to those with no vascular etiology (p<0.001). Other demographic factors were associated with specific vascular lesion etiologies. A combination of demographic features increases the association with the absence of vascular lesion, but not with absolute reliability (OR 0.1, CI 0.06–0.17, p<0.001). Conclusion An underlying vascular lesion as etiology of intraventricular hemorrhage cannot be excluded solely by demographic parameters in any patient. Some form of vascular imaging is necessary in screening patients before contemplating interventions like intraventricular fibrinolysis, where safety may be impacted by the presence of vascular lesion. PMID:28245439

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes

PubMed Central

Oh, Lawrence J.; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S.Y.; Francis, Ian C.

2017-01-01

AIM To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion® phacoemulsification system (CPS) with the Infiniti® phacoemulsification system (IPS). METHODS Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced® tip (n=207) or the IPS using the 30-degree Kelman® tip (n=205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. RESULTS CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS (n=70) compared with IPS (n=44) (P=0.010). Surgical complications were not statistically different between the two subcohorts (P=0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively (P=0.033). CONCLUSION CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei. PMID:29181313

Dose reduction of up to 89% while maintaining image quality in cardiovascular CT achieved with prospective ECG gating

NASA Astrophysics Data System (ADS)

Londt, John H.; Shreter, Uri; Vass, Melissa; Hsieh, Jiang; Ge, Zhanyu; Adda, Olivier; Dowe, David A.; Sabllayrolles, Jean-Louis

2007-03-01

We present the results of dose and image quality performance evaluation of a novel, prospective ECG-gated Coronary CT Angiography acquisition mode (SnapShot Pulse, LightSpeed VCT-XT scanner, GE Healthcare, Waukesha, WI), and compare it to conventional retrospective ECG gated helical acquisition in clinical and phantom studies. Image quality phantoms were used to measure noise, slice sensitivity profile, in-plane resolution, low contrast detectability and dose, using the two acquisition modes. Clinical image quality and diagnostic confidence were evaluated in a study of 31 patients scanned with the two acquisition modes. Radiation dose reduction in clinical practice was evaluated by tracking 120 consecutive patients scanned with the prospectively gated scan mode. In the phantom measurements, the prospectively gated mode resulted in equivalent or better image quality measures at dose reductions of up to 89% compared to non-ECG modulated conventional helical scans. In the clinical study, image quality was rated excellent by expert radiologist reviewing the cases, with pathology being identical using the two acquisition modes. The average dose to patients in the clinical practice study was 5.6 mSv, representing 50% reduction compared to a similar patient population scanned with the conventional helical mode.

Impact of Targeted Preoperative Optimization on Clinical Outcome in Emergency Abdominal Surgeries: A Prospective Randomized Trial.

PubMed

Sethi, Ashish; Debbarma, Miltan; Narang, Neeraj; Saxena, Anudeep; Mahobia, Mamta; Tomar, Gaurav Singh

2018-01-01

Perforation peritonitis continues to be one of the most common surgical emergencies that need a surgical intervention most of the times. Anesthesiologists are invariably involved in managing such cases efficiently in perioperative period. The assessment and evaluation of Acute Physiology and Chronic Health Evaluation II (APACHE II) score at presentation and 24 h after goal-directed optimization, administration of empirical broad-spectrum antibiotics, and definitive source control postoperatively. Outcome assessment in terms of duration of hospital stay and mortality in with or without optimization was also measured. It is a prospective, randomized, double-blind controlled study in hospital setting. One hundred and one patients aged ≥18 years, of the American Society of Anesthesiologists physical Status I and II (E) with clinical diagnosis of perforation peritonitis posted for surgery were enrolled. Enrolled patients were randomly divided into two groups. Group A is optimized by goal-directed optimization protocol in the preoperative holding room by anesthesiology residents whereas in Group S, managed by surgery residents in the surgical wards without any fixed algorithm. The assessment of APACHE II score was done as a first step on admission and 24 h postoperatively. Duration of hospital stay and mortality in both the groups were also measured and compared. Categorical data are presented as frequency counts (percent) and compared using the Chi-square or Fisher's exact test. The statistical significance for categorical variables was determined by Chi-square analysis. For continuous variables, a two-sample t -test was applied. The mean APACHE II score on admission in case and control groups was comparable. Significant lowering of serial scores in case group was observed as compared to control group ( P = 0.02). There was a significant lowering of mean duration of hospital stay seen in case group (9.8 ± 1.7 days) as compared to control group ( P = 0.007). Furthermore, a significant decline in death rate was noted in case group as compared to control group ( P = 0.03). Goal-directed optimized patients with perforation peritonitis were discharged early as compared to control group with significantly lesser mortality as compared with randomly optimized patients in the perioperative period.

Miscommunication across Cultures: The Case of Marketing in Indian English. Revised.

ERIC Educational Resources Information Center

Frank, Jane

A study of intercultural business communication problems compared three examples of direct marketing sales letters similar in function, format, content, and targeted recipient but originating in different cultures (India, England, and the United States) and companies. The letters were directed to a single prospective purchaser of "Who's…

An Investigation of the Representativeness Heuristic: The Case of a Multiple Choice Exam

ERIC Educational Resources Information Center

Chernoff, Egan J.; Mamolo, Ami; Zazkis, Rina

2016-01-01

By focusing on a particular alteration of the comparative likelihood task, this study contributes to research on teachers' understanding of probability. Our novel task presented prospective teachers with multinomial, contextualized sequences and asked them to identify which was least likely. Results demonstrate that determinants of…

Does a regular Wessex Head Injury Matrix assessment identify early signs of infections in people with Prolonged Disorders of Consciousness?

PubMed

Dhamapurkar, Samira Kashinath; Wilson, Barbara A; Rose, Anita; Florschutz, Gerhard; Watson, Peter; Shiel, Agnes

2018-06-12

Patients with brain injury are at high risk for infections. Although infection and cognitive deterioration are established for people with dementia, this has not been shown for patients with a prolonged disorder of consciousness (PDOC). This study determines whether regular Wessex Head Injury Matrix (WHIM) assessments can identify early signs of infections in patients with PDOC. Retrospective and prospective approaches were used to assess the WHIM scores of patients with a PDOC (N = 21 in the retrospective study and 22 in the prospective study). The WHIM total scores decreased due to infections in 17 of the 21 cases of infection (p < 0.001) in the retrospective study and 15 (p = 0.001) of the 22 prospective cases of infection. Patients in a minimally conscious state (MCS) showed a bigger proportion of change between their baseline score and the scores taken in the pre-infection stage in both the retrospective and prospective studies when compared to patients in a vegetative state (VS). The findings suggest the importance of serial WHIM assessments throughout the period of recovery, not only to measure cognitive changes but also to highlight underlying physical changes such as infections that will impact the response to rehabilitation and recovery.

Comparison of clinical features and outcomes of medically attended influenza A and influenza B in a defined population over four seasons: 2004-2005 through 2007-2008.

PubMed

Irving, Stephanie A; Patel, Darshan C; Kieke, Burney A; Donahue, James G; Vandermause, Mary F; Shay, David K; Belongia, Edward A

2012-01-01

There are few prospectively collected data comparing illnesses caused by different subtypes of influenza. We compared the clinical presentation and outcomes of subjects with primarily outpatient-attended influenza A and B infections during four consecutive influenza seasons (2004-2005 through 2007-2008). Patients were prospectively enrolled and tested for influenza following an encounter for acute respiratory illness. Influenza infections were confirmed by culture or reverse transcription polymerase chain reaction; subtype was determined for a sample of influenza A isolates each season. Clinical characteristics of influenza A and B infections were compared across and within individual seasons. We identified 901 cases of influenza A and 284 cases of influenza B; 98% of cases were identified through an outpatient medical encounter. Thirty-six percent of patients with each strain had received seasonal influenza vaccine prior to illness onset. There were no consistent differences in symptoms associated with influenza A and B. Influenza A infection was associated with earlier care seeking compared with influenza B during the 2005-2006 and 2007-2008 seasons, when H3N2 was the dominant type A virus, and in a combined analysis that included all seasons. Twenty-six (2·2%) of 1185 cases were diagnosed with radiographically confirmed pneumonia, and 59 (5%) of 1185 patients were hospitalized within 30 days of illness onset. Over four influenza seasons, aside from shorter intervals from illness onset to clinical encounter for infections with the A(H3N2) subtype, clinical symptoms and outcomes were similar for patients with predominantly outpatient-attended influenza A and B infections. © 2011 Blackwell Publishing Ltd.

[Secondary malignancies after breast cancer surgery. Comparison of retro- and prospective findings].

PubMed

Holdener, E E; Osterwalder, J; Senn, H J; Enderlin, F; Gloor, F

1982-12-04

Second malignancies (SM) represent one of the potential hazards of modern cancer treatment and especially of radio- and chemotherapy after surgery for breast cancer. For this reason, regional tumor registry data (1960-1975) on 1985 breast cancer patients were analyzed for SM in the retrospective part of our study. These data were compared with the prospective part of the study in which 241 patients were randomly assigned to either mastectomy or mastectomy and chemoimmunotherapy (CT + IT). In the retrospective part of the study, SM were observed in 83 cases (4.2%), 49% of which were SM of the contralateral breast. Most frequent extramammary SM were of gastrointestinal (25%), gynecologic (8%) and cerebral (5%) origin. Leukemias were found in 4% of all SM. Median time interval to SM was 5 years and 1 month. Within 5, 10 and 15 years after mastectomy 60%, 85% and 95% of SM were observed respectively. Median survival of patients with SM was 6 1/2 years. In the prospective part of the study, SM were observed in 9 cases (3.7%), 4.1% in the surgical control group and 3.4% in the adjuvant CT + IT group with a median observation time of 6 years post mastectomy. These data are compared to other current adjuvant breast trials and do not indicate as of now an increase in SM under present adjuvant therapy.

22 CFR 96.54 - Placement standards in outgoing cases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in the case in which the birth parent(s) have identified specific prospective adoptive parent(s) or... print, media, and internet resources designed to communicate with potential prospective adoptive parent....S. prospective adoptive parent(s). (b) The agency or person demonstrates to the satisfaction of the...

Regression Discontinuity in Prospective Evaluations: The Case of the FFVP Evaluation

ERIC Educational Resources Information Center

Klerman, Jacob Alex; Olsho, Lauren E. W.; Bartlett, Susan

2015-01-01

While regression discontinuity has usually been applied retrospectively to secondary data, it is even more attractive when applied prospectively. In a prospective design, data collection can be focused on cases near the discontinuity, thereby improving internal validity and substantially increasing precision. Furthermore, such prospective…

Pharyngocutaneous fistulae following total laryngectomy comparison between manual and mechanical sutures.

PubMed

Gonçalves, Antonio José; de Souza, J A L; Menezes, M B; Kavabata, N K; Suehara, A B; Lehn, C N

2009-11-01

The extension of the surgery and closure type of the pharynx can be the determinants in the pharyngocutaneous fistula development. The objective of the study is to evaluate the incidence of pharingocutaneous salivary fistulae after total laryngectomies comparing manual and mechanical sutures. The study is designed as non-randomized, prospective clinical study. Sixty patients with squamous cell carcinoma were submitted to total laryngectomies. In 30 cases, the linear stapler (75 mm) closure (surgical technique described in details) and in other 30 cases manual suture was used. The cases of mechanical suture were prospective and consecutive and the cases of manual suture were a review series of patients who underwent a manual suture of pharynx, in the same period of time. The statistical analysis between the two groups concluded that both were comparable. Fistulae incidence was 6.7% (2/30) in the group with the mechanical suture and 36.7% (11/30) in the group with manual suture closure, presenting a significant difference (p = 0.0047). The total laryngectomy with mechanical closure is an easy and fast learning technique, allowing watertight closure of the pharynx with a low risk of contamination of the surgical field. It is an assured method, even in previously irradiated patients, since we respect the limits of its indication regarding the extension of primary tumor that must be confirmed by previous suspension laryngectomy performed in the operating room.

Study methods, recruitment, socio-demographic findings and demographic representativeness in the OPPERA study

PubMed Central

Slade, Gary D.; Bair, Eric; By, Kunthel; Mulkey, Flora; Baraian, Cristina; Rothwell, Rebecca; Reynolds, Maria; Miller, Vanessa; Gonzalez, Yoly; Gordon, Sharon; Ribeiro-Dasilva, Margarete; Lim, Pei Feng; Greenspan, Joel D; Dubner, Ron; Fillingim, Roger B; Diatchenko, Luda; Maixner, William; Dampier, Dawn; Knott, Charles; Ohrbach, Richard

2011-01-01

This paper describes methods used in the project “Orofacial Pain Prospective Evaluation and Risk Assessment” (OPPERA) and evaluates socio-demographic characteristics associated with temporomandibular disorders (TMD) in the OPPERA case-control study. Representativeness was investigated by comparing socio-demographic profiles of OPPERA participants with population census profiles of counties near study sites and by comparing age- and gender-associations with TMD in OPPERA and the 2007-09 US National Health Interview Survey. Volunteers aged 18-44 years were recruited at four US study sites: 3,263 people without TMD were enrolled into the prospective cohort study; 1,633 of them were selected as controls for the baseline case-control study. Cases were 185 volunteers with examiner-classified TMD. Distributions of some demographic characteristics among OPPERA participants differed from census profiles, although there was less difference in socio-economic profiles. Odds of TMD was associated with greater age in this 18-44 year range; females had three times the odds of TMD as males; and relative to non-Hispanic-Whites, other racial groups had one-fifth the odds of TMD. Age- and gender-associations with chronic TMD were strikingly similar to associations observed in the US population. Assessments of representativeness in this demographically diverse group of community volunteers suggest that OPPERA case-control findings have good internal validity. PMID:22074749

A prospective study from south India to compare the severity of malaria caused by Plasmodium vivax, P. falciparum and dual infection.

PubMed

Mitra, Shubhanker; Abhilash, Kpp; Arora, Shalabh; Miraclin, Angel

2015-12-01

Traditionally, Plasmodium falciparum has been attributed to cause severe malaria, whereas P. vivax is considered to cause "benign" tertian malaria. Recently, there has been an increasing body of evidence challenging this conviction. However, the spectrum and degree of severity of the disease caused by P. vivax, as per World Health Organization (2012) remains unclear. Thus, in this prospective study, we aimed at comparing the severity of malaria caused by P. vivax, P. falciparum and dual infection. Adult patients presenting to Christian Medical College, Vellore from October 2012 to September 2013 with microscopically confirmed malaria were included in the study. Their clinical and laboratory parameters were recorded and analyzed. Paired t-test and chi-square with 95% CI and post-hoc analyses using the Scheffι post-hoc criterion were used to assess the statistical significance at the level of α <0.05. In total, 131 cases of malaria were identified during the study period, comprising 83 cases of P. vivax, 35 cases of P. falciparum and 13 cases of mixed vivax and falciparum infections. The spectrum and degree of hematological, hepatic, renal, metabolic, central nervous system complications of vivax malaria was not different from that of falciparum group. Thrombocytopenia and hyperbilirubinemia were the most common laboratory abnormalities identified in all the groups. This cross-sectional comparative study clearly demonstrates that clinical features, complications and case-fatality rates in vivax malaria can be as severe as in falciparum malaria. Hence, vivax malaria could not be considered benign; and appropriate preventive strategies along with antimalarial therapies should be adopted for control and elimination of this disease.

Treatment of Neurogenic Cough with Tramadol: A Pilot Study.

PubMed

Dion, Gregory R; Teng, Stephanie E; Achlatis, Efstratios; Fang, Yixin; Amin, Milan R

2017-07-01

This study employs validated cough assessment tools to prospectively determine the impact of tramadol on cough severity and quality of life in subjects with neurogenic cough. The study was a prospective case series with planned data collection at a tertiary care academic medical center laryngology practice. Sixteen consecutive collected subjects with neurogenic cough prospectively completed pre- and posttreatment validated cough assessment tools, the cough severity index (CSI) and Leicester Cough Questionnaire (LCQ). All subjects in the study reported at least some improvement in their cough symptoms. In a Wilcoxon signed rank test that compared paired results, CSI scores improved from 23 to 14 and LCQ scores improved from 74 to 103 ( P = .003 and P = .005, respectively). This small preliminary assessment suggests that tramadol warrants additional evaluation as a treatment for neurogenic cough.

Quality of life in preoperative patients with sacroiliac joint dysfunction is at least as depressed as in other lumbar spinal conditions.

PubMed

Cher, Daniel Joseph; Reckling, W Carlton

2015-01-01

Pain from the sacroiliac joint (SIJ) is an under-recognized cause of low back pain. The degree to which SIJ pain decreases quality of life has not been directly compared to other more familiar conditions of the lumbar spine. Multivariate regression analysis of individual patient data from two prospective multicenter clinical trials of SIJ fusion and three prospective multicenter clinical trials of surgical treatments for degenerative lumbar spine conditions. Controlling for baseline demographic parameters as well as a validated disability score, quality of life scores (EuroQOL 5-D and SF-36) were, in most cases, lower in the SIJ cohorts compared to the three other spine surgery cohorts. Patients with SIJ dysfunction considering surgery have decrements in quality of life as or more severe compared to patients with degenerative spondylolisthesis, spinal stenosis, and intervertebral disc herniation.

Assessing a Novel Method to Reduce Anesthesia Machine Contamination: A Prospective, Observational Trial.

PubMed

Biddle, Chuck J; George-Gay, Beverly; Prasanna, Praveen; Hill, Emily M; Davis, Thomas C; Verhulst, Brad

2018-01-01

Anesthesia machines are known reservoirs of bacterial species, potentially contributing to healthcare associated infections (HAIs). An inexpensive, disposable, nonpermeable, transparent anesthesia machine wrap (AMW) may reduce microbial contamination of the anesthesia machine. This study quantified the density and diversity of bacterial species found on anesthesia machines after terminal cleaning and between cases during actual anesthesia care to assess the impact of the AMW. We hypothesized reduced bioburden with the use of the AMW. In a prospective, experimental research design, the AMW was used in 11 surgical cases (intervention group) and not used in 11 control surgical cases. Cases were consecutively assigned to general surgical operating rooms. Seven frequently touched and difficult to disinfect "hot spots" were cultured on each machine preceding and following each case. The density and diversity of cultured colony forming units (CFUs) between the covered and uncovered machines were compared using Wilcoxon signed-rank test and Student's t -tests. There was a statistically significant reduction in CFU density and diversity when the AMW was employed. The protective effect of the AMW during regular anesthetic care provides a reliable and low-cost method to minimize the transmission of pathogens across patients and potentially reduces HAIs.

The Rivalry between Simulation and Problem-Based Learning: A Study of Learning Transfer in Physician Assistant Students

ERIC Educational Resources Information Center

Meyer, Kimberly E.

2010-01-01

The purpose of this dissertation was to evaluate learning transfer achieved by physician assistant students comparing two instructional methods, human patient simulation and electronic clinical case studies. This prospective, randomized, mixed-methods study utilized first and second-year physician assistant student volunteers taking a pretest and…

Adult Day Health Center Participation and Health-Related Quality of Life

ERIC Educational Resources Information Center

Schmitt, Eva M.; Sands, Laura P.; Weiss, Sara; Dowling, Glenna; Covinsky, Kenneth

2010-01-01

Purpose: The purpose of this study was to assess the association between Adult Day Health Center (ADHC) participation and health-related quality of life. Design and Methods: Case-controlled prospective study utilizing the Medical Outcomes Survey Form 36 (SF-36) to compare newly enrolled participants from 16 ADHC programs with comparable…

[Laparoscopic Proximal Gastrectomy as a Surgical Treatment for Upper Third Early Gastric Cancer].

PubMed

Park, Do Joong; Park, Young Suk; Ahn, Sang Hoon; Kim, Hyung Ho

2017-09-25

Recently, the incidence of upper third gastric cancer has increased, and with it the number of endoscopic submucosal dissection (ESD) procedures performed has been increasing. However, if ESD is not indicated or non-curable, surgical treatment may be necessary. In the case of lower third gastric cancer, it is possible to preserve the upper part of the stomach; however, in the case of upper third gastric cancer, total gastrectomy is still the standard treatment option, regardless of the stage. This is due to the complications associated with upper third gastric cancer, such as gastroesophageal reflux after proximal gastrectomy rather than oncologic problems. Recently, the introduction of the double tract reconstruction method after proximal gastrectomy has become one of the surgical treatment methods for upper third early gastric cancer. However, since there has not been a prospective comparative study evaluating its efficacy, the ongoing multicenter prospective randomized controlled trial (KLASS-05) comparing laparoscopic proximal gastrectomy with double tract reconstruction and laparoscopic total gastrectomy is expected to be important for determining the future of treatment of upper third early gastric cancer.

Online platform for applying space-time scan statistics for prospectively detecting emerging hot spots of dengue fever.

PubMed

Chen, Chien-Chou; Teng, Yung-Chu; Lin, Bo-Cheng; Fan, I-Chun; Chan, Ta-Chien

2016-11-25

Cases of dengue fever have increased in areas of Southeast Asia in recent years. Taiwan hit a record-high 42,856 cases in 2015, with the majority in southern Tainan and Kaohsiung Cities. Leveraging spatial statistics and geo-visualization techniques, we aim to design an online analytical tool for local public health workers to prospectively identify ongoing hot spots of dengue fever weekly at the village level. A total of 57,516 confirmed cases of dengue fever in 2014 and 2015 were obtained from the Taiwan Centers for Disease Control (TCDC). Incorporating demographic information as covariates with cumulative cases (365 days) in a discrete Poisson model, we iteratively applied space-time scan statistics by SaTScan software to detect the currently active cluster of dengue fever (reported as relative risk) in each village of Tainan and Kaohsiung every week. A village with a relative risk >1 and p value <0.05 was identified as a dengue-epidemic area. Assuming an ongoing transmission might continuously spread for two consecutive weeks, we estimated the sensitivity and specificity for detecting outbreaks by comparing the scan-based classification (dengue-epidemic vs. dengue-free village) with the true cumulative case numbers from the TCDC's surveillance statistics. Among the 1648 villages in Tainan and Kaohsiung, the overall sensitivity for detecting outbreaks increases as case numbers grow in a total of 92 weekly simulations. The specificity for detecting outbreaks behaves inversely, compared to the sensitivity. On average, the mean sensitivity and specificity of 2-week hot spot detection were 0.615 and 0.891 respectively (p value <0.001) for the covariate adjustment model, as the maximum spatial and temporal windows were specified as 50% of the total population at risk and 28 days. Dengue-epidemic villages were visualized and explored in an interactive map. We designed an online analytical tool for front-line public health workers to prospectively detect ongoing dengue fever transmission on a weekly basis at the village level by using the routine surveillance data.

The accuracy of colonoscopic localisation of colorectal tumours: a prospective, multi-centred observational study.

PubMed

Johnstone, M S; Moug, S J

2014-05-01

Colonoscopy is essential for accurate pre-operative colorectal tumour localisation, but its accuracy for localisation remains undetermined due to limitations of previous work. This study aimed to establish the accuracy of colonoscopic localisation and to determine how frequently inaccuracy results in altered surgical management. A prospective, multi-centred, powered observational study recruited 79 patients with colorectal tumours that underwent curative surgical resection. Patient and colonoscopic factors were recorded. Pre-operative colonoscopic and radiological lesion localisations were compared to intra-operative localisation using pre-defined anatomical bowel segments to determine accuracy, with changes in planned surgical management documented. Colonoscopy accurately located the colorectal tumour in 64/79 patients (81%). Five out of 15 inaccurately located patients required on-table alteration in planned surgical management. Pre-operative imaging was unable to visualise the primary tumour in 23.1% of cases, a finding that was more prevalent amongst bowel screener patients compared to symptomatic patients (45.8% vs. 13%; p = 0.003). Colonoscopic lesion localisation is inaccurate in 19.0% of cases and occurred throughout the colon with a change in on-table surgical management in 6.3%. With CT unable to visualise lesions in just under a quarter of cases, particularly in the screening population, preoperative localisation is heavily reliant on colonoscopy.

Prospective comparison of virtual fluoroscopy to fluoroscopy and plain radiographs for placement of lumbar pedicle screws.

PubMed

Resnick, Daniel K

2003-06-01

Fluoroscopy-based frameless stereotactic systems provide feedback to the surgeon using virtual fluoroscopic images. The real-life accuracy of these virtual images has not been compared with traditional fluoroscopy in a clinical setting. We prospectively studied 23 consecutive cases. In two cases, registration errors precluded the use of virtual fluoroscopy. Pedicle probes placed with virtual fluoroscopic imaging were imaged with traditional fluoroscopy in the remaining 21 cases. Position of the probes was judged to be ideal, acceptable but not ideal, or not acceptable based on the traditional fluoroscopic images. Virtual fluoroscopy was used to place probes in for 97 pedicles from L1 to the sacrum. Eighty-eight probes were judged to be in ideal position, eight were judged to be acceptable but not ideal, and one probe was judged to be in an unacceptable position. This probe was angled toward an adjacent disc space. Therefore, 96 of 97 probes placed using virtual fluoroscopy were found to be in an acceptable position. The positive predictive value for acceptable screw placement with virtual fluoroscopy compared with traditional fluoroscopy was 99%. A probe placed with virtual fluoroscopic guidance will be judged to be in an acceptable position when imaged with traditional fluoroscopy 99% of the time.

Prospective Comparison of Collagen Plug (Angio-Seal™) and Suture-Mediated (the Closer S™) Closure Devices at Femoral Access Sites

PubMed Central

Park, Yulri; Choo, Sung Wook; Lee, Sung Hoon; Shin, Sung Wook; Do, Young Soo; Byun, Hong Sik; Park, Kwang Bo; Jeon, Pyoung

2005-01-01

Objective Rapid and effective hemostasis at femoral puncture sites minimizes both the hospital stay and patient discomfort. Therefore, a variety of arterial closure devices have been developed to facilitate the closure of femoral arteriotomy. The objective of this prospective study was to compare the efficacy of two different closure devices; a collagen plug device (Angio-Seal) and a suture-mediated closure device (the Closer S). Materials and Methods From March 28, 2003 to August 31, 2004, we conducted a prospective study in which 1,676 cases of 1,180 patients were treated with two different types of closure device. Angio-Seal was used in 961 cases and the Closer S in 715 cases. The efficacy of the closure devices was assessed, as well as complications occurring at the puncture sites. Results Successful immediate hemostasis was achieved in 95.2% of the cases treated with Angio-Seal, and in 89.5% of the cases treated with the Closer S (p < 0.05). The rates of minor and major complications occurring between the two groups were not significantly different. In the Closer S group, we observed four major complications (0.6%), that consisted of one massive retroperitoneal hemorrhage (surgically explored) and three pseudoaneurysms. In the Angio-Seal group, we observed three major complications (0.3%) that consisted of one femoral artery occlusion, one case of infection treated with intravenous antibiotics and one pseudoaneurysm. Conclusion The use of Angio-Seal was found to be more effective than that of the Closer S with regard to the immediate hemostasis of the femoral puncture sites. However, we detected no significant differences in the rate at which complications occurred. PMID:16374083

The Singapore Heart Failure Outcomes and Phenotypes (SHOP) study and Prospective Evaluation of Outcome in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction (PEOPLE) study: rationale and design.

PubMed

Santhanakrishnan, Rajalakshmi; Ng, Tze P; Cameron, Vicky A; Gamble, Greg D; Ling, Lieng H; Sim, David; Leong, Gerard Kui Toh; Yeo, Poh Shuan Daniel; Ong, Hean Yee; Jaufeerally, Fazlur; Wong, Raymond Ching-Chiew; Chai, Ping; Low, Adrian F; Lund, Mayanna; Devlin, Gerry; Troughton, Richard; Richards, A Mark; Doughty, Robert N; Lam, Carolyn S P

2013-03-01

Heart failure (HF) with preserved ejection fraction (EF) accounts for a substantial proportion of cases of HF, and to date no treatments have clearly improved outcome. There are also little data comparing HF cohorts of differing ethnicity within the Asia-Pacific region. The Singapore Heart Failure Outcomes and Phenotypes (SHOP) study and Prospective Evaluation of Outcome in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction (PEOPLE) study are parallel prospective studies using identical protocols to enroll patients with HF across 6 centers in Singapore and 4 in New Zealand. The objectives are to determine the relative prevalence, characteristics, and outcomes of patients with HF and preserved EF (EF ≥50%) compared with those with HF and reduced EF, and to determine initial data on ethnic differences within and between New Zealand and Singapore. Case subjects (n = 2,500) are patients hospitalized with a primary diagnosis of HF or attending outpatient clinics for management of HF within 6 months of HF decompensation. Control subjects are age- and gender-matched community-based adults without HF from Singapore (n = 1,250) and New Zealand (n = 1,073). All participants undergo detailed clinical assessment, echocardiography, and blood biomarker measurements at baseline, 6 weeks, and 6 months, and are followed over 2 years for death or hospitalization. Substudies include vascular assessment, cardiopulmonary exercise testing, retinal imaging, and cardiac magnetic resonance imaging. The SHOP and PEOPLE studies are the first prospective multicenter studies defining the epidemiology and interethnic differences among patients with HF in the Asia-Oceanic region, and will provide unique insights into the pathophysiology and outcomes for these patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Pregnancy outcome of threatened abortion with demonstrable fetal cardiac activity: a cohort study.

PubMed

Tongsong, T; Srisomboon, J; Wanapirak, C; Sirichotiyakul, S; Pongsatha, S; Polsrisuthikul, T

1995-08-01

Pregnancy with visible fetal heart beat complicated by first trimester threatened abortion had significant increased risk of subsequent spontaneous abortion compared with normal pregnancy. To compare pregnancy outcomes in cases complicated by first trimester threatened abortion with those that were not. Prospective cohort study of 255 cases of first trimester threatened abortions but with visible heart beat and 265 other normal pregnancies. Spontaneous abortion rates of 5.5% (with relative abortal risk of 2.91) was found for study group, compared to 1.88% for controls (p < 0.05). Preterm delivery was also higher, but was not statistically significant. First trimester bleeding with visible fetal heart beat appears to associate significantly with higher subsequent spontaneous abortion rate than those without.

Prospective evaluation of RT-PCR on sputum versus culture, urinary antigens and serology for Legionnaire's disease diagnosis.

PubMed

Botelho-Nevers, Elisabeth; Grattard, Florence; Viallon, Alain; Allegra, Séverine; Jarraud, Sophie; Verhoeven, Paul; Marcuccilli, Adrien; Lucht, Fréderic; Pozzetto, Bruno; Berthelot, Philippe

2016-08-01

Legionnaires' disease (LD) is a severe disease associated with community and hospital-acquired pneumonia, frequently under diagnosed. The main aim of our study was to determine the value of PCR for the diagnosis of LD in routine clinical practice. In a prospective study, from March 2007 to April 2010, the value of PCR on non-invasive respiratory specimens (NIRS) was compared to those of the other available tools for LD diagnosis in patients hospitalized for pneumonia. Among 254 consecutive cases of pneumonia included, 24 cases were LD (19 confirmed and 5 probable) representing the first documented microbiological etiology. Molecular diagnosis of LD was performed on NIRS by using 16S rRNA PCR, and secondarily mip PCR, with no discrepant results between the 2 methods: it was found positive in 14 cases and led to identify 2 supplementary probable cases of LD. Based on clinical and at least 2 positive LD tests, PCR yielded a better diagnostic value than antigen urinary test (12 vs 10 cases). These results revealed that molecular diagnosis of LD on NIRS is reliable and may contribute to better identify cases of LD. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Vaginal breech delivery: results of a prospective registration study

PubMed Central

2013-01-01

Background Most countries recommend planned cesarean section in breech deliveries, which is considered safer than vaginal delivery. As one of few countries in the western world Norway has continued to practice planned vaginal delivery in selected women. The aim of this study is to evaluate prospectively registered neonatal and maternal outcomes in term singleton breech deliveries in a Norwegian hospital during a ten years period. We aim to compare maternal and neonatal outcomes in term breech pregnancies subjected either to planned vaginal or elective cesarean section. Methods A prospective registration study including 568 women with term breech deliveries (>37 weeks) consecutively registered at Sorlandet Hospital Kristiansand between 2001 and 2011. Fetal and maternal outcomes were compared according to delivery method; planned vaginal delivery versus planned cesarean section. Results Of 568 women, elective cesarean section was planned in 279 (49%) cases and vaginal delivery was planned in 289 (51%) cases. Acute cesarean section was performed in 104 of the planned vaginal deliveries (36.3%). There were no neonatal deaths. Two cases of serious neonatal morbidity were reported in the planned vaginal group. One infant had seizures, brachial plexus injury, and cephalhematoma. The other infant had 5-minutes Apgar < 4. Twenty-nine in the planned vaginal group (10.0%) and eight in the planned cesarean section group (2.9%) (p < 0.001) were transferred to the neonatal intensive care unit. However, only one infant was admitted for ≥4 days. According to follow-up data (median six years) none of these infants had long-term sequelae. Regarding maternal morbidity, blood loss was the only variable that was significantly higher in the planned cesarean section group versus in the vaginal delivery group (p < 0.001). Conclusions Strict guidelines were followed in all cases. There were no neonatal deaths. Two infants had serious neonatal morbidity in the planned vaginal group without long-term sequelae. PMID:23883361

A Case Study on Mathematical Literacy of Prospective Elementary School Teachers

ERIC Educational Resources Information Center

Suharta, I. Gusti Putu; Suarjana, I. Made

2018-01-01

The purpose of this study is to describe Mathematical Literacy (ML) of Prospective Elementary School Teachers with attention to aspects of mathematical skills and gender. The type of research is qualitative with the research design of Case Study. Respondents are assigned 12 Prospective Elementary School Teachers, consisting of 6 men and 6 women.…

Correlation of bone defect dimensions with healing outcome one year after apical surgery.

PubMed

von Arx, Thomas; Hänni, Stefan; Jensen, Simon Storgård

2007-09-01

This clinical study prospectively evaluated the healing outcome 1 year after apical surgery in relation to bony crypt dimensions measured intraoperatively. The study cohort included 183 teeth in an equal number of patients. For statistical analysis, results were dichotomized (healed versus non-healed cases). The overall success rate was 83% (healed cases). Healing outcome was not significantly related to the level and height of the facial bone plate. In contrast, a significant difference was found for the mean size of the bony crypt when healed cases (395 mm(3)) were compared with non-healed cases (554 mm(3)). In addition, healed cases had a significantly shorter mean distance (4.30 mm) from the facial bone surface to the root canal (horizontal access) compared with non-healed cases (5.13 mm). With logistic regression, however, the only parameter found to be significantly related to healing outcome was the length of the access window to the bony crypt.

Acinetobacter bacteraemia in Thailand: evidence for infections outside the hospital setting

PubMed Central

PORTER, K. A.; RHODES, J.; DEJSIRILERT, S.; HENCHAICHON, S.; SILUDJAI, D.; THAMTHITIWAT, S.; PRAPASIRI, P.; JORAKATE, P.; KAEWPAN, A.; PERUSKI, L. F.; KERDSIN, A.; PRASERT, K.; YUENPRAKONE, S.; MALONEY, S. A.; BAGGETT, H. C.

2015-01-01

SUMMARY Acinetobacter is a well-recognized nosocomial pathogen. Previous reports of community-associated Acinetobacter infections have lacked clear case definitions and assessment of healthcare-associated (HCA) risk factors. We identified Acinetobacter bacteraemia cases from blood cultures obtained <3 days after hospitalization in rural Thailand and performed medical record reviews to assess HCA risk factors in the previous year and compare clinical and microbiological characteristics between cases with and without HCA risk factors. Of 72 Acinetobacter cases, 32 (44%) had no HCA risk factors. Compared to HCA infections, non-HCA infections were more often caused by Acinetobacter species other than calcoaceticus–baumannii complex species and by antibiotic-susceptible organisms. Despite similar symptoms, the case-fatality proportion was lower in non-HCA than HCA cases (9% vs. 45%, P < 0·01). Clinicians should be aware of Acinetobacter as a potential cause of community-associated infections in Thailand; prospective studies are needed to improve understanding of associated risk factors and disease burden. PMID:24001479

A multicenter, prospective, randomized comparison of a novel signal transmission capsule endoscope to an existing capsule endoscope.

PubMed

Choi, Eric H; Mergener, Klaus; Semrad, Carol; Fisher, Laurel; Cave, David R; Dodig, Milan; Burke, Carol; Leighton, Jonathan A; Kastenberg, David; Simpson, Peter; Sul, James; Bhattacharya, Kanishka; Charles, Roger; Gerson, Lauren; Weber, Luke; Eisen, Glenn; Reidel, Warren; Vargo, John J; Wakim-Fleming, Jamile; Lo, Simon K

2013-08-01

MiroCam, a capsule endoscope, uses a novel transmission technology, electric-field propagation, which uses the human body as a conduction medium for data transmission. To compare the ability of the MiroCam (MC) and PillCam (PC) to identify sources of obscure GI bleeding (OGIB). Prospective, multicenter, comparative study. Six academic hospitals. A total of 105 patients with OGIB. Patients ingested both the MC and PC capsules sequentially in a randomized fashion. Concordance of rates in identifying a source of OGIB, operational times, and rates of complete small-bowel examination. Data analysis resulted in 43 (48%) "abnormal" cases identifying a source of OGIB by either capsule. Twenty-four cases (55.8%) were positive by both capsules. There was negative agreement in 46 of 58 cases (79.3%). The κ index was 0.547 (χ(2) = 1.32; P = .36). In 12 cases, MC positively identified a source that was not seen on PC, whereas in 7 cases, PC positively identified a source that was not seen on MC. MC had a 5.6% higher rate of detecting small-bowel lesions (P = .54). MC captured images at 3 frames per second for 11.1 hours, and PC captured images at 2 frames per second for 7.8 hours (P < .0001). Complete small-bowel examination was achieved in 93.3% for MC and 84.3% for PC (P = .10). Readers were not blinded to the particular capsule they were reading. A positive diagnostic finding for OGIB was identified by either capsule in 48% of cases. The concordance rate between the 2 capsules was comparable to that of prior studies in identifying sources of small-bowel bleeding. The longer operational time of the MC may result in higher rates of complete small-bowel examination, which may, in turn, translate into a higher rate of detecting small-bowel lesions. ( NCT00878982.). Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Hepatitis B and C virus infection and diabetes mellitus: A cohort study.

PubMed

Hong, Yun Soo; Chang, Yoosoo; Ryu, Seungho; Cainzos-Achirica, Miguel; Kwon, Min-Jung; Zhang, Yiyi; Choi, Yuni; Ahn, Jiin; Rampal, Sanjay; Zhao, Di; Pastor-Barriuso, Roberto; Lazo, Mariana; Shin, Hocheol; Cho, Juhee; Guallar, Eliseo

2017-07-04

The role of hepatitis virus infection in glucose homeostasis is uncertain. We examined the associations between hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and the development of diabetes in a cohort (N = 439,708) of asymptomatic participants in health screening examinations. In cross-sectional analyses, the multivariable-adjusted odds ratio for prevalent diabetes comparing hepatitis B surface antigen (HBsAg) (+) to HBsAg (-) participants was 1.17 (95% CI 1.06-1.31; P = 0.003). The corresponding odds ratio comparing hepatitis C antibodies (HCV Ab) (+) to HCV Ab (-) participants was 1.43 (95% CI 1.01-2.02, P = 0.043). In prospective analyses, the multivariable-adjusted hazard ratio for incident diabetes comparing HBsAg (+) to HbsAg (-) participants was 1.23 (95% CI 1.08-1.41; P = 0.007). The number of incident cases of diabetes among HCV Ab (+) participants (10 cases) was too small to reliably estimate the prospective association between HCV infection and diabetes. In this large population at low risk of diabetes, HBV and HCV infections were associated with diabetes prevalence and HBV infection with the risk of incident diabetes. Our studies add evidence suggesting that diabetes is an additional metabolic complication of HBV and HCV infection.

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2014 CFR

2014-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2013 CFR

2013-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2012 CFR

2012-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

Clinical Research Methodology 2: Observational Clinical Research.

PubMed

Sessler, Daniel I; Imrey, Peter B

2015-10-01

Case-control and cohort studies are invaluable research tools and provide the strongest feasible research designs for addressing some questions. Case-control studies usually involve retrospective data collection. Cohort studies can involve retrospective, ambidirectional, or prospective data collection. Observational studies are subject to errors attributable to selection bias, confounding, measurement bias, and reverse causation-in addition to errors of chance. Confounding can be statistically controlled to the extent that potential factors are known and accurately measured, but, in practice, bias and unknown confounders usually remain additional potential sources of error, often of unknown magnitude and clinical impact. Causality-the most clinically useful relation between exposure and outcome-can rarely be definitively determined from observational studies because intentional, controlled manipulations of exposures are not involved. In this article, we review several types of observational clinical research: case series, comparative case-control and cohort studies, and hybrid designs in which case-control analyses are performed on selected members of cohorts. We also discuss the analytic issues that arise when groups to be compared in an observational study, such as patients receiving different therapies, are not comparable in other respects.

A laparoscopic approach to CBD stones.

PubMed

Khanzada, Zubair; Morgan, Richard

2013-12-01

: This study aimed to evaluate single-stage surgical (laparoscopic or open) approach to the management of common bile duct (CBD) stones, as treatment of choice. Prospectively collected data to assess outcomes of CBD clearance, morbidity, mortality, and hospital stay, and compared with published data. Successful clearance of CBD stones was achieved in 96% cases, laparoscopic exploration successful in 83%. Retained stones were found in 4% cases and another 5% developed postoperative complications. Common length of stay in hospital was 2 days, although mean stay was 4 days. Seventy-three percent of cases were elective, 27% were emergencies. Conversion rate to open surgery was 14%, which was mainly in emergency cases. Postoperative mortality was 1.2%, not directly related to the procedure. Good outcomes can be achieved, comparing favorably with those of other modalities, when laparoscopic bile duct exploration is chosen as treatment for CBD stones; the best results can be anticipated in elective patients.

A prospective, randomized, comparative clinical study of resin composite and glass ionomer cement for retrograde root filling.

PubMed

Jensen, S S; Nattestad, A; Egdø, P; Sewerin, I; Munksgaard, E C; Schou, S

2002-12-01

To compare the clinical and radiographic treatment outcome of retrograde root filling with either dentin-bonded resin composite (Retroplast, RP) or glass ionomer cement (Chelon-Silver, CS). A prospective, randomized clinical study of 134 consecutive patients with indication of retrograde root filling of an incisor, canine, premolar, or first molar. Either RP or CS was chosen at random as retrograde filling material. Either material was applied onto the entire resection surface after prepared slightly concave. This preparation technique makes a sealing of the entire resection surface possible and prevents marginal contraction gaps during polymerization. A total of 122 patients were available for 1-year follow-up. After 1 year the proportion of successful cases was significantly higher in the RP group (73%) than in the CS group (31%) (p<0.001). Doubtful healing with a need for a longer observation period was seen in 17% of the RP cases and 19% of the CS cases. The proportion of failures in the RP group (10%) was significantly lower than that in the CS group (50%) (p<0.001). Most of the unsuccessful CS cases failed due to loosening of the retrograde filling. Dentin-bonded RP applied onto the entire, slightly concave resection surface is a predictable apical sealant characterized by a high success rate. In contrast, retrograde root filling with CS results in an unacceptably high failure rate due to insufficient bonding strength to the concave resection surface.

A prospective controlled study: Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage

PubMed Central

2011-01-01

Background Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with the high mortality twofold to sixfold higher than that for ischemic stroke. But the treatment of haematomas within the basal ganglia continues to be a matter of debate among neurologists and neurosurgeons. The purpose of this study is to judge the clinical value of minimally invasive stereotactic puncture therapy (MISPT) on acute ICH. Methods A prospective controlled study was undertaken. The clinical trial was in compliance with the WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. According to the enrollment criterion, there were 168 acute ICH cases analyzed, of which 90 cases were performed by MISPT ( MISPT group, MG) and 78 cases by Conventional craniotomy (CC group, CG), by means of compare of Glasgow Coma Scale(GCS) score, postoperative complications(PC) and rebleeding incidence(RI), moreover, long-term outcome of 1 year postoperation judged by Glasgow Outcome Scale (GOS), Barthel Index (BI), modified Rankin Scale (mRS) and case fatality(CF). Results MG patients showed obvious amelioration in GCS score compared with that of CG. The total incidence of PC in MG decreased obviously compared with that of CG. The incidences of rebleeding in MG and CG were 10.0% and 15.4% respectively. There was no obvious difference between CFs of MG and CG. For three parameters representing long-term outcome, the GOS, BI and mRS in MG were ameliorated significantly than that of CG. Conclusion These data suggested that the advantage of MISPT was displayed in minute trauma and safety, and seemed to be feasible and to had a trend towards improved long-term outcome. Trial Registration The Australian New Zealand Clinical Trials Registry (ANZCTR), the registration number:ACTRN12610000945022. PMID:21699716

A prospective study of the prevalence of tuberculosis and bacteraemia in Bangladeshi children with severe malnutrition and pneumonia including an evaluation of Xpert MTB/RIF assay.

PubMed

Chisti, Mohammod Jobayer; Graham, Stephen M; Duke, Trevor; Ahmed, Tahmeed; Ashraf, Hasan; Faruque, Abu Syed Golam; La Vincente, Sophie; Banu, Sayera; Raqib, Rubhana; Salam, Mohammed Abdus

2014-01-01

Severe malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of Mycobacterium tuberculosis is uncertain. We prospectively investigated severely malnourished young children (<5 years) with radiological pneumonia admitted over a 15-month period. Investigations included blood culture, sputa for microscopy and mycobacterial culture. Xpert MTB/RIF assay was introduced during the study. Study children were followed for 12 weeks following their discharge from the hospital. 405 eligible children were enrolled, with a median age of 10 months. Bacterial pathogens were isolated from blood culture in 18 (4.4%) children, of which 72% were Gram negatives. Tuberculosis was confirmed microbiologically in 7% (27/396) of children that provided sputum - 10 by culture, 21 by Xpert MTB/RIF assay, and 4 by both tests. The diagnostic yield from induced sputum was 6% compared to 3.5% from gastric aspirate. Sixty (16%) additional children had tuberculosis diagnosed clinically that was not microbiologically confirmed. Most confirmed tuberculosis cases did not have a positive contact history or positive tuberculin test. The sensitivity and specificity of Xpert MTB/RIF assay compared to culture was 67% (95% CI: 24-94) and 92% (95% CI: 87-95) respectively. Overall case-fatality rate was 17% and half of the deaths occurred in home following discharge from the hospital. TB was common in severely malnourished Bangladeshi children with pneumonia. X-pert MTB/RIF assay provided higher case detection rate compared to sputum microscopy and culture. The high mortality among the study children underscores the need for further research aimed at improved case detection and management for better outcomes.

A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability.

PubMed

Cho, Byung-Ki; Kim, Yong-Min; Park, Kyoung-Jin; Park, Ji-Kang; Kim, Do-Kyoon

2015-02-01

There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique. Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability. There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group. Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies. Level II, prospective comparative study. © The Author(s) 2014.

[Etiologic classification of cerebral infarct. Experience from a prospective data register].

PubMed

Brainin, M

1990-12-01

Most classifications of stroke include clinically heterogeneous subgroups and therefore are of limited value for comparative studies or clinical protocols. The view is held that a classification according to stroke etiology is clinically more reasonable and more consistent for therapeutic strategies. In order to determine the frequency of various etiological subgroups in a series of stroke cases, the results of the Klosterneuburger Schlaganfall-Datenbank (KSDB) are reported. This stroke registry has prospectively recorded over 300 items on all stroke cases referred to one center since March 1988. Investigation rates include CT in almost 100% and the investigation of cerebral vessels in over 90% of all cases. By applying defined etiological categories (undetermined etiology, atherosclerosis of the large craniocervical vessels, cardiogenic embolism, lacunar, primary hemorrhage, and multiple and other causes) to the first 420 patients registered within the first two years it can be shown that even with CT and neurosonology in routine use, in 29% of all cases the cause of the stroke cannot be determined. To investigate this largest subgroup by means of additional new methods as well as by investigating the long-term natural course represents an important challenge for clinical stroke research.

Fecal incontinence after minor anorectal surgery.

PubMed

Zbar, A P; Beer-Gabel, M; Chiappa, A C; Aslam, M

2001-11-01

Fecal leakage after open lateral internal anal sphincterotomy for chronic anal fissure is common, but underreported. The aim of this study was to prospectively assess the physiologic and morphologic effects of sphincterotomy, comparing continent and incontinent patients after surgery. This group was further compared with an unselected group of patients presenting with incontinence after hemorrhoidectomy. Between January 1997 and June 1999, 23 patients were prospectively followed up through internal sphincterotomy with conventional and vector volume anorectal manometry, parametric assessment of the rectoanal inhibitory reflex, and endoanal magnetic resonance imaging. Fourteen continent patients were compared with 9 incontinent postoperative cases, 9 patients referred with incontinence after hemorrhoidectomy, and 33 healthy volunteers without anorectal disease. Significant differences were noted between continent and incontinent postsphincterotomy cases for all resting conventional and vector volume parameters and for some squeeze parameters. Although there was a significant reduction in postoperative high pressure zone length at rest, there were no differences between the postoperative groups. There was an increase in sphincter asymmetry of 6.7 percent (+/- 3.5 percent) in incontinent postsphincterotomy patients and a decrease of 2.8 percent (+/- 3.2 percent) in continent cases. Significant differences were noted for resting parameters between incontinent postsphincterotomy and posthemorrhoidectomy patients, with a higher resting sphincter asymmetry in the latter group. The area under the rectoanal inhibitory curve was smaller in postsphincterotomy incontinent patients when compared with continent cohorts over the distal and intermediate sphincter zones at rest with a reduced latency of inhibition. There was no difference in the magnetic resonance images of the sphincterotomy site between incontinent and continent postsphincterotomy cases and no posthemorrhoidectomy case had evidence of sphincteric damage. There are complex significant differences in the postoperative physiology of patients undergoing lateral internal sphincterotomy who become incontinent when compared with those who maintain continence. These physiologic changes are not reflected in detectable morphologic sphincteric differences. It is unknown whether these changes predict for long-term incontinence, and it is suggested that postoperative incontinence after minor anorectal surgery is not necessarily related either to a preexisting sphincter defect or inadvertent intraoperative sphincter injury.

Dengue in Thailand and Cambodia: An Assessment of the Degree of Underrecognized Disease Burden Based on Reported Cases

PubMed Central

Wichmann, Ole; Yoon, In-Kyu; Vong, Sirenda; Limkittikul, Kriengsak; Gibbons, Robert V.; Mammen, Mammen P.; Ly, Sowath; Buchy, Philippe; Sirivichayakul, Chukiat; Buathong, Rome; Huy, Rekol; Letson, G. William; Sabchareon, Arunee

2011-01-01

Background Disease incidence data are needed to guide decision-making for public health interventions. Although dengue is a reportable disease in Thailand and Cambodia, the degree that reported incidence underrecognizes true disease burden is unknown. We utilized dengue incidence calculated from laboratory-confirmed outpatient and inpatient cases in prospective cohort studies to estimate the magnitude of dengue underrecognition and to establish more accurate disease burden estimates for these countries. Methods and Findings Cohort studies were conducted among children aged <15 years by members of a dengue field site consortium over at least 2 dengue seasons. Age-group specific multiplication factors (MFs) were computed by comparing data from three cohort studies to national surveillance data in the same province and year. In Thailand, 14,627 person-years of prospective cohort data were obtained in two provinces and 14,493 person-years from one province in Cambodia. Average annual incidence of laboratory-confirmed dengue was 23/1,000 and 25/1,000 in Thailand, and 41/1,000 in Cambodia. Calculated MFs in these provinces varied by age-group and year (range 0.4–29). Average age-group specific MFs were then applied to country-level reporting data and indicated that in Thailand a median 229,886 (range 210,612–331,236) dengue cases occurred annually during 2003–2007 and a median 111,178 (range 80,452–357,135) cases occurred in Cambodia in children <15 years of age. Average underrecognition of total and inpatient dengue cases was 8.7 and 2.6-fold in Thailand, and 9.1 and 1.4-fold in Cambodia, respectively. During the high-incidence year 2007, >95,000 children in Thailand and >58,000 children in Cambodia were estimated to be hospitalized due to dengue. Conclusion Calculating MFs by comparing prospective cohort study data to locally-reported national surveillance data is one approach to more accurately assess disease burden. These data indicate that although dengue is regularly reported in many countries, national surveillance data significantly underrecognize the true burden of disease. PMID:21468308

Utility of a non-invasive serum biomarker panel for diagnosis and monitoring of eosinophilic esophagitis: A prospective study

PubMed Central

Dellon, Evan S.; Rusin, Spencer; Gebhart, Jessica H.; Covey, Shannon; Higgins, Leana L.; Beitia, RoseMary; Speck, Olga; Woodward, Kimberly; Woosley, John T.; Shaheen, Nicholas J.

2015-01-01

Objectives Non-invasive biomarkers would be valuable for diagnosis and monitoring of eosinophilic esophagitis (EoE). The aim of this study was to determine the utility of a panel of serum biomarkers for the diagnosis and management of EoE. Methods We conducted a prospective cohort study of consecutive adults undergoing outpatient EGD. Incident cases of EoE were diagnosed per consensus guidelines; controls had GERD or dysphagia and did not meet EoE criteria. EoE cases were treated with topical steroids and had repeat endoscopy. Pre- and post-treatment serum samples were analyzed in a blinded fashion for: IL-4, IL-5, IL-6, IL-9, IL-13, TGF-α, TGF-β, TNF-α, eotaxin-1, -2, and -3, TSLP, major basic protein (MBP), and eosinophil-derived neurotoxin (EDN). Cases and controls were compared at baseline, and pre- and post-treatment assays were compared in cases. Results A total of 61 incident EoE cases and 87 controls were enrolled; 51 EoE cases had post-treatment serum analyzed. There were no significant differences in any of the biomarkers between EoE cases and controls at baseline. IL-13 and eotaxin-3 for cases and controls were 85 ±160 vs 43 ±161 pg/mL (p=0.12), and 41 ±159 vs 21 ±73 (p=0.30). There were no significant differences in assay values among cases before and after treatment. There were also no differences after stratification by atopic status or treatment response. Conclusions A panel of inflammatory factors known to be associated with EoE pathogenesis were not increased in the serum, nor were they responsive to therapy. None of these biomarkers are likely candidates for a serum test for EoE. Histologic analysis for diagnosis and management of EoE continues to be necessary, and novel, less invasive, biomarkers are needed. PMID:25781367

Propranolol reduces the anxiety associated with day case surgery.

PubMed

Mealy, K; Ngeh, N; Gillen, P; Fitzpatrick, G; Keane, F B; Tanner, A

1996-01-01

To find out if propranolol, a non-cardioselective beta-blocker, can reduce the anxiety associated with day case surgery. Prospective randomized double blind trial. University hospital, Ireland. An unselected group of 53 patients undergoing day case surgery. Subjects randomised to receive either propranolol (10 mg) or placebo on the morning of operation. Blood pressure; pulse, anxiety, pain score and patient satisfaction. Mean (SD) Hospital Anxiety and Depression score was significantly lower in the propranolol group than in the control group (2.5 (0.7) compared with 4.6 (0.7), p < 0.0001) before discharge. A low dose of propranolol given on the morning of day case surgery significantly reduced patients' anxiety.

NLP based congestive heart failure case finding: A prospective analysis on statewide electronic medical records.

PubMed

Wang, Yue; Luo, Jin; Hao, Shiying; Xu, Haihua; Shin, Andrew Young; Jin, Bo; Liu, Rui; Deng, Xiaohong; Wang, Lijuan; Zheng, Le; Zhao, Yifan; Zhu, Chunqing; Hu, Zhongkai; Fu, Changlin; Hao, Yanpeng; Zhao, Yingzhen; Jiang, Yunliang; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Todd, Rogow; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

2015-12-01

In order to proactively manage congestive heart failure (CHF) patients, an effective CHF case finding algorithm is required to process both structured and unstructured electronic medical records (EMR) to allow complementary and cost-efficient identification of CHF patients. We set to identify CHF cases from both EMR codified and natural language processing (NLP) found cases. Using narrative clinical notes from all Maine Health Information Exchange (HIE) patients, the NLP case finding algorithm was retrospectively (July 1, 2012-June 30, 2013) developed with a random subset of HIE associated facilities, and blind-tested with the remaining facilities. The NLP based method was integrated into a live HIE population exploration system and validated prospectively (July 1, 2013-June 30, 2014). Total of 18,295 codified CHF patients were included in Maine HIE. Among the 253,803 subjects without CHF codings, our case finding algorithm prospectively identified 2411 uncodified CHF cases. The positive predictive value (PPV) is 0.914, and 70.1% of these 2411 cases were found to be with CHF histories in the clinical notes. A CHF case finding algorithm was developed, tested and prospectively validated. The successful integration of the CHF case findings algorithm into the Maine HIE live system is expected to improve the Maine CHF care. Copyright © 2015. Published by Elsevier Ireland Ltd.

Life Satisfaction and Risk of Chronic Diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany Study

PubMed Central

Feller, Silke; Teucher, Birgit; Kaaks, Rudolf; Boeing, Heiner; Vigl, Matthaeus

2013-01-01

Objective The aim of the study was to examine the prospective association between life satisfaction and risk of type 2 diabetes mellitus, myocardial infarction, stroke, and cancer. Previous studies suggested that psychosocial factors may affect the development of chronic diseases but the impact of positive attitudes, in particular life satisfaction, is yet to be determined. Methods The analysis included 50,358 participants of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study in Potsdam and Heidelberg. Life satisfaction was assessed in a baseline interview and incident cases of chronic diseases were identified and verified during follow-up. Hazard ratios were calculated using Cox proportional hazards regression models that were systematically multivariable-adjusted for established risk factors and prevalent diseases. Results During an average of 8 years of follow-up 2,293 cases of cancer, 1,840 cases of type 2 diabetes mellitus, 440 cases of stroke, and 562 cases of myocardial infarction were observed. Women who were unsatisfied with life at baseline showed in all models a significantly increased risk of cancer (HR: 1.45; 95% CI: 1.18-1.78) and stroke (HR: 1.69; 95% CI: 1.05-2.73) as well as an increased risk of type 2 diabetes mellitus by trend across categories (p-trend=0.04) compared to women very satisfied with life. In men, a relationship between life satisfaction and stroke was found but did not persist after consideration of lifestyle factors and prevalent diseases. No significant association was observed between life satisfaction and risk of myocardial infarction. Conclusions The results of this study suggest that reduced life satisfaction is related to the development of chronic diseases—particularly in women and partly mediated by established risk factors. PMID:23977388

Efficacy and Safety of Gabapentin in the Treatment of Chronic Cough: A Systematic Review.

PubMed

Shi, Guanglin; Shen, Qin; Zhang, Caixin; Ma, Jun; Mohammed, Anaz; Zhao, Huan

2018-06-19

Despite recent clinical guidelines, the optimal therapeutic strategy for the management of refractory chronic cough is still a challenge. The present systematic review was designed to assess the evidence for efficacy and safety of gabapentin in the treatment of chronic cough. A systematic search of PubMed, Embase, Cochrane Library databases, and publications cited in bibliographies was performed. Articles were searched by two reviewers with a priori criteria for study selection. Seven relevant articles were identified, including two randomized controlled trials, one prospective case-series designed with consecutive patients, one retrospective case series of consecutive patients, one retrospective case series with unknown consecutive status, and two case reports comprising six and two patients, respectively. Improvements were detected in cough-specific quality of life (Leicester Cough Questionnaire score) and cough severity (visual analogue scale score) following gabapentin treatment in randomized controlled trials. The results of prospective case-series showed that the rate of overall improvement of cough and sensory neuropathy with gabapentin was 68%. Gabapentin treatment of patients with chronic cough showed superior efficacy and a good safety record compared with placebo or standard medications. Additional randomized and controlled trials are needed. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections

PubMed Central

Anderson, Aleisha; Cleland, Gavin; Bowen, Asha C.

2017-01-01

Background Complications of scabies and impetigo such as glomerulonephritis and invasive bacterial infection in Australian Aboriginal children remain significant problems and the overall global burden of disease attributable to these skin infections remains high despite the availability of effective treatment. We hypothesised that one factor contributing to this high burden is that skin infection is under-recognised and hence under-treated, in settings where prevalence is high. Methods We conducted a prospective, cross-sectional study to assess the burden of scabies, impetigo, tinea and pediculosis in children admitted to two regional Australian hospitals from October 2015 to January 2016. A retrospective chart review of patients admitted in November 2014 (mid-point of the prospective data collection in the preceding year) was performed. Prevalence of documented skin infection was compared in the prospective and retrospective population to assess clinician recognition and treatment of skin infections. Results 158 patients with median age 3.6 years, 74% Aboriginal, were prospectively recruited. 77 patient records were retrospectively reviewed. Scabies (8.2% vs 0.0%, OR N/A, p = 0.006) and impetigo (49.4% vs 19.5%, OR 4.0 (95% confidence interval [CI 2.1–7.7) were more prevalent in the prospective analysis. Skin examination was only documented in 45.5% of cases in the retrospective review. Patients in the prospective analysis were more likely to be prescribed specific treatment for skin infection compared with those in the retrospective review (31.6% vs 5.2%, OR 8.5 (95% CI 2.9–24.4). Conclusions Scabies and impetigo infections are under-recognised and hence under-treated by clinicians. Improving the recognition and treatment of skin infections by clinicians is a priority to reduce the high burden of skin infection and subsequent sequelae in paediatric populations where scabies and impetigo are endemic. PMID:28671945

Are scabies and impetigo "normalised"? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections.

PubMed

Yeoh, Daniel K; Anderson, Aleisha; Cleland, Gavin; Bowen, Asha C

2017-07-01

Complications of scabies and impetigo such as glomerulonephritis and invasive bacterial infection in Australian Aboriginal children remain significant problems and the overall global burden of disease attributable to these skin infections remains high despite the availability of effective treatment. We hypothesised that one factor contributing to this high burden is that skin infection is under-recognised and hence under-treated, in settings where prevalence is high. We conducted a prospective, cross-sectional study to assess the burden of scabies, impetigo, tinea and pediculosis in children admitted to two regional Australian hospitals from October 2015 to January 2016. A retrospective chart review of patients admitted in November 2014 (mid-point of the prospective data collection in the preceding year) was performed. Prevalence of documented skin infection was compared in the prospective and retrospective population to assess clinician recognition and treatment of skin infections. 158 patients with median age 3.6 years, 74% Aboriginal, were prospectively recruited. 77 patient records were retrospectively reviewed. Scabies (8.2% vs 0.0%, OR N/A, p = 0.006) and impetigo (49.4% vs 19.5%, OR 4.0 (95% confidence interval [CI 2.1-7.7) were more prevalent in the prospective analysis. Skin examination was only documented in 45.5% of cases in the retrospective review. Patients in the prospective analysis were more likely to be prescribed specific treatment for skin infection compared with those in the retrospective review (31.6% vs 5.2%, OR 8.5 (95% CI 2.9-24.4). Scabies and impetigo infections are under-recognised and hence under-treated by clinicians. Improving the recognition and treatment of skin infections by clinicians is a priority to reduce the high burden of skin infection and subsequent sequelae in paediatric populations where scabies and impetigo are endemic.

Safety of intravenous thrombolysis in stroke mimics: prospective 5-year study and comprehensive meta-analysis.

PubMed

Tsivgoulis, Georgios; Zand, Ramin; Katsanos, Aristeidis H; Goyal, Nitin; Uchino, Ken; Chang, Jason; Dardiotis, Efthimios; Putaala, Jukka; Alexandrov, Anne W; Malkoff, Marc D; Alexandrov, Andrei V

2015-05-01

Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series. We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of ≥4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1. Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60±14 years; median National Institutes of Health Stroke scale, 11; range, 3-22), SMs comprised 75 cases. Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%-2%) and 0.3% (95% confidence interval, 0%-2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14-0.77; P=0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07-3.73; P<0.00001). Our prospective, single-center experience coupled with the findings of the comprehensive meta-analysis underscores the safety of IVT in SM. © 2015 American Heart Association, Inc.

Comparison of the clinical and microbiologic characteristics of patients with Enterobacter cloacae and Enterobacter aerogenes bacteremia: a prospective observation study.

PubMed

Song, Eun Hee; Park, Ki-Ho; Jang, Eun-Young; Lee, Eun Jung; Chong, Yong Pil; Cho, Oh-Hyun; Kim, Sung-Han; Lee, Sang-Oh; Sung, Heungsup; Kim, Mi-Na; Jeong, Jin-Yong; Kim, Yang Soo; Woo, Jun Hee; Choi, Sang-Ho

2010-04-01

We compared the characteristics and outcomes of 172 Enterobacter cloacae bacteremia and 67 Enterobacter aerogenes bacteremia (EAB) cases. Antimicrobial resistance rates to E. cloacae were higher than those to E. aerogenes. However, EAB more frequently presented as septic shock and was associated with poorer outcomes. 2010 Elsevier Inc. All rights reserved.

Pharyngocutaneous fistula after total laryngectomy: Less common with mechanical stapler closure.

PubMed

Calli, Caglar; Pinar, Ercan; Oncel, Semih

2011-05-01

The aim of the study was to compare the incidences of pharyngocutaneous fistula after total laryngectomy between patients who underwent manual and mechanical suturing for pharyngoesophageal closure. In a retrospective and prospective nonrandomized clinical study conducted at a single tertiary medical center between May 2002 and April 2009, we compared the incidence of pharyngocutaneous salivary fistula between two groups of patients after total laryngectomy. Sixty-one consecutive patients who underwent mechanical suturing with a 60-mm linear stapler (group A) were prospectively enrolled, and 121 patients who had undergone manual suturing (group B) were retrospectively reviewed. The groups were similar in terms of age, gender, comorbidities, TNM (tumor, node, metastasis) stage, and laryngeal tumor extension. The incidence of pharyngocutaneous salivary fistula was 4.9% in group A and 19.8% in group B (p = 0.014). Mechanical stapler closure of the pharynx after total laryngectomy was associated with a significant reduction in the incidence of pharyngocutaneous fistula compared with manual suture in selected cases.

Specific exercises reduce brace prescription in adolescent idiopathic scoliosis: a prospective controlled cohort study with worst-case analysis.

PubMed

Negrini, Stefano; Zaina, Fabio; Romano, Michele; Negrini, Alessandra; Parzini, Silvana

2008-06-01

To compare the effect of Scientific Exercises Approach to Scoliosis (SEAS) exercises with "usual care" rehabilitation programmes in terms of the avoidance of brace prescription and prevention of curve progression in adolescent idiopathic scoliosis. Prospective controlled cohort observational study. Seventy-four consecutive outpatients with adolescent idiopathic scoliosis, mean 15 degrees (standard deviation 6) Cobb angle, 12.4 (standard deviation 2.2) years old, at risk of bracing who had not been treated previously. Thirty-five patients were included in the SEAS exercises group and 39 in the usual physiotherapy group. The primary outcome included the number of braced patients, Cobb angle and the angle of trunk rotation. There were 6.1% braced patients in the SEAS exercises group vs 25.0% in the usual physiotherapy group. Failures of treatment in the worst-case analysis were 11.5% and 30.8%, respectively. In both cases the differences were statistically significant. Cobb angle improved in the SEAS exercises group, but worsened in the usual physiotherapy group. In the SEAS exercises group, 23.5% of patients improved and 11.8% worsened, while in the usual physiotherapy group 11.1% improved and 13.9% worsened. These data confirm the effectiveness of exercises in patients with scoliosis who are at high risk of progression. Compared with non-adapted exercises, a specific and personalized treatment (SEAS) appears to be more effective.

Clinical epidemiology of amyotrophic lateral sclerosis in Liguria, Italy: An update of LIGALS register.

PubMed

Scialò, Carlo; Novi, Giovanni; Bandettini di Poggio, Monica; Canosa, Antonio; Sormani, Maria Pia; Mandich, Paola; Origone, Paola; Truffelli, Romina; Mancardi, Giovanni Luigi; Caponnetto, Claudia

Our objectives were: (1) to assess amyotrophic lateral sclerosis (ALS) incidence and its trend over time in Liguria, an Italian north-western region, performing an analysis of data prospectively collected from 1 January 2009 to 31 December 2014; (2) to determine the mean and median survival in the 2009-2014 Ligurian ALS incident cases; and (3) to evaluate the presence of disease prognostic factors. The Liguria Register for ALS (LIGALS) is an ongoing, multicentre prospective register enrolling all ALS incident cases in Liguria. Cases were identified using several concurrent sources. ALS diagnosis was based on El Escorial revised criteria (EEC-R). Two hundred and ninety-eight patients were enrolled in this study. The mean annual crude incidence rate in the 2009-2014 period was 3.11/100,000 population (95% CI 2.77-3.49); the point prevalence at 31 December 2014 was 7.85/100,000 (95% CI 6.54-9.36) population. Survival analysis demonstrated a median survival from symptom onset of 37.0 months (95% CI 32.0-42.0). In conclusion, ALS crude incidence in Liguria is higher compared to other Italian regions. Clinical and epidemiological data are comparable with those of the Italian ALS population. Survival analysis showed that higher age at onset, bulbar onset, definite EEC-R diagnostic category and a shorter diagnostic delay are related with worse outcomes.

42 CFR 412.112 - Payments determined on a per case basis.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.112 Payments determined on a per case basis. A hospital is... 42 Public Health 2 2010-10-01 2010-10-01 false Payments determined on a per case basis. 412.112...

Do case-mix adjusted nursing home reimbursements actually reflect costs? Minnesota's experience.

PubMed

Nyman, J A; Connor, R A

1994-07-01

Some states have adopted Medicaid reimbursement systems that pay nursing homes according to patient type. These case-mix adjusted reimbursements are intended in part to eliminate the incentive in prospective systems to exclude less profitable patients. This study estimates the marginal costs of different patient types under Minnesota's case-mix system and compares them to their corresponding reimbursements. We find that estimated costs do not match reimbursement rates, again making some patient types less profitable than others. Further, in confirmation of our estimates, we find that the percentage change in patient days between 1986 and 1990 is explained by our profitability estimates.

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... address changes to the case-mix that are a result of changes in the coding or classification of different...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels...

Prospective observational study of midtarsal joint sprain: Epidemiological and ultrasonographic analysis.

PubMed

Thiounn, A; Szymanski, C; Lalanne, C; Soudy, K; Demondion, X; Maynou, C

2016-09-01

Foot and ankle injuries (FAI) are very common, with about 6000 cases per day in France. Unlike lateral ankle sprain (LAS), the diagnosis of midtarsal joint sprain (MJS, also known as Chopart's joint sprain) is not widely known. This prospective study aims to detail the epidemiology of MJS and compare it to LAS. The study was conducted within our institution over a period of 16 months. Patients with clinical signs predictive of MJS without radiographic bone lesion underwent ultrasound assessment. MJS was diagnosed in case of at least 1 lesion of the dorsal midtarsal joint ligaments. A total of 2412 patients consulted for FAI; 188 had clinical and radiographic criteria for ultrasound examination. Eighty-two cases of MJS were diagnosed (3.4% of FAIs). Sports injuries were more frequent in MJS (P=0.04), and mechanisms more varied than in LAS, with inversion injury in 75% of cases and plantar hyperflexion in 22%. Sprain was severe in 70% of cases, with complete ligament tear. Clinical and ultrasound analyses correlated in only 40% of cases of MJS, versus 98% for LAS. MJS is frequent, difficult to diagnose clinically, and often severe. Clinical presentation and injury mechanisms differ from ankle sprain. Ultrasound seems to be an indispensable tool in diagnosis. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Immediate fetal-maternal morbidity of first instrumental vaginal delivery using Thierry's spatulas. A prospective continuous study of 195 fetal extractions].

PubMed

Parant, O; Simon-Toulza, C; Capdet, J; Fuzier, V; Arnaud, C; Rème, J-M

2009-10-01

To investigate the immediate fetal-maternal morbidity related to Thierry's spatula for first instrumental vaginal delivery. We conducted a prospective observational study in Toulouse university hospital, including primiparas who vaginally delivered a live singleton cephalic infant>36 WG, between December 2005 and June 2006. Instrumental deliveries were performed using short spatulas in all cases. Outcome measures were: perineal complications (episiotomy, laceration and associated lesions, urinary retention, pain at H48), neonatal morbidity (cutaneous injuries, neonatal transfer, cord pH, Apgar score). Instrumental deliveries were compared with spontaneous vaginal deliveries (SVD). Six hundred and eight primiparas were included, distributed in 195 extractions (32%) and 413 SVD (68%). Spatulas allowed fetal extraction in all cases. Main differences between the two groups were: length of labour, occiput posterior position (12.8% for spatulas vs 1.7% for SVD; p<0.0001), episiotomy rate (97.9% vs 51.3%; p<0.0001), severe perineal lacerations (3.6% vs 0.2%; p=0.0007), post-partum morbidity (pain, hematoma, and urinary retention). No case of early severe neonatal complication was related to the use of the spatulas. Perineal complications (severe lacerations) associated with spatulas are increased with regard to SVD, but comparable to that reported with forceps. The main disadvantage is the high frequency of episiotomy, which should not be systematic. Neonatal morbidity is reduced. Comparative studies (spatulas vs. other procedures) are needed to confirm these data, but spatulas remain a multipurpose instrument which should continue to be taught.

Google Calendar Enhances Prospective Memory in Alzheimer's Disease: A Case Report.

PubMed

El Haj, Mohamad; Gallouj, Karim; Antoine, Pascal

2017-01-01

We investigated whether an external memory aid (i.e., Google Calendar) would alleviate prospective memory compromise in a patient with mild Alzheimer's disease. The patient was asked in the baseline phase to perform three prospective targeted events (e.g., attending her weekly bridge game at the community club) and three prospective control events (e.g., buying her weekly magazine). The same six prospective events were assessed in the intervention phase but the targeted-events were cued by Google Calendar while the control-events were not. Results showed less omission of the targeted events in the training phase than in the baseline phase, suggesting a positive effect of Google Calendar. This case report offers a unique view into how smartphone calendars may alleviate prospective memory compromise in patients with mild Alzheimer's disease.

Prospective, randomised, controlled trial comparing suture needle drainage and argon laser drainage of subretinal fluid.

PubMed Central

Aylward, G W; Orr, G; Schwartz, S D; Leaver, P K

1995-01-01

AIMS--This study was designed to compare suture needle drainage (SND) with argon laser drainage (ALD) of subretinal fluid. METHODS--A prospective, randomised, controlled, clinical trial was carried out on 93 patients undergoing external drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment. The incidence of successful drainage, incidence of subretinal haemorrhage, incidence of retinal incarceration, and incidence of retinal perforation were determined. RESULTS--The success rate was 97.9% in the ALD group and 84.8% in the SND group (difference-13.1%, 95% CI-26.4% to 2.0%). The incidence of clinically significant subretinal haemorrhage was 4.3% in the ALD group compared with 28.3% in the SND group (difference 24.0%, 95% CI 7.6% to 40.4%). The incidence of incarceration was comparable in each group. There were no cases of retinal perforation. CONCLUSIONS--The use of ALD was associated with a higher rate of successful SRF drainage, and a lower incidence of clinically significant subretinal haemorrhage than SND. ALD is preferred when an endolaser is available. PMID:7547781

Feline leprosy due to Candidatus 'Mycobacterium lepraefelis': Further clinical and molecular characterisation of eight previously reported cases and an additional 30 cases.

PubMed

O'Brien, Carolyn R; Malik, Richard; Globan, Maria; Reppas, George; McCowan, Christina; Fyfe, Janet A

2017-09-01

This paper, the last in a series of three on 'feline leprosy', provides a detailed description of disease referable to the previously unnamed species, Candidatus 'Mycobacterium lepraefelis', a close relative of the human pathogens Mycobacterium leprae and Mycobacterium lepromatosis. Cases were sourced retrospectively and prospectively for this observational study, describing clinical, geographical and molecular microbiological data for cats definitively diagnosed with Candidatus 'M lepraefelis' infection. A total of 145 cases of feline leprosy were scrutinised; 114 'new' cases were sourced from the Victorian Infectious Diseases Reference Laboratory (VIDRL) records, veterinary pathology laboratories or veterinarians, and 31 cases were derived from six published studies. Thirty-eight cats were definitively diagnosed with Candidatus 'M lepraefelis' infection. Typically, cats tended to be middle-aged or older when first infected, with a male predilection. Affected cats typically had widespread cutaneous lesions, in some cases after initially localised disease. Advanced cases were often systemically unwell. All cats had outdoor access. The histological picture was lepromatous in the majority of patients, although two cases had tuberculoid disease. In one case that underwent necropsy, lesions were evident in the liver, spleen and lungs. Treatment was varied, although most cats received a combination of oral clarithromycin and rifampicin. Prognosis for recovery was variable, but typically poor. Candidatus 'M lepraefelis' typically causes high bacterial index (lepromatous) feline leprosy that in some cases progresses to systemic mycobacteriosis. The disease has a variable clinical course and prognosis. Many cases either died or were euthanased due to the infection. Multilocus sequence analysis reveals a heterogeneous picture and further analysis of draft genome sequencing may give clues to the taxonomy and epidemiology of this organism. Prospective treatment trials and/or additional drug susceptibility testing in specialised systems would further inform treatment recommendations. Comparative aspects: This paper finishes with a discussion of comparative aspects of infection caused by the three feline leproid disease agents that have been the subject of this series: Candidatus 'Mycobacterium tarwinense', Mycobacterium lepraemurium and Candidatus 'M lepraefelis'.

Overview of EPA's Approach to Developing Prospective Case Studies Technical Workshop: Case Studies to Assess Potential Impacts of Hydraulic Fracturing on Drinking Water Resources

EPA Science Inventory

One component of the United States Environmental Protection Agency's (EPA) study of the potential impacts of hydraulic fracturing on drinking water resources is prospective case studies, which are being conducted to more fully understand and assess if and how site specific hydrau...

Comparative prospective study of rhegmatogenous retinal detachments in phakic or pseudophakic patients with high myopia.

PubMed

Bernheim, Diane; Rouberol, Frederic; Palombi, Karine; Albrieux, Magali; Romanet, Jean-Paul; Chiquet, Christophe

2013-01-01

To compare the anatomical and functional results of primary rhegmatogenous retinal detachment in highly myopic phakic or pseudophakic eyes. This prospective 2-center study included 191 consecutive eyes (151 phakic and 40 pseudophakic eyes) from a prospective cohort of 835 patients (IRB #5891, between 2004 and 2008). Baseline and follow-up data were systematically recorded at presentation, 1 month, and 6 months or more after surgery. On final examination, two groups were considered based on the need for one or more surgeries to achieve retinal reapplication. End points were primary reattachment rate at the 6-month visit, final anatomical success rate, postoperative visual acuity, and intraoperative and postoperative complications. Pseudophakic eyes differed from phakic eyes in age (60.8 ± 10.4 vs. 49.9 ± 12.3, P < 0.001), smaller pupil dilation (8.0 ± 1.5 vs. 8.5 ± 1.2 mm, P = 0.02), fewer retinal tears seen preoperatively (1.5 ± 1.6 vs. 2.2 ± 2.2, P = 0.06), more frequent use of pars plana vitrectomy (80% vs. 28.5%, P < 0.001), and higher single reattachment rate (92.5% vs. 80.7%). Visual acuity was greater than or equal to 20/40 in 54% of cases with single retinal detachment surgery and 44% of cases with multiple surgeries. Multiple logistic regression analysis showed that only 3 independent variables were significantly predictive of good final visual acuity (20/40): initial visual acuity (<20/400, odds ratio = 0.19; 95% confidence interval, 0.07-0.51; P = 0.002), axial length (odds ratio = 0.57; 95% confidence interval, 0.44-0.75, P < 0.001), and pars plana vitrectomy (odds ratio = 0.33; 95% confidence interval, 0.15-0.71, P = 0.004). This prospective study showed similar baseline retinal detachment characteristics of high myopic phakic or pseudophakic eyes, suggesting that high myopia was the main pathogenic factor in both groups. Although high myopic eye presents anatomical characteristics that could favor surgical morbidity, these recent prospective data show that high myopic eyes exhibit functional and anatomical prognosis close to that described in emmetropic eyes.

[A prospective comparison of day care and freely chosen occupational therapy for elderly patients with dementia].

PubMed

Yamada, Shizuru; Toba, Kenji

2005-01-01

Since the introduction of long-term care insurance, day care services have become popular throughout Japan and many kinds of behavioral approaches have been used. Although there have been many reports on the non-pharmacological effects on cognitive function, case control studies to evaluate the effect of day care services are insufficient Furthermore, no study has compared the advantages of different behavioral therapies for elderly subjects with loss of cognitive function. To clarify these issues, we compared the changes in activities of daily living, cognitive function and vitality/depression among 78 subjects receiving different day care services. Community dwelling subjects using day care (day care group: n = 29, 80+/-7.3 years old) showed an improvement in abnormal behavior (DBD scale; before 8.5+/-2.1, after 3.2+/-1.3, p<0.05). Vitality and volition measured by the Vitality Index were significantly preserved in the day care group compared with community dwelling subjects without day care services (n = 11, 78.6+/-9.4 y.o.). Comparing the effect of three different behavioral therapies (physical fitness, cooking and gardening), there was no difference in changes in cognitive function or in other comprehensive measurements among the groups. On the other hand, different responses to various therapies were observed among subjects. To determine the advantage of various non-pharmacological therapies for dementia, geriatricians need to perform prospective case-control studies with a large number of subjects, using comprehensive geriatric assessment as the art of a geriatrician.

HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: A prospective case series.

PubMed

Thorleifsdottir, Ragna H; Sigurdardottir, Sigrun L; Sigurgeirsson, Bardur; Olafsson, Jon H; Petersen, Hannes; Sigurdsson, Martin I; Gudjonsson, Johann E; Johnston, Andrew; Valdimarsson, Helgi

2016-11-01

Carriage of the HLA-Cw*0602 allele is associated with a particular set of clinical features and treatment responses in psoriasis. Tonsillectomy can improve psoriasis. We sought to evaluate whether HLA-Cw*0602 predicts a favorable outcome after tonsillectomy of patients with psoriasis. This prospective case series followed up 28 tonsillectomized patients with plaque psoriasis for 24 months. The Psoriasis Area and Severity Index, Psoriasis Disability Index, and Psoriasis Life Stress Inventory were used for assessment. Tonsils were swabbed for bacteria and patients genotyped for HLA-Cw*0602. After tonsillectomy, HLA-Cw*0602 homozygotes showed significantly more improvement, compared with heterozygous and HLA-Cw*0602-negative patients. Thus, Psoriasis Area and Severity Index score was reduced by 82% in the homozygous patients compared with 42% and 31%, respectively (P < .001), Psoriasis Disability Index score improved by 87% compared with 38% and 41%, respectively (P < .001), and Psoriasis Life Stress Inventory score was 82% reduced compared with 60% and 54%, respectively (P < .001). The homozygotes more often had psoriasis onset associated with a throat infection (P = .007) and an increased frequency of streptococcal throat infections per lifetime (P = .038). Few patients were included and some data were retrospective. Homozygous HLA-Cw*0602 carriage in plaque psoriasis may predict a favorable outcome after tonsillectomy. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Development of a time-trend model for analyzing and predicting case-pattern of Lassa fever epidemics in Liberia, 2013-2017.

PubMed

Olugasa, Babasola O; Odigie, Eugene A; Lawani, Mike; Ojo, Johnson F

2015-01-01

The objective was to develop a case-pattern model for Lassa fever (LF) among humans and derive predictors of time-trend point distribution of LF cases in Liberia in view of the prevailing under-reporting and public health challenge posed by the disease in the country. A retrospective 5 years data of LF distribution countrywide among humans were used to train a time-trend model of the disease in Liberia. A time-trend quadratic model was selected due to its goodness-of-fit (R2 = 0.89, and P < 0.05) and best performance compared to linear and exponential models. Parameter predictors were run on least square method to predict LF cases for a prospective 5 years period, covering 2013-2017. The two-stage predictive model of LF case-pattern between 2013 and 2017 was characterized by a prospective decline within the South-coast County of Grand Bassa over the forecast period and an upward case-trend within the Northern County of Nimba. Case specific exponential increase was predicted for the first 2 years (2013-2014) with a geometric increase over the next 3 years (2015-2017) in Nimba County. This paper describes a translational application of the space-time distribution pattern of LF epidemics, 2008-2012 reported in Liberia, on which a predictive model was developed. We proposed a computationally feasible two-stage space-time permutation approach to estimate the time-trend parameters and conduct predictive inference on LF in Liberia.

A Prospective Study Investigating Pre-diagnostic Leukocyte Telomere Length and Risk of Developing Rheumatoid Arthritis in Women

PubMed Central

Prescott, Jennifer; Karlson, Elizabeth W.; Orr, Esther H.; Zee, Robert Y.L.; De Vivo, Immaculata; Costenbader, Karen H.

2015-01-01

Objective To prospectively examine the association between leukocyte telomere length (LTL) and subsequent RA development in women. Methods Using a case-control design nested within the prospective Nurses’ Health Study (NHS), Nurses’ Health Study II (NHSII), and Women’s Health Study (WHS), each validated case of RA with a pre-diagnostic blood sample was matched to three controls by cohort, age, menopausal status, postmenopausal hormone therapy, and blood collection covariates. We measured telomere length in genomic DNA extracted from stored buffy coat samples using quantitative PCR. We used unconditional logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI), and random-effects meta-analysis to combine study results. Results In total, we analyzed 296 incident RA cases and 827 matched controls. Mean age of diagnosis among women who developed RA was 60.5 in NHS/NHSII and 61.3 in WHS. Meta-analysis demonstrated that longer pre-diagnostic LTL was associated with increased RA risk when women in the longest vs. shortest LTL tertile were compared (OR=1.51, 95% CI=1.03–2.23; pheterogeneity=0.27). However, statistically significant between study heterogeneity was observed for the intermediate tertile category (pheterogeneity=0.008). We did not observe heterogeneity by menopausal status, inflammatory cytokine levels, age at diagnosis, age at blood collection, body mass index, seropositivity, or HLA-DRB1 shared epitope status. Conclusion Our results do not support a role for short LTL preceding RA development. PMID:26773113

Chocolate consumption and risk of stroke: a prospective cohort of men and meta-analysis.

PubMed

Larsson, Susanna C; Virtamo, Jarmo; Wolk, Alicja

2012-09-18

To investigate the association between chocolate consumption and risk of stroke in men and conduct a meta-analysis to summarize available evidence from prospective studies of chocolate consumption and stroke. We prospectively followed 37,103 men in the Cohort of Swedish Men. Chocolate consumption was assessed at baseline using a food-frequency questionnaire. Cases of first stroke were ascertained from the Swedish Hospital Discharge Registry. For the meta-analysis, pertinent studies were identified by searching the PubMed and EMBASE databases through January 13, 2012. Study-specific results were combined using a random-effects model. During 10.2 years of follow-up, we ascertained 1,995 incident stroke cases, including 1,511 cerebral infarctions, 321 hemorrhagic strokes, and 163 unspecified strokes. High chocolate consumption was associated with a lower risk of stroke. The multivariable relative risk of stroke comparing the highest quartile of chocolate consumption (median 62.9 g/week) with the lowest quartile (median 0 g/week) was 0.83 (95 % CI 0.70-0.99). The association did not differ by stroke subtypes. In a meta-analysis of 5 studies, with a total of 4,260 stroke cases, the overall relative risk of stroke for the highest vs lowest category of chocolate consumption was 0.81 (95% CI 0.73-0.90), without heterogeneity among studies (p = 0.47). These findings suggest that moderate chocolate consumption may lower the risk of stroke.

Assessment of follow-up, and the completeness and accuracy of cancer case ascertainment in three areas of India

PubMed Central

Mathew, Aleyamma; Daniel, Carrie R.; Ferrucci, Leah M.; Seth, Tulika; Devesa, Susan S.; George, Preethi S.; Shetty, Hemali; Devasenapathy, Niveditha; Yurgalevitch, Susan; Rastogi, Tanuja; Prabhakaran, Dorairaj; Gupta, Prakash C.; Chatterjee, Nilanjan; Sinha, Rashmi

2012-01-01

Background A prospective study of diet and cancer has not been conducted in India; consequently, little is known regarding follow-up rates or the completeness and accuracy of cancer case ascertainment. Methods We assessed follow-up in the India Health Study (IHS; 4,671 participants aged 35–69 residing in New Delhi, Mumbai, or Trivandrum). We evaluated the impact of medical care access and relocation, re-contacted the IHS participants to estimate follow-up rates, and conducted separate studies of cancer cases to evaluate registry coverage (604 cases in Trivandrum) and the accuracy of self- and proxy-reporting (1600 cases in New Delhi and Trivandrum). Results Over 97% of people reported seeing a doctor and 85% had lived in their current residence for over six years. The 2-year follow-up rate was 91% for Trivandrum and 53% for New Delhi. No cancer cases were missed among public institutions participating in the surveillance program in Trivandrum during 2003–04; but there are likely to be unmatched cases (ranging from 5 to13% of total cases) from private hospitals in the Trivandrum registry, as there are no mandatory reporting requirements. Vital status was obtained for 36% of cancer cases in New Delhi as compared to 78% in Trivandrum after a period of 4 years. Conclusions A prospective cohort study of cancer may be feasible in some centers in India with active follow-up to supplement registry data. Inclusion of cancers diagnosed at private institutions, unique identifiers for individuals, and computerized medical information would likely improve cancer registries. PMID:21621499

Results of a prospective surgical audit of bilateral paediatric cochlear implantation in the UK.

PubMed

Broomfield, Stephen J; Murphy, John; Wild, Dominik C; Emmett, Stevan R; O'Donoghue, Gerard M

2014-09-01

Since being approved in 2009, bilateral simultaneous cochlear implantation (CI) has been the standard treatment for children in the UK who meet the criteria for CI. The aim was to report surgical outcomes of bilateral CI in the UK. Between January 2010 and December 2011, 14 UK CI centres collected data prospectively: demographics, aetiology, use of imaging, device type, surgery duration, use of intra-operative electrophysiology, length of stay, and post-operative complications. 1397 CI procedures in 961 CI recipients were included; 436 bilateral simultaneous, 394 bilateral sequential, and 131 unilateral. The majority (85%) were congenitally deaf. The commonest causes of acquired deafness were meningitis and cytomegalovirus infection. The median age for congenitally deaf bilateral simultaneous CI was 2.2 years, mean surgical duration 4.5 hours. 6.3% surgeries were day case procedures. Eight cases (2.0%) of planned bilateral CI had unilateral surgery. The overall major complication rate was 1.6% (0.9% excluding device failures), including explantation due to infection (0.2%), cerebrospinal fluid leak (0.2%), and meningitis (0.1%). There were no permanent facial nerve palsies and no deaths. Sixty-two (6.5%) immediate minor complications included 12 (1.3%) children with significant vestibular impairment. The complication rate was similar following bilateral CI compared to sequential and unilateral CI, and is comparable to other published series. This prospective multi-centre audit provides evidence that bilateral paediatric CI is a safe procedure in the UK, thus endorsing its role as a major therapeutic intervention in childhood deafness.

Incidence of acute intussusception among infants in eastern France: results of the EPIstudy trial.

PubMed

Fotso Kamdem, Arnaud; Vidal, Chrystelle; Pazart, Lionel; Leroux, Franck; Pugin, Aurore; Savet, Caroline; Sainte-Claire Deville, Geoffroy; Riou França, Lionel; Guillemot, Didier; Massol, Jacques

2017-03-01

The incidence of intussusception in infants varies around the world. The epidemiology of intussusception in France has never been prospectively studied. We performed a prospective observational study with systematic inclusion of all infants aged <1 year with suspected intussusception admitted to the emergency departments of the hospitals in the eastern region of France (98,000 live births per year), from 4/1/2008 to 3/31/2012. Cases were classified using the Brighton Collaboration classification. In total, 185 infants with suspected intussusception were included of which 169 were idiopathic intussusception. Among these 169 cases, 115 (68%) were classed as Brighton level 1 (confirmed cases). Overall incidence of intussusception over the 4 years of the study was 29.8 (95% CI 24.6-35.7) cases per 100,000 live births for level 1 and 37.5 (95% CI 31.7-44.2) cases per 100,000 live births for all cases (levels 1-4). Annual incidence rates of level 1 intussusception were as follows: 44 (95% CI 31.9-59.3), 30.9 (20.9-44.2), 21.7 (13.4-33.2) and 22.1 (13.7-33.8) per 100,000 live births in the 1st, 2nd, 3rd and 4th study years, respectively. The incidence rate of intussusception in the eastern part of France is comparable to that of other European countries. There was a significant trend towards a decrease in the incidence of intussusception. What is known • Intussusception is the most frequent causes of intestinal obstruction in infants and young children. Overall incidence of intussusception in infants aged <1 year varies widely around the world. No specific epidemiological studies have not been conducted in France on intussusception. What is new: • This prospective and multicenter study provides important information about the epidemiology of intussusception in infants in France over a period of 4 years.

Utility of ultrasound and magnetic resonance imaging in prenatal diagnosis of placenta accreta: A prospective study.

PubMed

Satija, Bhawna; Kumar, Sanyal; Wadhwa, Leena; Gupta, Taru; Kohli, Supreethi; Chandoke, Rajkumar; Gupta, Pratibha

2015-01-01

Placenta accreta is the abnormal adherence of the placenta to the uterine wall and the most common cause for emergency postpartum hysterectomy. Accurate prenatal diagnosis of affected pregnancies allows optimal obstetric management. To summarize our experience in the antenatal diagnosis of placenta accreta on imaging in a tertiary care setup. To compare the accuracy of ultrasound (USG) with color Doppler (CDUS) and magnetic resonance imaging (MRI) in prenatal diagnosis of placenta accreta. Prospective study in a tertiary care setup. A prospective study was conducted on pregnant females with high clinical risk of placenta accreta. Antenatal diagnosis was established based on CDUS and MRI. The imaging findings were compared with final diagnosis at the time of delivery and/or pathologic examination. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CDUS and MRI. The sensitivity and specificity values of USG and MRI were compared by the McNemar test. Thirty patients at risk of placenta accreta underwent both CDUS and MRI. Eight cases of placenta accreta were identified (3 vera, 4 increta, and 1 percreta). All patients had history of previous cesarean section. Placenta previa was present in seven out of eight patients. USG correctly identified the presence of placenta accreta in seven out of eight patients (87.5% sensitivity) and the absence of placenta accreta in 19 out of 22 patients (86.4% specificity). MRI correctly identified the presence of placenta accreta in 6 out of 8 patients (75.0% sensitivity) and absence of placenta accreta in 17 out of 22 patients (77.3% specificity). There were no statistical differences in sensitivity (P = 1.00) and specificity (P = 0.687) between USG and MRI. Both USG and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. Both modalities have complimentary role and in cases of inconclusive findings with one imaging modality, the other modality may be useful for obtaining the diagnosis. CDUS remains the first primary modality for antenatal diagnosis of placenta accreta, with MRI reserved for cases where USG is inconclusive.

42 CFR 413.340 - Transition period.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... minus 1 percentage point. (c) SNFs participating in the Multistate Nursing Home Case-Mix and Quality Demonstration. SNFs that participated in the Multistate Nursing Home Case-Mix and Quality Demonstration in a...

42 CFR 413.340 - Transition period.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... minus 1 percentage point. (c) SNFs participating in the Multistate Nursing Home Case-Mix and Quality Demonstration. SNFs that participated in the Multistate Nursing Home Case-Mix and Quality Demonstration in a...

Sustained Presence of Cutaneous Leishmaniasis in Urban Manaus, the Largest Human Settlement in the Amazon.

PubMed

Benício, Ednelza; Cordeiro, Mayara; Monteiro, Hannah; Saboia Moura, Marco Antônio; Oliveira, Cintia; Nunes Gadelha, Ellen Pricilla; Chrusciak-Talhari, Anette; Talhari, Carolina; de Lima Ferreira, Luiz Carlos; Mira, Marcelo Távora; Lima Machado, Paulo Roberto; Talhari, Sinésio; Schriefer, Albert

2015-12-01

The Amazon is responsible for approximately 40% of the American tegumentary leishmaniasis (ATL) in Brazil. Herein the sustained presence of ATL in Manaus, the largest settlement in the Amazon, was investigated. Records of notification of historic cases, and data from cases prospectively enrolled in the Tropical Medicine Foundation of the Amazonas State were used. Geographic coordinates of prospective patients' living sites were used to detect inner-city clusters of ATL. Infecting Leishmania species was determined by polymerase chain reaction. Among prospectively enrolled subjects, 94.8% were infected with Leishmania (Viannia) guyanensis, 76.7% were male, 30.2% were 0-20 years old, and 69.8% had an urban residence. Historic cases showed a profile similar to that of prospectively enrolled subjects. Several clusters of ATL, widely distributed within the city of Manaus, could be detected. In conclusion, there was a high frequency of disease in young age groups and cases clustered in urban neighborhoods. It cannot be determined from these data whether transmission of these cases occurred within or outside the city of Manaus. © The American Society of Tropical Medicine and Hygiene.

Sustained Presence of Cutaneous Leishmaniasis in Urban Manaus, the Largest Human Settlement in the Amazon

PubMed Central

Benício, Ednelza; Cordeiro, Mayara; Monteiro, Hannah; Moura, Marco Antônio Saboia; Oliveira, Cintia; Gadelha, Ellen Pricilla Nunes; Chrusciak-Talhari, Anette; Talhari, Carolina; de Lima Ferreira, Luiz Carlos; Mira, Marcelo Távora; Machado, Paulo Roberto Lima; Talhari, Sinésio; Schriefer, Albert

2015-01-01

The Amazon is responsible for approximately 40% of the American tegumentary leishmaniasis (ATL) in Brazil. Herein the sustained presence of ATL in Manaus, the largest settlement in the Amazon, was investigated. Records of notification of historic cases, and data from cases prospectively enrolled in the Tropical Medicine Foundation of the Amazonas State were used. Geographic coordinates of prospective patients' living sites were used to detect inner-city clusters of ATL. Infecting Leishmania species was determined by polymerase chain reaction. Among prospectively enrolled subjects, 94.8% were infected with Leishmania (Viannia) guyanensis, 76.7% were male, 30.2% were 0–20 years old, and 69.8% had an urban residence. Historic cases showed a profile similar to that of prospectively enrolled subjects. Several clusters of ATL, widely distributed within the city of Manaus, could be detected. In conclusion, there was a high frequency of disease in young age groups and cases clustered in urban neighborhoods. It cannot be determined from these data whether transmission of these cases occurred within or outside the city of Manaus. PMID:26483119

The financial performance of selected investor-owned and not-for-profit system hospitals before and after Medicare prospective payment.

PubMed Central

Friedman, B; Shortell, S

1988-01-01

This article analyzes determinants of cost and profitability, including the influence of Medicare prospective payment (PPS), between 1983 and 1985 for nearly 300 hospitals belonging to investor-owned (IO) and not-for-profit (NFP) systems. Using approaches that assure comparability of financial data, and including case mix, quality, competition, and regulation measures, the findings indicate that (1) in both years, competitive environment, case mix, age of facility, and scope of diversified services were important determinants of average cost, while a process measure of quality was insignificant and the independent effect of ownership type was insignificant for cost; (2) effects of HMO competition and hospital strategy were stronger in 1985 than in 1983; (3) operating margins for all types of hospitals showed increases, with a somewhat greater improvement for NFP system members; and (4) significantly greater declines in volume of care occurred for IO system members. Implications for future research are discussed. PMID:3133323

Surgical infection in a videolaparoscopic cholecystectomy when using peracetic acid for the sterilization of instruments.

PubMed

de Melo, Edluza Maria Viana Bezerra; Leão, Cristiano de Souza; Andreto, Luciana Marques; de Mello, Maria Júlia Gonçalves

2013-01-01

To determine the frequency of surgical site infection in patients undergoing laparoscopic cholecystectomy with instruments sterilized by peracetic acid. We conducted a retrospective, cohort, descriptive, cross-sectional study. Peracetic acid has been used for sterilization following the protocol recommended by the manufacturer. We observed the criteria and indicators of process and structure for preventing surgical site infection pre and intraoperatively. For epidemiological surveillance, outpatient visits were scheduled for the 15th and between the 30th and 45th days after discharge. Among the 247 patients, there were two cases of surgical site infection (0.8%). One patient was readmitted to systemic antibiotic therapy and percutaneous puncture; in the other the infection was superficial and followed at the clinic. Ethical issues prevent the conduction of a prospective study because of peracetic acid have been banned for the sterilization of instruments that penetrate organs and cavities. Nevertheless, these results encourage prospective case-control studies comparing its use (historical control) with ethylene oxide sterilization.

Does transfusion of residual cardiopulmonary bypass circuit blood increase postoperative bleeding? A prospective randomized study in patients undergoing on pump cardiopulmonary bypass

PubMed Central

Duara, Rajnish; Misra, Manoranjan; Bhuyan, Ritwick Raj; Sarma, P. Sankara; Jayakumar, Karunakaran

2008-01-01

Objective: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB) circuit i.e., pump blood as a means to reduce homologous transfusion after coronary artery bypass surgery (CABG) and whether its use increases postoperative drainage. Materials and Methods: Sixty-seven consecutive patients who underwent elective CABGs under CPB were randomized into 2 groups: (1) cases where residual pump blood was used and (2) controls where residual pump blood was not used. Patients were monitored for hourly drainage on the day of surgery and the 1st postoperative day and the requirements of homologous blood and its products. Data were matched regarding change in Hemoglobin, Packed Cell Volume and coagulation parameters till 1st postoperative day. All cases were followed up for three years. Results: There was a marginal reduction in bleeding pattern in the early postoperative period in the cases compared to controls. The requirement of homologous blood and its products were also reduced in the cases. Conclusions: The use of CPB circuit blood is safe in the immediate postoperative period. The requirement of homologous blood transfusion can come down if strict transfusion criteria are maintained. PMID:20041077

Localizing value of electrical source imaging: Frontal lobe, malformations of cortical development and negative MRI related epilepsies are the best candidates.

PubMed

Abdallah, Chifaou; Maillard, Louis G; Rikir, Estelle; Jonas, Jacques; Thiriaux, Anne; Gavaret, Martine; Bartolomei, Fabrice; Colnat-Coulbois, Sophie; Vignal, Jean-Pierre; Koessler, Laurent

2017-01-01

We aimed to prospectively assess the anatomical concordance of electric source localizations of interictal discharges with the epileptogenic zone (EZ) estimated by stereo-electroencephalography (SEEG) according to different subgroups: the type of epilepsy, the presence of a structural MRI lesion, the aetiology and the depth of the EZ. In a prospective multicentric observational study, we enrolled 85 consecutive patients undergoing pre-surgical SEEG investigation for focal drug-resistant epilepsy. Electric source imaging (ESI) was performed before SEEG. Source localizations were obtained from dipolar and distributed source methods. Anatomical concordance between ESI and EZ was defined according to 36 predefined sublobar regions. ESI was interpreted blinded to- and subsequently compared with SEEG estimated EZ. 74 patients were finally analyzed. 38 patients had temporal and 36 extra-temporal lobe epilepsy. MRI was positive in 52. 41 patients had malformation of cortical development (MCD), 33 had another or an unknown aetiology. EZ was medial in 27, lateral in 13, and medio-lateral in 34. In the overall cohort, ESI completely or partly localized the EZ in 85%: full concordance in 13 cases and partial concordance in 50 cases. The rate of ESI full concordance with EZ was significantly higher in (i) frontal lobe epilepsy (46%; p  = 0.05), (ii) cases of negative MRI (36%; p  = 0.01) and (iii) MCD (27%; p  = 0.03). The rate of ESI full concordance with EZ was not statistically different according to the depth of the EZ. We prospectively demonstrated that ESI more accurately estimated the EZ in subgroups of patients who are often the most difficult cases in epilepsy surgery: frontal lobe epilepsy, negative MRI and the presence of MCD.

Thoracic multidisciplinary tumor board routinely impacts therapeutic plans in patients with lung and esophageal cancer: a prospective cohort study.

PubMed

Schmidt, Henner M; Roberts, John M; Bodnar, Artur M; Kunz, Sonia; Kirtland, Steven H; Koehler, Richard P; Hubka, Michal; Low, Donald E

2015-05-01

National and subspecialty guidelines for lung and esophageal cancers recommend treatment decisions to be made in a multidisciplinary tumor board (MTB). This study prospectively analyzes the actual impact of presentation at the thoracic tumor board on decision making in thoracic cancer cases. During the electronic submission process for presentation at MTB managing physicians documented their current treatment plan. The initial treatment plan was compared with the MTB final recommendation. Patient demographics, physician's proposed treatment plan, MTB recommendation, and documentation of application of MTB recommendations were prospectively recorded in an Institutional Review Board approved database. Between June 2010 and December 2012, 185 patients with esophageal and 294 patients with lung cancer were presented at the MTB. One hundred sixty-six patients were presented on more than 1 occasion, resulting in 724 assessments of 479 patients. In 48 esophageal cancer patients (26%) and 118 lung cancer patients (40%) MTB recommendations differed from the initial treatment plan. Overall, a differing MTB recommendation from the primary treatment plan occurred in 330 of 724 case presentations (46%). The MTB recommendations changed treatment plans in 40% and staging and assessment plans in 60% of patients. Follow-up in a cohort of 249 patients confirmed that MTB recommendations were followed in 97% of cases. This study validates the impact of the thoracic MTB. Recommendations will differ from the managing providers' initial plan in 26% to 40% of cases. However, MTB recommendations can be successfully initiated in the majority of patients. Complex thoracic cancer patients will benefit from multidisciplinary review and should ideally be presented at tumor board. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Prospective screening for subtelomeric rearrangements in children with mental retardation of unknown aetiology: the Amsterdam experience

PubMed Central

van Karnebeek, C D M; Koevoets, C; Sluijter, S; Bijlsma, E; Smeets, D; Redeker, E; Hennekam, R; Hoovers, J

2002-01-01

Objective: The frequency of subtelomeric rearrangements in patients with unexplained mental retardation (MR) is uncertain, as most studies have been retrospective and case retrieval may have been biased towards cases more likely to have a chromosome anomaly. To ascertain the frequency of cytogenetic anomalies, including subtelomeric rearrangements, we prospectively screened a consecutive cohort of cases with unexplained MR in an academic tertiary centre. Methods: Inclusion criteria were: age <18 years at referral, IQ<85, no aetiological diagnosis after complete examination, which included karyotyping with high resolution banding (HRB). Results: In 266 karyotyped children, anomalies were detected in 20 (7.5%, seven numerical, 13 structural); 39 cases were analysed by FISH for specific interstitial microdeletions, and anomalies were found in nine (23%). FISH analyses for subtelomeric microdeletions were performed in 184 children (44% moderate-profound MR, 51% familial MR), and one rearrangement (0.5%) was identified in a non-familial MR female with mild MR (de novo deletion 12q24.33-qter). The number of probable polymorphisms was considerable: 2qter (n=7), Xpter (n=3), and Ypter (n=1). A significantly higher total number of malformations and minor anomalies was present in the cytogenetic anomaly group compared to the group without cytogenetic anomalies. Conclusions: The total frequency of cytogenetic anomalies in this prospective study was high (1:10), but the frequency of subtelomeric rearrangements was low. The most likely explanations are the high quality of HRB cytogenetic studies and the lack of clinical selection bias. Conventional cytogenetic analyses, combined with targeted microdeletion testing, remain the single most effective way of additional investigation in mentally retarded children, also in a tertiary centre. PMID:12161591

Performance of Momguard, a new non-invasive prenatal testing protocol developed in Korea.

PubMed

Lee, Mi-Young; Cho, Dae-Yeon; Won, Hye-Sung; Hwang, Ah Reum; Jeong, Bada; Kim, Jihun; Oh, Mijin

2015-09-01

To evaluate the performance of Momguard, non-invasive prenatal test (NIPT) for detecting trisomy (T) 21, T18, T13, and sex-chromosome abnormalities recently developed in Korea. This preliminary study formed part of a large prospective cohort study conducted at Asan Medical Center, Seoul, Korea. Only pregnant women who underwent both NIPT and confirmatory karyotyping were included in this study. NIPT results were compared with those of karyotype analyses. Among 93 eligible cases, NIPT results could not be obtained in one case due to a low fetal cell-free DNA fraction. Based on NIPT, eight cases of fetal aneuploidies, including T21 (n=5), T18 (n=2), and T13 (n=1), were identified. For T21 and T18, the sensitivity and specificity of NIPT were both 100%, with a false-positive and false-negative rate of 0% and a positive-predictive value of 100%. One patient classified as having intermediate risk for T13 by NIPT was confirmed to have T13 by karyotyping, and there were no false-negative cases. No cases of sex-chromosome anomalies were detected by NIPT or karyotyping during the study period. Momguard is a reliable screening tool for detecting T21 and T18. For T13 and sex-chromosome anomalies, further prospective studies are necessary to confirm its utility.

Prospective time-resolved LCA of fully electric supercap vehicles in Germany.

PubMed

Zimmermann, Benedikt M; Dura, Hanna; Baumann, Manuel J; Weil, Marcel R

2015-07-01

The ongoing transition of the German electricity supply toward a higher share of renewable and sustainable energy sources, called Energiewende in German, has led to dynamic changes in the environmental impact of electricity over the last few years. Prominent scenario studies predict that comparable dynamics will continue in the coming decades, which will further improve the environmental performance of Germany's electricity supply. Life cycle assessment (LCA) is the methodology commonly used to evaluate environmental performance. Previous LCA studies on electric vehicles have shown that the electricity supply for the vehicles' operation is responsible for the major part of their environmental impact. The core question of this study is how the prospective dynamic development of the German electricity mix will affect the impact of electric vehicles operated in Germany and how LCA can be adapted to analyze this impact in a more robust manner. The previously suggested approach of time-resolved LCA, which is located between static and dynamic LCA, is used in this study and compared with several static approaches. Furthermore, the uncertainty issue associated with scenario studies is addressed in general and in relation to time-resolved LCA. Two scenario studies relevant to policy making have been selected, but a moderate number of modifications have been necessary to adapt the data to the requirements of a life cycle inventory. A potential, fully electric vehicle powered by a supercapacitor energy storage system is used as a generic example. The results show that substantial improvements in the environmental repercussions of the electricity supply and, consequentially, of electric vehicles will be achieved between 2020 and 2031 on the basis of the energy mixes predicted in both studies. This study concludes that although scenarios might not be able to predict the future, they should nonetheless be used as data sources in prospective LCA studies, because in many cases historic data appears to be unsuitable for providing realistic information on the future. The time-resolved LCA approach improves the assessment's robustness substantially, especially when nonlinear developments are foreseen in the future scenarios. This allows for a reduction of bias in LCA-based decision making. However, a deeper integration of time-resolved data in the life cycle inventory and the implementation of a more suitable software framework are desirable. The study describes how life cycle assessment's (LCA) robustness can be improved by respecting prospective fluctuations, like the transition of the German electricity mix, in the modeling of the life cycle inventory. It presents a feasible and rather simple process to add time-resolved data to LCA. The study selects 2 different future scenarios from important German studies and processes their data systematically to make them compatible with the requirements of a life cycle inventory. The use of external scenarios as basis for future-oriented LCA is reflected critically. A case study on electric mobility is presented and used to compare historic, prospective static, and prospective time-resolved electricity mix modeling approaches. The case study emphasizes the benefits of time-resolved LCA in direct comparison with the currently used approaches. © 2015 SETAC.

Lipoprotein (a) as a risk factor for ischemic stroke: a meta-analysis.

PubMed

Nave, Alexander H; Lange, Kristin S; Leonards, Christopher O; Siegerink, Bob; Doehner, Wolfram; Landmesser, Ulf; Steinhagen-Thiessen, Elisabeth; Endres, Matthias; Ebinger, Martin

2015-10-01

Lipoprotein (a) [Lp(a)] harbors atherogenic potential but its role as a risk factor for ischemic stroke remains controversial. We conducted a meta-analysis to determine the relative strength of the association between Lp(a) and ischemic stroke and identify potential subgroup-specific risk differences. A systematic search using the MeSH terms "lipoproteins" OR "lipoprotein a" AND "stroke" was performed in PubMed and ScienceDirect for case-control studies from June 2006 and prospective cohort studies from April 2009 until December 20th 2014. Data from eligible papers published before these dates were reviewed and extracted from previous meta-analyses. Studies that assessed the relationship between Lp(a) levels and ischemic stroke and reported generic data-i.e. odds ratio [OR], hazard ratio, or risk ratio [RR]-were eligible for inclusion. Studies that not distinguish between ischemic and hemorrhagic stroke and transient ischemic attack were excluded. Random effects meta-analyses with mixed-effects meta-regression were performed by pooling adjusted OR or RR. A total of 20 articles comprising 90,904 subjects and 5029 stroke events were eligible for the meta-analysis. Comparing high with low Lp(a) levels, the pooled estimated OR was 1.41 (95% CI, 1.26-1.57) for case-control studies (n = 11) and the pooled estimated RR was 1.29 (95% CI, 1.06-1.58) for prospective studies (n = 9). Sex-specific differences in RR were inconsistent between case-control and prospective studies. Study populations with a mean age of ≤55 years had an increased RR compared to older study populations. Reported Lp(a) contrast levels and ischemic stroke subtype significantly contributed to the heterogeneity observed in the analyses. Elevated Lp(a) is an independent risk factor for ischemic stroke and may be especially relevant for young stroke patients. Sex-specific risk differences remain conflicting. Further studies in these subgroups may be warranted. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A Comparison of Functional Outcome in Patients Sustaining Major Trauma: A Multicentre, Prospective, International Study

PubMed Central

Rainer, Timothy H.; Yeung, Hiu Hung; Gabbe, Belinda J.; Yuen, Kai Y.; Ho, Hiu F.; Kam, Chak W.; Chang, Annice; Poon, Wai S.; Cameron, Peter A.; Graham, Colin A.

2014-01-01

Objectives To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. Summary Background Data Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR). Methods Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE) functional outcome and risk-adjusted Short-Form 12 (SF-12) health status at 6 and 12 months after injury. Results 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17), and at 12 months was 0.83 (95% CI: 0.60, 1.12). Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: −1.2, 3.6) and 12-months (adjusted mean difference: −0.4, 95% CI: −3.2, 2.4) compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: −2.1, 2.8) or 12-months (adjusted mean difference: 1.8, 95% CI: −0.8, 4.5). Conclusion The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions. PMID:25157522

Prospects of Sino-India Relations 2020

DTIC Science & Technology

2011-06-01

there has been a realization among analysts in India that the prospects of Sino-India relations are not a case of conflict OR cooperation, but conflict...29 Peter J. Katzenstein and Nobua Okowara, "Japan, Asian-Pacific Security, and the Case for...Thesis F. CHAPTER OUTLINE This thesis is based upon the single case study of Sino-India relations extending over the past six decades. Chapter II

Hemodialysis as a treatment of severe accidental hypothermia.

PubMed

Caluwé, Rogier; Vanholder, Raymond; Dhondt, Annemieke

2010-03-01

We describe a case of severe accidental hypothermia (core body temperature 23.2 degrees C) successfully treated with hemodialysis in a diabetic patient with preexisting renal insufficiency. Consensus exists about cardiopulmonary bypass as the treatment of choice in cases of severe accidental hypothermia with cardiac arrest. Prospective randomized controlled trials comparing the different rewarming modalities for hemodynamically stable patients with hypothermia, however, are lacking. In our opinion, the choice of a rewarming technique should be patient tailored, knowing that hemodialysis is an efficient, minimally invasive, and readily available technique with the advantage of providing electrolyte support.

[A prospective study of drug-facilitated sexual assault in Barcelona].

PubMed

Xifró-Collsamata, Alexandre; Pujol-Robinat, Amadeo; Barbería-Marcalain, Eneko; Arroyo-Fernández, Amparo; Bertomeu-Ruiz, Antonia; Montero-Núñez, Francisco; Medallo-Muñiz, Jordi

2015-05-08

To determine the frequency and characteristics of suspected drug-facilitated sexual assault (DFSA) among the victims of sexual assault in Barcelona. Prospective study of every adult consulting an emergency service because of alleged sexual assault and receiving forensic assessment in the city of Barcelona in 2011. A total of 35 of 114 cases (30.7%) met suspected DFSA criteria. Compared with the other victims, suspected DFSA cases were more likely to experience amnesia, to have been assaulted by night, after a social situation and by a recently acquainted man, to have used alcohol before the assault and to be foreigners. In this group ethanol was detected in blood or urine in 48.4% of analyzed cases; their mean back calculated blood alcohol concentration was 2.29g/l (SD 0.685). Also, at least one central nervous system drug other than ethanol was detected in 60,6%, mainly stimulant drugs of abuse. Suspected DFSA is frequent among victims of alleged sexual assault in Barcelona nowadays. The depressor substance most commonly encountered is alcohol, which contributes to victims' vulnerability. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Prospective Evaluation of Opioid Consumption Following Carpal Tunnel Release Surgery

PubMed Central

Chapman, Talia; Kim, Nayoung; Maltenfort, Mitchell; Ilyas, Asif M.

2016-01-01

Background: Postoperative pain management and opioid consumption following carpal tunnel release (CTR) surgery may be influenced by many variables. To understand factors affecting opioid consumption, a prospective study was undertaken with the hypothesis that CTR performed under local anesthesia (wide awake local anesthesia with no tourniquet [WALANT]) would result in increased opioid consumption postoperatively compared with cases performed under sedation. Methods: All patients undergoing open CTR surgery were consecutively enrolled over a 6-month period. Information collected included patient demographics, surgical technique, amount and type of narcotic prescribed, number of pills taken, and type of anesthesia. Results: 277 patients were enrolled (56% women, 44% men). On average, 21 pills were prescribed, and 4.3 pills (median = 2) were consumed. There was no difference in consumption between patients who received WALANT (78 cases) versus (198 cases) sedation (4.9 vs 3.9 pills, respectively) (P = .22). There was no difference in opioid consumption based on insurance type (P = .47) or type of narcotic (P = .85). However, more men consumed no opioids (47%) compared with women (36%) (P < .05) and older patients consumed less than younger patients (P < .05). Conclusions: Opioid consumption following CTR is more influenced by age and gender, and less influenced by anesthesia type, insurance type, or the type of opioid prescribed. Many more opioids were prescribed than needed, on an average of 5:1. Many patients, particularly older patients, do not require any opioid analgesia after CTR. PMID:28082841

Incidence, clinical features and diagnosis of cicatrising conjunctivitis in Australia and New Zealand.

PubMed

Bobba, Samantha; Devlin, Connor; Di Girolamo, Nick; Wakefield, Denis; McCluskey, Peter; Chan, Elsie; Daniell, Mark; Watson, Stephanie

2018-06-19

This study aimed to determine the incidence, clinical features and management of cicatrising conjunctivitis in Australia and New Zealand, also enabling comparison with data from the United Kingdom. A prospective surveillance study was conducted over 17 months via the Australian and New Zealand Ophthalmic Surveillance Unit with a one-year follow-up period. Practicing ophthalmologists on the Surveillance Unit's database were asked to report recently diagnosed cases of cicatrising conjunctivitis on a monthly basis. Initial and follow-up questionnaires were sent to ophthalmologists who had reported positive cases to obtain demographic and clinical data. The minimum incidence of cicatrising conjunctivitis was calculated based on cases reported during the study period and from population data. During the 17-month study period (December 2011-April 2013), 56 cases of cicatrising conjunctivitis were reported. Data was obtained for 35 cases (62%) with a mean age of 74 years (range, 28-94 years). The most common aetiologies were ocular mucus membrane pemphigoid (n = 18 cases, 51.4%), Stevens-Johnson Syndrome (n = 3, 8.6%) and graft versus host disease (n = 3, 8.6%). The minimum incidence of cicatrising conjunctivitis in Australia and New Zealand was 1.5 per million, comparable to incidence data from the United Kingdom. This study is the first to prospectively record the incidence of cicatrising conjunctivitis in Australia and New Zealand and the second worldwide. It provides novel data on demographics and management of cicatrising conjunctivitis, as reported by treating ophthalmologists.

On the Content-Dependence of Prospective Teachers' Knowledge: A Case of Exemplifying Definitions

ERIC Educational Resources Information Center

Leikin, Roza; Zazkis, Rina

2010-01-01

In this article, we demonstrate that prospective teachers' content knowledge related to defining mathematical concepts is dependent on content area. We use the example of generation (a research tool we developed in a previous study) to investigate prospective teachers' knowledge. We asked prospective secondary mathematics teachers to provide…

The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey.

PubMed

Barret, Maximilien; Lepilliez, Vincent; Coumaros, Dimitri; Chaussade, Stanislas; Leblanc, Sarah; Ponchon, Thierry; Fumex, Fabien; Chabrun, Edouard; Bauret, Paul; Cellier, Christophe; Coron, Emmanuel; Bichard, Philippe; Bulois, Philippe; Charachon, Antoine; Rahmi, Gabriel; Bellon, Serge; Lerhun, Marc; Arpurt, Jean-Pierre; Koch, Stéphane; Napoleon, Bertrand; Vaillant, Eric; Esch, Anouk; Farhat, Said; Robin, Francoise; Kaddour, Nadira; Prat, Frédéric

2017-02-01

Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time. All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008-2010 period. Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010-2013 vs 32.1 ± 21 for 2008-2010 ( p  = 0.004). En bloc resection improved from 77.1% to 91.7% ( p  < 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% ( p  = 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 ( p  < 0.0001), with bleeding decreasing from 11.2% to 4.7% ( p  = 0.01) and perforations from 18.1% to 8.1% ( p  = 0.002) over time. No procedure-related mortality was recorded. In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.

The incidence of neuro-ophthalmic diseases in Singapore: a prospective study in public hospitals.

PubMed

Lim, Su Ann; Wong, Wan Ling; Fu, Esther; Goh, Kong Yong; Seah, Alvin; Tan, Clement; Tow, Sharon; Cullen, James F; Wong, Tien Y

2009-01-01

To describe the incidence of neuro-ophthalmic diseases in a multi-ethnic Asian population in Singapore. Prospective study in public hospitals in Singapore. All neuro-ophthalmic cases seen in four public sector hospitals over a 22-month period (September 2002 to June 2004) were identified using a standardized protocol. The 2004 Singapore population was used as a denominator to estimate annual incidence. The prevalence of ischemic risk factors (hypertension, diabetes, and hypercholesterolemia) among cases was compared to population data. A total of 1,356 patients with neuro-ophthalmic diseases were seen during the study period, of which 627 were new incident cases. The overall annual incidence of neuro-ophthalmic diseases was 9.81 per 100,000 (95% confidence interval, 8.80-10.90). The incidence increased with age. After controlling for age, the annual incidence was similar between men (10.75 per 100,000) and women (9.00 per 100,000), but was higher in Chinese (10.33 per 100,000) and Indians (9.34 per 100,000) than in Malays (6.62 per 100,000). The three commonest specific neuro-ophthalmic conditions were abducens nerve palsy (1.27 per 100,000), anterior ischemic optic neuropathy (1.08 per 100,000) and oculomotor nerve palsy (0.91 per 100,000). The incidence of optic neuritis was 0.83 per 100,000. Compared with the Singapore general population, the prevalence of diabetes was significantly higher in people aged 40-59, while the prevalence of hypercholesterolemia was significantly higher in 60-69 year age group. In this study of public hospitals in Singapore, the incidence of neuro-ophthalmic diseases was higher in Chinese and Indians compared to Malays.

Empirical and targeted therapy of candidemia with fluconazole versus echinocandins: a propensity score-derived analysis of a population-based, multicentre prospective cohort.

PubMed

López-Cortés, L E; Almirante, B; Cuenca-Estrella, M; Garnacho-Montero, J; Padilla, B; Puig-Asensio, M; Ruiz-Camps, I; Rodríguez-Baño, J

2016-08-01

We compared the clinical efficacy of fluconazole and echinocandins in the treatment of candidemia in real practice. The CANDIPOP study is a prospective, population-based cohort study on candidemia carried out between May 2010 and April 2011 in 29 Spanish hospitals. Using strict inclusion criteria, we separately compared the impact of empirical and targeted therapy with fluconazole or echinocandins on 30-day mortality. Cox regression, including a propensity score (PS) for receiving echinocandins, stratified analysis on the PS quartiles and PS-based matched analyses, were performed. The empirical and targeted therapy cohorts comprised 316 and 421 cases, respectively; 30-day mortality was 18.7% with fluconazole and 33.9% with echinocandins (p 0.02) in the empirical therapy group and 19.8% with fluconazole and 27.7% with echinocandins (p 0.06) in the targeted therapy group. Multivariate Cox regression analysis including PS showed that empirical therapy with fluconazole was associated with better prognosis (adjusted hazard ratio 0.38; 95% confidence interval 0.17-0.81; p 0.01); no differences were found within each PS quartile or in cases matched according to PS. Targeted therapy with fluconazole did not show a significant association with mortality in the Cox regression analysis (adjusted hazard ratio 0.77; 95% confidence interval 0.41-1.46; p 0.63), in the PS quartiles or in PS-matched cases. The results were similar among patients with severe sepsis and septic shock. Empirical or targeted treatment with fluconazole was not associated with increased 30-day mortality compared to echinocandins among adults with candidemia. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Assessing the Impact of Free Primary Education Using Retrospective and Prospective Data: Lessons from the Nairobi Case Study

ERIC Educational Resources Information Center

Ngware, Moses Waithanji; Oketch, Moses; Ezeh, Alex Chika; Mutisya, Maurice; Ejakait, Charles Epari

2012-01-01

This paper describes the design and methodology used to assess the impact of free primary education (FPE) policy in Nairobi, Kenya. The key outcome of the study was to assess the impact of FPE on schooling outcomes among the urban poor. The study assesses the impact of FPE by examining how two non-comparable groups responded to the introduction of…

Determinants of Entrepreneurial Intention among Prospective Graduates of Higher Institutions Case of Wolaita Sodo University

ERIC Educational Resources Information Center

Tegegn, Tesfahun; Paulos, Mesfin; Desalegn, Yonatan

2016-01-01

This study entitled "Determinants of Entrepreneurial Intention among Prospective Graduates of Higher Institutions, Case of Wolaita Sodo University" aimed at profiling entrepreneurship among graduating class students at WSU and identify determinants of their entrepreneurial intentions. The study used survey design and collected…

Long-term outcomes of patients with Streptococcus suis infection in Viet Nam: A case-control study.

PubMed

Huong, Vu T L; Long, Hoang B; Kinh, Nguyen V; Ngan, Ta T D; Dung, Vu T V; Nadjm, Behzad; van Doorn, H Rogier; Hoa, Ngo T; Horby, Peter; Wertheim, Heiman F L

2018-02-01

Streptococcus suis is a zoonotic cause of severe meningitis and sepsis in humans. We aimed to assess the long-term outcomes in patients who survived S. suis infection, in particular the progress and impact of vestibulocochlear sequelae. This case-control study evaluated outcomes of S. suis infection at discharge and 3 and 9 months post-discharge for 47 prospectively enrolled cases and at 11-34 months for 31 retrospectively enrolled cases. Outcomes in patients were compared to 270 controls matched for age, sex and residency. The prevalence ratio (PR) of moderate-to-complete hearing loss was 5.0(95%CI 3.6-7.1) in cases at discharge, 3.7(2.5-5.4) at 3 months, 3.2(2.2-4.7) at 9 months, and 3.1(2.1-4.4) in retrospective cases compared to controls. Hearing improvement occurred mostly within the first 3 months with a change in hearing level of 11.1%(95%CI 7.0-15.1%) compared to discharge. The PR of vestibular dysfunction was 2.4(95%CI 1.7-3.3) at discharge, 2.2(1.4-3.1) at 3 months, 1.8(1.1-2.5) at 9 months, and 1.8(1.1-2.6) for retrospective cases compared to controls. Cases also indicated more problems with mobility, self-care and usual activities. Both hearing and vestibular impairment were common and persist in cases. Appropriate patient management strategies are needed to reduce the incidence and impact of these sequelae. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Misconception of Case-Control Studies in the Plastic Surgery Literature: A Literature Audit.

PubMed

Hatchell, Alexandra C; Farrokhyar, Forough; Choi, Matthew

2017-06-01

Case-control study designs are commonly used. However, many published case-control studies are not true case-controls and are in fact mislabeled. The purpose of this study was to identify all case-control studies published in the top three plastic surgery journals over the past 10 years, assess which were truly case-control studies, clarify the actual design of the articles, and address common misconceptions. MEDLINE, Embase, and Web of Science databases were searched for case-control studies in the three highest-impact factor plastic surgery journals (2005 to 2015). Two independent reviewers screened the resulting titles, abstracts, and methods, if applicable, to identify articles labeled as case-control studies. These articles were appraised and classified as true case-control studies or non-case-control studies. The authors found 28 articles labeled as case-control studies. However, only six of these articles (21 percent) were truly case-control designs. Of the 22 incorrectly labeled studies, one (5 percent) was a randomized controlled trial, three (14 percent) were nonrandomized trials, two (9 percent) were prospective comparative cohort designs, 14 (64 percent) were retrospective comparative cohort designs, and two (9 percent) were cross-sectional designs. The mislabeling was worse in recent years, despite increases in evidence-based medicine awareness. The majority of published case-control studies are not in fact case-control studies. This misunderstanding is worsening with time. Most of these studies are actually comparative cohort designs. However, some studies are truly clinical trials and thus a higher level of evidence than originally proposed.

PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies

PubMed Central

Laver, Lior; Marom, Niv; Dnyanesh, Lad; Mei-Dan, Omer; Espregueira-Mendes, João; Gobbi, Alberto

2016-01-01

Objective: To explore the utilization of platelet-rich plasma (PRP) for degenerative cartilage processes and evaluate whether there is sufficient evidence to better define its potential effects. Design: Systematic literature reviews were conducted in PubMed/MEDLINE and Cochrane electronic databases till May 2015, using the keywords “platelet-rich plasma OR PRP OR autologous conditioned plasma OR ACP AND cartilage OR chondrocyte OR chondrogenesis OR osteoarthritis (OA) OR arthritis.” Results: The final result yielded 29 articles. Twenty-six studies examined PRP administration for knee OA and 3 involved PRP administration for hip OA. The results included 9 prospective randomized controlled trials (RCTs) (8 knee and 1 hip), 4 prospective comparative studies, 14 case series, and 2 retrospective comparative studies. Hyaluronic acid (HA) was used as a control in 11 studies (7 RCTs, 2 prospective comparative studies, and 2 retrospective cohort). Overall, all RCTs reported on improved symptoms compared to baseline scores. Only 2 RCTs—one for knee and one for hip—did not report significant superiority of PRP compared to the control group (HA). Nine out of 11 HA controlled studies showed significant better results in the PRP groups. A trend toward better results for PRP injections in patients with early knee OA and young age was observed; however, lack of uniformity was evident in terms of indications, inclusion criteria, and pathology definitions in the different studies. Conclusion: Current clinical evidence supports the benefit in PRP treatment for knee and hip OA, proven to temporarily relieve pain and improve function of the involved joint with superior results compared with several alternative treatments. Further research to establish the optimal preparation protocol and characteristics of PRP injections for OA is needed. PMID:28317389

Bioactive glass in cavitary bone defects: a comparative experimental study in rabbits

PubMed Central

Camargo, André Ferrari de França; Baptista, André Mathias; Natalino, Renato; de Camargo, Olavo Pires

2015-01-01

OBJECTIVES: To compare bioactive glass and autograft regarding their histomorphometric characteristics. METHODS: The authors conducted a prospective case-control experimental study on animals in order to compare the histomorphometric characteristics of bioactive glass versus autograft. Eight rabbits underwent surgery in which a cavitary defect was created in both proximal femurs. One side was filled with bioactive glass granules and the other, with autograft grafted from the contralateral side. The sides were randomized. Fourteen days after surgery, the animals were euthanized. RESULTS: Histologic analysis revealed that bone neoformation was equivalent among the two groups and the osteoblasts cell-count was higher in the femurs treated with bioactive glass. The osteocytes cell-count, however, was lower. The similarity in bone formation between both groups was consistent to literature findings. CONCLUSION: Bioactive glass is similar to autograft regarding bone neoformation in this animal model of cavitary bone defects. Level of Evidence III, Case-Control Study. PMID:26327802

Sleep quality in patients with xerostomia: a prospective and randomized case-control study.

PubMed

Lopez-Jornet, Pia; Lucero Berdugo, Maira; Fernandez-Pujante, Alba; C, Castillo Felipe; Lavella C, Zamora; A, Pons-Fuster; J, Silvestre Rangil; Silvestre, Francisco Javier

2016-01-01

Objectives To investigate sleep quality, anxiety/depression and quality-of-life in patients with xerostomia. Materials and methods This prospective, observational, cross-sectional study was conducted among a group of xerostomia patients (n = 30) compared with 30 matched control subjects. The following evaluation scales were used to assess the psychological profile of each patient: the Hospital Anxiety and Depression Scale, the Oral Health Impact Profile-14 (OHIP-14), the Xerostomia Inventory, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Results The PSQI obtained 5.3 3 ± 1.78 for patients with xerostomia compared with 4.26 ± 1.01 for control subjects (p = 0.006); ESS obtained 5.7 ± 2.1 for test patients vs 4.4 0 ± 1 for control subjects (p = 0.010). Statistical regression analysis showed that xerostomia was significantly associated with depression (p = 0.027). Conclusions Patients with xerostomia exhibited significant decreases in sleep quality compared with control subjects.

Efficacy and safety of a porcine collagen sponge for cranial neurosurgery: a prospective case-control study.

PubMed

Brandão, Rafael Augusto Castro Santiago; Costa, Bruno Silva; Dellaretti, Marcos Antonio; de Carvalho, Gervásio Teles C; Faria, Marcello Penholate; de Sousa, Atos Alves

2013-01-01

The use of dural grafts is very useful when primary dural closure cannot be achieved. Our primary objective was to study the incidence of postoperative cerebrospinal fluid leak, including fistula and pseudomeningocele, and postoperative infection by comparing autologous material and a new collagen graft. A prospective nonrandomized study with a new collagen-based product derived from porcine cells (Peridry) was performed. It was used for dural replacement in 50 patients who underwent a variety of neurosurgical procedures requiring the use of a dural graft. These results were compared with a control group of 50 patients who were treated with autologous duraplasty material. The follow-up period was 3 months. Postoperative overall cerebrospinal fluid fistula occurred in 6% of both groups. No patient in the collagen group developed any sort of infection. One patient in the control developed osteomyelitis in the bone flap. The new collagen-based product derived from porcine cells (Peridry), compared with an autologous tissue, is safe, effective, easy to use, as well as time saving in cranial neurosurgery. Copyright © 2013 Elsevier Inc. All rights reserved.

[Cutaneous adverse drug reaction: prospective study of 118 cases].

PubMed

Chaabane, Hend; Masmoudi, Abderrahmen; Amouri, Meriem; Ghorbel, Sonda; Boudaya, Sonia; Hammami, Serriya; Zghal, Khaled; Turki, Hamida

2013-01-01

Few prospective studies are available on the incidence and analysis of the characteristics of adverse cutaneous drug reactions. To describe the adverse cutaneous reactions, their epidemiologic characteristics as well as the different causative drugs through a prospective hospital study. A 12-month prospective study was managed in our department of dermatology of the teaching hospital Hedi Chaker of Sfax. Requested information included patient characteristics (associated disorders), drug intake (list and chronology of the drug intake during the 3 weeks preceding the adverse reaction) and characteristics of the skin reaction (type, course). The diagnosis was based on a beam of clinical and anamnestic arguments. The drug imputability was evaluated according to the Begaud's French method. One hundred eighteen cases were collected. A prevalence of 1.08/100 among patients consulting in dermatology department was estimated. The macular and papular exanthema represented the most frequent clinical aspects (42 cases) followed by acute urticaria (23 cases), photosensitivity (19 cases) and fixed drug eruption (15 cases). Principal imputable drugs were antibiotics, mainly penicillins followed by analgesics and non-steroidal anti-inflammatory. Although it was monocentric, this study revealed a high frequency of drug-induced dermatitis with different clinical presentation. The high incidence of drug-induced dermatitis induced by antibiotics, analgesics and anti-inflammatory is due to their widespread use, often in self-medication.

A prospective study of caffeine intake and risk of incident tinnitus.

PubMed

Glicksman, Jordan T; Curhan, Sharon G; Curhan, Gary C

2014-08-01

Caffeine is a commonly consumed substance that has been thought to play a role in the development of tinnitus, but prospective data are lacking. We prospectively evaluated the association between caffeine intake and self-reported tinnitus in a female cohort. Participants were 65,085 women in the Nurses' Health Study II, aged 30 to 44 years and without tinnitus at baseline in 1991, who completed questionnaires about lifestyle and medical history every 2 years and food frequency questionnaires every 4 years. Information on self-reported tinnitus and date of onset was obtained from the 2009 questionnaire, with cases defined as those reporting experiencing symptoms "a few days/week" or "daily." Multivariable adjusted hazard ratios were calculated using Cox proportional hazards regression models. At baseline, the mean age of the cohort was 36.3 years and the mean caffeine intake was 242.3 mg/d. After 18 years of follow-up, 5289 incident cases of tinnitus were reported. There was a significant inverse association between caffeine intake and the incidence of tinnitus. Compared with women with caffeine intake less than 150 mg/d (150 mg corresponds to ∼ one 8-ounce cup of coffee), the multivariable adjusted hazard ratios were 0.85 (95% confidence interval, 0.76-0.95) for those who consumed 450 to 599 mg/d and 0.79 (0.68-0.91) for those who consumed 600 mg/d or more. In this prospective study, higher caffeine intake was associated with a lower risk of incident tinnitus in women. Copyright © 2014 Elsevier Inc. All rights reserved.

Prospective randomized comparison of coronary bypass grafting with minimal extracorporeal circulation system (MECC) versus off-pump coronary surgery.

PubMed

Mazzei, Valerio; Nasso, Giuseppe; Salamone, Giovanni; Castorino, Filippo; Tommasini, Antonello; Anselmi, Amedeo

2007-10-16

We aimed to evaluate the clinical results and biocompatibility of the minimal extracorporeal circulation system (MECC) compared with off-pump coronary revascularization (OPCABG). In a prospective randomized study, 150 patients underwent coronary surgery with the use of MECC and 150 underwent OPCABG. End points were (1) circulating markers of inflammation and organ injury, (2) operative results, and (3) outcome at 1-year follow-up. Operative mortality and morbidity were comparable between the groups. Release of inflammatory markers was similar between groups at all time points (peak interleukin-6 167.2+/-13.5 versus 181+/-6.5 pg/mL, P=0.14, OPCABG versus MECC group, respectively). Peak creatine kinase was 419.3+/-103.5 versus 326+/-84.2 mg/dL (P=0.28), and peak S-100 protein was 0.13+/-0.08 versus 0.29+/-0.1 pg/mL (P=0.058, OPCABG versus MECC group, respectively). Length of hospital stay and use of blood products were similar between groups. Two cases of angina recurrence at 1 year in the MECC group were observed versus 5 cases observed in the OPCABG group (P=0.44). A residual perfusion defect at myocardial nuclear scan was less frequent among patients in the MECC group (3 versus 9 cases, P=0.14; odds ratio 0.32, 95% confidence interval 0.07 to 1.32). Six (OPCABG group) versus 3 (MECC group) coronary grafts were occluded or severely stenotic at 1 year (P=0.33, odds ratio 0.47, 95% confidence interval 0.09 to 2.14). Clinical results of coronary revascularization with MECC are optimal when this procedure is performed by experienced teams. Postoperative morbidity is comparable to that with OPCABG. MECC is associated with little pump-related systemic and organ injury. It may achieve the benefits of OPCABG (less morbidity in high-risk patients) while facilitating complete revascularization in the case of complex lesions unsuitable for OPCABG.

Plasma 25-hydroxyvitamin D concentration and subsequent risk of total and site specific cancers in Japanese population: large case-cohort study within Japan Public Health Center-based Prospective Study cohort

PubMed Central

Budhathoki, Sanjeev; Hidaka, Akihisa; Sawada, Norie; Tanaka-Mizuno, Sachiko; Kuchiba, Aya; Charvat, Hadrien; Goto, Atsushi; Kojima, Satoshi; Sudo, Natsuki; Shimazu, Taichi; Sasazuki, Shizuka; Inoue, Manami; Tsugane, Shoichiro; Iwasaki, Motoki

2018-01-01

Abstract Objective To evaluate the association between pre-diagnostic circulating vitamin D concentration and the subsequent risk of overall and site specific cancer in a large cohort study. Design Nested case-cohort study within the Japan Public Health Center-based Prospective Study cohort. Setting Nine public health centre areas across Japan. Participants 3301 incident cases of cancer and 4044 randomly selected subcohort participants. Exposure Plasma concentration of 25-hydroxyvitamin D measured by enzyme immunoassay. Participants were divided into quarters based on the sex and season specific distribution of 25-hydroxyvitamin D among subcohorts. Weighted Cox proportional hazard models were used to calculate the multivariable adjusted hazard ratios for overall and site specific cancer across categories of 25-hydroxyvitamin D concentration, with the lowest quarter as the reference. Main outcome measure Incidence of overall or site specific cancer. Results Plasma 25-hydroxyvitamin D concentration was inversely associated with the risk of total cancer, with multivariable adjusted hazard ratios for the second to fourth quarters compared with the lowest quarter of 0.81 (95% confidence interval 0.70 to 0.94), 0.75 (0.65 to 0.87), and 0.78 (0.67 to 0.91), respectively (P for trend=0.001). Among the findings for cancers at specific sites, an inverse association was found for liver cancer, with corresponding hazard ratios of 0.70 (0.44 to 1.13), 0.65 (0.40 to 1.06), and 0.45 (0.26 to 0.79) (P for trend=0.006). A sensitivity analysis showed that alternately removing cases of cancer at one specific site from total cancer cases did not substantially change the overall hazard ratios. Conclusions In this large prospective study, higher vitamin D concentration was associated with lower risk of total cancer. These findings support the hypothesis that vitamin D has protective effects against cancers at many sites. PMID:29514781

Prospective survey of veterinary practitioners’ primary assessment of equine colic: clinical features, diagnoses, and treatment of 120 cases of large colon impaction

PubMed Central

2014-01-01

Background Large colon impactions are a common cause of colic in the horse. There are no scientific reports on the clinical presentation, diagnostic tests and treatments used in first opinion practice for large colon impaction cases. The aim of this study was to describe the presentation, diagnostic approach and treatment at the primary assessment of horses with large colon impactions. Methods Data were collected prospectively from veterinary practitioners on the primary assessment of equine colic cases over a 12 month period. Inclusion criteria were a diagnosis of primary large colon impaction and positive findings on rectal examination. Data recorded for each case included history, signalment, clinical and diagnostic findings, treatment on primary assessment and final case outcome. Case outcomes were categorised into three groups: simple medical (resolved with single treatment), complicated medical (resolved with multiple medical treatments) and critical (required surgery, were euthanased or died). Univariable analysis using one-way ANOVA and Tukey’s post-hoc test, Kruskal Wallis with Dunn’s post-hoc test and Chi squared analysis were used to compare between different outcome categories. Results 1032 colic cases were submitted by veterinary practitioners: 120 cases met the inclusion criteria for large colon impaction. Fifty three percent of cases were categorised as simple medical, 36.6% as complicated medical, and 9.2% as critical. Most cases (42.1%) occurred during the winter. Fifty nine percent of horses had had a recent change in management, 43% of horses were not ridden, and 12.5% had a recent / current musculoskeletal injury. Mean heart rate was 43bpm (range 26-88) and most cases showed mild signs of pain (67.5%) and reduced gut sounds (76%). Heart rate was significantly increased and gut sounds significantly decreased in critical compared to simple medical cases (p<0.05). Fifty different treatment combinations were used, with NSAIDs (93%) and oral fluids (71%) being administered most often. Conclusions Large colon impactions typically presented with mild signs of colic; heart rate and gut sounds were the most useful parameters to distinguish between simple and critical cases at the primary assessment. The findings of seasonal incidence and associated management factors are consistent with other studies. Veterinary practitioners currently use a wide range of different treatment combinations for large colon impactions. PMID:25238179

Employment of Oligodeoxynucleotide plus Interleukin-2 Improves Cytogenetic Analysis in Splenic Marginal Zone Lymphoma

PubMed Central

Bardi, Antonella; Cavazzini, Francesco; Rigolin, Gian Matteo; Tammiso, Elisa; Volta, Eleonora; Pezzolo, Elisa; Formigaro, Luca; Sofritti, Olga; Daghia, Giulia; Ambrosio, Cristina; Rizzotto, Lara; Abass, Awad E.; D'Auria, Fiorella; Musto, Pellegrino; Cuneo, Antonio

2011-01-01

To compare the efficiency of novel mitogenic agents and traditional mitosis inductors, 18 patients with splenic marginal zone lymphoma (SMZL) were studied. Three cultures using oligodeoxynucleotide (ODN) plus interleukin-2 (IL-2), or TPA, or LPS were setup in each patient. Seventeen/18 cases with ODN + IL2 had moderate/good proliferation (94, 4%) as compared with 10/18 cases with TPA and LPS (55%) (P = .015); 14/18 (77, 7%) cases with ODN + IL2 had sufficient good quality of banding as compared with 8/18 cases (44, 4%) with TPA and LPS. The karyotype could be defined from ODN + IL2-stimulated cultures in all 18 patients, 14 of whom (77, 7%) had a cytogenetic aberration, whereas clonal aberrations could be documented in 9 and in 3 cases by stimulation with LPS and TPA, respectively. Recurrent chromosome aberrations in our series were represented by aberrations of chromosome 14q in 5 patients, by trisomy 12 and 7q deletion in 4 cases each, and by abnormalities involving 11q and 13q in two cases each. These findings show that stimulation with ODN + IL2 offers more mitotic figures of better quality and results in an increased rate of clonal aberrations in SMZL, making this method ideal for prospective studies aiming at the definition of the prognostic impact of cytogenetic aberrations in this disorder. PMID:21629757

Screening for ROS1 gene rearrangements in non-small cell lung cancers using immunohistochemistry with FISH confirmation is an effective method to identify this rare target

PubMed Central

Selinger, Christina I; Li, Bob T; Pavlakis, Nick; Links, Matthew; Gill, Anthony J; Lee, Adrian; Clarke, Stephen; Tran, Thang N; Lum, Trina; Yip, Po Yee; Horvath, Lisa; Yu, Bing; Kohonen-Corish, Maija RJ; O’Toole, Sandra A; Cooper, Wendy A

2016-01-01

Aims To assess the prevalence of ROS1 rearrangements in a retrospective and prospective diagnostic Australian cohort and evaluate the effectiveness of immunohistochemical screening. Methods A retrospective cohort of 278 early stage lung adenocarcinomas and an additional 104 prospective NSCLC cases referred for routine molecular testing were evaluated. ROS1 immunohistochemistry (IHC) was performed (D4D6 clone, Cell Signaling Technology) on all cases as well as fluorescence in situ hybridisation (FISH) using the ZytoVision and Abbott Molecular ROS1 FISH probes, with ≥15% of cells with split signals considered positive for rearrangement. Results Eighty eight cases (32%) from the retrospective cohort showed staining by ROS1 IHC, and one case (0.4%) showed ROS1 rearrangement by FISH. Nineteen of the prospective diagnostic cases showed ROS1 IHC staining of which 12 (12%) cases were confirmed as ROS1 rearranged by FISH. There were no ROS1 rearranged cases that showed no expression of ROS1 with IHC. The ROS1 rearranged cases in the prospective cohort were all EGFR wildtype and ALK rearrangement negative. The sensitivity of ROS1 IHC in the retrospective cohort was 100% and specificity was 76%. Conclusions ROS1 rearrangements are rare events in lung adenocarcinomas. Selection of cases for ROS1 FISH testing, by excluding EGFR/ALK positive cases and use of IHC to screen for potentially positive cases can be used to enrich for the likelihood of a identifying a ROS1 rearranged lung cancer and prevent the need to undertake expensive and time consuming FISH testing in all cases. PMID:27599111

Screening for ROS1 gene rearrangements in non-small-cell lung cancers using immunohistochemistry with FISH confirmation is an effective method to identify this rare target.

PubMed

Selinger, Christina I; Li, Bob T; Pavlakis, Nick; Links, Matthew; Gill, Anthony J; Lee, Adrian; Clarke, Stephen; Tran, Thang N; Lum, Trina; Yip, Po Y; Horvath, Lisa; Yu, Bing; Kohonen-Corish, Maija R J; O'Toole, Sandra A; Cooper, Wendy A

2017-02-01

To assess the prevalence of ROS1 rearrangements in a retrospective and prospective diagnostic Australian cohort and evaluate the effectiveness of immunohistochemical screening. A retrospective cohort of 278 early stage lung adenocarcinomas and an additional 104 prospective non-small-cell lung cancer (NSCLC) cases referred for routine molecular testing were evaluated. ROS1 immunohistochemistry (IHC) was performed (D4D6 clone, Cell Signaling Technology) on all cases as well as fluorescence in-situ hybridization (FISH) using the ZytoVision and Abbott Molecular ROS1 FISH probes, with ≥15% of cells with split signals considered positive for rearrangement. Eighty-eight cases (32%) from the retrospective cohort showed staining by ROS1 IHC, and one case (0.4%) showed ROS1 rearrangement by FISH. Nineteen of the prospective diagnostic cases showed ROS1 IHC staining, 12 (12%) cases of which were confirmed as ROS1 rearranged by FISH. There were no ROS1 rearranged cases that showed no expression of ROS1 with IHC. The ROS1 rearranged cases in the prospective cohort were all EGFR wild-type and anaplastic lymphoma kinase (ALK) rearrangement-negative. The sensitivity of ROS1 IHC in the retrospective cohort was 100% and specificity was 76%. ROS1 rearrangements are rare events in lung adenocarcinomas. Selection of cases for ROS1 FISH testing, by excluding EGFR/ALK-positive cases and use of IHC to screen for potentially positive cases, can be used to enrich for the likelihood of identifying a ROS1 rearranged lung cancer and prevent the need to undertake expensive and time-consuming FISH testing in all cases. © 2016 John Wiley & Sons Ltd.

Clinico-pathological study to evaluate oral lichen planus for the establishment of clinical and histopathological diagnostic criteria.

PubMed

Hiremath, Santhosh; Kale, Alka D; Hallikerimath, Seema

2015-01-01

Lichen planus and lichenoid lesions affecting the oral cavity show similar clinico-pathological features creating a diagnostic dilemma. Hence, the aim of the present study was to establish a clinical and histopathological correlation in the diagnosis of oral lichen planus, based on the modified WHO diagnostic criteria of oral lichen planus and oral lichenoid lesions proposed by Van der Meij and Van der Waal in 2003. In the present study, 100 cases of oral lichen planus were clinically and histopathologically analyzed. Out of the 100 cases, 50 were prospective and 50 were retrospective cases. Prospective cases were collected based on the clinical diagnosis of oral lichen planus and oral lichenoid lesion. Retrospective cases were collected based on the histopathological diagnosis of oral lichen planus. Both the clinical and histopathological analyses were performed based on a proposal for a set of modified diagnostic criteria of oral lichen planus and oral lichenoid lesion. A final diagnosis of oral lichen planus was made only after the correlation of the clinical diagnosis with the histopathological diagnosis. The interobserver agreement among three observers for both prospective and retrospective cases in the final diagnosis of oral lichen planus was found to be "good" to "very good" indicating high reproducibility. However, the final diagnoses of true oral lichen planus after clinico-pathological correlation in prospective and retrospective study groups appeared to be 38.0% and 54.0% respectively. The results of the present study revealed mild to moderate clinico-pathological correlation in the final diagnosis of oral lichen planus for the prospective and retrospective study groups respectively.

Plasma bicarbonate and odds of incident hypertension.

PubMed

Mandel, Ernest I; Forman, John P; Curhan, Gary C; Taylor, Eric N

2013-12-01

Several biomarkers of metabolic acidosis, including lower plasma bicarbonate, have been associated with prevalent hypertension in cross-sectional studies. We sought to examine prospectively whether lower plasma bicarbonate is associated with incident hypertension. We conducted a prospective case-control study nested within the Nurses' Health Study II. Plasma bicarbonate was measured in 695 nonobese women without hypertension at time of blood draw who subsequently developed hypertension during 6 years of follow-up. Control subjects were matched to case subjects according to age, race, time and day of blood draw, and day of menstrual cycle. We used unconditional logistic regression to generate odds ratios (ORs) for development of hypertension by quintile of baseline plasma bicarbonate. After adjusting for matching factors, body mass index, family history of hypertension, plasma creatinine, and dietary and lifestyle factors, higher plasma bicarbonate was associated with lower odds of developing hypertension across quintiles (P for linear trend = 0.04). Those in the highest compared with the lowest quintile of plasma bicarbonate had 31% lower odds of developing hypertension (OR = 0.69; 95% confidence interval = 0.48-0.99). Further adjustment for diet-estimated net endogenous acid production, plasma insulin, 25-hydroxyvitamin D, and uric acid did not alter these findings. Our case-control study is consistent with a modest association between higher plasma bicarbonate and reduced odds of developing hypertension among nonobese women, although our findings are of borderline statistical significance. Further research is required to confirm this finding as part of a larger prospective cohort study and to elucidate the mechanism for this relation.

Long-term effectiveness of varicella vaccine: a 14-Year, prospective cohort study.

PubMed

Baxter, Roger; Ray, Paula; Tran, Trung N; Black, Steve; Shinefield, Henry R; Coplan, Paul M; Lewis, Edwin; Fireman, Bruce; Saddier, Patricia

2013-05-01

Varicella vaccine was licensed in the United States in 1995 for individuals ≥12 months of age. A second dose was recommended in the United States in June 2006. Varicella incidence and vaccine effectiveness were assessed in a 14-year prospective study conducted at Kaiser Permanente Northern California. A total of 7585 children vaccinated with varicella vaccine in their second year of life in 1995 were followed up prospectively for breakthrough varicella and herpes zoster (HZ) through 2009. A total of 2826 of these children received a second dose in 2006-2009. Incidences of varicella and HZ were estimated and compared with prevaccine era rates. In this cohort of vaccinated children, the average incidence of varicella was 15.9 per 1000 person-years, nine- to tenfold lower than in the prevaccine era. Vaccine effectiveness at the end of the study period was 90%, with no indication of waning over time. Most cases of varicella were mild and occurred early after vaccination. No child developed varicella after a second dose. HZ cases were mild, and rates were lower in the cohort of vaccinated children than in unvaccinated children during the prevaccine era (relative risk: 0.61 [95% confidence interval: 0.43-0.89]). This study confirmed that varicella vaccine is effective at preventing chicken pox, with no waning noted over a 14-year period. One dose provided excellent protection against moderate to severe disease, and most cases occurred shortly after the cohort was vaccinated. The study data also suggest that varicella vaccination may reduce the risks of HZ in vaccinated children.

Added value of second biopsy target in screen-detected widespread suspicious breast calcifications.

PubMed

Falkner, Nathalie M; Hince, Dana; Porter, Gareth; Dessauvagie, Ben; Jeganathan, Sanjay; Bulsara, Max; Lo, Glen

2018-06-01

There is controversy on the optimal work-up of screen-detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen-detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value. Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen's Kappa were calculated. A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post-hoc second target biopsy cases. While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post-hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological-pathological concordant; discordance still requires repeat sampling. © 2018 The Royal Australian and New Zealand College of Radiologists.

Maternal mortality in Denmark, 1985-1994.

PubMed

Andersen, Betina Ristorp; Westergaard, Hanne Brix; Bødker, Birgit; Weber, Tom; Møller, Margrete; Sørensen, Jette Led

2009-02-01

In Denmark, maternal mortality has been reported over the last century, both locally through hospital reports and in national registries. The purpose of this study was to analyze data from national medical registries of pregnancy-related deaths in Denmark 1985-1994 and to classify them according to the UK Confidential Enquiry into Maternal Deaths (CEMD). All deaths of women with a registered pregnancy within 12 months prior to the death were identified by comparing the Danish medical registries, death certificates, and relevant codes according to International Classification of Diseases (ICD-10). All cases were classified using the UK CEMD classification. Cases of maternal death were further evaluated by an audit group. 311 cases were classified. 92 deaths (29.6%) occurred 42 days), 1 woman died from a direct obstetric cause, 46 from indirect causes, and 172 from fortuitous causes. Hypertensive disorders of pregnancy were the major cause of direct maternal deaths. The rate of maternal deaths constituted 9.8/100,000 maternities (i.e. the number of women delivering registrable live births at any gestation or stillbirths at 24 weeks of gestation or later). This is the first systematic report on deaths in Denmark based on data from national registries. The maternal mortality rate in Denmark is comparable to the rates in other developed countries. Fortunately, statistics are low, but each case represents potential learning. Obstetric care has changed and classification methods differ between countries. Prospective registration and registry linkage seem to be a way to ensure completion. This retrospective study has provided the background for a prospective study on registration and evaluation of maternal mortality in Denmark.

A Practical Application of Value of Information and Prospective Payback of Research to Prioritize Evaluative Research.

PubMed

Andronis, Lazaros; Billingham, Lucinda J; Bryan, Stirling; James, Nicholas D; Barton, Pelham M

2016-04-01

Efforts to ensure that funded research represents "value for money" have led to increasing calls for the use of analytic methods in research prioritization. A number of analytic approaches have been proposed to assist research funding decisions, the most prominent of which are value of information (VOI) and prospective payback of research (PPoR). Despite the increasing interest in the topic, there are insufficient VOI and PPoR applications on the same case study to contrast their methods and compare their outcomes. We undertook VOI and PPoR analyses to determine the value of conducting 2 proposed research programs. The application served as a vehicle for identifying differences and similarities between the methods, provided insight into the assumptions and practical requirements of undertaking prospective analyses for research prioritization, and highlighted areas for future research. VOI and PPoR were applied to case studies representing proposals for clinical trials in advanced non-small-cell lung cancer and prostate cancer. Decision models were built to synthesize the evidence available prior to the funding decision. VOI (expected value of perfect and sample information) and PPoR (PATHS model) analyses were undertaken using the developed models. VOI and PPoR results agreed in direction, suggesting that the proposed trials would be cost-effective investments. However, results differed in magnitude, largely due to the way each method conceptualizes the possible outcomes of further research and the implementation of research results in practice. Compared with VOI, PPoR is less complex but requires more assumptions. Although the approaches are not free from limitations, they can provide useful input for research funding decisions. © The Author(s) 2015.

Prevalence of allergic rhinitis and asthma in patients with chronic rhinosinusitis and gastroesophageal reflux disease

PubMed Central

Mahdavinia, Mahboobeh; Bishehsari, Faraz; Hayat, Waqas; Codispoti, Christopher D.; Sarrafi, Shahram; Husain, Inna; Mehta, Arpita; Benhammuda, Mohamed; Tobin, Mary C.; Bandi, Sindhura; LoSavio, Philip S.; Jeffe, Jill S.; Palmisano, Erica L.; Schleimer, Robert P.; Batra, Pete S.

2017-01-01

Background An association between chronic rhinosinusitis (CRS) and gastroesophageal reflux disease (GERD) has been previously reported; however, the underlying factors linking CRS and GERD remain to be elucidated. Objective To assess the association of GERD and CRS using prospective and retrospective approaches. Methods The retrospective study comprised a large cohort of CRS cases, whereas the prospective arm evaluated a series of CRS cases and controls. Results In the retrospective arm of the study, of the 1066 patients with CRS, 112 (10.5%) had GERD. Among patients with CRS, GERD was associated with higher body mass index, older age, and female sex. The odds ratios (ORs) for asthma and allergic rhinitis in the CRS group with GERD compared with the CRS group without GERD were 2.89 (95% confidence interval [CI], 1.905–4.389) and 2.021 (95% CI, 1.035–3.947). Furthermore, GERD was associated with a greater duration of CRS. Ninety patients with CRS and 81 controls were enrolled in the prospective arm of the study. In the CRS group, GERD was associated with asthma (OR, 4.77; 95% CI, 1.27–18.01). Patients with CRS and GERD had a longer duration and a younger age at onset of CRS. In controls, no association was found between GERD and asthma (OR, 0.67; 95% CI, 0.09–5.19) or allergic rhinitis (OR, 0.35; 95% CI, 0.05–2.59). Conclusion Patients with CRS and GERD are more likely to have atopic conditions and asthma when compared with patients with CRS but without GERD. One of the potential explanations of this link is that comorbid GERD and atopic disease are potential risk factors for development of CRS. PMID:27283453

Fruits, vegetables, and bladder cancer risk: a systematic review and meta-analysis.

PubMed

Vieira, Ana R; Vingeliene, Snieguole; Chan, Doris S M; Aune, Dagfinn; Abar, Leila; Navarro Rosenblatt, Deborah; Greenwood, Darren C; Norat, Teresa

2015-01-01

Smoking is estimated to cause about half of all bladder cancer cases. Case-control studies have provided evidence of an inverse association between fruit and vegetable intake and bladder cancer risk. As part of the World Cancer Research/American Institute for Cancer Research Continuous Update Project, we conducted a systematic review and meta-analysis of prospective studies to assess the dose-response relationship between fruit and vegetables and incidence and mortality of bladder cancer. We searched PubMed up to December 2013 for relevant prospective studies. We conducted highest compared with lowest meta-analyses and dose-response meta-analyses using random effects models to estimate summary relative risks (RRs) and 95% confidence intervals (CIs), and used restricted cubic splines to examine possible nonlinear associations. Fifteen prospective studies were included in the review. The summary RR for an increase of 1 serving/day (80 g) were 0.97 (95% CI: 0.95-0.99) I(2)  = 0%, eight studies for fruits and vegetables, 0.97 (95% CI: 0.94-1.00, I(2)  = 10%, 10 studies) for vegetables and 0.98 (95% CI: 0.96-1.00, I(2)  = 0%, 12 studies) for fruits. Results were similar in men and women and in current, former and nonsmokers. Amongst fruits and vegetables subgroups, for citrus fruits the summary RR for the highest compared with the lowest intake was 0.87 (95% CI: 0.76-0.99, I(2)  = 0%, eight studies) and for cruciferous vegetables there was evidence of a nonlinear relationship (P = 0.001). The current evidence from cohort studies is not consistent with a role for fruits and vegetables in preventing bladder cancer. © 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

A Case Study of Two Groups of Elementary Prospective Teachers' Experiences in Distinct Mathematics Content Courses

ERIC Educational Resources Information Center

Auslander, Susan Swars; Smith, Stephanie Z.; Smith, Marvin E.; Hart, Lynn C.; Carothers, Jody

2016-01-01

This multiple case study examined two groups of elementary prospective teachers (n=12) completing distinct mathematics content courses. Data were collected via two belief surveys, one content knowledge assessment, and individual interviews. The findings revealed differences in specialized content knowledge and mathematical beliefs between the two…

The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration: a descriptive overview.

PubMed

Reilly, Karen E; Mueller, Christine; Zimmerman, David R

2007-01-01

This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration-the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQDemonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool-the MDS-was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.

A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood.

PubMed

Widom, Cathy Spatz; Czaja, Sally J; Paris, Joel

2009-10-01

Child abuse has been implicated as a risk factor for borderline personality disorder (BPD), yet few prospective longitudinal studies exist. The current study examined whether 500 individuals with documented cases of childhood physical and sexual abuse and neglect were at elevated risk of BPD in adulthood, compared to 396 demographically similar control children. Results indicated that significantly more abused and/or neglected children overall met criteria for BPD as adults, compared to controls, as did physically abused and neglected children. Having a parent with alcohol/drug problems and not being employed full-time, not being a high school graduate, and having a diagnosis of drug abuse, major depressive disorder, and posttraumatic stress disorder were predictors of BPD and mediated the relationship between childhood abuse/neglect and adult BPD. These results call attention to a heightened risk of BPD in physically abused and neglected children and the need to consider multiple pathways to BPD.

Alcohol and Risk of Parkinson Disease in a Large Prospective Cohort of Men and Women

PubMed Central

Palacios, N.; Gao, X.; O’Reilly, E.; Schwarzschild, M.; McCullough, M.L.; Mayo, T.; Gapstur, S.M.; Ascherio, A.

2012-01-01

Background Addictive behaviors such as cigarette smoking and coffee drinking have been associated with a reduced risk of Parkinson disease. Whether alcohol consumption is also associated with risk is less certain. Methods We prospectively followed 132,403 participants in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2005. Alcohol intake was assessed at baseline. Incident cases of Parkinson Disease (n = 605; 389 male and 216 female) were confirmed by treating physicians and medical record review. Relative risks were estimated using proportional hazards models, adjusting for age, smoking and other risk factors. Results Alcohol consumption was not significantly associated with Parkinson Disease risk. After adjustment for age, smoking, and other risk factors, the Relative Risk comparing men consuming 30 or more grams of alcohol (highest category) to non-drinker men was 1.29 (95% CI: 0.90, 1.86, p-trend: 0.40) and the Relative Risk comparing women consuming 15 or more grams of alcohol (highest category) per day to non-drinker women was 0.77 (95% CI: 0.41, 1.45, p-trend: 0.87). Consumption of beer, wine or liquor was also not associated with Parkinson Disease risk. Conclusions The results of this large prospective study do not support an association between alcohol intake and risk of Parkinson disease. PMID:22714720

The Examining of Prospective Teachers? Views about Renewable and Non-Renewable Energy Sources: A Case Study of Turkey

ERIC Educational Resources Information Center

Hasiloglu, Mehmet Akif

2014-01-01

The aim of this study is to determine prospective teachers? views about renewable and non-renewable energy sources. To collect data, a questionnaire with 5 open-ended questions was conveyed to 463 prospective teachers selected from Agri Ibrahim Cecen University. The results showed that almost three fourths of the prospective teachers tend to…

[Use of emergency 2-dimensional echocardiography in the diagnosis and maintenance of newborn and nursing infants hospitalized because of poorly tolerated cardiopathy. A prospective study of 82 cases].

PubMed

Cloez, J L; Hda, A; Khalife, K; Marçon, F; Worms, A M; Pernot, C

1983-05-01

The value of 2D echocardiography was assessed prospectively in 82 patients (average age 2.6 months) including 41 newborn babies, in the emergency investigation of cardiac distress. The recording was made before any other investigations or treatment and associated subcostal and supra sternal views, and the results were compared with angiography (64 cases) or anatomical findings (44 cases). A cardiac abnormality was excluded in 5 cyanotic newborn children (persistent foetal circulation) and a precise diagnosis was made in 74 of the remaining 77 patients (94 p. 100). All cases of malposition of the great vessels were recognised (17 cases). The diagnosis was based on the simultaneous recording of the vessels, proximal branches and their ventricular connections. In conditions with severe obstruction of the pulmonary outflow tract (26 cases), 2D echo enabled an exact evaluation of ventriculo arterial concordance, pulmonary confluence and a quantitative assessment of the diameter of the pulmonary artery in 25 patients. Angiography provided little further information, mainly concerning associated lesions (anterior muscular VSDs, abnormalities of the supra aortic vessels). On the other hand, 2D echocardiography was superior to angiocardiography for the study of the atrioventricular values and intracavitary and subvalvular obstruction. 2D echo is a reliable method for emergency assessment of the indication for therapeutic catheterisation (atrioseptostomy). In other cases it allows it to be deferred and guided. The comparison of the results of 2D echo and angiocardiography in this series suggests the possibility of reducing the number of endocavitary investigations in the newborn and infant in the future, even in cases where surgery is being considered.

[Prospective economic evaluation of image-guided radiation therapy for prostate cancer in the framework of the national programme for innovative and costly therapies assessment].

PubMed

Pommier, P; Morelle, M; Perrier, L; de Crevoisier, R; Laplanche, A; Dudouet, P; Mahé, M-A; Chauvet, B; Nguyen, T-D; Créhange, G; Zawadi, A; Chapet, O; Latorzeff, I; Bossi, A; Beckendorf, V; Touboul, E; Muracciole, X; Bachaud, J-M; Supiot, S; Lagrange, J-L

2012-09-01

The main objective of the economical study was to prospectively and randomly assess the additional costs of daily versus weekly patient positioning quality control in image-guided radiotherapy (IGRT), taking into account the modalities of the 3D-imaging: tomography (CBCT) or gold seeds implants. A secondary objective was to prospectively assess the additional costs of 3D versus 2D imaging with portal imaging for patient positioning controls. Economics data are issued from a multicenter randomized medico-economics trial comparing the two frequencies of patient positioning control during prostate IGRT. A prospective cohort with patient positioning control with PI (control group) was constituted for the cost comparison between 3D (IGRT) versus 2D imaging. The economical evaluation was focused to the radiotherapy direct costs, adopting the hospital's point of view and using a microcosting method applied to the parameters that may lead to cost differences between evaluated strategies. The economical analysis included a total of 241 patients enrolled between 2007 and 2011 in seven centres, 183 in the randomized study (128 with CBCT and 55 with fiducial markers) and 58 in the control group. Compared to weekly controls, the average additional cost per patient of daily controls was €847 (CBCT) and €179 (markers). Compared to PI, the average additional cost per patient was €1392 (CBCT) and €997 (fiducial markers) for daily controls; €545 (CBCT) and €818 (markers) in case of weekly controls. A daily frequency for image control in IGRT and 3D images patient positioning control (IGRT) for prostate cancer lead to significant additional cost compared to weekly control and 2D imaging (PI). Long-term clinical assessment will permit to assess the medico-economical ratio of these innovative radiotherapy modalities. Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Coffee consumption and risk of gastric and pancreatic cancer--a prospective cohort study.

PubMed

Bidel, Siamak; Hu, Gang; Jousilahti, Pekka; Pukkala, Eero; Hakulinen, Timo; Tuomilehto, Jaakko

2013-04-01

Only few prospective studies have examined the association between coffee consumption and risk of gastric and pancreatic cancer. This study is designed to evaluate this relationship among Finns, whose coffee consumption is the highest in the world. A total of 60,041 Finnish men and women who were 26-74 years of age and without history of any cancer at baseline were included in the present analyses. Coffee consumption and other study parameters were determined at baseline using standardized measurements. Participants were prospectively followed up for onset of gastric and/or pancreatic cancer, emigration, death or until June 30, 2006. During a mean follow-up period of 18 years, 299 cases of gastric cancer and 235 cases of pancreatic cancer were found. There was a nonsignificant inverse association between coffee consumption and risk of gastric cancer among men but not in the women. The multivariate-adjusted hazard ratio of stomach and pancreatic cancer incidence for ≥ 10 cups of coffee per day compared with nondrinkers were 0.75 (95% CI, 0.40-1.41) (P for trend = 0.19) and 0.82 (95% CI, 0.38-1.76) (P for trend = 0.95) for the combined population of men and women, respectively. We did not find a significant association between coffee consumption and the risk of gastric and/or pancreatic cancers. Copyright © 2012 UICC.

Alcohol Consumption, Genetic Variants in Alcohol Deydrogenases, and Risk of Cardiovascular Diseases: A Prospective Study and Meta-Analysis

PubMed Central

Drogan, Dagmar; Sheldrick, Abigail J.; Schütze, Madlen; Knüppel, Sven; Andersohn, Frank; di Giuseppe, Romina; Herrmann, Bianca; Willich, Stefan N.; Garbe, Edeltraut; Bergmann, Manuela M.; Boeing, Heiner; Weikert, Cornelia

2012-01-01

Objective First, to investigate and compare associations between alcohol consumption and variants in alcohol dehydrogenase (ADH) genes with incidence of cardiovascular diseases (CVD) in a large German cohort. Second, to quantitatively summarize available evidence of prospective studies on polymorphisms in ADH1B and ADH1C and CVD-risk. Methods We conducted a case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort including a randomly drawn subcohort (n = 2175) and incident cases of myocardial infarction (MI; n = 230) or stroke (n = 208). Mean follow-up time was 8.2±2.2 years. The association between alcohol consumption, ADH1B or ADH1C genotypes, and CVD-risk was assessed using Cox proportional hazards regression. Additionally, we report results on associations of variants in ADH1B and ADH1C with ischemic heart disease and stroke in the context of a meta-analysis of previously published prospective studies published up to November 2011. Results Compared to individuals who drank >0 to 6 g alcohol/d, we observed a reduced risk of MI among females consuming >12 g alcohol/d (HR = 0.31; 95% CI: 0.10–0.97) and among males consuming >24 to 60 g/d (HR = 0.57; 95% CI: 0.33–0.98) or >60 g alcohol/d (HR = 0.30; 95% CI: 0.12–0.78). Stroke risk was not significantly related to alcohol consumption >6 g/d, but we observed an increased risk of stroke in men reporting no alcohol consumption. Individuals with the slow-coding ADH1B*1/1 genotype reported higher median alcohol consumption. Yet, polymorphisms in ADH1B or ADH1C were not significantly associated with risk of CVD in our data and after pooling results of eligible prospective studies [ADH1B*1/1: RR = 1.35 (95% CI: 0.98–1.88; p for heterogeneity: 0.364); ADH1C*2/2: RR = 1.07 (95% CI: 0.90–1.27; p for heterogeneity: 0.098)]. Conclusion The well described association between alcohol consumption and CVD-risk is not reflected by ADH polymorphisms, which modify the rate of ethanol oxidation. PMID:22363810

Risk factors for self-directed violence in US Soldiers: A case-control study.

PubMed

Skopp, Nancy A; Zhang, Ying; Smolenski, Derek J; Reger, Mark A

2016-11-30

Military suicide has escalated in recent years, however almost no research has used military surveillance data to examine suicide risk factors. The aims of the current study were to compare suicide risk factors among US Soldiers who died by suicide, attempted suicide, and controls using a prospective case-control design. Controls were 247 Soldiers completing standard post-deployment assessment procedures. Cases were 276 suicide decedents (n=85) or suicide attempters (n=191), drawn from the Department of Defense Suicide Event Report. Compared to controls, suicide attempters and decedents had greater odds of failed intimate relationships, legal problems, and substance abuse problems in the past 90 days. Suicide attempters and decedents also had greater odds of a history of a mood disorder and prior suicide attempt compared to controls. Suicide decedents had greater odds of exposure to legal problems in the past 90 days and lower odds of ever having an anxiety disorder, compared to suicide attempters. Vigilance toward early detection of modifiable suicide risk factors such as relationship dissolution, mood disorders, substance abuse, and legal problems may help reduce suicide risk among US Soldiers. Published by Elsevier Ireland Ltd.

75 FR 42835 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-22

... estimated cost of the case exceeds the adjusted outlier threshold. We calculate the adjusted outlier... to 80 percent of the difference between the estimated cost of the case and the outlier threshold. In... Federal Prospective Payment Rates VI. Update to Payments for High-Cost Outliers under the IRF PPS A...

22 CFR 96.50 - Placement and post-placement monitoring until final adoption in incoming cases.

Code of Federal Regulations, 2012 CFR

2012-04-01

... assumes responsibility for making another placement of the child. (e) The agency or person acts promptly... child's country of origin about any new prospective adoptive parent(s). (1) In all cases where removal... the referral of the child for adoption; (2) Informs the prospective adoptive parent(s) that they will...

22 CFR 96.50 - Placement and post-placement monitoring until final adoption in incoming cases.

Code of Federal Regulations, 2013 CFR

2013-04-01

... assumes responsibility for making another placement of the child. (e) The agency or person acts promptly... child's country of origin about any new prospective adoptive parent(s). (1) In all cases where removal... the referral of the child for adoption; (2) Informs the prospective adoptive parent(s) that they will...

22 CFR 96.50 - Placement and post-placement monitoring until final adoption in incoming cases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... assumes responsibility for making another placement of the child. (e) The agency or person acts promptly... child's country of origin about any new prospective adoptive parent(s). (1) In all cases where removal... the referral of the child for adoption; (2) Informs the prospective adoptive parent(s) that they will...

22 CFR 96.50 - Placement and post-placement monitoring until final adoption in incoming cases.

Code of Federal Regulations, 2011 CFR

2011-04-01

... assumes responsibility for making another placement of the child. (e) The agency or person acts promptly... child's country of origin about any new prospective adoptive parent(s). (1) In all cases where removal... the referral of the child for adoption; (2) Informs the prospective adoptive parent(s) that they will...

22 CFR 96.50 - Placement and post-placement monitoring until final adoption in incoming cases.

Code of Federal Regulations, 2014 CFR

2014-04-01

... assumes responsibility for making another placement of the child. (e) The agency or person acts promptly... child's country of origin about any new prospective adoptive parent(s). (1) In all cases where removal... the referral of the child for adoption; (2) Informs the prospective adoptive parent(s) that they will...

Case Western Reserve U. Builds Virtual Campus to Woo Prospective Students

ERIC Educational Resources Information Center

Young, Jeffrey R.

2007-01-01

This article describes a virtual world program that Case Western University administrators built using Second Life. It is designed for use by prospective students, who can tour the campus online. The program shows campus buildings, athletic facilities, a diner, and a virtual dormitory with window views of the athletics fields, a feature of the…

Hopes and Prospects for the Sustainability Cross-Curriculum Priority: Provocations from a State-Wide Case Study

ERIC Educational Resources Information Center

Hill, Allen; Dyment, Janet E.

2016-01-01

This article draws on research data from a state-wide case study, intertwined with three key moments that occurred in late 2014, to critically engage with the hopes and prospects of the Sustainability Cross-Curriculum Priority (CCP) in Australian schools. These key moments--the "IPCC 5th Assessment Synthesis Report" (Intergovernmental…

The Physics of Music with Interdisciplinary Approach: A Case of Prospective Music Teachers

ERIC Educational Resources Information Center

Turna, Özge; Bolat, Mualla

2016-01-01

Physics of music is an area that is covered by interdisciplinary approach. In this study it is aimed to determine prospective music teachers' level of association with physics concepts which are related to music. The research is a case study which combines qualitative and quantitative methods. Eighty-four students who were studying at the…

Social importance enhances prospective memory: evidence from an event-based task.

PubMed

Walter, Stefan; Meier, Beat

2017-07-01

Prospective memory performance can be enhanced by task importance, for example by promising a reward. Typically, this comes at costs in the ongoing task. However, previous research has suggested that social importance (e.g., providing a social motive) can enhance prospective memory performance without additional monitoring costs in activity-based and time-based tasks. The aim of the present study was to investigate the influence of social importance in an event-based task. We compared four conditions: social importance, promising a reward, both social importance and promising a reward, and standard prospective memory instructions (control condition). The results showed enhanced prospective memory performance for all importance conditions compared to the control condition. Although ongoing task performance was slowed in all conditions with a prospective memory task when compared to a baseline condition with no prospective memory task, additional costs occurred only when both the social importance and reward were present simultaneously. Alone, neither social importance nor promising a reward produced an additional slowing when compared to the cost in the standard (control) condition. Thus, social importance and reward can enhance event-based prospective memory at no additional cost.

The effect of multimedia cases on science teaching self-efficacy beliefs of prospective teachers in Kenya

NASA Astrophysics Data System (ADS)

Nthiga, Peter Rugano

This study examined the effects of multimedia cases on science teaching self-efficacy beliefs of prospective teachers in Kenya using mixed methods in data collection and analysis. Collaborating with two teacher educators at Central University, I designed and implemented two multimedia case-based intervention lessons, one with prospective chemistry teachers and the other with prospective physics teachers. I determined the changes in self-efficacy beliefs using a pretest and posttest with the Science Teaching Efficacy Beliefs Instrument (STEBI) for N=41 participants. I also collected data using a worksheet during the intervention lesson. When the prospective teachers went for their field practice, I sampled eight of them for in depth interviews to determine what they drew on from the intervention lesson during their classroom teaching. I used Roth McDuffie's et al. (2014) framing to categorize the comments that the prospective teachers made on the worksheet into the four lenses of teacher, students, task or power and participation. I used paired sample t-test to determine the changes in self-efficacy beliefs and then developed profiles of the prospective teachers from the in depth interviews. The results revealed that prospective teachers paid more attention to the actions of the teacher and paid less attention to students' activities. Their attention to the task was predominantly about the cognitive level of the task and almost always focused on the errors they noted. The prospective teacher noticing using the power and participation lens was not clearly delineable from the teacher lens, because most instructional activities that led to more participation were teacher actions. Science teaching efficacy beliefs has two constructs: personal science teaching efficacy (PSTE) and science teaching outcome expectancy (STOE). The PSTE scores were very high at 4.46 out of five on the pretest, and 4.41 on posttest. There was a decrease in the mean scores, but the change was not significant. There was a statistically significant increase in STOE (M=1.78, SD=5.8 t(40)=2.802 p=0.008) and an overall increase in the self-efficacy beliefs. The teacher profiles showed that prospective teachers drew from specific examples from the multimedia cases as well as learned from a gestalt interpretation of the teaching and learning activities in the clips that were shown. From these results, I discuss how prospective science teachers' self-efficacy beliefs are altered in the process of watching multimedia cases. Their beliefs about knowledge start to change from absolute ownership to shared and co-constructed knowledge in class, as seen in the decrease in the personal teaching outcome expectancy (PSTE) and an increase in noticing of students' role in learning.

Prospective Teachers' Perceptions on Different Aspects of Portfolio

ERIC Educational Resources Information Center

Ok, Ahmet; Erdogan, Mehmet

2010-01-01

This qualitative-case study examined how portfolio and portfolio assessment were perceived by prospective teachers. The participants were 23 prospective teachers from seven different teaching areas from a Turkish university. A semi-structured individual interview was conducted. The interview schedule included 15 open-ended questions. The main…

The Cost Effectiveness of Embedding a Behavioral Health Clinician into an Existing Primary Care Practice to Facilitate the Integration of Care: A Prospective, Case-Control Program Evaluation.

PubMed

Ross, Kaile M; Klein, Betsy; Ferro, Katherine; McQueeney, Debra A; Gernon, Rebecca; Miller, Benjamin F

2018-04-30

This project evaluated the cost effectiveness of integrating behavioral health services into a primary care practice using a prospective, case-control design. New Directions Behavioral Health collaborated with a large Kansas City primary care practice to integrate a licensed psychologist (i.e., behavioral health clinician) into the practice. Patient claims data were examined 21 months prior to and 14 months after the psychologist began providing full-time behavioral health services within the practice. Claims data from patients with Blue Cross Blue Shield of Kansas City insurance (BCBSKC) who had at least one encounter with the psychologist (N = 239) were compared to control patients (BCBSKC fully insured patients at large) to calculate cost savings. The results demonstrated that integrating behavioral health services into the practice was associated with $860.16 per member per year savings or 10.8% savings in costs for BCBSKC patients. Integrating behavioral health services into primary care may lead to reductions in health care costs.

Direct costs of osteoporosis and hip fracture: an analysis for the Mexican Social Insurance Health Care System.

PubMed

Carlos, Fernando; Clark, Patricia; Maciel, Humberto; Tamayo, Juan A

2009-01-01

To compare costs of diagnosis and annual treatment of osteoporosis and hip fracture between the Instituto Nacional de Rehabilitación (INR) and the protocol used by the Seguro Popular de Salud (SPSS). Direct costs gathered in a prospective study with real cases at the INR are presented, and then this data is re-analyzed with the methodology and protocol for the SPSS to estimate the costs of those cases if treated with the SPSS protocol. Important differences were found in the cost of hip fracture: the SPSS estimates ($37,363.73 MXN) almost double the INR cost ($20,286.86 MXN ). This discrepancy was caused by the different types of surgeries the INR and SPSS protocols call for (the SPSS assumes that all hip fractures will necessitate a hip replacement) and the cost of subsequent hospitalization. A prospective study at the SPSS is needed to validate these results. Important differences were found between treatment of the same osteoporosis related problems at the INR and SPSS. We recommend revising the SPSS protocol to include less costly surgical treatments.

Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study.

PubMed

Kim, Jae-Hwa; Chung, Ju-Hwan; Lee, Dong-Hoon; Lee, Yoon-Seok; Kim, Jung-Ryul; Ryu, Keun-Jung

2011-12-01

To evaluate functional and radiographic results of arthroscopic suture anchor repair for posterior root tear of the medial meniscus (PRTMM) and compare with pullout suture repair. From December 2006 to August 2008, 51 consecutive patients underwent arthroscopic repair of PRTMM at our hospital. The repair technique was switched over time from pullout suture repair (group 1) to suture anchor repair (group 2). Of the patients, 6 were lost to follow-up, leaving a study population of 45 patients, with 22 menisci (48.9%) in group 1 and 23 (51.1%) menisci in group 2. The mean follow-up duration was 25.9 months (range, 24 to 27 months) in group 1 and 26.8 months (range, 24 to 28 months) in group 2. Compared variables included International Knee Documentation Committee criteria, Kellgren-Lawrence grade, gap distance at PRTMM, structural healing, meniscal extrusion, and cartilage degeneration of the medial femoral condyle. At 2 years postoperatively, both groups showed significant improvements in function (P < .05) and did not show significant differences in Kellgren-Lawrence grade (P > .05) compared with preoperatively. On magnetic resonance imaging, the gap distance at PRTMM was 3.2 ± 1.1 mm in group 1 and 2.9 ± 0.9 mm in group 2 preoperatively (P > .05). Complete structural healing was seen in 11 cases in group 1 and 12 cases in group 2 (P > .05). Mean meniscal extrusion of 4.3 ± 0.9 mm (group 1) and 4.1 ± 1.0 mm (group 2) preoperatively was significantly decreased to 2.1 ± 1.0 mm (group 1) and 2.2 ± 0.8 mm (group 2) postoperatively (P < .05). Regardless of repair technique, incompletely healed cases showed progression of cartilage degeneration (4 cases in group 1 and 2 cases in group 2). For PRTMM, our results show significant functional improvement in both the suture anchor repair and pullout suture repair groups. Reduction of meniscal extrusion seems to be appropriate to preserve its protective role against progression of cartilage degeneration after complete healing at PRTMM. Level III, prospective therapeutic comparative study. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Clinical use of the resorbable bioscaffold poly lactic co-glycolic acid (PLGA) in post-extraction socket for maintaining the alveolar height: A prospective study.

PubMed

Hoda, Nadeemul; Saifi, Aamir Malick; Giraddi, Girish B

2016-01-01

A common sequel of tooth extraction is alveolar bone resorption. It makes the placement of dental implants difficult and creates an esthetic problem for the fabrication of conventional prostheses. Therefore, alveolar bone following tooth extraction should be preserved. The present prospective study was conducted to evaluate the efficacy of the resorbable bioscaffold poly lactic co-glycolic acid (PLGA) in maintaining the alveolar height in post-extraction socket. 20 patients were selected based on inclusion and exclusion criteria and were randomly divided into two groups: cases and control comprising of 10 patients each. Atraumatic tooth extraction was done in all patients. PLGA bioscaffold was placed in cases and socket was closed with 3-0 vicryl. In control group, socket was directly closed with 3-0 vicryl. The patients were kept on follow-up and complications such as dry socket, pain, and swelling were recorded. IOPA were taken at 1st, 4th, 12th, and 24th week to record changes in the height of alveolar bone. The radiographic measurements were compared and the differences were statistically analyzed. Reduction in alveolar bone height after placement of PLGA bioscaffold was significantly less in cases as compared to controls at 4th, 12th, and 24th week following extraction. No complications were observed throughout the follow-up period. PLGA scaffold significantly reduces bone resorption. Application is very simple and can be easily performed in a dental setup. However, PLGA scaffold adds significantly to the cost of treatment.

Acrylamide Hemoglobin Adduct Levels and Ovarian Cancer Risk: a nested case-control study

PubMed Central

Xie, Jing; Terry, Kathryn L.; Poole, Elizabeth M.; Wilson, Kathryn M.; Rosner, Bernard A.; Willett, Walter C.; Vesper, Hubert W.; Tworoger, Shelley S.

2013-01-01

Background Acrylamide is a probable human carcinogen formed during cooking of starchy foods. Two large prospective cohort studies of dietary acrylamide intake and ovarian cancer risk observed a positive association, although two other studies reported no association. Methods We measured acrylamide exposure using red blood cell acrylamide and glycidamide hemoglobin adducts among women in two large prospective cohorts: the Nurses’ Health Study and Nurses’ Health Study II. Between blood collection and 2010, we identified 263 incident cases of epithelial ovarian cancer, matching two controls per case. We used logistic regression models to examine the association between acrylamide exposure and ovarian cancer risk, adjusting for matching factors, family history of ovarian cancer, tubal ligation, oral contraceptive use, body mass index (BMI), parity, alcohol intake, smoking, physical activity, and caffeine intake. Results The multivariate-adjusted relative risk (RR) of ovarian cancer comparing the highest versus lowest tertile of total acrylamide adducts was 0.79 (95% CI: 0.50–1.24, P trend = 0.08). The comparable RR of ovarian cancer among non-smokers at blood draw was 0.85 (95% CI: 0.57–1.27, P trend =0.14). The association did not differ by tumor histology (serous invasive versus not), P for heterogeneity=0.41. Individual adduct types (acrylamide or glycidamide) were not associated with risk. Conclusions We observed no evidence that acrylamide exposure as measured by adducts to hemoglobin is associated with an increased risk of ovarian cancer. Impact Our finding indicates that acrylamide intake may not increase risk of ovarian cancer. PMID:23417989

Use of acetaminophen and risk of endometrial cancer: evidence from observational studies.

PubMed

Ding, Yuan-Yuan; Yao, Peng; Verma, Surya; Han, Zhen-Kai; Hong, Tao; Zhu, Yong-Qiang; Li, Hong-Xi

2017-05-23

Previous meta-analyses suggested that aspirin was associated with reduced risk of endometrial cancer. However, there has been no study comprehensively summarize the evidence of acetaminophen use and risk of endometrial cancer from observational studies. We systematically searched electronic databases (PubMed , EMBASE, Web of Science, and Cochrane Library) for relevant cohort or case-control studies up to February 28, 2017. Two independent authors performed the eligibility evaluation and data extraction. All differences were resolved by discussion. A random-effects model was applied to estimate summary relative risks (RRs) with 95% CIs. All statistical tests were two-sided. Seven observational studies including four prospective cohort studies and three case-control studies with 3874 endometrial cancer cases were included for final analysis. Compared with never use acetaminophen, ever use this drug was not associated with risk of endometrial cancer (summarized RR = 1.02; 95% CI: 0.93-1.13, I2 = 0%). Similar null association was also observed when compared the highest category of frequency/duration with never use acetaminophen (summarized RR = 0.88; 95% CI: 0.70-1.11, I2 = 15.2%). Additionally, the finding was robust in the subgroup analyses stratified by study characteristics and adjustment for potential confounders and risk factors. There was no evidence of publication bias by a visual inspection of a funnel plot and formal statistical tests. In summary, the present meta-analysis reveals no association between acetaminophen use and risk of endometrial cancer. More large scale prospective cohort studies are warranted to confirm our findings and carry out the dose-response analysis of aforementioned association.

Application of electrical geophysics to the release of water resources, case of Ain Leuh (Morocco)

NASA Astrophysics Data System (ADS)

Zitouni, A.; Boukdir, A.; El Fjiji, H.; Baite, W.; Ekouele Mbaki, V. R.; Ben Said, H.; Echakraoui, Z.; Elissami, A.; El Maslouhi, M. R.

2018-05-01

Being seen needs in increasing waters in our contry for fine domestics, manufactures and agricultural, the prospecting of subterranean waters by geologic and hydrogeologic classic method remains inaplicable in the cases of the regions where one does not arrange drillings or polls (soundings) of gratitude (recongnition) in very sufficient (self-important) number. In that case of figure, the method of prospecting geophysics such as the method of nuclear magnetic resonance (NMR) and the method of the geophysics radar are usually used most usually because they showed, worldwide, results very desive in the projects of prospecting and evaluation of the resources in subterranean waters. In the present work, which concerns only the methodology of the electric resistivity, we treat the adopted methodological approach and the study of the case of application in the tray of Ajdir Ain Leuh.

Development and Inter-Rater Reliability of the Liverpool Adverse Drug Reaction Causality Assessment Tool

PubMed Central

Gallagher, Ruairi M.; Kirkham, Jamie J.; Mason, Jennifer R.; Bird, Kim A.; Williamson, Paula R.; Nunn, Anthony J.; Turner, Mark A.; Smyth, Rosalind L.; Pirmohamed, Munir

2011-01-01

Aim To develop and test a new adverse drug reaction (ADR) causality assessment tool (CAT). Methods A comparison between seven assessors of a new CAT, formulated by an expert focus group, compared with the Naranjo CAT in 80 cases from a prospective observational study and 37 published ADR case reports (819 causality assessments in total). Main Outcome Measures Utilisation of causality categories, measure of disagreements, inter-rater reliability (IRR). Results The Liverpool ADR CAT, using 40 cases from an observational study, showed causality categories of 1 unlikely, 62 possible, 92 probable and 125 definite (1, 62, 92, 125) and ‘moderate’ IRR (kappa 0.48), compared to Naranjo (0, 100, 172, 8) with ‘moderate’ IRR (kappa 0.45). In a further 40 cases, the Liverpool tool (0, 66, 81, 133) showed ‘good’ IRR (kappa 0.6) while Naranjo (1, 90, 185, 4) remained ‘moderate’. Conclusion The Liverpool tool assigns the full range of causality categories and shows good IRR. Further assessment by different investigators in different settings is needed to fully assess the utility of this tool. PMID:22194808

A critical look at prospective surveillance using a scan statistic.

PubMed

Correa, Thais R; Assunção, Renato M; Costa, Marcelo A

2015-03-30

The scan statistic is a very popular surveillance technique for purely spatial, purely temporal, and spatial-temporal disease data. It was extended to the prospective surveillance case, and it has been applied quite extensively in this situation. When the usual signal rules, as those implemented in SaTScan(TM) (Boston, MA, USA) software, are used, we show that the scan statistic method is not appropriate for the prospective case. The reason is that it does not adjust properly for the sequential and repeated tests carried out during the surveillance. We demonstrate that the nominal significance level α is not meaningful and there is no relationship between α and the recurrence interval or the average run length (ARL). In some cases, the ARL may be equal to ∞, which makes the method ineffective. This lack of control of the type-I error probability and of the ARL leads us to strongly oppose the use of the scan statistic with the usual signal rules in the prospective context. Copyright © 2014 John Wiley & Sons, Ltd.

Reflective action assessment with a prospective clinical problem solving tool in the context of rehabilitation medicine: an illustrative case study.

PubMed

Kellett, David; Mpofu, Elias; Madden, Richard

2013-06-01

This study describes a case formulation approach applying a prospective ICF derived clinical tool to assess rehabilitation needs for a community dwelling stroke survivor with care from an outpatient rehabilitation medicine clinic. Case history data on the person were assessed for rehabilitation management planning using a prospective tool to interlink current with projected future functional status in everyday settings. Implicit assessment with reflective action informed decision points at each stage of the rehabilitation process. As a result of reflective action using the prospective tool, rehabilitation management led to significant changes in client participation after limitations to mobility and self care were mapped to the living conditions of the stroke survivor. The context sensitive rehabilitative plan resulted in higher subjective health-related quality of life in the stroke survivor and significant other and enhanced their capacity for participation. Reflective action informed assessment applying ICF concepts to clinical problem solving resulted in positive gains in health-related quality of life in a stroke survivor.

Percutaneous Cervical Nucleoplasty vs. Pulsed Radio Frequency of the Dorsal Root Ganglion in Patients with Contained Cervical Disk Herniation; A Prospective, Randomized Controlled Trial.

PubMed

Halim, Willy; van der Weegen, Walter; Lim, Toine; Wullems, Jorgen Antonin; Vissers, Kris Christiaan

2017-07-01

Cervical neck pain is often caused by cervical disk pathology and may cause severe symptoms and disability. Surgeons and patients are increasingly aware of postsurgery-related complications. This stimulated the clinical usage of minimally invasive treatments such as percutaneous nucleoplasty (PCN) and pulsed radio frequency (PRF). However, scientific evidence on both treatments is limited. Our objective was to evaluate the efficacy of PCN compared to PRF in patients with contained cervical disk herniation. A prospective randomized clinical trial was conducted including 34 patients with radicular pain due to a single contained cervical disk herniation who were treated with either PCN or PRF. Demographic data were collected, and the Medical Outcomes Study 12-Item Short Form (SF-12) Health Survey, visual analog scale (VAS), and the Neck Disability Index (NDI) were completed 1, 2, and 3 months after treatment. Treatment satisfaction and complications were recorded. In the PCN group (n = 17, mean age 52.4 years, 10 female/7 male), patients were treated at C5 to C6 (8 cases) or C6 to C7 (9 cases). In the PRF group (n = 17, mean age 49.5 years, 8 female/9 male), patients were treated at C3 to C4 (1 case), C5 to C6 (10 cases), or C6 to C7 (6 cases). At 3 months, mean pain VAS improved significantly from baseline in the PCN group (mean improvement: 43.4 points) and in the PRF group (34.0 points). However, improvement in 1 group was not superior compared to the other group (P = 0.48). No serious complications were reported. Within 3 months, both PCN and PRF show significant pain improvement in patients with contained cervical disk herniation, but none is superior to the other. Both treatment options appear to be effective and safe in regular clinical practice. © 2016 World Institute of Pain.

Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance.

PubMed

Bertani, A; Launay, F; Candoni, P; Mathieu, L; Rongieras, F; Chauvin, F

2012-11-01

Djibouti has no paediatric orthopaedics department and three options are available for difficult cases: transfer of the patient to another country; overseas mission transfer to Djibouti by a specialised surgical team; and management by a local orthopaedic surgeon receiving guidance from an expert. The extreme poverty of part of the population of Djibouti often precludes the first two options. Telemedecine can allow the local orthopaedic surgeon to receive expert advice. HYPOTHESES AND STUDY DESIGN: We prospectively recorded all the paediatric orthopaedics teleconsultations that occurred between November 2009 and November 2011. Our objective was to assess the performance of the teleconsultations. We hypothetized that this option was influential in decision making. We assessed the influence of the teleconsultation on patient management (i.e., change in the surgical indication and/or procedure). We then used the electronic patient records to compare the actual management to that recommended retrospectively by two independent orthopaedic surgeon consultants who had experience working overseas. Finally, we assessed the clinical outcomes in the patients. Of 48 teleconsultations for 39 patients, 13 dealt with diagnostic problems and 35 with therapeutic problems. The teleconsultation resolved the diagnostic uncertainties in 90% of cases. Advice from the expert modified the management in 37 (77%) teleconsultations; the change was related to the surgical indication in 18 cases, the surgical technique in 13 cases, and both in six cases. Agreement between the advice from the independent consultants and the treatment delivered by the local surgeon was 2.2/3. Clinical outcomes were good or very good in 31 (81%) of the 38 treated patients. This study establishes the feasibility and usefulness of paediatric orthopaedics teleconsultations in Djibouti. The introduction of telemedicine has changed our approach to challenges raised by patients in remote locations or precarious situations. Input from experts considerably benefits patient management. III, prospective comparative study. Copyright © 2012. Published by Elsevier Masson SAS.

Utility of ultrasound and magnetic resonance imaging in prenatal diagnosis of placenta accreta: A prospective study

PubMed Central

Satija, Bhawna; Kumar, Sanyal; Wadhwa, Leena; Gupta, Taru; Kohli, Supreethi; Chandoke, Rajkumar; Gupta, Pratibha

2015-01-01

Context: Placenta accreta is the abnormal adherence of the placenta to the uterine wall and the most common cause for emergency postpartum hysterectomy. Accurate prenatal diagnosis of affected pregnancies allows optimal obstetric management. Aims: To summarize our experience in the antenatal diagnosis of placenta accreta on imaging in a tertiary care setup. To compare the accuracy of ultrasound (USG) with color Doppler (CDUS) and magnetic resonance imaging (MRI) in prenatal diagnosis of placenta accreta. Settings and Design: Prospective study in a tertiary care setup. Materials and Methods: A prospective study was conducted on pregnant females with high clinical risk of placenta accreta. Antenatal diagnosis was established based on CDUS and MRI. The imaging findings were compared with final diagnosis at the time of delivery and/or pathologic examination. Statistical Analysis Used: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CDUS and MRI. The sensitivity and specificity values of USG and MRI were compared by the McNemar test. Results: Thirty patients at risk of placenta accreta underwent both CDUS and MRI. Eight cases of placenta accreta were identified (3 vera, 4 increta, and 1 percreta). All patients had history of previous cesarean section. Placenta previa was present in seven out of eight patients. USG correctly identified the presence of placenta accreta in seven out of eight patients (87.5% sensitivity) and the absence of placenta accreta in 19 out of 22 patients (86.4% specificity). MRI correctly identified the presence of placenta accreta in 6 out of 8 patients (75.0% sensitivity) and absence of placenta accreta in 17 out of 22 patients (77.3% specificity). There were no statistical differences in sensitivity (P = 1.00) and specificity (P = 0.687) between USG and MRI. Conclusions: Both USG and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. Both modalities have complimentary role and in cases of inconclusive findings with one imaging modality, the other modality may be useful for obtaining the diagnosis. CDUS remains the first primary modality for antenatal diagnosis of placenta accreta, with MRI reserved for cases where USG is inconclusive. PMID:26752827

The cost-effectiveness of iodine 131 scintigraphy, ultrasonography, and fine-needle aspiration biopsy in the initial diagnosis of solitary thyroid nodules.

PubMed

Khalid, Ayesha N; Hollenbeak, Christopher S; Quraishi, Sadeq A; Fan, Chris Y; Stack, Brendan C

2006-03-01

To compare the cost-effectiveness of fine-needle aspiration biopsy, iodine 131 scintigraphy, and ultrasonography for the initial diagnostic workup of a solitary palpable thyroid nodule. A deterministic cost-effectiveness analysis was conducted using a decision tree to model the diagnostic strategies. A single, mid-Atlantic academic medical center. Expected costs, expected number of cases correctly diagnosed, and incremental cost per additional case correctly diagnosed. Relative to the routine use of fine-needle aspiration biopsy, the incremental cost per case correctly diagnosed is 24,554 dollars for the iodine 131 scintigraphy strategy and 1212 dollars for the ultrasound strategy. A diagnostic strategy using initial fine-needle aspiration biopsy for palpable thyroid nodules was found to be cost-effective compared with the other approaches as long as a payor's willingness to pay for an additional correct diagnosis is less than 1212 dollars. Prospective studies are needed to validate these finding in clinical practice.

The Influence of Simulations on Family Engagement--Prospective Early Childhood Educators' Perceptions

ERIC Educational Resources Information Center

Paz-Albo Prieto, Jesús

2018-01-01

Nurturing experiences in preparation for prospective early childhood educators' work with families during their training are critical for establishing empowering relationships. This article details a qualitative case study of 77 prospective early childhood educators engaged with the Parent, Family and Community Engagement Simulation. An electronic…

The Perception on Fundamentals of Online Courses: A Case on Prospective Instructional Designers

ERIC Educational Resources Information Center

Genç, Zülfü; Tinmaz, Hasan

2016-01-01

This study focuses on prospective instructional designers' perception toward creating online courses including which elements are essential for developing such platforms. The study is significant for revealing what the prospective instructional designers focus on while they design certain learning opportunities. The participants of the study were…

An overview of bipolar qualitative decision rules

NASA Astrophysics Data System (ADS)

Bonnefon, Jean-Francois; Dubois, Didier; Fargier, Hélène

Making a good decision is often a matter of listing and comparing positive and negative arguments, as studies in cognitive psychology have shown. In such cases, the evaluation scale should be considered bipolar, that is, negative and positive values are explicitly distinguished. Generally, positive and negative features are evaluated separately, as done in Cumulative Prospect Theory. However, contrary to the latter framework that presupposes genuine numerical assessments, decisions are often made on the basis of an ordinal ranking of the pros and the cons, and focusing on the most salient features, i.e., the decision process is qualitative. In this paper, we report on a project aiming at characterizing several decision rules, based on possibilistic order of magnitude reasoning, and tailored for the joint handling of positive and negative affects, and at testing their empirical validity. The simplest rules can be viewed as extensions of the maximin and maximax criteria to the bipolar case and, like them, suffer from a lack of discrimination power. More decisive rules that refine them are also proposed. They account for both the principle of Pareto-efficiency and the notion of order of magnitude reasoning. The most decisive one uses a lexicographic ranking of the pros and cons. It comes down to a special case of Cumulative Prospect Theory, and subsumes the “Take the best” heuristic.

Maternal bacteremia and the Irish maternity early warning system.

PubMed

Maguire, Patrick J; O'Higgins, Amy C; Power, Karen A; Daly, Niamh; McKeating, Aoife; Turner, Michael J

2015-05-01

To assess whether introduction of the Irish maternity early warning system (IMEWS) in 2013 has improved the recording of vital signs among women with proven maternal bacteremia. In a mixed retrospective and prospective study at a single center in Dublin, Ireland, the patient records of all cases of maternal bacteremia between January 1, 2009, and March 31, 2014, were reviewed. The IMEWS chart was applied retrospectively to records of vital signs from January 2009 to March 2013, and prospectively from April 2013 to March 2014. For the 61 cases from the period before IMEWS introduction, vital signs were recorded inconsistently on multiple pages. The frequency of recordings was not standardized. Respiratory rate, in particular, was under-recorded. Among the 17 cases between April 2013 and March 2014 that were eligible for IMEWS chart use, 14 women had vital signs recorded on an IMEWS chart. As compared with the period before IMEWS introduction, there was an improvement in respiratory rate recording as part of the first set of observations. Among pregnant women with proven bacteremia, introduction of IMEWS has been associated with an improvement in the recording of vital signs, particularly respiratory rate. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Prolapse repair using the Elevate™ kit: prospective study on 70 patients.

PubMed

Azaïs, H; Charles, C Jean; Delporte, P; Debodinance, P

2012-10-01

The aim of this study was to examine the anatomical and functional results of prolapse repair by a vaginal approach using the Elevate kit. This was a prospective study of 70 patients presenting with symptomatic urogenital prolapse. Twenty Elevate Anterior, 16 Posterior, and 34 Anterior and Posterior repair systems were placed. Perioperative and postoperative complications were assessed. The patients were interviewed at 2 months and 1 year post-surgery. Recurrences were recorded in 21 patients (31.3%) at the 1-year follow-up. However, at the 1-year follow-up, there were 14 cases (20.9%) of direct recurrence (two anterior, two posterior, and ten combined anterior and posterior) compared with seven cases (10.4%) of indirect recurrence. Of the 21 failures (stage ≥ 2), 13 were stage 2 with the leading edge above the hymen. None of the patients underwent revision surgery. The exposure rate was 4.5%. The anterior and posterior shrinkage rates were 68.7% and 31.9%, respectively. There were four cases of de novo dyspareunia. Patients reported a significant decrease in the impact of pelvic floor distress on the PFIQ-7 questionnaire, but an improvement on the PFDI-20. There was no improvement in sexual function (PISQ-12). The Elevate™ kit is associated with satisfactory functional results. However, the anatomical results require ongoing evaluation.

Cadmium exposure and risk of pancreatic cancer: A meta-analysis of prospective cohort studies and case-control studies among individuals without occupational exposure history

PubMed Central

Chen, Cheng; Xun, Pengcheng; Nishijo, Muneko; Sekikawa, Akira

2015-01-01

Pancreatic cancer is one of the most deadly types of cancer for both genders. Classified as a human carcinogen, cadmium has been related to diverse cancers. However, the association between cadmium exposure and the risk of pancreatic cancer is still unclear. We quantitatively reviewed the observational studies on the association of cadmium exposure with pancreatic cancer risk among individuals without occupational exposure history published through July 2014 in PubMed by using a fixed–effects model. Four prospective cohort studies (112,934 participants with 335 events) and two case-control studies (177 cases and 539 controls) were identified. The summarized relative risk (RR) with a 95% confidence interval (CI) was 2.05 (95% CI=1.58 – 2.66), comparing the highest to the lowest category of cadmium exposure. This positive association persisted in men (RR=1.78; 95% CI=1.04 – 3.05), but not in women (RR=1.02; 95% CI=0.63 – 1.65). Further research is needed to provide more solid evidence on the association of cadmium exposure with pancreatic cancer risk and to elucidate the underlying biological mechanism of the potential gender difference. PMID:26423282

Cadmium exposure and risk of pancreatic cancer: a meta-analysis of prospective cohort studies and case-control studies among individuals without occupational exposure history.

PubMed

Chen, Cheng; Xun, Pengcheng; Nishijo, Muneko; Sekikawa, Akira; He, Ka

2015-11-01

Pancreatic cancer is one of the most deadly types of cancer for both genders. Classified as a human carcinogen, cadmium has been related to diverse cancers. However, the association between cadmium exposure and the risk of pancreatic cancer is still unclear. We quantitatively reviewed the observational studies on the association of cadmium exposure with pancreatic cancer risk among individuals without occupational exposure history published through July 2014 in PubMed by using a fixed-effect model. Four prospective cohort studies (112,934 participants with 335 events) and two case-control studies (177 cases and 539 controls) were identified. The summarized relative risk (RR) with a 95% confidence interval (CI) was 2.05 (95% CI = 1.58-2.66), comparing the highest to the lowest category of cadmium exposure. This positive association persisted in men (RR = 1.78, 95% CI = 1.04-3.05) but not in women (RR = 1.02, 95% CI = 0.63-1.65). Further research is needed to provide more solid evidence on the association of cadmium exposure with pancreatic cancer risk and to elucidate the underlying biological mechanism of the potential gender difference.

Association between the 2008-09 seasonal influenza vaccine and pandemic H1N1 illness during Spring-Summer 2009: four observational studies from Canada.

PubMed

Skowronski, Danuta M; De Serres, Gaston; Crowcroft, Natasha S; Janjua, Naveed Z; Boulianne, Nicole; Hottes, Travis S; Rosella, Laura C; Dickinson, James A; Gilca, Rodica; Sethi, Pam; Ouhoummane, Najwa; Willison, Donald J; Rouleau, Isabelle; Petric, Martin; Fonseca, Kevin; Drews, Steven J; Rebbapragada, Anuradha; Charest, Hugues; Hamelin, Marie-Eve; Boivin, Guy; Gardy, Jennifer L; Li, Yan; Kwindt, Trijntje L; Patrick, David M; Brunham, Robert C

2010-04-06

In late spring 2009, concern was raised in Canada that prior vaccination with the 2008-09 trivalent inactivated influenza vaccine (TIV) was associated with increased risk of pandemic influenza A (H1N1) (pH1N1) illness. Several epidemiologic investigations were conducted through the summer to assess this putative association. (1) test-negative case-control design based on Canada's sentinel vaccine effectiveness monitoring system in British Columbia, Alberta, Ontario, and Quebec; (2) conventional case-control design using population controls in Quebec; (3) test-negative case-control design in Ontario; and (4) prospective household transmission (cohort) study in Quebec. Logistic regression was used to estimate odds ratios for TIV effect on community- or hospital-based laboratory-confirmed seasonal or pH1N1 influenza cases compared to controls with restriction, stratification, and adjustment for covariates including combinations of age, sex, comorbidity, timeliness of medical visit, prior physician visits, and/or health care worker (HCW) status. For the prospective study risk ratios were computed. Based on the sentinel study of 672 cases and 857 controls, 2008-09 TIV was associated with statistically significant protection against seasonal influenza (odds ratio 0.44, 95% CI 0.33-0.59). In contrast, estimates from the sentinel and three other observational studies, involving a total of 1,226 laboratory-confirmed pH1N1 cases and 1,505 controls, indicated that prior receipt of 2008-09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring-summer 2009, with estimated risk or odds ratios ranging from 1.4 to 2.5. Risk of pH1N1 hospitalization was not further increased among vaccinated people when comparing hospitalized to community cases. Prior receipt of 2008-09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring-summer 2009 in Canada. The occurrence of bias (selection, information) or confounding cannot be ruled out. Further experimental and epidemiological assessment is warranted. Possible biological mechanisms and immunoepidemiologic implications are considered.

COMPARATIVE EFFECTIVENESS OF AN ADJUSTABLE TRANSFEMORAL PROSTHETIC INTERFACE ACCOMMODATING VOLUME FLUCTUATION: CASE STUDY

PubMed Central

Kahle, Jason T.; Klenow, Tyler D.; Highsmith, M. Jason

2016-01-01

The socket-limb interface is vital for functionality and provides stability and mobility for the amputee. Volume fluctuation can lead to compromised fit and function. Current socket technology does not accommodate for volume fluctuation. An adjustable interface may improve function and comfort by filling this technology gap. The purpose of this study was to compare the effectiveness of the standard of care (SOC) ischial ramus containment to an adjustable transfemoral prosthetic interface socket in the accommodation of volume fluctuation. A prospective experimental case study using repeated measures of subjective and performance outcome measures between socket conditions was employed. In the baseline volume condition, the adjustable socket improved subjective and performance measures 19% to 37% over SOC, whereas the two-minute walk test demonstrated equivalence. In the volume loss condition, the adjustable socket improved all subjective and performance measures 22% to 93%. All aggregated data improved 16% to 50% compared with the SOC. In simulated volume gain, the SOC socket failed, while the subject was able to complete the protocol using the adjustable socket. In this case study, the SOC socket was inferior to the comparative adjustable transfemoral amputation interface in subjective and performance outcomes. There is a lack of clinical trials and evidence comparing socket functional outcomes related to volume fluctuation. PMID:28066526

Breast-feeding and maternal risk of type 2 diabetes: a prospective study and meta-analysis.

PubMed

Jäger, Susanne; Jacobs, Simone; Kröger, Janine; Fritsche, Andreas; Schienkiewitz, Anja; Rubin, Diana; Boeing, Heiner; Schulze, Matthias B

2014-07-01

We aimed to examine the association between breast-feeding and maternal risk of type 2 diabetes and to investigate whether this association is mediated by anthropometric and biochemical factors. A case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study between 1994 and 2005 including 1,262 childbearing women (1,059 in a random sub-cohort and 203 incident cases) mainly aged between 35 and 64 years at baseline was applied. Self-reported lifetime duration of breast-feeding was assessed by questionnaire. Blood samples were used for biomarker measurement (HDL-cholesterol, triacylglycerols, C-reactive protein, fetuin-A, γ-glutamyltransferase, adiponectin). A systematic literature search and meta-analysis was conducted of prospective cohort studies investigating breast-feeding and risk of type 2 diabetes. The HR for each additional 6 months of breast-feeding was 0.73 (95% CI 0.56, 0.94) in EPIC-Potsdam. Meta-analysis of three previous prospective studies and the current study revealed an inverse association between breast-feeding duration and risk of diabetes (pooled HR for lifetime breast-feeding duration of 6-11 months compared with no breast-feeding 0.89; 95% CI 0.82, 0.97). Adjustment for BMI and waist circumference attenuated the association (HR per six additional months in EPIC-Potsdam 0.80; 95% CI 0.61, 1.04). Further controlling for potentially mediating biomarkers largely explained this association (HR 0.89; 95% CI 0.68, 1.16). Longer duration of breast-feeding may be related to a lower risk of diabetes. This potentially protective effect seems to be reflected by a more favourable metabolic profile; however, the role of body weight as a mediator or confounder remains uncertain.

Imaging of intrahepatic progression of hepatocellular carcinoma post transarterial chemoembolization. A long-term, prospective evaluation of contrast-enhanced ultrasonography (CEUS).

PubMed

Moschouris, Hippocrates; Kalokairinou-Motogna, Mariana; Vrakas, Spyros; Papadatou, Aggeliki; Karagiannis, Eyaggelos; Kiltenis, Michail; Kladis-Kalentzis, Konstantinos; Marmaridou, Kyriaki; Papadogeorgopoulos, Nikolaos; Malagari, Katerina

2017-04-22

To assess the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) in the context of intrahepatic progression (IHP) of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). Sixty HCC patients were prospectively included in the study. They were treated with transarterial chemoembolization (TACE)with doxorubicin-eluting microspheres (231 sessions). Imaging follow-up was performed 1 month after each session and at 3-6 month intervals after the last session of TACE and included CEUS and contrast-enhanced magnetic resonance (MR) imaging (reference modality). The diagnosis of IHP was based on mRECIST criteria and the respective findings of MR and CEUS were recorded, categorized and correlated. A total of 441 CEUS studies were compared with the corresponding MR studies. During a follow-up period of 5-82 months (mean: 22 months), MR diagnosed 51 cases of IHP in 34/60 (56.6%) patients. CEUS correctly diagnosed 12/14 (85.7%) cases of IHP of target tumors, 2/5 (40%) cases of IHP of non-target tumors, 13/18 (72.2%) cases of distal and 6/9 (66.6%) cases of proximal new lesions, and 5/5 (100%) cases of major vessel involvement. On a per-lesion basis, CEUS was significantly inferior to MR in the detection of new lesions (p=0.002). No false positive CEUS diagnoses of IHP were observed. 54% of the diagnostic failures of CEUS were considered clinically significant.  In the long term evaluation of HCC post TACE, CEUS appears to have limitations in the detection of IHP, which are more prominent in the case of new lesions and of progressive non-target tumors.

Alzheimer's Disease Sequencing Project discovery and replication criteria for cases and controls: Data from a community-based prospective cohort study with autopsy follow-up.

PubMed

Crane, Paul K; Foroud, Tatiana; Montine, Thomas J; Larson, Eric B

2017-12-01

The Alzheimer's Disease Sequencing Project (ADSP) used different criteria for assigning case and control status from the discovery and replication phases of the project. We considered data from a community-based prospective cohort study with autopsy follow-up where participants could be categorized as case, control, or neither by both definitions and compared the two sets of criteria. We used data from the Adult Changes in Thought (ACT) study including Diagnostic and Statistical Manual-IV criteria for dementia status, McKhann et al. criteria for clinical Alzheimer's disease, and Braak and Consortium to Establish a Registry for AD findings on neurofibrillary tangles and neuritic plaques to categorize the 621 ACT participants of European ancestry who died and came to autopsy. We applied ADSP discovery and replication definitions to identify controls, cases, and people who were neither controls nor cases. There was some agreement between the discovery and replication definitions. Major areas of discrepancy included the finding that only 40% of the discovery sample controls had sufficiently low levels of neurofibrillary tangles and neuritic plaques to be considered controls by the replication criteria and the finding that 16% of the replication phase cases were diagnosed with non-AD dementia during life and thus were excluded as cases for the discovery phase. These findings should inform interpretation of genetic association findings from the ADSP. Differences in genetic association findings between the two phases of the study may reflect these different phenotype definitions from the discovery and replication phase of the ADSP. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

[Diagnosis of lung embolism. Prospective study].

PubMed

Melcher, G A; Frauchiger, B; Brunner, W; Nager, F

1987-01-31

In a prospective study over the years 1983-1985, 300 cases of acute pulmonary embolism were analyzed in relation to predisposing factors, clinical signs, arterial blood gas analysis and isotope perfusion scanning. Comparison of this prospective study with an earlier retrospective one showed similar results, with the exception of isotope scanning, an investigation which has gained increasing diagnostic reliability (highly suggestive results in 94% of patients with massive pulmonary embolism and in 64% with submassive pulmonary embolism). In two thirds of the cases the diagnosis was established during the first day after hospitalisation. In 10% of the patients pulmonary embolism occurred despite anticoagulant therapy.

Trait valence and the better-than-average effect.

PubMed

Gold, Ron S; Brown, Mark G

2011-12-01

People tend to regard themselves as having superior personality traits compared to their average peer. To test whether this "better-than-average effect" varies with trait valence, participants (N = 154 students) rated both themselves and the average student on traits constituting either positive or negative poles of five trait dimensions. In each case, the better-than-average effect was found, but trait valence had no effect. Results were discussed in terms of Kahneman and Tversky's prospect theory.

Protocol for the "Michigan Awareness Control Study": A prospective, randomized, controlled trial comparing electronic alerts based on bispectral index monitoring or minimum alveolar concentration for the prevention of intraoperative awareness.

PubMed

Mashour, George A; Tremper, Kevin K; Avidan, Michael S

2009-11-05

The incidence of intraoperative awareness with explicit recall is 1-2/1000 cases in the United States. The Bispectral Index monitor is an electroencephalographic method of assessing anesthetic depth that has been shown in one prospective study to reduce the incidence of awareness in the high-risk population. In the B-Aware trial, the number needed to treat in order to prevent one case of awareness in the high-risk population was 138. Since the number needed to treat and the associated cost of treatment would be much higher in the general population, the efficacy of the Bispectral Index monitor in preventing awareness in all anesthetized patients needs to be clearly established. This is especially true given the findings of the B-Unaware trial, which demonstrated no significant difference between protocols based on the Bispectral Index monitor or minimum alveolar concentration for the reduction of awareness in high risk patients. To evaluate efficacy in the general population, we are conducting a prospective, randomized, controlled trial comparing the Bispectral Index monitor to a non-electroencephalographic gauge of anesthetic depth. The total recruitment for the study is targeted for 30,000 patients at both low and high risk for awareness. We have developed a novel algorithm that is capable of real-time analysis of our electronic perioperative information system. In one arm of the study, anesthesia providers will receive an electronic page if the Bispectral Index value is >60. In the other arm of the study, anesthesia providers will receive a page if the age-adjusted minimum alveolar concentration is <0.5. Our minimum alveolar concentration algorithm is sensitive to both inhalational anesthetics and intravenous sedative-hypnotic agents. Awareness during general anesthesia is a persistent problem and the role of the Bispectral Index monitor in its prevention is still unclear. The Michigan Awareness Control Study is the largest prospective trial of awareness prevention ever conducted. Clinical Trial NCT00689091.

Male kidney allograft recipients at risk for urinary tract infection?

PubMed Central

Schuette-Nuetgen, Katharina; Vogl, Thomas; Dobrindt, Ulrich; Kahl, Barbara C.; Brand, Marcus; Pavenstädt, Hermann; Suwelack, Barbara

2017-01-01

Background Urinary tract infection (UTI) is the most common infection after renal transplantation (RTx). Although female sex is a well-known risk factor for the development of UTI after RTx, the role of the donor sex in this context remains unclear. Methods In this case control study 6,763 RTx cases were screened for UTI when presenting at our transplant outpatient clinics. 102 different RTx patients fulfilled the inclusion criteria and were compared to 102 controls. Data on renal function was prospectively followed for 12 months. Results were compared to a previous RTx cohort from our transplant center. Additionally, we assessed the immunological response of leukocytes from 58 kidney recipients and 16 controls to lipopolysaccharide stimulation. Result After identification by univariate analysis, multivariate logistic regression analysis indicated female sex, minor height, advanced age and male kidney allograft sex to be associated with the occurrence of UTI after RTx. Female recipients who received male grafts had the best renal function 12 months after presentation. However, leukocyte response of recipients to lipopolysaccharide was impaired irrespective of donor and recipient sex to the same extend. Conclusions We conclude from our data that male kidney allografts are associated with the occurrence of UTI after RTx but did not influence the response of leukocytes to lipopolysaccharide. Further prospective studies are needed to identify the underlying mechanisms of higher male kidney donor dependent UTI. PMID:29145515

A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients.

PubMed

Paulinelli, Régis Resende; Freitas-Junior, Ruffo; Rahal, Rosemar Macedo de Souza; Oliveira, Luis Fernando de Pádua; Vilela, Maria Helena Tavares; Moreira, Marise Amaral Rebouças; Alves, Katyane Larissa; Peleja, Marina Berquó; Resende, Tatiane Coelho Capel de

2017-02-01

Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis. The two dyes were compared regarding detection of the sentinel lymph node (SLN). A prospective, randomized trial involved 142 patients with invasive breast carcinoma. Sixty-nine (49.3%) assigned to patent blue (group A) and 71 (50.70%) to methylene blue (group B). Thirty-five patients (25.0%) were clinical stage III or IV; 55 (38.7%) had axillary lymph nodes affected; and 69 (49.3%) underwent neoadjuvant chemotherapy. Two patients were excluded because the dye type was not recorded. Patients and tumor characteristics were similar in both groups. SLNs were identified in 47 women (68.1%) in group A and 43 (60.6%) in group B (p=0.35). SLNs were affected in 22 cases (51.2%) in group A and 21 (48.8%) in group B (p=0.62). The SLN was the only node affected in 12 cases (54.5%) in group A and six (33.3%) in group B (p=0.18). The time and degree of difficulty involved in identifying the SLN were similar in both groups. There were no complications or allergies. Methylene blue performed as well as patent blue in identifying the SLN in breast cancer patients.

Radiosurgery for epilepsy: Systematic review and International Stereotactic Radiosurgery Society (ISRS) practice guideline.

PubMed

McGonigal, Aileen; Sahgal, Arjun; De Salles, Antonio; Hayashi, Motohiro; Levivier, Marc; Ma, Lijun; Martinez, Roberto; Paddick, Ian; Ryu, Samuel; Slotman, Ben J; Régis, Jean

2017-11-01

While there are many reports of radiosurgery for treatment of drug-resistant epilepsy, a literature review is lacking. The aim of this systematic review is to summarize current literature on the use of stereotactic radiosurgery (RS) for treatment of epilepsy. Literature search was performed using various combinations of the search terms "radiosurgery", "stereotactic radiosurgery", "Gamma Knife", "epilepsy" and "seizure", from 1990 until October 2015. Level of evidence was assessed according to the PRISMA guidelines. Fifty-five articles fulfilled inclusion criteria. Level 2 evidence (prospective studies) was available for the clinical indications of mesial temporal lobe epilepsy (MTLE) and hypothalamic hamartoma (HH) treated by Gamma Knife (GK) RS. For remaining indications including corpus callosotomy as palliative treatment, epilepsy related to cavernous malformation and extra-temporal epilepsy, only Level 4 data was available (case report, prospective observational study, or retrospective case series). No Level 1 evidence was available. Based on level 2 evidence, RS is an efficacious treatment to control seizures in MTLE, possibly resulting in superior neuropsychological outcomes and quality of life metrics in selected subjects compared to microsurgery. RS has a better risk-benefit ratio for small hypothalamic hamartomas compared to surgical methods Delayed therapeutic effect resulting in ongoing seizures is associated with morbidity and mortality risk. Lack of level 1 evidence precludes the formation of guidelines at present. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of listing strategies for allosensitized heart transplant candidates requiring transplant at high urgency: a decision model analysis.

PubMed

Feingold, B; Webber, S A; Bryce, C L; Park, S Y; Tomko, H E; Comer, D M; Mahle, W T; Smith, K J

2015-02-01

Allosensitized children who require a negative prospective crossmatch have a high risk of death awaiting heart transplantation. Accepting the first suitable organ offer, regardless of the possibility of a positive crossmatch, would improve waitlist outcomes but it is unclear whether it would result in improved survival at all times after listing, including posttransplant. We created a Markov decision model to compare survival after listing with a requirement for a negative prospective donor cell crossmatch (WAIT) versus acceptance of the first suitable offer (TAKE). Model parameters were derived from registry data on status 1A (highest urgency) pediatric heart transplant listings. We assumed no possibility of a positive crossmatch in the WAIT strategy and a base-case probability of a positive crossmatch in the TAKE strategy of 47%, as estimated from cohort data. Under base-case assumptions, TAKE showed an incremental survival benefit of 1.4 years over WAIT. In multiple sensitivity analyses, including variation of the probability of a positive crossmatch from 10% to 100%, TAKE was consistently favored. While model input data were less well suited to comparing survival when awaiting transplantation across a negative virtual crossmatch, our analysis suggests that taking the first suitable organ offer under these circumstances is also favored. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Quality of water and antibiotic resistance of Escherichia coli from water sources of hilly tribal villages with and without integrated watershed management-a one year prospective study.

PubMed

Nerkar, Sandeep S; Tamhankar, Ashok J; Khedkar, Smita U; Lundborg, Cecilia Stålsby

2014-06-01

In many hilly tribal areas of the world, water scarcity is a major problem and diarrhoea is common. Poor quality of water also affects the environment. An integrated watershed management programme (IWMP) aims to increase availability of water and to improve life conditions. Globally, there is a lack of information on water contamination, occurrence of diarrhoea and antibiotic resistance, a serious global concern, in relation to IWMP in hilly tribal areas. Therefore, a prospective observational study was conducted during 2011–2012 in six villages in a hilly tribal belt of India, three with and three without implementation of an IWMP, to explore quality of water, diarrhoeal cases in the community and antibiotic resistance of Escherichia coli from water sources. The results showed that physico-chemical quality of water was within limits of safe consumption in all samples. The odds of coliform contamination in water samples was 2.3 times higher in non-watershed management villages (NWMV) compared to integrated watershed management villages (IWMV) (95% CI 0.8–6.45, p = 0.081). The number of diarrhoeal cases (18/663 vs. 42/639, p < 0.05) was lower in IWMV as compared to NWMV. Overall E. coli isolates showed high susceptibility to antibiotics. Resistance to a wider range of antibiotics was observed in NWMV.

Use of Medicare services before and after introduction of the prospective payment system.

PubMed

Manton, K G; Woodbury, M A; Vertrees, J C; Stallard, E

1993-08-01

The case mix-adjusted pattern of use of health care services, especially posthospital care, is compared before and after the introduction of Medicare's Prospective Payment System (PPS). The 1982 and 1984 National Long Term Care Surveys (NLTCS) linked to Medicare administrative records 1982-1986 provide health and health service use data for 12-month periods before and after the introduction of PPS. Case-mix differences between pre- and post-periods are controlled by using the Grade of Membership model to identify health groups from the NLTCS data. Differences in timing (e.g., hospital length of stay) were controlled using life table models estimated for each health group, that is, service use patterns pre- and post-PPS are compared within groups. Hospital LOS and admission rates declined post-PPS. Changes in the timing and location of death occurred but, overall, mortality did not increase. Changes in post-acute care service use by elderly, chronically disabled Medicare beneficiaries were observed: home health service use increased overall and among the unmarried disabled population. PPS did not adversely affect quality of care as reflected in mortality or in hospital readmissions. Moreover, the differential use of post-acute care, and changes in hospital LOS by health group, indicate that the system responded, specific to marital status and age, to the severity of needs of chronically disabled persons.

Quality of Water and Antibiotic Resistance of Escherichia coli from Water Sources of Hilly Tribal Villages with and without Integrated Watershed Management—A One Year Prospective Study

PubMed Central

Nerkar, Sandeep S.; Tamhankar, Ashok J.; Khedkar, Smita U.; Stålsby Lundborg, Cecilia

2014-01-01

In many hilly tribal areas of the world, water scarcity is a major problem and diarrhoea is common. Poor quality of water also affects the environment. An integrated watershed management programme (IWMP) aims to increase availability of water and to improve life conditions. Globally, there is a lack of information on water contamination, occurrence of diarrhoea and antibiotic resistance, a serious global concern, in relation to IWMP in hilly tribal areas. Therefore, a prospective observational study was conducted during 2011–2012 in six villages in a hilly tribal belt of India, three with and three without implementation of an IWMP, to explore quality of water, diarrhoeal cases in the community and antibiotic resistance of Escherichia coli from water sources. The results showed that physico-chemical quality of water was within limits of safe consumption in all samples. The odds of coliform contamination in water samples was 2.3 times higher in non-watershed management villages (NWMV) compared to integrated watershed management villages (IWMV) (95% CI 0.8–6.45, p = 0.081). The number of diarrhoeal cases (18/663 vs. 42/639, p < 0.05) was lower in IWMV as compared to NWMV. Overall E. coli isolates showed high susceptibility to antibiotics. Resistance to a wider range of antibiotics was observed in NWMV. PMID:24991664

Hospital cost control in Norway: a decade's experience with prospective payment.

PubMed Central

Crane, T S

1985-01-01

Under Norway's prospective payment system, which was in existence from 1972 to 1980, hospital costs increased 15.8 percent annually, compared with 15.3 percent in the United States. In 1980 the Norwegian national government started paying for all institutional services according to a population-based, morbidity-adjusted formula. Norway's prospective payment system provides important insights into problems of controlling hospital costs despite significant differences, including ownership of medical facilities and payment and spending as a percent of GNP. Yet striking similarities exist. Annual real growth in health expenditures from 1972 to 1980 in Norway was 2.2 percent, compared with 2.4 percent in the United States. In both countries, public demands for cost control were accompanied by demands for more services. And problems of geographic dispersion of new technology and distribution of resources were similar. Norway's experience in the 1970s demonstrates that prospective payment is no panacea. The annual budget process created disincentives to hospitals to control costs. But Norway's changes in 1980 to a population-based methodology suggest a useful approach to achieve a more equitable distribution of resources. This method of payment provides incentives to control variations in both admissions and cost per case. In contrast, the Medicare approach based on Diagnostic Related Groups (DRGs) is limited, and it does not affect variations in admissions and capital costs. Population-based methodologies can be used in adjusting DRG rates to control both problems. In addition, the DRG system only applies to Medicare payments; the Norwegian experience demonstrates that this system may result in significant shifting of costs onto other payors. PMID:3927385

Vision after trans-sylvian or temporobasal selective amygdalohippocampectomy: a prospective randomised trial.

PubMed

Delev, Daniel; Wabbels, Bettina; Schramm, Johannes; Nelles, Michael; Elger, Christian E; von Lehe, Marec; Clusmann, Hans; Grote, Alexander

2016-09-01

Selective amygdalohippocampectomy (SAH) is an accepted surgical procedure for treatment of pharmacoresistant mesial temporal lobe epilepsy, but it may lead to postoperative visual field deficits (VFDs). Here we present a prospective randomised trial comparing the postoperative VFDs after either a trans-sylvian or temporobasal approach for SAH. Forty-eight patients were randomly assigned to trans-sylvian (n = 24) or temporobasal (n = 24) SAH. Postoperative VFD were quantitatively evaluated using automated static and kinetic perimetry. In 24 cases, diffusion tensor imaging-based deterministic fibre-tracking of the optic radiation was performed. The primary endpoint was absence of postoperative VFD. The secondary endpoint was seizure outcome and driving ability. Three patients (13 %) from the trans-sylvian group showed no VFD, compared to 11 patients (46 %) from the temporobasal group without VFD (p = 0.01, RR = 3.7; CI = 1.2-11.5). Fifteen patients from each group (63 %) became completely seizure-free (ILAE1). Among those seizure-free cases, five trans-sylvian (33 %) and ten temporobasal (66 %) patients could apply for a driving licence (NNT = 3) when VFDs were considered. Although the trans-sylvian group experienced more frequent VFDs, the mean functional visual impairment showed a tendency to be less pronounced compared with the temporobasal group. DTI-based tracking of the optic radiation revealed that a lower distance of optic radiation to the temporal base correlated with increased rate of VFD in the temporobasal group. Temporobasal SAH shows significantly fewer VFDs and equal seizure-free rate compared with the trans-sylvian SAH. However, in patients in whom the optic radiation is close to the temporal base, the trans-sylvian approach may be a preferred alternative.

Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors.

PubMed

Mille, F; Adam, A; Aubry, S; Leclerc, G; Ghislandi, X; Sergent, P; Garbuio, P

2016-01-01

Quadriceps tendon avulsions are typically treated by reattaching the tendon through bone tunnels, with or without tendon or hardware augmentation. The operated knee joint can be moved right away; however, tendon grafting or tension banding will be required to protect the repair, and the hardware must be removed later on. The goal of this study was to evaluate the clinical and functional outcomes when suture anchors are used to reattached torn quadriceps tendon, and also to assess tendon healing using MRI. Thirteen consecutive patients with avulsed quadriceps tendons were operated and then followed prospectively. The surgical technique consisted of tendon reattachment using at least three anchors, in addition to intratendinous weaving of the sutures. Weight bearing was allowed while using a splint. Rehabilitation was initiated immediately after surgery according to a set protocol. Eleven patients were followed for a mean of 14.7 months. Two retears occurred in patients who did not wear the splint. Eighty-two per cent of patients were satisfied or very satisfied with the outcome. The mean knee flexion was 124.5°. All patients were able to return to their pre-injury activity levels. The mean time for clinical and functional recovery was 3 months. MRI performed 6 months after the surgical repair revealed good tendon healing. This was the first prospective study performed on quadriceps avulsion patients undergoing suture anchor repair. Prior clinical case reports have shown that this method leads to predictable clinical and functional results. Our results were comparable to those in published cases. The procedure is simpler when only suture anchors are used. Tendon healing was observed on MRI in all cases. This simple, reproducible technique is free of the drawbacks associated with the typical repair augmentation.

Computed tomography versus water-soluble contrast swallow in the detection of intrathoracic anastomotic leak complicating esophagogastrectomy (Ivor Lewis): a prospective study in 97 patients.

PubMed

Strauss, Christiane; Mal, Frederic; Perniceni, Thierry; Bouzar, Nadia; Lenoir, Stephane; Gayet, Brice; Palau, Robert

2010-04-01

Water-soluble contrast swallow (CS) is usually performed before refeeding for anastomosis assessment after esophagectomy with intrathoracic anastomosis but the sensitivity of CS is low. Another diagnostic approach is based on analysis of computed tomography (CT) scan with oral contrast and of CT mediastinal air images. We undertook to compare them prospectively. Ninety-seven patients with an esophageal carcinoma operated by intrathoracic anastomosis were included prospectively in a study based on a CT scan at postoperative day 3 (without oral and intravenous contrast) and CT scan and CS at day 7. CT scan analysis consisted of assessing contrast and air leakage. In case of doubt, an endoscopy was done. A diagnosis of anastomotic leak was made in 13 patients (13.4%), in 2 cases before day 7 and in 3 beyond day 7. At day 3, 94 CT scans were performed, but the diagnostic value was poor. In 95 patients with both CS and CT scan at day 7, CS disclosed a leak in 5 of 11, and CT scan was abnormal in 8 of 11. Leakage of contrast and/or presence of mediastinal gas had the best negative predictive value (95.8%). Endoscopy was done in 16 patients with only mediastinal gas at day 7 CT scan. It disclosed a normal anastomosis in 11, fibrin deposits in 4, and a leak in 1. In comparison with CS only, CT at day 7 improves the sensitivity and negative predictive value for diagnosing an anastomotic leak. In case of doubt endoscopy is advisable. This approach provides an accurate assessment of the anastomosis before refeeding.

The fibre-folate debate in colo-rectal cancer.

PubMed

Bingham, Sheila

2006-02-01

Intervention and prospective studies showing no effect of fibre in protection against colo-rectal cancer have challenged consensus recommendations that population intakes of fibre should be increased to reduce the risk of colo-rectal cancer. The European Prospective Investigation of Cancer and Nutrition (EPIC) of 519 978 individuals aged 25-70 years is the largest prospective study of diet and cancer to date worldwide. It incorporates ten different European countries in order to increase heterogeneity in dietary habits and calibration procedures to reduce measurement error. Data for 1065 reported cases of colo-rectal cancer were reported in 2003. There was a 40% reduction in risk for the highest quintile v. lowest quintile of fibre in food after calibration. It has been suggested that these effects were a result of confounding by folate and other factors. Although there are a number of hypotheses to explain why folate should be protective in colo-rectal cancer, a meta-analysis has shown that folate in food may be protective but there is no effect of total folate (i.e. food plus supplements). In a further analysis of 1826 cases in EPIC, identified in the latest follow-up, the inclusion of an additional 761 cases has confirmed the previously published results, with a strong and significant reduction in colo-rectal cancer of approximately 9% reduction in risk for each uncalibrated quintile increase in fibre (P<0.001 for linear trend) compared with an 8% reduction in the previous report, which had not been adjusted for folate. Inclusion of the other covariates (physical activity, alcohol, smoking and red and processed meat) with folate has confirmed this significant inverse association for colon cancer and strengthened the association with left-sided colon cancer (P < 0.001).

Role of prospective registries in defining the value and effectiveness of spine care.

PubMed

McGirt, Matthew J; Parker, Scott L; Asher, Anthony L; Norvell, Dan; Sherry, Ned; Devin, Clinton J

2014-10-15

Literature review and case example. Describe methodological considerations of spine surgery registries. Review existing spine surgery registries. Describe the Vanderbilt Prospective Spine Registry (VPSR) as a case example and demonstrate its impact on comparative effectiveness research, value analysis, quality improvement, and practice-based learning. To bend the cost curve and ultimately achieve sustainability in health care, medical providers and surgical treatments of the highest quality and effectiveness must be preferentially used and purchased. As the current US health care environment continues to evolve, it will be essential for all spine clinicians to understand and be facile with the principles of evidence-based health care reform. We describe the methodological considerations of spine surgery registries, review the literature to describe existing spine surgery registries, and discuss the VPSR as a case example. We were able to obtain detailed information on 13 existing spine surgery registries through various internet-based resources. Of the 13, 2 registries had start dates before 2000, 3 between 2001 and 2005, 5 starting in 2006, and 3 were indeterminate. Follow-up rates were in the range from 22% to 79%, with longer follow-up times consistently producing lower follow-up rates. Prospective, longitudinal, patient-reported outcomes registries are powerful tools that allow measurement of cost, safety, effectiveness, and health care value across clinically meaningful episodes of care. Registries entirely based on claims or billing data, safety measures alone, process measures, or other proxies of outcome offer valuable insights, but do not provide comprehensive data to drive patient-centered value-based reform. As more spine-focused registries emerge and their integration into the US health care delivery evolve, the evidence to power value-based reform will be enabled.

Evaluation of intraoperative fluorescence imaging-guided surgery in cancer-bearing dogs: a prospective proof-of-concept phase II study in 9 cases.

PubMed

Cabon, Quentin; Sayag, David; Texier, Isabelle; Navarro, Fabrice; Boisgard, Raphaël; Virieux-Watrelot, Dorothée; Ponce, Frédérique; Carozzo, Claude

2016-04-01

The objective was to prospectively evaluate the application of intraoperative fluorescence imaging (IOFI) in the surgical excision of malignant masses in dogs, using a novel lipid nanoparticle contrast agent. Dogs presenting with spontaneous soft-tissue sarcoma or subcutaneous tumors were prospectively enrolled. Clinical staging and whole-body computed tomography (CT) were performed. All the dogs received an intravenous injection of dye-loaded lipid nanoparticles, LipImage 815. Wide or radical resection was realized after CT examination. Real-time IOFI was performed before skin incision and after tumor excision. In cases of radical resection, the lymph nodes (LNs) were imaged. The margin/healthy tissues fluorescence ratio or LN/healthy tissues fluorescence ratio was measured and compared with the histologic margins or LN status. Nine dogs were included. Limb amputation was performed in 3 dogs, and wide resection in 6. No adverse effect was noted. Fluorescence was observed in all 9 of the tumors. The margins were clean in 5 of 6 dogs after wide surgical resection, and the margin/healthy tissues fluorescence ratio was close to 1.0 in all these dogs. Infiltrated margins were observed in 1 case, with a margin/healthy tissues fluorescence ratio of 3.2. Metastasis was confirmed in 2 of 3 LNs, associated with LN/healthy tissues fluorescence ratios of 2.1 and 4.2, whereas nonmetastatic LN was associated with a ratio of 1.0. LipImage 815 used as a contrast agent during IOFI seemed to allow for good discrimination between tumoral and healthy tissues. Future studies are scheduled to evaluate the sensitivity and specificity of IOFI using LipImage 815 as a tracer. Copyright © 2016 Elsevier Inc. All rights reserved.

Tea consumption and risk of ischaemic heart disease

PubMed Central

Li, Xia; Yu, Canqing; Guo, Yu; Bian, Zheng; Si, Jiahui; Yang, Ling; Chen, Yiping; Ren, Xiaolan; Jiang, Ge; Chen, Junshi; Chen, Zhengming; Lv, Jun; Li, Liming

2017-01-01

Objective To prospectively examine the association between tea consumption and the risk of ischaemic heart disease (IHD). Methods Prospective study using the China Kadoorie Biobank; participants from 10 areas across China were enrolled during 2004–2008 and followed up until 31 December 2013. After excluding participants with cancer, heart disease and stroke at baseline, the present study included 199 293 men and 288 082 women aged 30–79 years at baseline. Information on IHD incidence was collected through disease registries and the new national health insurance databases. Results During a median follow-up of 7.2 years, we documented 24 665 (7.19 cases/1000 person-years) incident IHD cases and 3959 (1.13 cases/1000 person-years) major coronary events (MCEs). Tea consumption was associated with reduced risk of IHD and MCE. In the whole cohort, compared with participants who never consumed tea during the past 12 months, the multivariable-adjusted HRs and 95% CIs for less than daily and daily tea consumers were 0.97 (0.94 to 1.00) and 0.92 (0.88 to 0.95) for IHD, 0.92 (0.85 to 1.00) and 0.90 (0.82 to 0.99) for MCE. No linear trends in the HRs across the amount of tea were observed in daily consumers for IHD and MCE (PLinear >0.05). The inverse association between tea consumption and IHD was stronger in rural (PInteraction 0.006 for IHD, <0.001 for MCE), non-obese (PInteraction 0.012 for MCE) and non-diabetes participants (PInteraction 0.004 for IHD). Conclusions In this large prospective study, daily tea consumption was associated with a reduced risk of IHD. PMID:28077466

Combined effects of 19 common variations on type 2 diabetes in Chinese: results from two community-based studies.

PubMed

Xu, Min; Bi, Yufang; Xu, Yu; Yu, Bing; Huang, Yun; Gu, Lina; Wu, Yaohua; Zhu, Xiaolin; Li, Mian; Wang, Tiange; Song, Aiyun; Hou, Jianing; Li, Xiaoying; Ning, Guang

2010-11-17

Many susceptible loci for type 2 diabetes mellitus (T2DM) have recently been identified from Caucasians through genome wide association studies (GWAS). We aimed to determine the association of 11 known loci with T2DM and impaired glucose regulation (IGR), individually and in combination, in Chinese. Subjects were enrolled in: (1) a case-control study including 1825 subjects with T2DM, 1487 with IGR and 2200 with normal glucose regulation; and (2) a prospective cohort with 734 non-diabetic subjects at baseline. The latter was followed up for 3.5 years, in which 67 subjects developed T2DM. Nineteen single nucleotide polymorphisms (SNPs) were selected to replicate in both studies. We found that CDKAL1 (rs7756992), SLC30A8 (rs13266634, rs2466293), CDKN2A/2B (rs10811661) and KCNQ1 (rs2237892) were associated with T2DM with odds ratio from 1.21 to 1.35. In the prospective study, the fourth quartile of risk scores based on the combined effects of the risk alleles had 3.05 folds (95% CI, 1.31-7.12) higher risk for incident T2DM as compared with the first quartile, after adjustment for age, gender, body mass index and diabetes family history. This combined effect was confirmed in the case-control study after the same adjustments. The addition of the risk scores to the model of clinical risk factors modestly improved discrimination for T2DM by 1.6% in the case-control study and 2.9% in the prospective study. Our study provided further evidence for these GWAS derived SNPs as the genetic susceptible loci for T2DM in Chinese and extended this association to IGR.

Arterial blood gases during and their dynamic changes after cardiopulmonary resuscitation: A prospective clinical study.

PubMed

Spindelboeck, Walter; Gemes, Geza; Strasser, Christa; Toescher, Kathrin; Kores, Barbara; Metnitz, Philipp; Haas, Josef; Prause, Gerhard

2016-09-01

An arterial blood gas analysis (ABG) yields important diagnostic information in the management of cardiac arrest. This study evaluated ABG samples obtained during out-of-hospital cardiopulmonary resuscitation (OHCPR) in the setting of a prospective multicenter trial. We aimed to clarify prospectively the ABG characteristics during OHCPR, potential prognostic parameters and the ABG dynamics after return of spontaneous circulation (ROSC). ABG samples were collected and instantly processed either under ongoing OHCPR performed according to current advanced life support guidelines or immediately after ROSC and data ware entered into a case report form along with standard CPR parameters. During a 22-month observation period, 115 patients had an ABG analysis during OHCPR. In samples obtained under ongoing CPR, an acidosis was present in 98% of all cases, but was mostly of mixed hypercapnic and metabolic origin. Hypocapnia was present in only 6% of cases. There was a trend towards higher paO2 values in patients who reached sustained ROSC, and a multivariate regression analysis revealed age, initial rhythm, time from collapse to CPR initiation and the arterio-alveolar CO2 difference (AaDCO2) to be associated with sustained ROSC. ABG samples drawn immediately after ROSC demonstrated higher paO2 and unaltered pH and base excess levels compared with samples collected during ongoing CPR. Our findings suggest that adequate ventilation and oxygenation deserve more research and clinical attention in the management of cardiac arrest and that oxygen uptake improves within minutes after ROSC. Hyperventilation resulting in arterial hypocapnia is not a major problem during OHCPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A prospective examination of whether childhood sexual abuse predicts subsequent sexual offending.

PubMed

Widom, Cathy Spatz; Massey, Christina

2015-01-01

Childhood sexual abuse has been assumed to increase the risk for sexual offending. However, despite methodological limitations of prior research, public policies and clinical practice have been based on this assumption. To empirically examine the commonly held belief that sexually abused children grow up to become sexual offenders and specialize in sex crimes. This prospective cohort study and archival records check included cases and control individuals originally from a metropolitan county in the Midwest. Children with substantiated cases of physical and sexual abuse and neglect (aged 0-11 years) were matched with children without such histories on the basis of age, sex, race/ethnicity, and approximate family social class (908 cases and 667 control individuals). Both groups were followed up into adulthood (mean age, 51 years). The court cases were from 1967 to 1971; the follow-up extended to 2013. Criminal history information was collected from federal and state law enforcement agency records at 3 points in time and from state sex offender registries. Overall, individuals with histories of childhood abuse and neglect were at increased risk for being arrested for a sex crime compared with control individuals (adjusted odds ratio [AOR], 2.17; 95% CI, 1.38-3.40), controlling for age, sex, and race/ethnicity. Specifically, individuals with histories of physical abuse (AOR, 2.06; 95% CI, 1.02-4.16) and neglect (AOR, 2.21; 95% CI, 1.39-3.51) were at significantly increased risk for arrest for sex offenses, whereas for sexual abuse, the AOR (2.13; 95% CI, 0.83-5.47) did not reach significance. Physically abused and neglected males (not females) were at increased risk and physically abused males also had a higher mean number of sex crime arrests compared with control individuals. The results did not provide support for sex crime specialization. The widespread belief that sexually abused children are uniquely at risk to become sex offenders was not supported by prospective empirical evidence. These new findings suggest that early intervention programs should target children with histories of physical abuse and neglect. They also indicate that existing policies and practices specifically directed at future risk for sex offending for sexually abused children may warrant reevaluation.

64Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with 111In-DTPA-Octreotide in 112 Patients.

PubMed

Pfeifer, Andreas; Knigge, Ulrich; Binderup, Tina; Mortensen, Jann; Oturai, Peter; Loft, Annika; Berthelsen, Anne Kiil; Langer, Seppo W; Rasmussen, Palle; Elema, Dennis; von Benzon, Eric; Højgaard, Liselotte; Kjaer, Andreas

2015-06-01

Neuroendocrine tumors (NETs) can be visualized using radiolabeled somatostatin analogs. We have previously shown the clinical potential of (64)Cu-DOTATATE in a small first-in-human feasibility study. The aim of the present study was, in a larger prospective design, to compare on a head-to-head basis the performance of (64)Cu-DOTATATE and (111)In-diethylenetriaminepentaacetic acid (DTPA)-octreotide ((111)In-DTPA-OC) as a basis for implementing (64)Cu-DOTATATE as a routine. We prospectively enrolled 112 patients with pathologically confirmed NETs of gastroenteropancreatic or pulmonary origin. All patients underwent both PET/CT with (64)Cu-DOTATATE and SPECT/CT with (111)In-DTPA-OC within 60 d. PET scans were acquired 1 h after injection of 202 MBq (range, 183-232 MBq) of (64)Cu-DOTATATE after a diagnostic contrast-enhanced CT scan. Patients were followed for 42-60 mo for evaluation of discrepant imaging findings. The McNemar test was used to compare the diagnostic performance. Eighty-seven patients were congruently PET- and SPECT-positive. No SPECT-positive cases were PET-negative, whereas 10 false-negative SPECT cases were identified using PET. The diagnostic sensitivity and accuracy of (64)Cu-DOTATATE (97% for both) were significantly better than those of (111)In-DTPA-OC (87% and 88%, respectively, P = 0.017). In 84 patients (75%), (64)Cu-DOTATATE identified more lesions than (111)In-DTPA-OC and always at least as many. In total, twice as many lesions were detected with (64)Cu-DOTATATE than with (111)In-DTPA-OC. Moreover, in 40 of 112 cases (36%) lesions were detected by (64)Cu-DOTATATE in organs not identified as disease-involved by (111)In-DTPA-OC. With these results, we demonstrate that (64)Cu-DOTATATE is far superior to (111)In-DTPA-OC in diagnostic performance in NET patients. Therefore, we do not hesitate to recommend implementation of (64)Cu-DOTATATE as a replacement for (111)In-DTPA-OC. © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Priorities and prospect theory.

PubMed

Happich, M; Mazurek, B

2002-01-01

Whose preferences are to be used for cost-effectiveness analysis? It has been recommended that community preferences for health states are the most appropriate ones for use in a reference case analysis. However, critics maintain that persons are not able properly to judge a health state if they have not experienced the condition themselves. This problem is analyzed here in the framework of Prospect Theory. It can be argued that the differing reference points of patients and the general public are responsible for deviating results. In addition, we argue that risk attitudes with respect to health-related quality of life are an indicator of reference points. If patients and the general public refer to the same reference point, i.e., they have the same risk attitude, the hypothesis is that deviations no longer significantly differ. Evaluations of the health condition of tinnitus by 210 patients and 210 unaffected persons were compared. The Time Tradeoff and Standard Gamble methods were applied to elicit preferences. Risk attitude was measured with the question of whether participants would undergo a treatment that could either improve or worsen their health condition, both with an equal chance (five possible answers between "in no case" and "in any case"). Affected persons indicated significantly higher values for tinnitus-related quality of life according to the Standard Gamble method. The difference between Time Tradeoff values was less dramatic but still significant. In addition, nonaffected persons are more risk-averse than affected persons. However, differences in evaluations are not significant considering single risk groups (e.g., those who answered "in no case"). Prospect Theory is a reasonable framework for considering the question of whose preferences count. If this result can be generalized for other diseases as well, it allows the mathematical combination of "objective" evaluations by the general public with the illness experience of patients. These evaluations should be weighted with patients' risk attitudes, i.e., community preferences can be used if they are corrected for risk attitudes.

Convergent and Divergent Thinking in Task Modification: A Case of Korean Prospective Mathematics Teachers' Exploration

ERIC Educational Resources Information Center

Lee, Kyeong-Hwa

2017-01-01

This study investigated how 38 secondary mathematics prospective teachers modified textbook tasks for convergent and divergent thinking while learning to teach mathematics during university coursework. The coursework focused prospective teachers' attention on their analyses of textbook tasks in terms of potential affordances and constraints for…

Consistency between Constructivist Profiles and Instructional Practices of Prospective Physics Teachers

ERIC Educational Resources Information Center

Ates, Ozlem; Unal Coban, Gul; Kaya Sengoren, Serap

2018-01-01

This study aims to explain the extent to which prospective physics teachers' views and practices are consistent with the constructivist framework. A case study design was employed as the research approach. The study was conducted with 11 prospective physics teachers attending a state university in Turkey. Data was collected through semi-structured…

Utility of additional tissue sections in dermatopathology: diagnostic, clinical and financial implications.

PubMed

Stuart, Lauren N; Rodriguez, Adrianna S; Gardner, Jerad M; Foster, Toby E; MacKelfresh, Jamie; Parker, Douglas C; Chen, Suephy C; Stoff, Benjamin K

2014-02-01

As histopathologic assessment is subject to sampling error, some institutions 'preorder' deeper sections on some or all cases (hereafter referred to as prospective deeper sections), while others order additional sections only when needed (hereafter referred to as retrospective deeper sections). We investigated how often additional sections changed a diagnosis and/or clinical management. Given the recent decrease in reimbursement for CPT-code 88305, we also considered the financial implications of ordering additional sections. Cases (n = 204) were assigned a preliminary diagnosis, based on review of the initial slide, and a final diagnosis, after reviewing additional sections. Cases with discordant diagnoses were assessed by two dermatologists, who indicated whether the change in diagnosis altered clinical management. Expenses were estimated for three scenarios: (a) no additional sections, (b) prospective deeper sections and (c) retrospective deeper sections. Diagnoses were modified in 9% of cases, which changed clinical management in 56% of these cases. Lesions obtained by punch-biopsy and inflammatory lesions were disproportionately overrepresented amongst cases with changed diagnoses (p < 0.001, p = 0.12, respectively). The cost of prospective deeper sections and retrospective deeper sections represented a 56% and 115% increase over base costs, respectively. Labor costs, particularly the cost of dermatopathologist evaluation, were the most significant cost-drivers. While additional sections improve diagnostic accuracy, they delay turn-around-time and increase expenditures. In our practice, prospective deeper sections are cost effective, however, this may vary by institution. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-centre haemodialysis: a prospective, case-controlled study.

PubMed

Ok, Ercan; Duman, Soner; Asci, Gulay; Tumuklu, Murat; Onen Sertoz, Ozen; Kayikcioglu, Meral; Toz, Huseyin; Adam, Siddik M; Yilmaz, Mumtaz; Tonbul, Halil Zeki; Ozkahya, Mehmet

2011-04-01

Longer dialysis sessions may improve outcome in haemodialysis (HD) patients. We compared the clinical and laboratory outcomes of 8- and 4-h thrice-weekly HD. Two-hundred and forty-seven HD patients who agreed to participate in a thrice-weekly 8-h in-centre nocturnal HD (NHD) treatment and 247 age-, sex-, diabetes status- and HD duration-matched control cases to 4-h conventional HD (CHD) were enrolled in this prospective controlled study. Echocardiography and psychometric measurements were performed at baseline and at the 12th month. The primary outcome was 1-year overall mortality. Overall mortality rates were 1.77 (NHD) and 6.23 (CHD) per 100 patient-years (P = 0.01) during a mean 11.3 ± 4.7 months of follow-up. NHD treatment was associated with a 72% risk reduction for overall mortality compared to the CHD treatment (hazard ratio = 0.28, 95% confidence interval 0.09-0.85, P = 0.02). Hospitalization rate was lower in the NHD arm. Post-HD body weight and serum albumin levels increased in the NHD group. Use of antihypertensive medications and erythropoietin declined in the NHD group. In the NHD group, left atrium and left ventricular end-diastolic diameters decreased and left ventricular mass index regressed. Both use of phosphate binders and serum phosphate level decreased in the NHD group. Cognitive functions improved in the NHD group, and quality of life scores deteriorated in the CHD group. Eight-hour thrice-weekly in-centre NHD provides morbidity and possibly mortality benefits compared to conventional 4-h HD.

Evaluation of intradermal absorbable and mattress sutures to close pilonidal sinus wounds with Limberg flap: a prospective randomized comparative study.

PubMed

Çetin, Kenan; Sikar, Hasan Ediz; Kocaoğlu, Aytaç Emre; Kündeş, Muhammet Fikri; Karahan, Mehmet; Kaptanoğlu, Levent

2018-02-01

We aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure. From July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups. There was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm 2 , recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05). In conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.

Quality control for normal liquid-based cytology: Rescreening, high-risk HPV targeted reviewing and/or high-risk HPV detection?

PubMed Central

Depuydt, Christophe E; Arbyn, Marc; Benoy, Ina H; Vandepitte, Johan; Vereecken, Annie J; Bogers, Johannes J

2009-01-01

The objective of this prospective study was to compare the number of CIN2+cases detected in negative cytology by different quality control (QC) methods. Full rescreening, high-risk (HR) human papillomavirus (HPV)-targeted reviewing and HR HPV detection were compared. Randomly selected negative cytology detected by BD FocalPoint™ (NFR), by guided screening of the prescreened which needed further review (GS) and by manual screening (MS) was used. A 3-year follow-up period was available. Full rescreening of cytology only detected 23.5% of CIN2+ cases, whereas the cytological rescreening of oncogenic positive slides (high-risk HPV-targeted reviewing) detected 7 of 17 CIN2+ cases (41.2%). Quantitative real-time PCR for 15 oncogenic HPV types detected all CIN2+ cases. Relative sensitivity to detect histological CIN2+ was 0.24 for full rescreening, 0.41 for HR-targeted reviewing and 1.00 for HR HPV detection. In more than half of the reviewed negative cytological preparations associated with histological CIN2+cases no morphologically abnormal cells were detected despite a positive HPV test. The visual cut-off for the detection of abnormal cytology was established at 6.5 HR HPV copies/cell. High-risk HPV detection has a higher yield for detection of CIN2+ cases as compared to manual screening followed by 5% full review, or compared to targeted reviewing of smears positive for oncogenic HPV types, and show diagnostic properties that support its use as a QC procedure in cytologic laboratories. PMID:18544049

Transgender Day of Remembrance and a Prospective Student Open House: How One Student Inspired a School to Do Both

ERIC Educational Resources Information Center

Fusarelli, Bonnie C.; Eaton, Lucy E.

2011-01-01

This case study explores the challenges a school leader faced when her commitment to diversity was tested by a scheduling conflict. The school principal approved a Transgender Day of Remembrance but then realized that it was scheduled for the same night as the school's Open House to recruit prospective students. The case study provides an…

Calibrating the social value of prospective new goods: The case of hydrogen fuel cell electric Vehicles

NASA Astrophysics Data System (ADS)

Topel, Robert H.

2018-01-01

Economic studies of the value of a new good or product innovation are typically retrospective: after a new good has been developed and marketed to consumers, data on prices and consumer choices can be used to estimate welfare gains. This paper calibrates the prospective welfare gains in the United States from a nascent vehicle platform, fuel cell electric vehicles (FCVs), that may or may not succeed in competition with existing vehicle platforms. Prospective gains are due to three main sources: (1) possibly reduced carbon emissions compared to existing vehicle alternatives; (2) the monopsony benefit to the U.S. from reducing world oil demand and hence the price of oil; (3) national security benefits due to reduced "oil dependence", mitigating the impact of oil price shocks on national income. I find that the benefits of reduced carbon emissions are likely to be quite small because reduced oil demand in the U.S. as only a small impact on world oil consumption and carbon emissions. Net monopsony benefits to U.S. consumers are much larger.

Dietary flavonoid intake and the risk of stroke: a dose-response meta-analysis of prospective cohort studies

PubMed Central

Tang, Zhenyu; Li, Min; Zhang, Xiaowei; Hou, Wenshang

2016-01-01

Objective To clarify and quantify the potential association between intake of flavonoids and risk of stroke. Design Meta-analysis of prospective cohort studies. Data source Studies published before January 2016 identified through electronic searches using PubMed, Embase and the Cochrane Library. Eligibility criteria for selecting studies Prospective cohort studies with relative risks and 95% CIs for stroke according to intake of flavonoids (assessed as dietary intake). Results The meta-analysis yielded 11 prospective cohort studies involving 356 627 participants and more than 5154 stroke cases. The pooled estimate of the multivariate relative risk of stroke for the highest compared with the lowest dietary flavonoid intake was 0.89 (95% CI 0.82 to 0.97; p=0.006). Dose-response analysis indicated that the summary relative risk of stroke for an increase of 100 mg flavonoids consumed per day was 0.91 (95% CI 0.77 to 1.08) without heterogeneity among studies (I2=0%). Stratifying by follow-up duration, the relative risk of stroke for flavonoid intake was 0.89 (95% CI 0.81 to 0.99) in studies with more than 10 years of follow-up. Conclusions Results from this meta-analysis suggest that higher dietary flavonoid intake may moderately lower the risk of stroke. PMID:27279473

[Application of ecosystem service value in land use change research: Bottlenecks and prospects].

PubMed

Zhang, Zhou; Wu, Ci-Fang; Tan, Rong

2013-02-01

In recent years, the application of ecosystem service value in land use change research is a hot topic in many famous international journals. However, policy makers are seldom taking into account the achievements of the related studies in practice. This paper summarized the three main bottlenecks in applying ecosystem service value in land management practices, i. e., the difficulty in measuring the service values, the complexity of driving factors, and the bias of evaluation criteria. Some solutions on the bottlenecks were provided, and the future research directions in China were prospected. It was suggested that in the studies of land use change based on ecosystem service value, it would be more appropriate to adopt comparative analysis method in small scale case studies, especially focusing on the natural ecological resources and the excessive loss of their values.

Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial.

PubMed

Nealon, Joshua; Taurel, Anne-Frieda; Capeding, Maria Rosario; Tran, Ngoc Huu; Hadinegoro, Sri Rezeki; Chotpitayasunondh, Tawee; Chong, Chee Kheong; Wartel, T Anh; Beucher, Sophie; Frago, Carina; Moureau, Annick; Simmerman, Mark; Laot, Thelma; L'Azou, Maïna; Bouckenooghe, Alain

2016-08-01

Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2-14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14's active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions.

Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial

PubMed Central

Taurel, Anne-Frieda; Capeding, Maria Rosario; Tran, Ngoc Huu; Hadinegoro, Sri Rezeki; Chotpitayasunondh, Tawee; Chong, Chee Kheong; Wartel, T. Anh; Beucher, Sophie; Frago, Carina; Moureau, Annick; Simmerman, Mark; Laot, Thelma; L’Azou, Maïna; Bouckenooghe, Alain

2016-01-01

Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2–14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14’s active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions. PMID:27532617

Interaction between Arsenic Exposure from Drinking Water and Genetic Polymorphisms on Cardiovascular Disease in Bangladesh: A Prospective Case-Cohort Study

PubMed Central

Wu, Fen; Jasmine, Farzana; Kibriya, Muhammad G.; Liu, Mengling; Cheng, Xin; Parvez, Faruque; Islam, Tariqul; Ahmed, Alauddin; Rakibuz-Zaman, Muhammad; Jiang, Jieying; Roy, Shantanu; Paul-Brutus, Rachelle; Slavkovich, Vesna; Islam, Tariqul; Levy, Diane; VanderWeele, Tyler J.; Pierce, Brandon L.; Graziano, Joseph H.; Ahsan, Habibul

2015-01-01

Background: Epidemiologic data on genetic susceptibility to cardiovascular effects of arsenic exposure from drinking water are limited. Objective: We investigated whether the association between well-water arsenic and cardiovascular disease (CVD) differed by 170 single nucleotide polymorphisms (SNPs) in 17 genes related to arsenic metabolism, oxidative stress, inflammation, and endothelial dysfunction. Method: We conducted a prospective case-cohort study nested in the Health Effects of Arsenic Longitudinal Study, with a random subcohort of 1,375 subjects and 447 incident fatal and nonfatal cases of CVD. Well-water arsenic was measured in 2000 at baseline. The CVD cases, 56 of which occurred in the subcohort, included 238 coronary heart disease cases, 165 stroke cases, and 44 deaths due to other CVD identified during follow-up from 2000 to 2012. Results: Of the 170 SNPs tested, multiplicative interactions between well-water arsenic and two SNPs, rs281432 in ICAM1 (padj = 0.0002) and rs3176867 in VCAM1 (padj = 0.035), were significant for CVD after adjustment for multiple testing. Compared with those with GC or CC genotype in rs281432 and lower well-water arsenic, the adjusted hazard ratio (aHR) for CVD was 1.82 (95% CI: 1.31, 2.54) for a 1-SD increase in well-water arsenic combined with the GG genotype, which was greater than expected given aHRs of 1.08 and 0.96 for separate effects of arsenic and the genotype alone, respectively. Similarly, the joint aHR for arsenic and the rs3176867 CC genotype was 1.34 (95% CI: 0.95, 1.87), greater than expected given aHRs for their separate effects of 1.02 and 0.84, respectively. Conclusions: Associations between CVD and arsenic exposure may be modified by genetic variants related to endothelial dysfunction. Citation: Wu F, Jasmine F, Kibriya MG, Liu M, Cheng X, Parvez F, Islam T, Ahmed A, Rakibuz-Zaman M, Jiang J, Roy S, Paul-Brutus R, Slavkovich V, Islam T, Levy D, VanderWeele TJ, Pierce BL, Graziano JH, Ahsan H, Chen Y. 2015. Interaction between arsenic exposure from drinking water and genetic polymorphisms on cardiovascular disease in Bangladesh: a prospective case-cohort study. Environ Health Perspect 123:451–457; http://dx.doi.org/10.1289/ehp.1307883 PMID:25575156

Prospective sonographic detection of spina bifida at 11-14 weeks and systematic literature review.

PubMed

Orlandi, Emanuela; Rossi, Cinzia; Perino, Antonio; Cucinella, Gaspare; Orlandi, Francesco

2016-01-01

To conduct a literature review to assess the effectiveness of first trimester ultrasonographic markers of spina bifida (SB) integrating data with our prospective experience. The analysis of the SB cases that we prospectively detected in the first trimester, between January 2012 and February 2014, and a systematic review of all the papers evaluating the effectiveness of SB ultrasonographic markers at 11-14 weeks, namely brain stem diameter (BS), fourth ventricle/intracranial translucency (IT), cisterna magna (CM), brain stem/occipital bone distance (BSOB), the ratio between BS and BSOB. Some studies assess only the effectiveness of IT, others include more parameters, and few include them all. We prospectively detected four SB cases, three open (OSB) and one closed (CSB), in a low risk population undergoing first trimester screening. In the three OSB, CM (in 2/3 cases) and BSOB (3/3) distance were below the 5th percentile, BS and BS/BSOB ratio (3/3) were above the 95th percentile. In the CSB, all the measurements were within normal limits. The literature and our data agree that most fetuses with OSB demonstrate in the first trimester positive sonographic markers in the posterior fossa, but additional prospective studies are needed to establish the best protocol for OSB screening.

A comparison of the results of prospective and retrospective cohort studies in the field of digestive surgery.

PubMed

Ukai, Tomohiko; Shikata, Satoru; Nakayama, Takeo; Takemura, Yousuke C

2017-07-01

We compared the results of prospective and retrospective cohort studies in the field of digestive surgery to clarify whether the results of prospective cohort studies were more similar to those of randomized controlled trials (RCTs). We conducted a secondary analysis of the results to compare the results of RCTs with those of cohort studies in meta-analyses of 18 digestive surgical topics. The data from the prospective and retrospective cohort studies were combined. The summary estimates of each design were compared with those of RCTs. We used the Z score to investigate discrepancies. Twenty-nine outcomes of 11 topics were investigated in 289 cohort studies (prospective, n = 69; retrospective, n = 220). These were compared with the outcomes of 123 RCTs. In comparison to retrospective studies, the summary estimates of the prospective cohort studies were more similar to those of the RCTs [19/29 (prospective) vs. 10/29 (retrospective), P = 0.035). Five of the 29 outcomes of prospective studies and 6 of 29 outcomes of retrospective studies (P = 0.99) showed significant discrepancies in comparison to RCTs. In the digestive surgical field, the results of prospective cohort studies tended to be more similar to those of RCTs than retrospective studies; however, there were no significant discrepancies between the two types of cohort study.

Successful control of methicillin-resistant Staphylococcus aureus in a spinal cord injury center: a 10-year prospective study including molecular typing.

PubMed

Kappel, C; Widmer, A; Geng, V; von Arx, P; Frei, R; Koch, H-G; Knecht, H

2008-06-01

Prospective cohort study with medical record review. To evaluate the clinical utility of an infection control program in a patient cohort at high risk for methicillin-resistant Staphylococcus aureus (MRSA) infection and to identify risk factors interfering with successful decolonization of MRSA. All spinal cord injured (SCI) patients hospitalized at the Swiss Paraplegic Center (SPC) Nottwil from April 1991 to April 2001. Patients whose medical records indicated laboratory-confirmed MRSA colonization or infection were included. Incidence of MRSA colonization or infection was classified as community acquired, nosocomial or transferred based on standardized criteria. Risk factors for community-acquired MRSA colonization in SCI patients were determined. MRSA subtyping and identification of nosocomial spread was performed through pulse-field gel electrophoresis (PFGE). Of 5992 admissions, 100 episodes of MRSA (colonization 22 cases, infection 78 cases) were identified among 76 patients. Overall incidence (1991-2001) per 1000 patient days was 0.26 cases on admission compared to 0.08 at discharge (P<0.001). Community-acquired MRSA was most frequent (56%) followed by nosocomial acquisition (34%). PFGE subtyping identified two nosocomial clusters with six and three cases, respectively. Most of community-acquired MRSA isolates were genetically unrelated and also distinct from epidemic strains identified in Switzerland during the study period. Decolonization was successful in 60 of 76 (78.9%) MRSA-positive patients. In the largest European SCI center, MRSA controlling is feasible if infection control policies are vigorously applied.

Xpert MTB/RIF assay for diagnosis of pulmonary tuberculosis in children: a prospective, multi-centre evaluation.

PubMed

Reither, Klaus; Manyama, Christina; Clowes, Petra; Rachow, Andrea; Mapamba, Daniel; Steiner, Andreas; Ross, Amanda; Mfinanga, Elirehema; Sasamalo, Mohamed; Nsubuga, Martin; Aloi, Francesco; Cirillo, Daniela; Jugheli, Levan; Lwilla, Fred

2015-04-01

Following endorsement by the World Health Organisation, the Xpert MTB/RIF assay has been widely incorporated into algorithms for the diagnosis of adult tuberculosis (TB). However, data on its performance in children remain scarce. This prospective, multi-centre study evaluated the performance of Xpert MTB/RIF to diagnose pulmonary tuberculosis in children. Children older than eight weeks and younger than 16 years with suspected pulmonary tuberculosis were enrolled at three TB endemic settings in Tanzania and Uganda, and assigned to five well-defined case definition categories: culture-confirmed TB, highly probable TB, probable TB, not TB, or indeterminate. The diagnostic accuracy of Xpert MTB/RIF was assessed using culture-confirmed TB cases as reference standard. In total, 451 children were enrolled. 37 (8%) had culture-confirmed TB, 48 (11%) highly probably TB and 62 probable TB (13%). The Xpert MTB/RIF assay had a sensitivity of 68% (95% CI, 50%-82%) and specificity of 100% (95% CI, 97%-100%); detecting 1.7 times more culture-confirmed cases than smear microscopy with a similar time to detection. Xpert MTB/RIF was positive in 2% (1/48) of highly probable and in 3% (2/62) of probable TB cases. Xpert MTB/RIF provided timely results with moderate sensitivity and excellent specificity compared to culture. Low yields in children with highly probable and probable TB remain problematic. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Endometriosis and the risk of skin cancer: a prospective cohort study.

PubMed

Farland, Leslie V; Lorrain, Simon; Missmer, Stacey A; Dartois, Laureen; Cervenka, Iris; Savoye, Isabelle; Mesrine, Sylvie; Boutron-Ruault, Marie-Christine; Kvaskoff, Marina

2017-10-01

Endometriosis has been associated with an increased risk of skin melanoma. However, associations with other skin cancer types and how they compare with melanoma are unclear. Our objective was to prospectively investigate the relationships between endometriosis and risk of non-melanoma and melanoma skin cancers. E3N is a prospective cohort of 98,995 French women aged 40-65 years in 1990. Data on surgically confirmed endometriosis and skin cancer diagnoses were collected every 2-3 years through self-report, with skin cancer cases confirmed through pathology reports. Hazard Ratios (HR) and 95% confidence intervals (CIs) were calculated using Cox regression models. Between 1990 and 2008, 535 melanoma, 247 squamous-cell carcinoma (SCC), and 1,712 basal-cell carcinoma (BCC) cases were ascertained. Endometriosis was associated with an increased overall risk of skin cancer (HR 1.28, 95% CI 1.05-1.55). When considering skin cancer type, endometriosis was associated with melanoma risk (HR 1.64, 95% CI 1.15-2.35), but not with SCC (HR 1.21, 95% CI 0.62-2.36) or BCC (HR 1.16, 95% CI 0.91-1.48) (non-melanoma skin cancers combined: HR 1.17, 95% CI 0.93-1.46), although no heterogeneity was detected across skin cancer types (Phomogeneity = 0.13). These data support an association between a personal history of endometriosis and the risk of skin cancer and suggest that the association is strongest for melanoma.

Meat intake and bladder cancer risk in a Swedish prospective cohort.

PubMed

Larsson, Susanna C; Johansson, Jan-Erik; Andersson, Swen-Olof; Wolk, Alicja

2009-02-01

High meat consumption could potentially increase the risk of bladder cancer, but findings from epidemiologic studies are inconsistent. We prospectively examined the association between meat intake and bladder cancer risk in a population-based cohort study. We prospectively followed 82,002 Swedish women and men who were free from cancer and completed a food-frequency questionnaire in 1997. Incident cases of bladder cancer were identified in the Swedish cancer registries. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, education, smoking status, pack-years of smoking, and total energy intake. During a mean follow-up of 9.4 years, 485 incident cases of bladder cancer (76 women and 409 men) were ascertained in the cohort. We observed no association between the intake of total or any specific type of meat and the risk of bladder cancer. The multivariate HRs (95% CIs) comparing the highest and the lowest category of intake were 1.05 (0.71-1.55) for total meat, 1.00 (0.71-1.41) for red meat, 1.01 (0.80-1.28) for processed meats, 0.96 (0.70-1.30) for chicken/poultry, and 0.92 (0.65-1.30) for fried meats/fish. The associations did not vary by sex or smoking status. These results do not support the hypothesis that intake of red meat, processed meat, poultry, or fried meats/fish is associated with the risk of developing bladder cancer.

A prospective evaluation of antral follicle function in women with 46,XX spontaneous primary ovarian insufficiency

PubMed Central

Hubayter, Ziad R; Popat, Vaishali; Vanderhoof, Vien H; Ndubizu, Obioma; Johnson, Diane; Mao, Edie; Calis, Karim A; Troendle, James F.; Nelson, Lawrence M.

2010-01-01

Objective To assess ovarian follicle function in women with 46,XX spontaneous primary ovarian insufficiency Design Case-control with nested prospective cohort Setting Clinical Research Center, National Institutes of Health Patients Women with primary ovarian insufficiency without estrogen replacement for two weeks (N=97) and regularly menstruating control women (N=42) Interventions Single injection of 300 IU hrFSH Main outcome measures Change in serum estradiol at 24 hours Results Antral follicles ≥ 3 mm were detected in 73% (69/95) of patients; both serum estradiol and progesterone levels correlated significantly with maximum follicle diameter in these women. Patients with a maximum follicle diameter ≥ 8 mm had significantly higher serum estradiol and progesterone levels and significantly lower FSH and LH levels as compared to patients without such follicles. In controls estradiol levels increased significantly after FSH administration but in patients this was not the case despite the presence of an antral follicle ≥ 8 mm. Conclusion Most women with 46,XX spontaneous primary ovarian insufficiency have antral follicles detectable by ultrasound, suggesting that down-regulation of FSH receptors is not the predominant mechanism of follicle dysfunction. Evidence of progesterone secretion by antral follicles ≥ 8 mm in these patients is consistent with prior histologic evidence that follicle luteinization is the predominant mechanism of follicle dysfunction in this condition. Prospective controlled investigation designed to improve ovulatory function and fertility in these women is indicated. PMID:19939372

Shifting the lens: the introduction of population-based funding in Alberta.

PubMed

Smith, Neale; Church, John

2008-01-01

This paper offers a detailed historical description of the development of Alberta's population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition--in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study.

Medicaid prospective payment: Case-mix increase

PubMed Central

Baker, Samuel L.; Kronenfeld, Jennie J.

1990-01-01

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

Control of traumatic wound bleeding by compression with a compact elastic adhesive dressing.

PubMed

Naimer, Sody Abby; Tanami, Menachem; Malichi, Avishai; Moryosef, David

2006-07-01

Compression dressing has been assumed effective, but never formally examined in the field. A prospective interventional trial examined efficacy and feasibility of an elastic adhesive dressing compression device in the arena of the traumatic incident. The primary variable examined was the bleeding rate from wounds compared before and after dressing. Sixty-two consecutive bleeding wounds resulting from penetrating trauma were treated. Bleeding intensity was profuse in 58%, moderate 23%, and mild in 19%. Full control of bleeding was achieved in 87%, a significantly diminished rate in 11%, and, in 1 case, the technique had no influence on the bleeding rate. The Wilcoxon test for variables comparing bleeding rates before and after the procedure obtained significant difference (Z = -6.9, p < 0.01). No significant complications were observed. Caregivers were highly satisfied in 90% of cases. Elastic adhesive dressing was observed as an effective and reliable technique, demonstrating a high rate of success without complications.

Comparison of 2 resident learning tools-interactive screen-based simulated case scenarios versus problem-based learning discussions: a prospective quasi-crossover cohort study.

PubMed

Rajan, Shobana; Khanna, Ashish; Argalious, Maged; Kimatian, Stephen J; Mascha, Edward J; Makarova, Natalya; Nada, Eman M; Elsharkawy, Hesham; Firoozbakhsh, Farhad; Avitsian, Rafi

2016-02-01

Simulation-based learning is emerging as an alternative educational tool in this era of a relative shortfall of teaching anesthesiologists. The objective of the study is to assess whether screen-based (interactive computer simulated) case scenarios are more effective than problem-based learning discussions (PBLDs) in improving test scores 4 and 8 weeks after these interventions in anesthesia residents during their first neuroanesthesia rotation. Prospective, nonblinded quasi-crossover study. Cleveland Clinic. Anesthesiology residents. Two case scenarios were delivered from the Anesoft software as screen-based sessions, and parallel scripts were developed for 2 PBLDs. Each resident underwent both types of training sessions, starting with the PBLD session, and the 2 cases were alternated each month (ie, in 1 month, the screen-based intervention used case 1 and the PBLD used case 2, and vice versa for the next month). Test scores before the rotation (baseline), immediately after the rotation (4 weeks after the start of the rotation), and 8 weeks after the start of rotation were collected on each topic from each resident. The effect of training method on improvement in test scores was assessed using a linear mixed-effects model. Compared to the departmental standard of PBLD, the simulation method did not improve either the 4- or 8-week mean test scores (P = .41 and P = .40 for training method effect on 4- and 8-week scores, respectively). Resident satisfaction with the simulation module on a 5-point Likert scale showed subjective evidence of a positive impact on resident education. Screen-based simulators were not more effective than PBLD for education during the neuroanesthesia rotation in anesthesia residency. Copyright © 2016 Elsevier Inc. All rights reserved.

Interaction between arsenic exposure from drinking water and genetic polymorphisms on cardiovascular disease in Bangladesh: a prospective case-cohort study.

PubMed

Wu, Fen; Jasmine, Farzana; Kibriya, Muhammad G; Liu, Mengling; Cheng, Xin; Parvez, Faruque; Islam, Tariqul; Ahmed, Alauddin; Rakibuz-Zaman, Muhammad; Jiang, Jieying; Roy, Shantanu; Paul-Brutus, Rachelle; Slavkovich, Vesna; Islam, Tariqul; Levy, Diane; VanderWeele, Tyler J; Pierce, Brandon L; Graziano, Joseph H; Ahsan, Habibul; Chen, Yu

2015-05-01

Epidemiologic data on genetic susceptibility to cardiovascular effects of arsenic exposure from drinking water are limited. We investigated whether the association between well-water arsenic and cardiovascular disease (CVD) differed by 170 single nucleotide polymorphisms (SNPs) in 17 genes related to arsenic metabolism, oxidative stress, inflammation, and endothelial dysfunction. We conducted a prospective case-cohort study nested in the Health Effects of Arsenic Longitudinal Study, with a random subcohort of 1,375 subjects and 447 incident fatal and nonfatal cases of CVD. Well-water arsenic was measured in 2000 at baseline. The CVD cases, 56 of which occurred in the subcohort, included 238 coronary heart disease cases, 165 stroke cases, and 44 deaths due to other CVD identified during follow-up from 2000 to 2012. Of the 170 SNPs tested, multiplicative interactions between well-water arsenic and two SNPs, rs281432 in ICAM1 (padj = 0.0002) and rs3176867 in VCAM1 (padj = 0.035), were significant for CVD after adjustment for multiple testing. Compared with those with GC or CC genotype in rs281432 and lower well-water arsenic, the adjusted hazard ratio (aHR) for CVD was 1.82 (95% CI: 1.31, 2.54) for a 1-SD increase in well-water arsenic combined with the GG genotype, which was greater than expected given aHRs of 1.08 and 0.96 for separate effects of arsenic and the genotype alone, respectively. Similarly, the joint aHR for arsenic and the rs3176867 CC genotype was 1.34 (95% CI: 0.95, 1.87), greater than expected given aHRs for their separate effects of 1.02 and 0.84, respectively. Associations between CVD and arsenic exposure may be modified by genetic variants related to endothelial dysfunction.

Diagnostic accuracy of sub-mSv prospective ECG-triggering cardiac CT in young infant with complex congenital heart disease.

PubMed

Gao, Wei; Zhong, Yu Min; Sun, Ai Min; Wang, Qian; Ouyang, Rong Zhen; Hu, Li Wei; Qiu, Han Sheng; Wang, Shi Yu; Li, Jian Ying

2016-06-01

To explore the clinical value and evaluate the diagnostic accuracy of sub-mSv low-dose prospective ECG-triggering cardiac CT (CCT) in young infants with complex congenital heart disease (CHD). A total of 102 consecutive infant patients (53 boys and 49 girls with mean age of 2.9 ± 2.4 m and weight less than 5 kg) with complex CHD were prospectively enrolled. Scans were performed on a 64-slice high definition CT scanner with low dose prospective ECG-triggering mode and reconstructed with 80 % adaptive statistical iterative reconstruction algorithm. All studies were performed during free breathing with sedation. The subjective image quality was evaluated by 5-point grading scale and interobserver variability was calculated. The objective image noise (standard deviation, SD) and contrast to noise ratio (CNR) was calculated. The effective radiation dose from the prospective ECG-triggering mode was recorded and compared with the virtual conventional retrospective ECG-gating mode. The detection rate for the origin of coronary artery was calculated. All patients also underwent echocardiography before CCT examination. 81 patients had surgery and their preoperative CCT and echocardiography findings were compared with the surgical results and sensitivity, specificity, positive and negative predictive values and accuracy were calculated for separate cardiovascular anomalies. Heart rates were 70-161 beats per minute (bpm) with mean value of 129.19 ± 14.52 bpm. The effective dose of 0.53 ± 0.15 mSv in the prospective ECG-triggering cardiac CT was lower than the calculated value in a conventional retrospective ECG-gating mode (2.00 ± 0.35 mSv) (p < 0.001). The mean CNR and SD were 28.19 ± 13.00 and 15.75 ± 3.61HU, respectively. The image quality scores were 4.31 ± 0.36 and 4.29 ± 0.41 from reviewer 1 and 2 respectively with an excellent agreement between them (Kappa = 0.85). The detection rate for the origins of the left and right coronary arteries was 96 and 90 %, respectively. The detection rates of the origins of left coronary artery and right coronary artery in all cases were 96 % (78/81) and 90 % (73/81), respectively. Twenty cases of conotruncal anomalies and ALCAPA were validated surgically and the accuracy of cardiac CT diagnosis was 95 % (19/20). The overall deformity based sensitivity, specificity, positive predictive value and negative predictive value were 94.0.1, 99.9, 98.6, 99.5 % respectively, by CCT, and 88.2, 99.9, 97.8, 99.0 %, respectively, by echocardiography. Prospective ECG-triggering CCT with sub-mSv effective dose provides excellent imaging quality and high diagnostic accuracy for young infants with complex CHD.

Getting Ready for the Profession: Prospective Teachers' Noticing Related to Teacher Actions

ERIC Educational Resources Information Center

Osmanoglu, Aslihan; Isiksal, Mine; Koc, Yusuf

2015-01-01

The aim of this study was to investigate what the prospective elementary mathematics teachers noticed and how their noticing changed in an environment in which they discuss on video cases. To achieve this aim, we asked senior elementary mathematics prospective teachers to watch and discuss videos depicting real elementary mathematics classrooms.…

Prospective Science Teachers' Subject-Matter Knowledge about Overflow Container

ERIC Educational Resources Information Center

Ültay, Eser

2016-01-01

The purpose of this study was to determine prospective science teachers' subject-matter knowledge (SMK) about overflow container. This study was carried out in the form of a case study in spring term of the academic year of 2013-2014 with seven sophomore prospective science teachers who were studying at Elementary Science Teaching Department in…

A Study on Prospective Science Teachers' Knowledge and Achievement Levels in Mathematical Logic in Electricity-Related Subjects

ERIC Educational Resources Information Center

Yilmaz, Ismail

2012-01-01

The purpose of this case study is to reveal prospective science teachers' knowledge and achievement levels in electricity-related subjects. The data for the study were collected from 44 prospective teachers using three measurement tools. The data were then analyzed using software developed for the Probability and Possibility Calculation Statistics…

The Limitations of a Prospective Study of Memories for Child Sexual Abuse

ERIC Educational Resources Information Center

Cheit, Ross E.

2003-01-01

Prospective studies have been held out as a kind of Holy Grail in research about remembering or forgetting child sexual abuse. They seem to hold the perfect answer to the verification problems that plague retrospective self-reports in the clinical literature. Prospective studies begin with verified cases of abuse. Then they require detective work…

Are Creative Comparisons Developed by Prospective Chemistry Teachers Evidence of Their Conceptual Understanding? The Case of Inter- and Intramolecular Forces

ERIC Educational Resources Information Center

Sendur, Gulten

2014-01-01

The aim of this study is to determine prospective chemistry teachers' creative comparisons about the basic concepts of inter- and intramolecular forces, and to uncover the relationship between these creative comparisons and prospective teachers' conceptual understanding. Based on a phenomenological research method, this study was conducted with…

Understanding of Prospective Mathematics Teachers of the Concept of Diagonal

ERIC Educational Resources Information Center

Ayvaz, Ülkü; Gündüz, Nazan; Bozkus, Figen

2017-01-01

This study aims to investigate the concept images of prospective mathematics teachers about the concept of diagonal. With this aim, case study method was used in the study. The participants of the study were consisted of 7 prospective teachers educating at the Department of Mathematics Education. Criterion sampling method was used to select the…

Prospective Mathematics Teachers' Opinions about Mathematical Modeling Method and Applicability of This Method

ERIC Educational Resources Information Center

Akgün, Levent

2015-01-01

The aim of this study is to identify prospective secondary mathematics teachers' opinions about the mathematical modeling method and the applicability of this method in high schools. The case study design, which is among the qualitative research methods, was used in the study. The study was conducted with six prospective secondary mathematics…

Conversations about the Moon with Prospective Teachers in Japan

ERIC Educational Resources Information Center

Suzuki, Mariko

2003-01-01

As an instructor in courses for prospective teachers, I am interested in my students' ideas and ways in which they reconstruct their ideas in conversations about science. In the case study presented here, I reflect upon (a) ways in which I engaged prospective teachers in thinking together about their observations of a natural phenomenon, the…

Childhood intussusception: A prospective study of management trend in a developing country.

PubMed

Ogundoyin, Olakayode Olaolu; Olulana, Dare Isaac; Lawal, Taiwo Akeem

2015-01-01

The management of intussusception has evolved universally from the use of hydrostatic reduction through operative reduction to the use of pneumatic reduction for the acute and uncomplicated cases and surgical reduction for the complicated cases. However, the process of evolution has been very slow in the developing countries, especially sub-Saharan Africa, due to lack of requisite facilities and expertise to manage these patients nonoperatively. This study examined the trends in the management of childhood intussusception in a developing country, compared operative and nonoperative modalities of treatment, and assessed the impact of delayed presentation on the outcome of management. This was a prospective study of the management of children with intussusception at the University College Hospital, Ibadan, Nigeria. Fifty-five consecutive cases of intussusception that presented to the Children Emergency Unit of the University College Hospital between January 2005 and December 2011 were prospectively studied. Details of sex, age of the patients, clinical presentation, duration of symptoms, mode of treatment, and incidence of recurrence were recorded and analyzed. The median age was 7 months. Moreover, the duration of symptoms varied from 1 to 21 days with a mean of 4 days. Twenty-two patients (40%) had attempted hydrostatic reduction; this was successful in 14 patients (63.6%), whereas 8 patients (36.4%) had failed reduction. In all, 41 patients (74.6%) had operative management of intussusceptions; primary operative intervention was carried out in 33 patients (60%) and secondary surgical management in 8 patients (14.5%) with failed hydrostatic reduction. At surgery, manual reduction of intussusception was carried out on 17 patients (30.9%) and resection of devitalized bowel with end to end anastomosis was carried out on the remaining 24 patients (43.6%). The incidence of surgical intervention for intussusception was 74.6%, mortality was 3.6%, and recurrence rate was 3.6%. Nonoperative management of intussusception should be adopted in carefully selected cases of intussusception in this subregion as it will help to reduce the financial burden on the parents while surgical management should be reserved for the complicated cases.

Plasma 25-hydroxyvitamin D concentration and subsequent risk of total and site specific cancers in Japanese population: large case-cohort study within Japan Public Health Center-based Prospective Study cohort.

PubMed

Budhathoki, Sanjeev; Hidaka, Akihisa; Yamaji, Taiki; Sawada, Norie; Tanaka-Mizuno, Sachiko; Kuchiba, Aya; Charvat, Hadrien; Goto, Atsushi; Kojima, Satoshi; Sudo, Natsuki; Shimazu, Taichi; Sasazuki, Shizuka; Inoue, Manami; Tsugane, Shoichiro; Iwasaki, Motoki

2018-03-07

To evaluate the association between pre-diagnostic circulating vitamin D concentration and the subsequent risk of overall and site specific cancer in a large cohort study. Nested case-cohort study within the Japan Public Health Center-based Prospective Study cohort. Nine public health centre areas across Japan. 3301 incident cases of cancer and 4044 randomly selected subcohort participants. Plasma concentration of 25-hydroxyvitamin D measured by enzyme immunoassay. Participants were divided into quarters based on the sex and season specific distribution of 25-hydroxyvitamin D among subcohorts. Weighted Cox proportional hazard models were used to calculate the multivariable adjusted hazard ratios for overall and site specific cancer across categories of 25-hydroxyvitamin D concentration, with the lowest quarter as the reference. Incidence of overall or site specific cancer. Plasma 25-hydroxyvitamin D concentration was inversely associated with the risk of total cancer, with multivariable adjusted hazard ratios for the second to fourth quarters compared with the lowest quarter of 0.81 (95% confidence interval 0.70 to 0.94), 0.75 (0.65 to 0.87), and 0.78 (0.67 to 0.91), respectively (P for trend=0.001). Among the findings for cancers at specific sites, an inverse association was found for liver cancer, with corresponding hazard ratios of 0.70 (0.44 to 1.13), 0.65 (0.40 to 1.06), and 0.45 (0.26 to 0.79) (P for trend=0.006). A sensitivity analysis showed that alternately removing cases of cancer at one specific site from total cancer cases did not substantially change the overall hazard ratios. In this large prospective study, higher vitamin D concentration was associated with lower risk of total cancer. These findings support the hypothesis that vitamin D has protective effects against cancers at many sites. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Design of the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study (NC ProCESS).

PubMed

Chen, Ronald C; Carpenter, William R; Kim, Mimi; Hendrix, Laura H; Agans, Robert P; Meyer, Anne-Marie; Hoffmeyer, Anna; Reeve, Bryce B; Nielsen, Matthew E; Usinger, Deborah S; Strigo, Tara S; Jackman, Anne M; Anderson, Mary; Godley, Paul A

2015-01-01

The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) was designed in collaboration with stakeholders to compare the effectiveness of different treatment options for localized prostate cancer. Using the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry, 1,419 patients (57% of eligible) with newly-diagnosed localized prostate cancer were enrolled from January 2011 to June 2013, on average 5 weeks after diagnosis. All participants were enrolled prior to treatment and this population-based cohort is sociodemographically diverse. Prospective follow-up continues to collect data on treatments received, disease control, survival and patient-reported outcomes. This study highlights several important considerations regarding stakeholder involvement, study design and generalizability regarding comparative effectiveness research in prostate cancer.

Outcome Analysis of Day-3 Frozen Embryo Transfer v/s Fresh Embryo Transfer in Infertility: A Prospective Therapeutic Study in Indian Scenario.

PubMed

Chandel, Neha Palo; Bhat, Vidya V; Bhat, B S; Chandel, Sidharth S

2016-10-01

Advanced fertilization techniques like frozen embryo transfer (FET) and assisted reproductive technology have become popular and commonly used methods to treat patients suffering from infertility. Incidences of infertility are on a rise due to increased representation of females in the work place, delay in marriages, stress, and ignorance. We performed this prospective therapeutic study to compare FET and fresh embryo transfer in the treatment of infertility in terms of conception rate, patient acceptance, complications, and patient's compliance. A prospective screening therapeutic study on 108 patients, from September 2013 to September 2014 in Karnataka, India, randomized the patients into 2 groups (n = 54), Group-I treated with day-3 FET while Group-II was treated with fresh embryo transfer, after performing ICSI. In 108 patients, 45 % patients were within 35 years of age, 35 % were in the age group 35-39. Significantly, 22 (40.75 %) patients treated with FET conceived (P = 0.022), whereas 16 (29.63 %) patients treated with fresh embryo transfer conceived (P = 0.59). There is limited published literature from the subcontinent, comparing techniques like FET and embryo transfers in the treatment of infertility. Awareness and economic reforms must be formulated in India to facilitate individuals facing infertility problems to conceive. FET has better and significant conception rates compared to fresh embryo transfers. FET shares an advantage of providing good quality embryos for future and subsequent implantations in cases of failure. Patient counseling and motivation play a pivotal role in the success of therapeutic procedure.

No difference in outcome for open versus arthroscopic rotator cuff repair: a prospective comparative trial.

PubMed

Bayle, Xavier; Pham, Thuy-Trang; Faruch, Marie; Gobet, Aurelie; Mansat, Pierre; Bonnevialle, Nicolas

2017-12-01

Arthroscopic techniques tend to become the gold standard in rotator cuff repair. However, little data are reported in the literature regarding the improvement of postoperative outcomes and re-tear rate relative to conventional open surgery. The aim of this study was to compare clinical outcomes and cuff integrity after arthroscopic versus open cuff repair. We prospectively assessed clinical outcomes and cuff integrity after an arthroscopic or open rotator cuff repair with a minimum follow-up of 12 months. Clinical evaluation was based on Constant score, Simple Shoulder Value (SSV) and American Shoulder and Elbow Score (ASES). Rotator cuff healing was explored with ultrasound. 44 patients in arthroscopic group A (mean age 56-year-old) and 43 in open group O (mean age 61-year-old) fulfilled the inclusion criteria. Tendons were repaired with a single row technique associated with biceps tenodesis and subacromial decompression. All objective clinical scores significantly improved postoperatively in both groups. No statistical difference was identified between group A and O regarding, respectively, Constant score (72 vs 75 points; p = 0.3), ASES score (88 vs 91 points; p = 0.3), and SSV (81 vs 85%). The overall rate of re-tear (Sugaya type IV or V) reached 7 and 9%, respectively, in group A and O (p = 0.8). This study did not prove any difference of arthroscopic over open surgery in case of rotator cuff repair regarding clinical outcome and cuff integrity at 1-year follow-up. Prospective comparative study.

Recording Adverse Events Following Joint Arthroplasty: Financial Implications and Validation of an Adverse Event Assessment Form.

PubMed

Lee, Matthew J; Mohamed, Khalid M S; Kelly, John C; Galbraith, John G; Street, John; Lenehan, Brian J

2017-09-01

In Ireland, funding of joint arthroplasty procedures has moved to a pay-by-results national tariff system. Typically, adverse clinical events are recorded via retrospective chart-abstraction methods by administrative staff. Missed or undocumented events not only affect the quality of patient care but also may unrealistically skew budgetary decisions that impact fiscal viability of the service. Accurate recording confers clinical benefits and financial transparency. The aim of this study was to compare a prospectively implemented adverse events form with the current national retrospective chart-abstraction method in terms of pay-by-results financial implications. An adverse events form adapted from a similar validated model was used to prospectively record complications in 51 patients undergoing total hip or knee arthroplasties. Results were compared with the same cohort using an existing data abstraction method. Both data sets were coded in accordance with current standards for case funding. Overall, 114 events were recorded during the study through prospective charting of adverse events, compared with 15 events documented by customary method (a significant discrepancy). Wound drainage (15.8%) was the most common complication, followed by anemia (7.9%), lower respiratory tract infections (7.9%), and cardiac events (7%). A total of €61,956 ($67,778) in missed funding was calculated as a result. This pilot study demonstrates the ability to improve capture of adverse events through use of a well-designed assessment form. Proper perioperative data handling is a critical aspect of financial subsidies, enabling optimal allocation of funds. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of Introducing Xpert MTB/RIF to Test and Treat Individuals at Risk of Multidrug-Resistant Tuberculosis in Kazakhstan: A Prospective Cohort Study.

PubMed

van Kampen, Sanne Christine; Tursynbayeva, Aigul; Koptleuova, Aliya; Murzakhmetova, Zauresh; Murzabekova, Zauresh; Bigalieva, Lyazzat; Aubakirova, Moldir; Pak, Svetlana; van den Hof, Susan

2015-01-01

Xpert MTB/RIF (Xpert) was piloted in Kazakhstan to detect tuberculosis (TB) and rifampicin resistance (RR-)TB among individuals at risk of multidrug-resistant (MDR-) TB. This study assessed the performance of Xpert compared to conventional diagnostic methods, RR-TB case detection among various risk groups, treatment initiation and time to diagnosis and treatment. Eligible individuals were tested with Xpert, smear microscopy, culture and drug-susceptibility testing (DST) at the national TB reference laboratory and three provincial laboratories. Data was collected prospectively from August 2012 to May 2013 from routine laboratory and treatment registers. A total of 5,611 Xpert tests were performed mostly targeting contacts of MDR-TB patients, 'other' presumptive MDR-TB patients, and retreatment cases (26%, 24% and 22%, respectively). Compared to phenotypic DST, the positive predictive value of Xpert to detect RR-TB was 93.1% and 96.4% and the negative predictive value was 94.6% and 92.7% using solid and liquid culture media, respectively. RR-TB detection was highest among (former) prisoners, retreatment cases, people living with HIV/AIDS (PLWHA), and TB patients with positive smears after intensive phase of treatment (59%, 58%, 54% and 53% among TB positives, respectively). 88.9% of RR-TB patients were registered to have started second-line TB treatment. Median time to diagnosis with Xpert was 0.0 days (IQR 0.0-1.0), time from diagnosis to start of first-line treatment 3.0 days (IQR 1.0-7.0), and to start of second-line treatment 7.0 days (IQR 4.0-16). Compared to conventional culture and DST, Xpert had a shorter result turn-around-time and excellent concordance to detect RR-TB. Time from sputum collection to start of second-line treatment was reduced to one week. The yield of Xpert could be maximized by increasing referrals from penitentiary and HIV centers to TB centers.

The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey

PubMed Central

Barret, Maximilien; Lepilliez, Vincent; Coumaros, Dimitri; Chaussade, Stanislas; Leblanc, Sarah; Ponchon, Thierry; Fumex, Fabien; Chabrun, Edouard; Bauret, Paul; Cellier, Christophe; Coron, Emmanuel; Bichard, Philippe; Bulois, Philippe; Charachon, Antoine; Rahmi, Gabriel; Bellon, Serge; Lerhun, Marc; Arpurt, Jean-Pierre; Koch, Stéphane; Napoleon, Bertrand; Vaillant, Eric; Esch, Anouk; Farhat, Said; Robin, Francoise; Kaddour, Nadira

2016-01-01

Introduction Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time. Material and methods All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008–2010 period. Results Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010–2013 vs 32.1 ± 21 for 2008–2010 (p = 0.004). En bloc resection improved from 77.1% to 91.7% (p < 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% (p = 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 (p < 0.0001), with bleeding decreasing from 11.2% to 4.7% (p = 0.01) and perforations from 18.1% to 8.1% (p = 0.002) over time. No procedure-related mortality was recorded. Conclusions In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates. PMID:28405321

Shivering in Febrile Children: Frequency and Usefulness in Predicting Serious Bacterial Infections - A Prospective Case-Control Study.

PubMed

Erell, Yair; Youngster, Ilan; Abu-Kishk, Ibrahim; Kozer, Eran

2017-11-01

A prospective case-control study was conducted in a pediatric emergency department to describe the proportion of febrile children experiencing shivering and its clinical significance. Shivering was reported in 186 of 645 febrile children (28.8%). The rate of serious bacterial infection was similar in 86 children with shivering and 86 matched controls. Copyright © 2017 Elsevier Inc. All rights reserved.

Microscopic Evaluation, Molecular Identification, Antifungal Susceptibility, and Clinical Outcomes in Fusarium, Aspergillus and, Dematiaceous Keratitis

PubMed Central

Gajjar, Devarshi U.; Pal, Anuradha K.; Ghodadra, Bharat K.; Vasavada, Abhay R.

2013-01-01

Purpose. Fusarium, Aspergillus, and Dematiaceous are the most common fungal species causing keratitis in tropical countries. Herein we report a prospective study on fungal keratitis caused by these three fungal species. Methodology. A prospective investigation was undertaken to evaluate eyes with presumed fungal keratitis. All the fungal isolates (n = 73) obtained from keratitis infections were identified using morphological and microscopic characters. Molecular identification using sequencing of the ITS region and antifungal susceptibility tests using microdilution method were done. The final clinical outcome was evaluated in terms of the time taken for resolution of keratitis and the final visual outcome. The results were analyzed after segregating the cases into three groups, namely, Fusarium, Aspergillus, and Dematiaceous keratitis. Results. Diagnosis of fungal keratitis was established in 73 (35.9%) cases out of 208 cases. The spectra of fungi isolated were Fusarium spp. (26.6%), Aspergillus spp. (21.6%), and Dematiaceous fungi (11.6%). The sequence of the ITS region could identify the Fusarium and Aspergillus species at the species complex level, and the Dematiaceous isolates were accurately identified. Using antifungal agents such as fluconazole, natamycin, amphotericin B, and itraconazole, the minimum inhibitory concentrations (MICs) for Fusarium spp. were >32 μg/mL, 4–8 μg/mL, 0.5–1 μg/mL, and >32 μg/mL, respectively. Antifungal susceptibility data showed that Curvularia spp. was highly resistant to all the antifungal agents. Overall, natamycin and amphotericin B were found to be the most effective antifungal agents. The comparative clinical outcomes in all cases showed that the healing response in terms of visual acuity of the Dematiaceous group was significantly good when compared with the Fusarium and Aspergillus groups (P < 0.05). The time required for healing in the Fusarium group was statistically significantly less when compared with the Aspergillus and Dematiaceous groups. Conclusion. This study demonstrates important differences in microscopic features of scraping material and antifungal susceptibility between the three groups. Early and accurate identification coupled with the MIC data, and thereby appropriate treatment is crucial for complete recovery. PMID:24260740

Totally implantable venous access devices: evaluation of complications and a prospective comparative study of two different port systems.

PubMed

Hartkamp, A; van Boxtel, A J; Zonnenberg, B A; Witteveen, P O

2000-12-01

Totally implantable venous access devices (TIVADs) are valuable instruments in case prolonged intravenous therapy is required, but implantation and use of these devices are associated with complications. The purpose of this study was to evaluate perioperative and long-term complications associated with TIVADs. In addition, we compared two different types of TIVADs with respect to implantation, care protocol and patients' comfort. In a retrospective study perioperative and long-term complications in a general oncology population were analysed. In a prospective randomized study comparison of two types of TIVADs was carried out. Perioperative complications occurred in 27 (21.4%) of 126 implanted TIVADs: catheter malposition (16.7%) in 21 patients, pneumothorax (0.8%) in one and haemorrhage (4.0%) in five. Long-term complications appeared in 31 (25.2%) out of 123 TIVADs: thrombosis in 9 (7.3%), especially associated with malposition of the tip of the catheter; infection in 10 (8.1%); extravasation in 2 (1.6%); migration of the catheter tip in 6 (4.8%); pain at reservoir in 3 (2.4%) and inaccessibility of the port in 1 (0.8%). No significant differences were found with respect to implantation, care accessibility and patients' comfort between the two TIVADs. The use of TIVADs is associated with some risk of serious perioperative and long-term complications. In case of thrombotic complications these systems can be saved with appropriate treatment. Correct positioning of the catheter tip is essential to prevent thrombotic complications. In case of TIVAD-related infectious complications, the possibility of saving the TIVAD depends on the causative microorganism and type of infection. Furthermore, to increase patients' satisfaction with TIVADs they should be well informed about the surgical procedure and possible disadvantages of these devices.

Non-HACEK gram-negative bacillus endocarditis.

PubMed

Morpeth, Susan; Murdoch, David; Cabell, Christopher H; Karchmer, Adolf W; Pappas, Paul; Levine, Donald; Nacinovich, Francisco; Tattevin, Pierre; Fernández-Hidalgo, Núria; Dickerman, Stuart; Bouza, Emilio; del Río, Ana; Lejko-Zupanc, Tatjana; de Oliveira Ramos, Auristela; Iarussi, Diana; Klein, John; Chirouze, Catherine; Bedimo, Roger; Corey, G Ralph; Fowler, Vance G

2007-12-18

Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users. To describe the clinical characteristics and outcomes of patients with non-HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients. Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database. 61 hospitals in 28 countries. Hospitalized patients with definite endocarditis. Characteristics of non-HACEK gram-negative bacillus endocarditis cases were described and compared with those due to other pathogens. Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11%; P < 0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%). Because of the small number of patients with non-HACEK gram-negative bacillus endocarditis in each treatment group and the lack of long-term follow-up, strong treatment recommendations are difficult to make. In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.

Population-based surveillance of neonatal herpes simplex virus infection in Australia, 1997-2011.

PubMed

Jones, Cheryl A; Raynes-Greenow, Camille; Isaacs, David

2014-08-15

Neonatal herpes simplex virus (HSV) infection is uncommon, but mortality after disseminated disease and morbidity after encephalitis are high. For the last decade, increased dose and duration of acyclovir has been advised to prevent disease progression and recurrence. We sought to determine prospectively the epidemiologic, clinical, and secular trends of this condition in Australia. This was prospective national active surveillance for neonatal HSV disease through the Australian Paediatric Surveillance Unit from 1997 to 2011. Case notification triggered a questionnaire requesting de-identified data from the pediatric clinician. We identified 131 confirmed cases of neonatal HSV disease in 15 years from 261 notifications (95% response). The reported incidence (3.27 cases per 100 000 live births overall; 95% confidence interval [CI], 2.73-3.86) was stable. Overall mortality was 18.8% (95% CI, 12.1-25.5); the mortality rate was significantly lower in the latter part of the study period, 2005-2011, compared with 1997-2004 (P = .04). There were significantly more young mothers (<20 years of age) compared with Australian birth record data (18.5% vs 4.8%; P < .001). HSV-1 infection was more common than HSV-2 (62.7% vs 37.3%; P < .001), and the rate of HSV-1 infections increased significantly over the surveillance period (P < .05). From 2002, most infants received high-dose acyclovir. The time from symptom onset to initiation of therapy in survivors did not change over time. Mortality from neonatal HSV infection has fallen but remains high. HSV-1 is the major serotype causing neonatal disease in Australia. Young mothers represent an important target group for prevention. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis.

PubMed

Monto, Raymond Rocco

2014-04-01

Chronic plantar fasciitis is a common orthopedic condition that can prove difficult to successfully treat. In this study, autologous platelet-rich plasma (PRP), a concentrated bioactive blood component rich in cytokines and growth factors, was compared to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. Forty patients (23 females and 17 males) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of standardized traditional nonoperative treatment modalities were prospectively randomized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scoring was completed for all patients immediately prior to PRP or cortisone injection (pretreatment = time 0) and at 3, 6, 12, and 24 months following injection treatment. Baseline pretreatment radiographs and MRI studies were obtained in all cases to confirm the diagnosis of plantar fasciitis. The cortisone group had a pretreatment average AOFAS score of 52, which initially improved to 81 at 3 months posttreatment but decreased to 74 at 6 months, then dropped to near baseline levels of 58 at 12 months, and continued to decline to a final score of 56 at 24 months. In contrast, the PRP group started with an average pretreatment AOFAS score of 37, which increased to 95 at 3 months, remained elevated at 94 at 6 and 12 months, and had a final score of 92 at 24 months. PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis. Level I, prospective randomized comparative series.

Association between road accidents and low-grade hepatic encephalopathy among Sri Lankan drivers with cirrhosis: a prospective case control study.

PubMed

Subasinghe, S K C E; Nandamuni, Y; Ranasinghe, S; Niriella, M A; Miththinda, J K N D; Dassanayake, A; de Silva, A P; de Silva, H J

2016-06-13

Low-grade hepatic encephalopathy (LGHE) comprises minimal hepatic encephalopathy (MHE) and grade 1 hepatic encephalopathy. LGHE has no or minimal recognizable symptoms but has mild cognitive and psychomotor deficits. Studies in Western countries have demonstrated increased road accidents (RA) among patients with MHE. Our objective was to investigate the association between Sri Lankan LGHE phenotype and RA. A prospective, case-control study was conducted in the University Medical Unit, North Colombo Teaching Hospital, Ragama Sri Lanka. Patients with cirrhosis of any aetiology, without OHE, who had been driving during previous 1 month were included. A similar number of age matched, healthy control drivers were also enrolled. Both groups were subjected to five pencil-paper based psychometric tests used to detect LGHE in cirrhotics. Self-reported RA during the previous 1 month were recorded: categorized as 'major' when resulted in hospitalization of the involved, 'minor' when there were injuries, but not serious enough for hospitalization of the involved and 'other' when limited to damages to vehicle or environment without injuries. Among 55 drivers with cirrhosis and LGHE [males, median age 53 years (range 30-60)], 7 (12.7 %) reported RA compared to 6 (10.9 %) among 55 controls [males; median age 51 years (range 30-60)]. There were no 'major' accidents in either group. 2/55 (3.6 %) cases and 2/55 (3.6 %) controls reported 'minor' accidents. There was no increased frequency of RA among Sri Lankan drivers with LGHE compared to healthy controls. This is with the limitation of the study based only on self reported RA.

The FIDELIS initiative: innovative strategies for increased case finding.

PubMed

Hinderaker, S G; Rusen, I D; Chiang, C-Y; Yan, L; Heldal, E; Enarson, D A

2011-01-01

Low-income, high tuberculosis (TB) burden countries. To compare case finding of new smear-positive pulmonary TB patients in projects funded to apply innovative approaches. Prospective application of innovative approaches to case finding within routine services to determine the numbers of additional cases detected and the cost per additional case detected, according to the type of approach applied. Between 2003 and 2007, 51 FIDELIS projects were implemented in 18 countries; 273,239 cases were reported, of which 85,267 were additional to the number reported in the previous year. The median cost per additional case was US$103. The interventions employed were: 1) social mobilisation and information, education and communication; 2) engagement of the private sector; 3) innovative approaches for microscopy services; 4) enhanced or semi-active case finding; 5) health systems strengthening; and 6) use of incentives. None of these was significantly more likely to detect additional cases or to have a lower cost per additional case than any of the others. While there was a substantial increase in cases detected, at a moderate cost per additional case, we were unable to show that any single intervention had an advantage over the others.

Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians.

PubMed

Crowe, Francesca L; Appleby, Paul N; Allen, Naomi E; Key, Timothy J

2011-07-19

To examine the associations of a vegetarian diet and dietary fibre intake with risk of diverticular disease. Prospective cohort study. The EPIC-Oxford study, a cohort of mainly health conscious participants recruited from around the United Kingdom. 47,033 men and women living in England or Scotland of whom 15,459 (33%) reported consuming a vegetarian diet. Diet group was assessed at baseline; intake of dietary fibre was estimated from a 130 item validated food frequency questionnaire. Cases of diverticular disease were identified through linkage with hospital records and death certificates. Hazard ratios and 95% confidence intervals for the risk of diverticular disease by diet group and fifths of intake of dietary fibre were estimated with multivariate Cox proportional hazards regression models. After a mean follow-up time of 11.6 years, there were 812 cases of diverticular disease (806 admissions to hospital and six deaths). After adjustment for confounding variables, vegetarians had a 31% lower risk (relative risk 0.69, 95% confidence interval 0.55 to 0.86) of diverticular disease compared with meat eaters. The cumulative probability of admission to hospital or death from diverticular disease between the ages of 50 and 70 for meat eaters was 4.4% compared with 3.0% for vegetarians. There was also an inverse association with dietary fibre intake; participants in the highest fifth (≥25.5 g/day for women and ≥26.1 g/day for men) had a 41% lower risk (0.59, 0.46 to 0.78; P<0.001 trend) compared with those in the lowest fifth (<14 g/day for both women and men). After mutual adjustment, both a vegetarian diet and a higher intake of fibre were significantly associated with a lower risk of diverticular disease. Consuming a vegetarian diet and a high intake of dietary fibre were both associated with a lower risk of admission to hospital or death from diverticular disease.

Effect of prospective reimbursement on nursing home costs.

PubMed Central

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-01-01

OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. STUDY DESIGN. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. PRINCIPAL FINDINGS. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. CONCLUSIONS. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems. PMID:8463109

Effect of prospective reimbursement on nursing home costs.

PubMed

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-04-01

This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.

Cause and motivation in cases of non-fatal drug overdoses in opiate addicts.

PubMed

Pfab, R; Eyer, F; Jetzinger, E; Zilker, Thomas

2006-01-01

Drug overdose (OD) is a frequent incident among opiate addicts. Survivors of ODs are at risk for additional and eventually fatal ODs. ODs may be classified as accidental (aOD) or deliberate (dOD). Investigations into the connection between OD and suicide attempts have led to insconsistent results. (1) to determine how many non-fatal ODs were dODs and how many were aODs; (2) to determine how many cases of dODs were motivated by explicit or by ambivalent suicidal intentions; (3) to determine how many cases of aODs had causes that might respond to preventative measures; (4) to compare the addiction histories of dODs and aODs; (5) to compare the drugs causing the ODs; and (6) to compare the severity of the ODs in both groups. Prospective study utilizing a standardized questionnaire to evaluate opiate-addicted patients admitted to our treatment unit for OD. All cases underwent standardized drug testing to identify drug use patterns. Seventy-four cases of OD underwent standardized interviews after awakening. Forty-three percent of the cases were dOD. Cases of dOD had significantly more OA in substitution programs, more previous ODs, and more often consumed methadone and cocaine. Among dODs, 22.5% had suicidal intention and 9.6% were ambivalent about committing suicide; background motivations were most often conflicts with spouses. Fifty-seven percent of the cases were aOD. Cases of aODs had significantly more potential lethal intoxications and had heroin detected more frequently. aODs happened with unexpected pure heroin (46%), in combination with alcohol (36%), as relapse after abstinence (40%) or after institutionalized treatment (19%). This group should be accessible for targeted education.

[Implementation and (cost-)effectiveness of case management for people with dementia and their informal caregivers: results of the COMPAS study].

PubMed

van Mierlo, Lisa D; MacNeil-Vroomen, Janet; Meiland, Franka J M; Joling, Karlijn J; Bosmans, Judith E; Dröes, Rose Marie; Moll van Charante, Eric P; de Rooij, Sophia E J A; van Hout, Hein P J

2016-12-01

Different forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form. Evaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation. A mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs). Outcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group. The integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.

A one-year prospective study of refractory status epilepticus in Modena, Italy.

PubMed

Giovannini, Giada; Monti, Giulia; Polisi, Michela M; Mirandola, Laura; Marudi, Andrea; Pinelli, Giovanni; Valzania, Franco; Girardis, Massimo; Nichelli, Paolo F; Meletti, Stefano

2015-08-01

Refractory status epilepticus (RSE) is a particular critical condition characterized by seizures that continue despite the use of first- and second-line therapies and by high mortality. To date, only one prospective study investigated clinical features and prognostic factors in RSE. In this study, we performed a one-year prospective survey to identify clinical features, outcomes, and variables associated with the development of RSE in the adolescent and adult population of Modena, northern Italy. We observed 83 episodes of SE in 83 patients. In 31% of the cases, third-line therapy (anesthetic drug) was needed. Among this group, 14% resolved and were classified as RSE, while, in 17%, seizures recurred at withdrawal of anesthetics and were classified as super-RSE. The development of RSE/super-RSE was associated with a stuporous/comatose state at presentation and with the absence of a previous history of epilepsy. Refractory status epilepticus/super-refractory status epilepticus showed a worse outcome compared with responsive SE: 54% versus 21% for 30-day mortality; 19% versus 56% for a return to baseline condition. This prospective study confirms stupor/coma at onset as a relevant clinical factor associated with SE refractoriness. We observed a rate of RSE comparable with previous reports, with high mortality and morbidity. Mortality in the observed RSE was higher than in previous studies; this result is probably related to the low rate of a previous epilepsy history in our population that reflects a high incidence of acute symptomatic etiologies, especially the inclusion of patients with postanoxic SE who have a bad prognosis per se. This article is part of a Special Issue entitled "Status Epilepticus". Copyright © 2015 Elsevier Inc. All rights reserved.

Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database.

PubMed

Etoh, Tsuyoshi; Honda, Michitaka; Kumamaru, Hiraku; Miyata, Hiroaki; Yoshida, Kazuhiro; Kodera, Yasuhiro; Kakeji, Yoshihiro; Inomata, Masafumi; Konno, Hiroyuki; Seto, Yasuyuki; Kitano, Seigo; Hiki, Naoki

2018-06-01

Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry. From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG. The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively). The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.

Video-Assisted Thoracic Surgical Lobectomy for Lung Cancer: Description of a Learning Curve.

PubMed

Yao, Fei; Wang, Jian; Yao, Ju; Hang, Fangrong; Cao, Shiqi; Cao, Yongke

2017-07-01

Video-assisted thoracic surgical (VATS) lobectomy is gaining popularity in the treatment of lung cancer. The aim of this study is to investigate the learning curve of VATS lobectomy by using multidimensional methods and to compare the learning curve groups with respect to perioperative clinical outcomes. We retrospectively reviewed a prospective database to identify 67 consecutive patients who underwent VATS lobectomy for lung cancer by a single surgeon. The learning curve was analyzed by using moving average and the cumulative sum (CUSUM) method. With the moving average and CUSUM analyses for the operation time, patients were stratified into two groups, with chronological order defining early and late experiences. Perioperative clinical outcomes were compared between the two learning curve groups. According to the moving average method, the peak point for operation time occurred at the 26th case. The CUSUM method also showed the operation time peak point at the 26th case. When results were compared between early- and late-experience periods, the operation time, duration of chest drainage, and postoperative hospital stay were significantly longer in the early-experience group (cases 1 to 26). The intraoperative estimated blood loss was significantly less in the late-experience group (cases 27 to 67). CUSUM charts showed a decreasing duration of chest drainage after the 36th case and shortening postoperative hospital stay after the 37th case. Multidimensional statistical analyses suggested that the learning curve for VATS lobectomy for lung cancer required ∼26 cases. Favorable intraoperative and postoperative care parameters for VATS lobectomy were observed in the late-experience group.

The influence of occupational exposure to pesticides, polycyclic aromatic hydrocarbons, diesel exhaust, metal dust, metal fumes, and mineral oil on prostate cancer: a prospective cohort study.

PubMed

Boers, D; Zeegers, M P A; Swaen, G M; Kant, Ij; van den Brandt, P A

2005-08-01

To investigate the relation between exposure to pesticides, polycyclic aromatic hydrocarbons (PAHs), diesel exhaust, metal dust, metal fumes, and mineral oil in relation to prostate cancer incidence in a large prospective study. This cohort study was conducted among 58,279 men in the Netherlands. In September 1986, cohort members (55-69 years) completed a self-administered questionnaire on potential cancer risk factors, including job history. Follow up for prostate cancer incidence was established by linkage to cancer registries until December 1995 (9.3 years of follow up). The analyses included 1386 cases of prostate cancer and 2335 subcohort members. A blinded case-by-case expert exposure assessment was carried out to assign cases and subcohort members a cumulative probability of exposure for each potential carcinogenic exposure. In multivariate analyses there was a significant negative association for pesticides (RR 0.60; 95% CI 0.37 to 0.95) when comparing the highest tertile of exposure to pesticides with no exposure. No association was found for occupational exposure to PAHs (RR 0.75; 95% CI 0.42 to 1.31), diesel exhaust (RR 0.81; 95% CI 0.62 to 1.06), metal dust (RR 1.01; 95% CI 0.72 to 1.40), metal fumes (RR 1.11; 95% CI 0.80 to 1.54), or mineral oil (RR 0.99; 95% CI 0.66 to 1.48) when comparing the highest tertile of exposure with no exposure. In subgroup analysis, with respect to tumour invasiveness and morphology, null results were found for occupational exposure to pesticides, PAH, diesel exhaust, metal dust, metal fumes, and mineral oil. These results suggest a negative association between occupational exposure to pesticides and prostate cancer. For other carcinogenic exposures results suggest no association between occupational exposure to PAHs, diesel exhaust, metal dust, metal fumes, or mineral oil and prostate cancer.

Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears.

PubMed

Kim, Yang-Soo; Lee, Hyo-Jin; Bae, Sung-Ho; Jin, Hyonki; Song, Hyun Seok

2015-11-01

To compare the clinical outcomes of arthroscopic in situ repair with the tear completion repair technique for partial-thickness rotator cuff tears (PT-RCTs). We prospectively enrolled 100 cases with articular-sided and bursal-sided PT-RCTs exceeding 50% of tendon thickness and allocated them randomly. An in situ repair was performed in group 1 (n = 50). Completion of the remaining cuff tissue and repair were performed in group 2 (n = 50). The medial row was knotted as transosseous repair (suture-bridge technique) in all cases. American Shoulder Elbow Society (ASES) score, Constant shoulder (CS) score, Simple shoulder (SS) score, and Korean shoulder (KS) score, and visual analog scale (VAS) for pain and range of motion were assessed at 3, 6, and 12 months and at the last visit. Repaired tendon integrity was determined at 6 to 12 months by magnetic resonance imaging. Eight cases were lost to follow-up. Ultimately, 92 cases were analyzed. The average follow-up was 19.1 months (range, 12 to 42 months). Significant improvements in the VAS for pain and functional outcomes were observed in both groups postoperatively (P = .001 for VAS; P < .001 for ASES score; P < .001 for CS score; P = .001 for SS score; P<.001 for KS score). No significant difference in the clinical results was observed at any time between the groups. No difference of retear rate on articular-sided PT-RCT was observed between the groups (P = .34). Retears on the bursal-sided PT-RCT were more frequent in group 2 (P = .02). Arthroscopic repair of PT-RCT exceeding 50% of the thickness provided functional improvements and pain relief regardless of the repair technique. The retear rate for bursal-sided PT-RCT was higher in group 2, although the retear rate for the articular-sided PT-RCT was not different. Level II, prospective comparative study. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Overall and abdominal obesity and incident aortic valve stenosis: two prospective cohort studies

PubMed Central

Larsson, Susanna C.; Wolk, Alicja; Håkansson, Niclas; Bäck, Magnus

2017-01-01

Abstract Aims The aim of this study was to examine the association of overall and abdominal obesity with aortic valve stenosis (AVS) incidence in two prospective cohorts. Methods and results We used data from the Cohort of Swedish Men and the Swedish Mammography Cohort, involving 71 817 men and women who were free of cardiovascular disease and had reported their anthropometric measures in 1997. Aortic valve stenosis cases were ascertained through linkage with nationwide registers on hospitalization and causes of death. Data were analysed using Cox proportional hazards regression. During a mean follow-up of 15.3 years, 1297 incident AVS cases (771 in men; 526 in women) were ascertained. Both overall and abdominal obesity, measured as body mass index (BMI) and waist circumference, respectively, was associated with AVS incidence, with similar associations in men and women. Compared with BMI 18.5–22.5 kg/m2, the multivariable hazard ratios were 1.24 (95% confidence interval [CI] 1.05–1.48) for overweight (BMI 25.0–29.9 kg/m2) and 1.81 (95% CI 1.47–2.23) for obesity (BMI ≥30 kg/m2). The hazard ratio for substantially increased waist circumference (men: ≥102 cm; women: ≥88 cm) compared with normal waist circumference (men: <94 cm; women: <80 cm) was 1.30 (95% CI 1.12–1.51). The proportion of AVS cases estimated to be attributed to overweight and obesity combined (BMI ≥25 kg/m2) was 10.8% (95% CI 5.2–16.4%). Conclusion These findings indicate that obesity is associated with an increased risk of AVS and that a large proportion of the cases may be prevented if the population maintained a healthy BMI. PMID:28402538

A Study on Prospective Teachers' Self-Efficacy Beliefs Regarding the Implementation of Constructivist Approach (A Case of Konya)

ERIC Educational Resources Information Center

Ektem, Isil Sönmez

2016-01-01

The purpose of this study was to reveal prospective teachers' perceptions and views about the implementation of the constructivist approach. The study was conducted on 528 prospective teachers in their 4th year at Necmettin Erbakan University Ahmet Kelesoglu Education Faculty and Selcuk University Faculty of Science and Faculty of Letters in the…

The Effect of Instruction through Mathematical Modelling on Modelling Skills of Prospective Elementary Mathematics Teachers

ERIC Educational Resources Information Center

Ciltas, Alper; Isik, Ahmet

2013-01-01

The aim of this study was to examine the modelling skills of prospective elementary mathematics teachers who were studying the mathematical modelling method. The research study group was composed of 35 prospective teachers. The exploratory case analysis method was used in the study. The data were obtained via semi-structured interviews and a…

Using Culture as a Resource in Mathematics: The Case of Four Mexican-American Prospective Teachers in a Bilingual After-School Program

ERIC Educational Resources Information Center

Vomvoridi-Ivanovic, Eugenia

2012-01-01

This paper explores Mexican-American prospective teachers' use of culture--defined as social practices and shared experiences--as an instructional resource in mathematics. The setting is an after-school mathematics program for the children of Mexican heritage. Qualitative analysis of the prospective teachers' and children's interactions reveals…

The prospective relationship between role stressors and new cases of self-reported workplace bullying.

PubMed

Reknes, Iselin; Einarsen, Ståle; Knardahl, Stein; Lau, Bjørn

2014-02-01

In line with the "Work environment hypothesis," role stressors have been proposed as important antecedents of bullying in the workplace. Only a few longitudinal studies on the relationship between role stressors and bullying exist, however, and earlier studies have largely been cross-sectional. The aim of the present prospective study was to determine whether role stressors at baseline predict new cases of workplace bullying at follow-up. A total of 2,835 Norwegian employees participated at both baseline and follow-up, with an interval of two years between the measurements. The study supports the hypotheses that role ambiguity and role conflict, independently, contribute to subsequent new reports of workplace bullying. However, there was a weak reverse effect: reporting being bullied at work at baseline predicted reporting increased levels of role ambiguity and role conflict at follow-up. Even though the results may indicate a circular relationship between the variables at hand, the weak reverse relationship seems to have little practical impact compared to the stronger relationship from role stressors to bullying. Hence, the results mainly support the hypotheses stating that role ambiguity and role conflict, independently, predict subsequent exposure to workplace bullying.

Improving the Accuracy of Diagnosing Placenta Previa on Transvaginal Ultrasound by Distinguishing between the Uterine Isthmus and Cervix: A Prospective Multicenter Observational Study.

PubMed

Hasegawa, Junichi; Kawabata, Ikuno; Takeda, Yoshiharu; Aoki, Hiroaki; Fukami, Takehiko; Tajima, Atsushi; Miyakoshi, Kei; Otsuki, Katsufumi; Shinozuka, Norio; Matsuda, Yoshio; Iwashita, Mitsutoshi; Okai, Takashi; Nakai, Akihito

2017-01-01

To clarify whether distinguishing between the uterine isthmus and cervix can improve the accuracy of diagnosing placenta previa at term. A multicenter prospective observational study was conducted among pregnant women with suspected placenta previa at 20-24 weeks' gestation. Subjects were divided into the open isthmus group and closed isthmus group. The accuracy of diagnosing placenta previa at term was compared between the 2 groups. We screened 9,341 patients, and 53 (0.6%) met the inclusion criteria. Nineteen cases with an open isthmus and 34 with a closed isthmus were followed. The accuracy for diagnosing placenta previa or a low-lying placenta at term was 94.7% in the open isthmus group and 26.5% in the closed isthmus group (p < 0.001). Elective or emergency Cesarean section was required in 100% of cases in the open isthmus group and 20.6% in the closed isthmus group (p < 0.001). A high prediction rate of placenta previa was obtained by using transvaginal ultrasound at 20-24 weeks' gestation after the isthmus opened by carefully distinguishing between the cervix and isthmus. © 2016 S. Karger AG, Basel.

Pulmonary toxoplasmosis in immunocompromised patients with interstitial pneumonia: a single-centre prospective study assessing PCR-based diagnosis.

PubMed

Desoubeaux, Guillaume; Cabanne, Églantine; Franck-Martel, Claire; Gombert, Martin; Gyan, Emmanuel; Lissandre, Séverine; Renaud, Marc; Monjanel, Hélène; Dartigeas, Caroline; Bailly, Éric; Van Langendonck, Nathalie; Chandenier, Jacques

2016-08-01

Pulmonary toxoplasmosis has become a very rare parasitic infection since the advent of highly active antiretroviral therapies. It is generally diagnosed by the direct microscopic observation of Toxoplasma gondii tachyzoites in bronchoalveolar lavage fluid (BALF). The aim of this study was to assess possible improvements in diagnostic performance associated with the use of real-time PCR. This prospective study was carried out on BALFs obtained from immunocompromised patients over a 2-year period. We systematically compared the results of conventional staining with those of molecular detection. Two cases of pulmonary toxoplasmosis were diagnosed for a total of 336 samples. PCR did not detect any additional cases and was more time-consuming than conventional staining. Conventional staining is a reliable technique and is probably the most appropriate method for experienced microbiology laboratories, whereas T. gondii-specific PCR may be useful for laboratories with less experience in parasitology. 2015_030, May 27th 2015. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Adolescent chronic fatigue syndrome: prevalence, incidence, and morbidity.

PubMed

Nijhof, Sanne L; Maijer, Kimberley; Bleijenberg, Gijs; Uiterwaal, Cuno S P M; Kimpen, Jan L L; van de Putte, Elise M

2011-05-01

To determine nationwide general practitioner (GP)-diagnosed prevalence and pediatrician-diagnosed incidence rates of adolescent chronic fatigue syndrome (CFS), and to assess CFS morbidity. We collected data from a cross-sectional national sample among GPs and prospective registration of new patients with CFS in all pediatric hospital departments in the Netherlands. Study participants were adolescents aged 10 to 18 years. A representative sample of GPs completed questionnaires on the prevalence of CFS in their adolescent patients. Pediatric hospital departments prospectively reported new cases of CFS in adolescent patients. For every new reported case, a questionnaire was sent to the reporting pediatrician and the reported patient to assess CFS morbidity. Prevalence was estimated through the data from GP questionnaires and incidence was estimated on the basis of cases newly reported by pediatricians from January to December 2008. Prevalence was calculated as 111 per 100 000 adolescents and incidence as 12 per 100 000 adolescents per year. Of newly reported patients with CFS, 91% scored at or above cutoff points for severe fatigue and 93% at or above the cutoff points for physical impairment. Forty-five percent of patients with CFS reported >50% school absence during the previous 6 months. Clinically diagnosed incidence and prevalence rates show that adolescent CFS is uncommon compared with chronic fatigue. The primary adverse impact of CFS is extreme disability associated with considerable school absence.

Impact of Haemophilus influenzae Type b conjugate vaccine in Mongolia: prospective population-based surveillance, 2002-2010.

PubMed

Scott, Susana; Altanseseg, Dorjpurev; Sodbayer, Demberelsuren; Nymadawa, Pagvajav; Bulgan, Davaadash; Mendsaikhan, Jamsran; Watt, James P; Slack, Mary P E; Carvalho, Maria G; Hajjeh, Rana; Edmond, Karen M

2013-07-01

Bacterial meningitis is associated with high mortality and long-term complications. This study assessed the impact of Haemophilus influenzae type b (Hib) conjugate vaccine on childhood bacterial meningitis in Ulaanbaatar, Mongolia. Prospective, active, population-based surveillance for suspected meningitis in children aged 2-59 months was conducted (February 2002-January 2011) in 6 hospitals. Clinical data, blood, and cerebrospinal fluid were collected. The impact of Hib conjugate vaccine was assessed by comparing Hib and all cause meningitis data in the 3 years preceding pentavalent conjugate vaccine implementation (2002-2004) with 3 years postimplementation (2008-2010). Five hundred eleven cases of suspected meningitis were identified from 2002-2011. Pentavalent conjugate vaccine coverage in December 2005 in Ulaanbaatar city was 97%. The proportion of suspected cases confirmed as Hib meningitis decreased from 25% (50/201) in the prevaccination era to 2% (4/193) in the postvaccination era (P < .0001). The annual incidence of Hib decreased from 28 cases per 100,000 children in 2002-2005 to 2 per 100,000 in 2008-2010 (P < .0001). This article demonstrates the marked impact of Hib conjugate vaccine introduction on meningitis in Mongolia. It is important to sustain this surveillance system to monitor the long-term impact of Hib conjugate vaccine, as well as other interventions such as pneumococcal and meningococcal vaccines. Copyright © 2013. Published by Mosby, Inc.

Update on the Methodological Quality of Research Published in The American Journal of Sports Medicine: Comparing 2011-2013 to 10 and 20 Years Prior.

PubMed

Brophy, Robert H; Kluck, Dylan; Marx, Robert G

2016-05-01

In recent years, the number of articles in The American Journal of Sports Medicine (AJSM) has risen dramatically, with an increasing emphasis on evidence-based medicine in orthopaedics and sports medicine. Despite the increase in the number of articles published in AJSM over the past decade, the methodological quality of articles in 2011-2013 has improved relative to those in 2001-2003 and 1991-1993. Meta-analysis. All articles published in AJSM during 2011-2013 were reviewed and classified by study design. For each article, the use of pertinent methodologies, such as prospective data collection, randomization, control groups, and blinding, was recorded. The frequency of each article type and the use of evidence-based techniques were compared relative to 1991-1993 and 2001-2003 by use of Pearson χ(2) testing. The number of research articles published in AJSM more than doubled from 402 in 1991-1993 and 423 in 2001-2003 to 953 in 2011-2013. Case reports decreased from 15.2% to 10.6% to 2.1% of articles published over the study period (P < .001). Cadaveric/human studies and meta-analysis/literature review studies increased from 5.7% to 7.1% to 12.4% (P < .001) and from 0.2% to 0.9% to 2.3% (P = .01), respectively. Randomized, prospective clinical trials increased from 2.7% to 5.9% to 7.4% (P = .007). Fewer studies used retrospective compared with prospective data collection (P < .001). More studies tested an explicit hypothesis (P < .001) and used controls (P < .001), randomization (P < .001), and blinding of those assessing outcomes (P < .001). Multi-investigator trials increased (P < .001), as did the proportion of articles citing a funding source (P < .001). Despite a dramatic increase in the number of published articles, the research published in AJSM shifted toward more prospective, randomized, controlled, and blinded designs during 2011-2013 compared with 2001-2003 and 1991-1993, demonstrating a continued improvement in methodological quality. © 2015 The Author(s).

Serum Cystatin C– Versus Creatinine-Based Definitions of Acute Kidney Injury Following Cardiac Surgery: A Prospective Cohort Study

PubMed Central

Spahillari, Aferdita; Parikh, Chirag R.; Sint, Kyaw; Koyner, Jay L.; Patel, Uptal D.; Edelstein, Charles L.; Passik, Cary S.; Thiessen-Philbrook, Heather; Swaminathan, Madhav; Shlipak, Michael G.

2012-01-01

Background The primary aim of this study was to compare the sensitivity and rapidity of AKI detection by cystatin C relative to creatinine following cardiac surgery. Study Design Prospective cohort study Settings and Participants 1,150 high-risk, adult cardiac surgery patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium. Predictor Changes in serum creatinine and cystatin C Outcome Post-surgical incidence of AKI Measurements Serum creatinine and cystatin C were measured at the preoperative visit and daily on postoperative days 1–5. To allow comparisons between changes in creatinine and cystatin C, AKI endpoints were defined by the relative increases in each marker from baseline (25, 50 and 100%) and the incidence of AKI was compared based upon each marker. Secondary aims were to compare clinical outcomes among patients defined as having AKI by cystatin C and/or creatinine. Results Overall, serum creatinine detected more cases of AKI than cystatin C: 35% developed a ≥25% increase in serum creatinine, whereas only 23% had ≥25% increase in cystatin C (p < 0.001). Creatinine also had higher proportions meeting the 50% (14% and 8%, p<0.001) and 100% (4% and 2%, p=0.005) thresholds for AKI diagnosis. Clinical outcomes were generally not statistically different for AKI cases detected by creatinine or cystatin C. However, for each AKI threshold, patients with AKI confirmed by both markers had significantly higher risk of the combined mortality/dialysis outcome compared with patients with AKI detected by creatinine alone (p=0.002). Limitations There were few adverse clinical outcomes, limiting our ability to detect differences in outcomes between subgroups of patients based upon their definitions of AKI. Conclusion In this large multicenter study, we found that cystatin C was less sensitive for AKI detection compared with creatinine. However, confirmation by cystatin C appeared to identify a subset of AKI patients with substantially higher risk of adverse outcomes. PMID:22809763

Variable prospective financing in the Danish hospital sector and the development of a Danish case-mix system.

PubMed

Ankjaer-Jensen, Anni; Rosling, Pernille; Bilde, Lone

2006-08-01

This article aims to describe and assess the Danish case-mix system, the cost accounting applied in setting national tariffs and the introduction of variable, prospective payment in the Danish hospital sector. The tariffs are calculated as a national average from hospital data gathered in a national cost database. However, uncertainty, mainly resulting from the definition of cost centres at the individual hospital, implies that the cost weights may not fully reflect the hospital treatment cost. As variable prospective payment of hospitals currently only applies to 20% of a hospital's budget, the incentives and the effects on productivity, quality and equality are still limited.

Prospective payment based on case mix: will it work in nursing homes?

PubMed

Rosko, M D; Broyles, R W; Aaronson, W E

1987-01-01

This article evaluates the potential efficacy of implementing a prospective payment system based on case mix in the nursing home industry. The analysis of structural differences between the nursing home and hospital industries suggests that the mechanism of compensating long-term care facilities should be based on functional health status rather than on diagnosis and that incentives to improve quality and access should be strengthened. The article assesses several systems of classifying patients that have been proposed as the basis for implementing a prospective payment system in the nursing home industry. The article concludes with a discussion of policy issues related to the appropriate unit of payment and the scope of regulatory authority.

Risk factors for near-fatal asthma. A case-control study in hospitalized patients with asthma.

PubMed

Turner, M O; Noertjojo, K; Vedal, S; Bai, T; Crump, S; Fitzgerald, J M

1998-06-01

We prospectively recruited patients admitted to the hospital with severe asthma to comprehensively evaluate the association of historical and physiologic features with the risk of near-fatal asthma (NFA). A case-control study design was used. All patients admitted with NFA (cases) were identified prospectively and compared with asthma patients admitted during the same period without respiratory failure (controls). Nineteen cases (age: 40.2 +/- 12.0 yr) (mean +/- SD) and 80 controls (age: 36 +/- 13.5 yr) were enrolled. Duration of asthma, gender, smoking status, ethnicity, and prevalence of atopy were similar in the case and control groups. More than 80% of patients in both groups reported worsening symptoms for more than 48 h before admission, and more than 50% were worse for longer than 7 d. There was no difference in degree of airways obstruction or bronchial hyperresponsiveness (PC20). Perception of dyspnea was similar in the cases and controls, but among cases the males had greater impairment than the females (Borg score: 1.9 +/- 1. 4 versus 3.9 +/- 1.2: p = 0.05). Univariate analysis identified a history of previous mechanical ventilation (OR: 27.5; 95% CI: 6.60 to 113.7), admission to the intensive care unit (ICU) (OR: 9.9; 95% CI: 3.0 to 32.9), history of worse asthma during January and February (OR: 3.5; 95% CI: 1.0 to 11.8), and use of air-conditioning (OR: 15.0; 95% CI: 1.3 to 166) as risk factors for NFA. Of concern was the dependence of most patients (59.8%) on the emergency department (ED) for initial care, and the small number of cases (16%) in which patients visited a physician before admission to the hospital. We have confirmed risk factors identified previously in retrospective studies of fatal and NFA, and have also shown that hospitalized patients with asthma, irrespective of severity of their asthma, share several characteristics, especially in terms of their failure to respond to worsening asthma.

Upper Blepharoplasty and Lateral Wound Dehiscence.

PubMed

Kashkouli, Mohsen Bahmani; Jamshidian-Tehrani, Mansooreh; Sharzad, Sahab; Sanjari, Mostafa Soltan

2015-01-01

To report the frequency of lateral wound dehiscence (LWD) after upper blepharoplasty (UB), a technique and its outcome to prevent LWD. A retrospective review was performed for cases of LWD after UB presenting between 2003 and 2009, and then a prospective comparative study was performed between February 2009 and March 2013. For the comparison, subjects were divided into two groups based on intraoperative assessment of lateral wound tension (same technique and surgeon). Group 1 received 1-3 orbicularis/subcutaneous buried sutures (6-0 polyglactin) before interrupted 6-0 nylon skin closure. Group 2 underwent skin closure only. Subjects, who had re-operation, skin healing disorders, and incomplete follow-up (<6 months), were excluded. P < 0.05 was considered as statistically significant. There were 14 (14/678, 2%) cases with LWD with a mean age of 36.2 years in the audit (2003-2009). The prospective study included 68 subjects (68/293, 23.2%) in Group 1 and 225 in Group 2. Gender and simultaneous forehead and eyebrow procedures were similar between groups (P = 0.3 and P = 0.4 respectively). Group 1 was statistically significantly younger at mean age of 41.4 years, compared to Group 2 at 56.1 years (P = 0.000). The frequency of LWD significantly (P = 0.04) decreased to 0.3% (1/293). In the presence of wound tension on skin closure (intraoperative assessment), tension relieving buried orbicularis/subcutaneous 6-0 polyglactin suturing of the lateral UB incision could prevent LWD.

Upper Blepharoplasty and Lateral Wound Dehiscence

PubMed Central

Kashkouli, Mohsen Bahmani; Jamshidian-Tehrani, Mansooreh; Sharzad, Sahab; Sanjari, Mostafa Soltan

2015-01-01

Purpose: To report the frequency of lateral wound dehiscence (LWD) after upper blepharoplasty (UB), a technique and its outcome to prevent LWD. Materials and Methods: A retrospective review was performed for cases of LWD after UB presenting between 2003 and 2009, and then a prospective comparative study was performed between February 2009 and March 2013. For the comparison, subjects were divided into two groups based on intraoperative assessment of lateral wound tension (same technique and surgeon). Group 1 received 1-3 orbicularis/subcutaneous buried sutures (6-0 polyglactin) before interrupted 6-0 nylon skin closure. Group 2 underwent skin closure only. Subjects, who had re-operation, skin healing disorders, and incomplete follow-up (<6 months), were excluded. P < 0.05 was considered as statistically significant. Results: There were 14 (14/678, 2%) cases with LWD with a mean age of 36.2 years in the audit (2003–2009). The prospective study included 68 subjects (68/293, 23.2%) in Group 1 and 225 in Group 2. Gender and simultaneous forehead and eyebrow procedures were similar between groups (P = 0.3 and P = 0.4 respectively). Group 1 was statistically significantly younger at mean age of 41.4 years, compared to Group 2 at 56.1 years (P = 0.000). The frequency of LWD significantly (P = 0.04) decreased to 0.3% (1/293). Conclusion: In the presence of wound tension on skin closure (intraoperative assessment), tension relieving buried orbicularis/subcutaneous 6-0 polyglactin suturing of the lateral UB incision could prevent LWD. PMID:26692716

Seaweed consumption and the risk of thyroid cancer in women: the Japan Public Health Center-based Prospective Study.

PubMed

Michikawa, Takehiro; Inoue, Manami; Shimazu, Taichi; Sawada, Norie; Iwasaki, Motoki; Sasazuki, Shizuka; Yamaji, Taiki; Tsugane, Shoichiro

2012-05-01

Iodine is a suspected risk factor for thyroid cancer. Seaweed accounts for about 80% of Japanese people's iodine intake. We examined the association between seaweed consumption and the risk of thyroid cancer in Japanese women. Women participating in the Japan Public Health Center-based Prospective Study (n=52 679; age: 40-69 years) were followed up for a mean of 14.5 years; 134 new thyroid cancer cases, including 113 papillary carcinoma cases, were identified. Seaweed consumption was assessed using a food-frequency questionnaire and divided into three categories: 2 days/week or less (reference); 3-4 days/week; and almost daily. The Cox proportional hazards model was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Seaweed consumption was clearly associated with an increased risk of papillary carcinoma (HR for almost daily consumption compared with 2 days/week or less=1.71; 95% CI: 1.01-2.90; trend P=0.04). After stratification for menopausal status, an increased risk was observed in postmenopausal women (papillary carcinoma HR for almost daily consumption compared with 2 days/week or less=3.81, 95% CI: 1.67-8.68; trend P<0.01), but not in premenopausal women (HR=0.91, 95% CI: 0.44-1.91; trend P=0.76). This study identified a positive association between seaweed consumption and the risk of thyroid cancer (especially for papillary carcinoma) in postmenopausal women.

Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study.

PubMed

Lin, Jiacheng; Zeng, Qian; Wei, Xi; Zhao, Wei; Cui, Minyi; Gu, Jing; Lu, Jiaxuan; Yang, Maobin; Ling, Junqi

2017-11-01

The aim of the study was to compare the outcomes of regenerative endodontic treatment (RET) and apexification on immature permanent teeth with pulp necrosis and apical periodontitis. A total of 118 patients (118 teeth) were recruited and randomly assigned to either RET or apexification treatment. Each treatment group was divided into 2 subgroups according to the etiology: dens evaginatus or trauma. Clinical symptoms and complications were recorded, and cone-beam computed tomographic imaging with a limited field of view was used to measure the change of root length, root thickness, and apical foramen size at the 12-month follow-up. The t test/rank sum test and Fisher exact test were applied to compare the change of root morphology between RET and apexification. One hundred three of 118 cases were completed at the 12-month follow-up. The survival rate was 100% for both treatment groups. All cases were asymptomatic with apical healing. The RET group showed a significant increase in root length and root thickness compared with the apexification group (P < .05). In the RET group, the cases caused by dens evaginatus achieved increased root length and root thickness compared with those caused by trauma (P < .05). RET and apexification achieved a comparable outcome in regard to the resolution of symptoms and apical healing. RET showed a better outcome than apexification regarding increased root thickness and root length. The etiology had an impact on the outcome of RET. Dens evaginatus cases showed better prognoses than trauma cases after RET. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard.

PubMed

Lowe, Nancy K; Neal, Jeremy L; Ryan-Wenger, Nancy A

2009-01-01

To estimate the accuracy of the clinical diagnosis of the three most common causes of acute vulvovaginal symptoms (bacterial vaginosis, candidiasis vaginitis, and trichomoniasis vaginalis) using a traditional, standardized clinical diagnostic protocol compared with a DNA probe laboratory standard. This prospective clinical comparative study had a sample of 535 active-duty United States military women presenting with vulvovaginal symptoms. Clinical diagnoses were made by research staff using a standardized protocol of history, physical examination including pelvic examination, determination of vaginal pH, vaginal fluid amines test, and wet-prep microscopy. Vaginal fluid samples were obtained for DNA analysis. The research clinicians were blinded to the DNA results. The participants described a presenting symptom of abnormal discharge (50%), itching/irritation (33%), malodor (10%), burning (4%), or others such as vulvar pain and vaginal discomfort. According to laboratory standard, there were 225 cases (42%) of bacterial vaginosis, 76 cases (14%) of candidiasis vaginitis, 8 cases (1.5%) of trichomoniasis vaginalis, 87 cases of mixed infections (16%), and 139 negative cases (26%). For each single infection, the clinical diagnosis had a sensitivity and specificity of 80.8% and 70.0% for bacterial vaginosis, 83.8% and 84.8% for candidiasis vaginitis, and 84.6% and 99.6% for trichomoniasis vaginalis when compared with the DNA probe standard. Compared with a DNA probe standard, clinical diagnosis is 81-85% sensitive and 70-99% specific for bacterial vaginosis, Candida vaginitis, and trichomoniasis. Even under research conditions that provided clinicians with sufficient time and materials to conduct a thorough and standardized clinical evaluation, the diagnosis and, therefore, subsequent treatment of these common vaginal problems remains difficult. II.

Exploring self-efficacy as a predictor of disease management.

PubMed

Clark, N M; Dodge, J A

1999-02-01

Self-efficacy is posited in social cognitive theory as fundamental to behavior change. Few health behavior studies have examined self-efficacy prospectively, viewed it as part of a reciprocal behavioral process, or compared self-efficacy beliefs in the same population across different behaviors. This article first discusses self-efficacy in its theoretical context and reviews the available prospective studies. Second, it explores self-efficacy as a predictor of disease management behaviors in 570 older women with heart disease. Although the R2 statistics in each case were modest, the construct is shown to be a statistically significant (p<.05) predictor at both 4 and 12 months postbaseline of several disease management behaviors: using medicine as prescribed, getting adequate exercise, managing stress, and following a recommended diet. Building self-efficacy is likely a reasonable starting point for interventions aiming to enhance heart disease management behaviors of mature female patients.

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

Tang Bosin; Wong Siuwai; Lau, Milton Chi-hong

This study examines the current prospects for and obstacles facing the implementation of social impact assessment (SIA) and participatory planning in the People's Republic of China. During the past two decades, rapid urbanisation and the conversion of rural land for urban development have led to numerous social conflicts and tensions between the Chinese government and its people. SIA and public participation in development decisions have received increasing attention from the Chinese authorities as possible ways to tackle the problem. Based on a Guangzhou case study, this paper argues that the assessment and mitigation of adverse impacts on the community frommore » urban development have been carried out with different objectives, core values and principles when compared with those in Western societies. It concludes that the poor prospects of SIA and collaborative planning in China lie not only in the weak framework for environmental legislation, but also in all institutions concerning state-society relations, the socialist governing ideology and traditional Chinese culture.« less

Comparing U.S. Army suicide cases to a control sample: initial data and methodological lessons.

PubMed

Alexander, Cynthia L; Reger, Mark A; Smolenski, Derek J; Fullerton, Nicole R

2014-10-01

Identification of risk and protective factors for suicide is a priority for the United States military, especially in light of the recent steady increase in military suicide rates. The Department of Defense Suicide Event Report contains comprehensive data on suicides for active duty military personnel, but no analogous control data is available to permit identification of factors that differentially determine suicide risk. This proof-of-concept study was conducted to determine the feasibility of collecting such control data. The study employed a prospective case-control design in which control cases were randomly selected from a large Army installation at a rate of four control participants for every qualifying Army suicide. Although 111 Army suicides were confirmed during the study period, just 27 control soldiers completed the study. Despite the small control sample, preliminary analyses comparing suicide cases to controls identified several factors more frequently reported for suicide cases, including recent failed intimate relationships, outpatient mental health history, mood disorder diagnosis, substance abuse history, and prior self-injury. No deployment-related risk factors were found. These data are consistent with existing literature and form a foundation for larger control studies. Methodological lessons learned regarding study design and recruitment are discussed to inform future studies. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Insurance principles and the design of prospective payment systems.

PubMed

Ellis, R P; McGuire, T G

1988-09-01

This paper applies insurance principles to the issues of optimal outlier payments and designation of peer groups in Medicare's case-based prospective payment system for hospital care. Arrow's principle that full insurance after a deductible is optimal implies that, to minimize hospital risk, outlier payments should be based on hospital average loss per case rather than, as at present, based on individual case-level losses. The principle of experience rating implies defining more homogenous peer groups for the purpose of figuring average cost. The empirical significance of these results is examined using a sample of 470,568 discharges from 469 hospitals.

Occupation and risk of sudden death in a United States community: a case-control analysis.

PubMed

Zhang, Lin; Narayanan, Kumar; Suryadevara, Vallabh; Teodorescu, Carmen; Reinier, Kyndaron; Uy-Evanado, Audrey; Chugh, Harpriya; Zheng, Zhi-Jie; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S

2015-12-18

Work environment is said to influence cardiovascular risk. We assessed whether nature of occupation affects risk of sudden cardiac death (SCD) in the general population. In the ongoing, prospective Oregon Sudden Unexpected Death Study (catchment population 1 million), working-age SCD cases (18-65 years) were compared with controls who died from any cause. Usual occupation obtained from death certificates was classified using the US Census Bureau standard occupational classification descriptions and categorised as white collar, blue collar or homemaker. Odds ratio (OR) for SCD by occupation category was obtained and clinical profile of SCD cases was compared by occupation type. Among SCD cases (n=646; 74% male) compared to controls (n=622; 73.6% male), the proportion of white collar workers was higher among male SCD cases (52.7% vs 43.7%; p=0.01); the difference in females was smaller (59.5% vs 55%; p=0.62). Adjusting for race and smoking status, male white collar workers had a higher risk of SCD compared to blue collar workers (OR=1.67, (1.26 to 2.23), p<0.001). A similar, non-significant trend was observed among females (OR 1.49 (0.81 to 2.75); p=0.20). White collar SCD cases were less likely to be current smokers (34.7% vs 45.3%, p=0.008), drug misusers (13.1% vs 18.5%) or have diabetes (21.4% vs 28.2%, both p=0.07) compared to blue collar workers. Other cardiac risk factors were similar. A white collar occupation was associated with increased risk of SCD, when compared to blue collar occupations. Since differences in conventional risk factors did not explain this elevated risk, work-related behavioural and psychosocial stressors warrant a closer evaluation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Clinical importance of re-interpretation of PET/CT scanning in patients referred to a tertiary care medical centre.

PubMed

Löfgren, Johan; Loft, Annika; Barbosa de Lima, Vinicius Araújo; Østerlind, Kell; von Benzon, Eric; Højgaard, Liselotte

2017-03-01

To evaluate, in a controlled prospective manner with double-blind read, whether there are differences in interpretations of PET/CT scans at our tertiary medical centre, Rigshospitalet, compared to the external hospitals. Ninety consecutive patients referred to our department who had an external F-18-FDG PET/CT scan were included. Only information that had been available at the time of the initial reading at the external hospital was available at re-interpretation. Teams with one radiologist and one nuclear medicine physician working side by side performed the re-interpretation in consensus. Two oncologists subsequently and independently compared the original reports with the re-interpretation reports. In case of 'major discordance', the oncologists assessed the respective reports validities. The interpretations were graded as 'accordant' in 43 patients (48%), 'minor discordance' in 30 patients (33%) and 'major discordance' in 17 patients (19%). In 11 (65%) of the 17 cases graded as 'major discordance', it was possible to determine which report that was most correct. In 9 of these 11 cases (82%), the re-interpretation was most correct; in one case, the original report and in another case, both interpretations were incorrect. Major discordant interpretations were frequent [19% (17 of 90 cases)]. In those cases where follow-up could assess the validity, the re-interpretation at Rigshospitalet was most correct in 9 of 11 cases (82%), indicating that there is a difference in expertise in interpreting PET/CT at a tertiary referral hospital compared to primary local hospitals. © 2015 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.

Maxillofacial fracture experiences: a review of 152 cases.

PubMed

Aydin, Osman Enver; Tan, Onder; Algan, Said; Kuduban, Selma Denktas; Barin, Ensar Zafer; Cinal, Hakan; Sarici, Murat; Avsar, Umit

2012-12-01

The fractures of facial structures lead to great morbidity. Cross-sectional studies are needed to evaluate the current state of maxillofacial traumas. Thus, this study aims to evaluate these experiences and to compare these results with the current literature. The medical records of the maxillofacial fracture cases hospitalized between January 2004 and November 2011 were examined. The age, sex, etiology, fracture localization and treatment method for each case were documented. The affected facial bones were grouped as mandible, maxilla, zygoma, naso-orbitoethmoid complex (NOEC) and blow-out. Nasal fractures were excluded. The cases were assigned to 3 groups with respect to age (below 16, above 65 and between 17 and 64). The chi Square test was used to assess the significance of the difference in mandibular fracture rates in the pediatric population compared to others. The total number of cases was 152. The total number of fractures was 185. Of the 152 cases, 117 were male and 35 were female. The average age was 31.4 (±18.3), ranging between 2 and 81. Thirty-one cases were 16 years old or less. Nine cases were 65 years old or more. Mandibular and zygomatic fractures were the most prevalent fractures in the adult group. Mandibular fractures were significantly more common in the pediatric age group compared to rest of the population (X(2), p<0.05). Traffic accidents were the most common etiological factor, with a 55.3% ratio. Open reduction and internal fixation was the most frequently conducted treatment modality in all age groups. Retrospective studies are important for the projection of future prospects. In summary, our results indicate that pediatric fractures are mostly in the lower face and usually affect the condylar region, which is consistent with the literature.

Does a Course on the History and Philosophy of Chemistry Have Any Effect on Prospective Chemistry Teachers' Perceptions? The Case of Chemistry and the Chemist

ERIC Educational Resources Information Center

Sendur, G.; Polat, M.; Kazanci, C.

2017-01-01

The creative comparisons prospective chemistry teachers make about "chemistry" and the "chemist" may reflect how they perceive these concepts. In this sense, it seems important to determine which creative comparisons prospective teachers make with respect to these and how these can change after the history of chemistry is…

Effects of child interview tactics on prospective jurors' decisions.

PubMed

Johnson, Jonni L; Shelley, Alexandra E

2014-01-01

Although decisions in child sexual abuse (CSA) cases are influenced by many factors (e.g., child age, juror gender), case and trial characteristics (e.g., interview quality) can strongly influence legal outcomes. In the present study, 319 prospective jurors read about a CSA investigation in which the alleged victim was interviewed at a child advocacy center (CAC) or traditional police setting. The prospective jurors then provided legally relevant ratings (e.g., child credibility, interview quality, defendant guilt). Structural equation modeling techniques revealed that child credibility predicted greater confidence in guilt decisions and also mediated all associations with such decisions. Having fewer negative prior opinions and rating the interview as of better quality were associated with higher child credibility ratings. Mitigating factors (e.g., interview quality), as opposed to proxy indicators (e.g., participant gender), better predicted CSA case outcomes. Similar associations across groups (e.g., CAC interviews did not make child victims more or less credible) permit a tentative conclusion that CACs do not positively or negatively affect decisions made in hypothetical CSA cases. Ideas for future studies examining factors influencing decisions in CSA cases are discussed. Copyright © 2014 John Wiley & Sons, Ltd.

A prospective study of Trichomonas vaginalis and prostate cancer risk among African American men.

PubMed

Fowke, Jay H; Han, Xijing; Alderete, J F; Moses, Kelvin A; Signorello, Lisa B; Blot, William J

2016-04-18

African Americans (AA) have a higher prevalence of Trichomonas vaginalis (Tv) infection and a higher prostate (PC) risk. Past studies suggest an association between Tv seropositivity and PC, and therefore we prospectively investigated this association among AA men. Incident PC cases were individually matched to controls in a nested case-control study within the Southern Community Cohort Study (SCCS). Primary analysis included 296 PC cases and 497 race-matched controls. Levels of Tv antibody response were measured by ELISA in serum collected at baseline. Tv antibody response did not significantly differ between cases and controls overall or within AA participants (253 AA cases). There were no significant associations or trends between levels of Tv response and PC risk or the diagnosis of aggressive PC. We found no evidence of a prospective association between baseline Tv infection and PC risk in AA men. Tv infection in men may have substantial health implications in HIV transmission and reproductive outcomes, but may not impact future PC risk in AA men at high-risk for PC. Further efforts need to define past vs. present Tv infection and to separate pathophysiology from PC detection.

Retrospective Validation of a Surveillance System for Unexplained Illness and Death: New Haven County, Connecticut

PubMed Central

Kluger, Michael D.; Sofair, Andre N.; Heye, Constance J.; Meek, James I.; Sodhi, Rajesh K.; Hadler, James L.

2001-01-01

Objectives. This study investigated retrospective validation of a prospective surveillance system for unexplained illness and death due to possibly infectious causes. Methods. A computerized search of hospital discharge data identified patients with potential unexplained illness and death due to possibly infectious causes. Medical records for such patients were reviewed for satisfaction of study criteria. Cases identified retrospectively were combined with prospectively identified cases to form a reference population against which sensitivity could be measured. Results. Retrospective validation was 41% sensitive, whereas prospective surveillance was 73% sensitive. The annual incidence of unexplained illness and death due to possibly infectious causes during 1995 and 1996 in the study county was conservatively estimated to range from 2.7 to 6.2 per 100 000 residents aged 1 to 49 years. Conclusions. Active prospective surveillance for unexplained illness and death due to possibly infectious causes is more sensitive than retrospective surveillance conducted through a published list of indicator codes. However, retrospective surveillance can be a feasible and much less labor-intensive alternative to active prospective surveillance when the latter is not possible or desired. PMID:11499106

Does antibiotic exposure during infancy lead to development of asthma?: a systematic review and metaanalysis.

PubMed

Marra, Fawziah; Lynd, Larry; Coombes, Megan; Richardson, Kathryn; Legal, Michael; Fitzgerald, J Mark; Marra, Carlo A

2006-03-01

To determine the association between antibiotic exposure in the first year of life and the development of childhood asthma. Metaanalysis of observational studies retrieved through systematic search of all available electronic data sources. Studies included in the metaanalyses were those with populations exposed to one or more courses of antibiotics during the first year of life, and asthma diagnosis was defined as diagnosis by a physician between the age of 1 to 18 years. Retrospective and prospective studies published in the English-language literature from 1966 to present. Eight studies (four prospective and four retrospective) examined the association between exposure to at least one course of antibiotics and development of childhood asthma. The total number of subjects for the analysis comparing exposure to at least one antibiotic to no exposure in the first year of life was 12,082 children and 1,817 asthma cases. In the dose-response analysis, we included data from a total of 27,167 children and 3,392 asthma cases. The pooled odds ratio (OR) for the eight studies was 2.05 (95% confidence interval [CI], 1.41 to 2.99). The association was significantly stronger in the retrospective studies (OR, 2.82; 95% CI, 2.07 to 3.85) than the prospective studies (OR, 1.12; 95% CI, 0.88 to 1.42). Five of the eight studies examined whether the association was related to the number of courses of antibiotics taken in the first year of life. The overall OR for the dose-response analysis was 1.16 (95% CI, 1.05 to 1.28) for each additional course of antibiotics; however, this association was not significantly stronger in the retrospective studies (OR, 1.37; 95% CI, 1.18 to 1.60) relative to the prospective studies (OR, 1.07; 95% CI, 0.95 to 1.20). Exposure to at least one course of antibiotics in the first year of life appears to be a risk factor for the development of childhood asthma. Because of the limitations of the studies conducted to date, additional large-scale, prospective studies are needed to confirm this potential association.

Association between the 2008–09 Seasonal Influenza Vaccine and Pandemic H1N1 Illness during Spring–Summer 2009: Four Observational Studies from Canada

PubMed Central

Skowronski, Danuta M.; De Serres, Gaston; Crowcroft, Natasha S.; Janjua, Naveed Z.; Boulianne, Nicole; Hottes, Travis S.; Rosella, Laura C.; Dickinson, James A.; Gilca, Rodica; Sethi, Pam; Ouhoummane, Najwa; Willison, Donald J.; Rouleau, Isabelle; Petric, Martin; Fonseca, Kevin; Drews, Steven J.; Rebbapragada, Anuradha; Charest, Hugues; Hamelin, Marie-Ève; Boivin, Guy; Gardy, Jennifer L.; Li, Yan; Kwindt, Trijntje L.; Patrick, David M.; Brunham, Robert C.

2010-01-01

Background In late spring 2009, concern was raised in Canada that prior vaccination with the 2008–09 trivalent inactivated influenza vaccine (TIV) was associated with increased risk of pandemic influenza A (H1N1) (pH1N1) illness. Several epidemiologic investigations were conducted through the summer to assess this putative association. Methods and Findings Studies included: (1) test-negative case-control design based on Canada's sentinel vaccine effectiveness monitoring system in British Columbia, Alberta, Ontario, and Quebec; (2) conventional case-control design using population controls in Quebec; (3) test-negative case-control design in Ontario; and (4) prospective household transmission (cohort) study in Quebec. Logistic regression was used to estimate odds ratios for TIV effect on community- or hospital-based laboratory-confirmed seasonal or pH1N1 influenza cases compared to controls with restriction, stratification, and adjustment for covariates including combinations of age, sex, comorbidity, timeliness of medical visit, prior physician visits, and/or health care worker (HCW) status. For the prospective study risk ratios were computed. Based on the sentinel study of 672 cases and 857 controls, 2008–09 TIV was associated with statistically significant protection against seasonal influenza (odds ratio 0.44, 95% CI 0.33–0.59). In contrast, estimates from the sentinel and three other observational studies, involving a total of 1,226 laboratory-confirmed pH1N1 cases and 1,505 controls, indicated that prior receipt of 2008–09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring–summer 2009, with estimated risk or odds ratios ranging from 1.4 to 2.5. Risk of pH1N1 hospitalization was not further increased among vaccinated people when comparing hospitalized to community cases. Conclusions Prior receipt of 2008–09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring–summer 2009 in Canada. The occurrence of bias (selection, information) or confounding cannot be ruled out. Further experimental and epidemiological assessment is warranted. Possible biological mechanisms and immunoepidemiologic implications are considered. Please see later in the article for the Editors' Summary PMID:20386731

[Manufacture and application of laparoscopic extraperitoneal sigmoid colostomy].

PubMed

Jin, Hei-ying; DU, Yong-hong; Wang, Xiao-feng; Yao, Hang; Wu, Kun-lan; Zhang, Bei; Zhang, Jin-hao

2013-10-01

To investigate the safety and feasibility of laparoscopic extraperitoneal sigmoid colostomy. Thirty-six patients with low rectal cancer undergoing laproscopic abdominoperineal resection from July 2011 to July 2012 were prospectively enrolled in the study and randomly divided into extraperitoneal colostomy group(EPC, n=18) and internal peritoneal colostomy group(IPC, n=18). Follow-up period was 4-16 (median, 7) months and postoperative complications were compared between two groups. One case in EPC group was converted to IPC because of poor blood supply of the proximal sigmoid, who was eliminated from the subsequent analysis. Compared with the IPC group, the surgery time was longer in EPC group [(25.3±8.5) min vs. (14.7±6.4) min], while the difference was not statistically significant(P>0.05). Each group had 1 case of stoma ischemia, who both received the colostomy reconstructive surgery. The incidence of stoma edema was significantly higher in EPC group[35.3%(6/17) vs. 0, P<0.05). The early postoperative complications rate did not significantly different between the two groups[58.8%(10/17) vs. 27.8%(5/18), P>0.05]. The late postoperative complications rate was 22.2%(4/18) in IPC group, including 1 case of stoma prolapse, 1 case of stoma stenosis and 2 cases of parastomal hernia. No later postoperative complication occurred in EPC group. Extraperitoneal sigmoid colostomy is an easy and safe procedure with lower late complications as compared to internal peritoneal sigmoid colostomy.

Candida infective endocarditis.

PubMed

Baddley, J W; Benjamin, D K; Patel, M; Miró, J; Athan, E; Barsic, B; Bouza, E; Clara, L; Elliott, T; Kanafani, Z; Klein, J; Lerakis, S; Levine, D; Spelman, D; Rubinstein, E; Tornos, P; Morris, A J; Pappas, P; Fowler, V G; Chu, V H; Cabell, C

2008-07-01

Candida infective endocarditis (IE) is uncommon but often fatal. Most epidemiologic data are derived from small case series or case reports. This study was conducted to explore the epidemiology, treatment patterns, and outcomes of patients with Candida IE. We compared 33 Candida IE cases to 2,716 patients with non-fungal IE in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS). Patients were enrolled and the data collected from June 2000 until August 2005. We noted that patients with Candida IE were more likely to have prosthetic valves (p < 0.001), short-term indwelling catheters (p < 0.0001), and have healthcare-associated infections (p < 0.001). The reasons for surgery differed between the two groups: myocardial abscess (46.7% vs. 22.2%, p = 0.026) and persistent positive blood cultures (33.3% vs. 9.9%, p = 0.003) were more common among those with Candida IE. Mortality at discharge was higher in patients with Candida IE (30.3%) when compared to non-fungal cases (17%, p = 0.046). Among Candida patients, mortality was similar in patients who received combination surgical and antifungal therapy versus antifungal therapy alone (33.3% vs. 27.8%, p = 0.26). New antifungal drugs, particularly echinocandins, were used frequently. These multi-center data suggest distinct epidemiologic features of Candida IE when compared to non-fungal cases. Indications for surgical intervention are different and mortality is increased. Newer antifungal treatment options are increasingly used. Large, multi-center studies are needed to help better define Candida IE.

Candida Infective Endocarditis

PubMed Central

Baddley, John W.; Benjamin, Daniel K.; Patel, Mukesh; Miró, José; Athan, Eugene; Barsic, Bruno; Bouza, Emilio; Clara, Liliana; Elliott, Tom; Kanafani, Zeina; Klein, John; Lerakis, Stamatios; Levine, Donald; Spelman, Denis; Rubinstein, Ethan; Tornos, Pilar; Morris, Arthur J.; Pappas, Paul; Fowler, Vance G.; Chu, Vivian H.; Cabell, Christopher

2009-01-01

Purpose Candida infective endocarditis (IE) is uncommon but often fatal. Most epidemiologic data are derived from small case series or case reports. This study was conducted to explore epidemiology, treatment patterns, and outcomes of patients with Candida IE. Methods We compared 33 Candida IE cases to 2716 patients with non-fungal IE in the International Collaboration on Endocarditis - Prospective Cohort Study. Patients were enrolled and data collected from June 2000 until August 2005. Results Patients with Candida IE were more likely to have prosthetic valves (p<0.001), short term indwelling catheters (p<0.0001), and have healthcare-associated infection (p<0.001). Reasons for surgery differed between the two groups: myocardial abscess (46.7% vs. 22.2% p=0.026) and persistent positive blood cultures (33.3% vs. 9.9%, p=0.003) were more common among those with Candida IE. Mortality at discharge was higher in patients with Candida IE (30.3%) when compared to non-fungal cases (17%, p=0.046). Among Candida patients, mortality was similar in patients who received combination surgical and antifungal therapy versus antifungal therapy alone (33.3% vs. 27.8%, p=0.26). New antifungal drugs, particularly echinocandins, were used frequently. Conclusions These multi-center data suggest distinct epidemiologic features of Candida IE when compared to non-fungal cases. Indications for surgical intervention are different and mortality is increased. Newer antifungal treatment options are increasingly used. Large, multi-center studies are needed to help better define Candida IE. PMID:18283504

Does ear endoscopy provide advantages in the outpatient management of open mastoidectomy cavities?

PubMed

Freire, Gustavo Subtil Magalhães; Sampaio, Andre Luiz Lopes; Lopes, Rafaela Aquino Fernandes; Nakanishi, Márcio; de Oliveira, Carlos Augusto Costa Pires

2018-01-01

To evaluate the use of ear endoscopy in the postoperative management of open mastoidectomy cavities, and to test whether ear endoscopy improves inspection and cleaning compared with ear microscopy. Prospective study. Thirty-two ears were divided into two groups: group 1, examination and cleaning of mastoid cavities under endoscopic visualization after microscopic standard ear cleaning; group 2, examination and cleaning of mastoid cavities under microscopic visualization after endoscope-assisted ear cleaning. We assessed the ability of each method to provide exposure and facilitate cleaning, comparing the benefits of microscopy and endoscopy when used sequentially and vice-versa. Endoscopy provided additional benefits for exposure in 61.1% of cases and cleaning in 66.7%. Microscopy provided no additional benefits in terms of exposure in any case, and provided added benefit for cleaning in only 21.4% of cases. For outpatient postoperative care of open mastoidectomy cavities, ear endoscopy provides greater benefit over ear microscopy than vice-versa. In over half of all cases, endoscopy was able to expose areas not visualized under the microscope. Furthermore, in two-thirds of cases, endoscopy enabled removal of material that could not be cleared under microscopy. Ear endoscopy was superior to microscopy in terms of enabling exposure and cleaning of hard-to-reach sites, due to its wider field of vision. Ear endoscopy is a feasible technique for the postoperative management of open mastoidectomy cavities. Ear endoscopy provided superior advantages in terms of exposure and aural cleaning compared with microscopy.

Impact of Oxidative Stress Biomarkers and Carboxymethyllysine (An Advanced Glycation End Product) on Prostate Cancer: A Prospective Study

PubMed Central

Yang, Shuman; Pinney, Susan M.; Mallick, Palash; Ho, Shuk-Mei; Bracken, Bruce; Wu, Tianying

2015-01-01

Introduction Biomarkers of oxidative stress and advanced glycation end products (AGE) have been linked to the development of prostate cancer, but evidence from human studies is either scarce or controversial. Materials and Methods We conducted a prospective nested case-control study among 48 men (24 prostate cancer cases and 24 controls) aged 48–76 years at baseline. The participants of our study were a part of the Fernald Community Cohort (FCC). Prostate cancer cases and controls were matched individually on age (± 3 years) with 1:1 ratio. Biomarkers included urine F2-isoprostanes (markers of lipid oxidation), plasma fluorescent oxidation products (FlOPs; markers of global oxidation) and carboxymethyllysine (CML; a major end-stage AGE). Results At baseline, cases had similar age, body mass index, proportion of family history of prostate cancer, history of benign prostatic hyperplasia, history of hypertension, history of diabetes, smokers and plasma glucose levels as compared to controls. Levels of plasma CML were significantly higher in cases than in controls (182 vs. 152 μg/ml, P < 0.05). In the conditional logistic regression model, an increase in CML equivalent to one standard deviation was associated with increased risk of incident prostate cancer (Relative risk = 1.79, 95% confidence interval = 1.00–3.21), and accounted for ~8% variance of prostate cancer liability. Urine F2-isoprostanes and plasma FlOPs were not associated with prostate cancer incidence. Conclusion Higher levels of plasma CML were associated with increased risk of prostate cancer. This suggests a potential new pathway for prostate cancer prediction and treatment. PMID:25972296

Improved alignment and operating room efficiency with patient-specific instrumentation for TKA.

PubMed

Renson, Luc; Poilvache, Pascal; Van den Wyngaert, Hans

2014-12-01

Achieving accurate alignment in total knee arthroplasty (TKA) remains a concern. Patient-specific instrumentation (PSI) produced using preoperative 3D models was developed to offer surgeons a simplified, reliable, efficient and customised TKA procedure. In this prospective study, 60 patients underwent TKA with conventional instrumentation and 71 patients were operated on using PSI. The primary endpoint was surgical time. Secondary endpoints included operating room (OR) time, the number of instrument trays used and postoperative radiographic limb alignment. Compared to conventional instrumentation, PSI significantly reduced total surgical time by 8.9 ± 3.3 min (p=0.038), OR time by 8.6 ± 4.2 min (p=0.043), and the number of instrument trays by six trays (p<0.001). Mechanical axis malalignment of the lower limb of >3° was observed in 13% of PSI patients versus 29% with conventional instrumentation (p=0.043). PSI predicted the size of the femoral and tibial components actually used in 85.9% and 78.9% of cases, respectively. PSI improves alignment, surgical and OR time, reduces the number of instruments trays used compared to conventional instrumentation in patients undergoing TKA and results in fewer outliers in overall mechanical alignment in the coronal plane. Prospective comparative therapeutic study. Copyright © 2014 Elsevier B.V. All rights reserved.

75 FR 49029 - Medicare Program; End-Stage Renal Disease Prospective Payment System

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

...This final rule implements a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities beginning January 1, 2011 (ESRD PPS), in compliance with the statutory requirement of the Medicare Improvements for Patients and Providers Act (MIPPA), enacted July 15, 2008. This ESRD PPS also replaces the current basic case-mix adjusted composite payment system and the methodologies for the reimbursement of separately billable outpatient ESRD services.

Mexico Is Not Colombia: Alternative Historical Analogies for Responding to the Challenge of Violent Drug-Trafficking Organizations

DTIC Science & Technology

2014-01-01

can a coun- try with a 93.5-percent adult literacy rate have such massive informal and illicit economies? Why does a country that has not fought a war...cases carefully to maximize our prospects for finding reasonably informative alternative comparisons. A companion report, Mexico Is Not Colombia...cases carefully to maximize our prospects for finding reasonably informative alternative comparisons. A companion report, Mexico Is Not Colombia

Online versus offline spatiotemporal image correlation (STIC) M-mode for the evaluation of cardiac longitudinal annular displacement in fetal growth restriction.

PubMed

Tanis, Jozien C; Mohammed, Nuruddin; Bennasar, Mar; Martinez, Josep Maria; Bijnens, Bart; Crispi, Fatima; Gratacos, Eduard

2018-07-01

Our first aim was to compare online M-mode with offline spatiotemporal image correlation (STIC) M-mode for assessing longitudinal annular displacement (LAD) in growth-restricted fetuses (FGR). Our second aim was to compare LAD measures of FGR cases with controls. Prospective study including 40 FGR cases (defined estimated fetal weight and birth weight <10th centile) and 72 normally grown fetuses matched to cases by gestational age at scan. LAD was measured with online M-mode and offline STIC M-mode at the left and right ventricular free walls and septum in all fetuses. FGR cases had a significant decrease in LAD by STIC in all sites as compared to controls (e.g. right LAD in FGR mean 6.7 mm (SD 1.2) versus controls 7.2 mm (1.2), p = .033). There was a non-significant trend for lower values in FGR when using online M-mode (e.g. right LAD in FGR 6.9 mm (1.5) versus controls 7.4 mm (1.5), p = .084). STIC M-mode seems a better method than online M-mode for detecting subtle changes in myocardial motion. STIC presents more precise results and allows an ideal placement of the M-mode arrow. These results confirm previous data suggesting decreased longitudinal motion in FGR.

Temporal association of cannabis use with symptoms in individuals at clinical high risk for psychosis.

PubMed

Corcoran, Cheryl M; Kimhy, David; Stanford, Arielle; Khan, Shamir; Walsh, Julie; Thompson, Judy; Schobel, Scott; Harkavy-Friedman, Jill; Goetz, Ray; Colibazzi, Tiziano; Cressman, Victoria; Malaspina, Dolores

2008-12-01

Cannabis use is reported to increase the risk for psychosis, but no prospective study has longitudinally examined drug use and symptoms concurrently in clinical high risk cases. We prospectively followed for up to 2 years 32 cases who met research criteria for prodromal psychosis to examine the relationship between substance use and clinical measures. Cases with a baseline history of cannabis use (41%) were older, but did not differ in clinical measures. Longitudinal assessments showed these cases had significantly more perceptual disturbances and worse functioning during epochs of increased cannabis use that were unexplained by concurrent use of other drugs or medications. These data demonstrate that cannabis use may be a risk factor for the exacerbation of subthreshold psychotic symptoms, specifically perceptual disturbances, in high risk cases.

Fructose-rich beverages and risk of gout in women.

PubMed

Choi, Hyon K; Willett, Walter; Curhan, Gary

2010-11-24

Fructose-rich beverages such as sugar-sweetened soda and orange juice can increase serum uric acid levels and, thus, the risk of gout, but prospective data on the relationship are limited. To examine the relationship between intake of fructose-rich beverages and fructose and the risk of incident gout among women. In the Nurses' Health Study, a US prospective cohort study spanning 22 years (1984-2006), we analyzed data from 78,906 women with no history of gout at baseline who provided information on intake of beverages and fructose through validated food frequency questionnaires. Incident cases that met the American College of Rheumatology survey criteria for gout. During 22 years of follow-up, we documented 778 confirmed incident cases of gout. Increasing intake of sugar-sweetened soda was independently associated with increasing risk of gout. Compared with consumption of less than 1 serving per month of sugar-sweetened soda, the multivariate relative risk of gout for 1 serving per day was 1.74 (95% confidence interval [CI], 1.19-2.55) and for 2 or more servings per day was 2.39 (95% CI, 1.34-4.26) (P<.001 for trend). The corresponding relative risks for orange juice were 1.41 (95% CI, 1.03-1.93) and 2.42 (95% CI, 1.27-4.63) (P = .02 for trend). The absolute risk differences corresponding to these relative risks were 36 and 68 cases per 100,000 person-years for sugar-sweetened soda and 14 and 47 cases per 100,000 person-years for orange juice, respectively. Diet soft drinks were not associated with the risk of gout (P = .27 for trend). Compared with the lowest quintile of fructose intake, the multivariate relative risk of gout in the top quintile was 1.62 (95% CI, 1.20-2.19; P = .004 for trend) (risk difference of 28 cases per 100,000 person-years). Among this cohort of women, consumption of fructose-rich beverages is associated with an increased risk of incident gout, although the contribution of these beverages to the risk of gout in the population is likely modest given the low incidence rate among women.

Association of Oral Microbiome With Risk for Incident Head and Neck Squamous Cell Cancer.

PubMed

Hayes, Richard B; Ahn, Jiyoung; Fan, Xiaozhou; Peters, Brandilyn A; Ma, Yingfei; Yang, Liying; Agalliu, Ilir; Burk, Robert D; Ganly, Ian; Purdue, Mark P; Freedman, Neal D; Gapstur, Susan M; Pei, Zhiheng

2018-03-01

Case-control studies show a possible relationship between oral bacteria and head and neck squamous cell cancer (HNSCC). Prospective studies are needed to examine the temporal relationship between oral microbiome and subsequent risk of HNSCC. To prospectively examine associations between the oral microbiome and incident HNSCC. This nested case-control study was carried out in 2 prospective cohort studies: the American Cancer Society Cancer Prevention Study II Nutrition Cohort (CPS-II) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Among 122 004 participants, 129 incident patient cases of HNSCC were identified during an average 3.9 years of follow-up. Two controls per patient case (n = 254) were selected through incidence density sampling, matched on age, sex, race/ethnicity, and time since mouthwash collection. All participants provided mouthwash samples and were cancer-free at baseline. Oral microbiome composition and specific bacterial abundances were determined through bacterial 16S rRNA gene sequencing. Overall oral microbiome composition and specific taxa abundances were compared for the case group and the control group, using PERMANOVA and negative binomial generalized linear models, respectively, controlling for age, sex, race, cohort, smoking, alcohol, and oral human papillomavirus-16 status. Taxa with a 2-sided false discovery rate (FDR)-adjusted P-value (q-value) <.10 were considered significant. Incident HNSCC. The study included 58 patient cases from CPS-II (mean [SD] age, 71.0 [6.4] years; 16 [27.6%] women) and 71 patient cases from PLCO (mean [SD] age, 62.7 [4.8] years; 13 [18.3%] women). Two controls per patient case (n = 254) were selected through incidence density sampling, matched on age, sex, race/ethnicity, and time since mouthwash collection. Head and neck squamous cell cancer cases and controls were similar with respect to age, sex, and race. Patients in the case group were more often current tobacco smokers, tended to have greater alcohol consumption (among drinkers), and to be positive for oral carriage of papillomavirus-16. Overall microbiome composition was not associated with risk of HNSCC. Greater abundance of genera Corynebacterium (fold change [FC], 0.58; 95% confidence interval [CI], 0.41-0.80; q = .06) and Kingella (FC, 0.63; 95% CI, 0.46-0.86; q = .08) were associated with decreased risk of HNSCC, potentially owing to carcinogen metabolism capacity. These findings were consistent for both cohorts and by cohort follow-up time. The observed relationships tended to be stronger for larynx cancer and for individuals with a history of tobacco use. This study demonstrates that greater oral abundance of commensal Corynebacterium and Kingella is associated with decreased risk of HNSCC, with potential implications for cancer prevention.

Shunt diameter in agenesis of the ductus venosus with extrahepatic portosystemic shunt impacts on prognosis.

PubMed

Shen, O; Valsky, D V; Messing, B; Cohen, S M; Lipschuetz, M; Yagel, S

2011-02-01

Agenesis of the ductus venosus (ADV) is a rare condition in which there are two variants of umbilical vein drainage: intrahepatic shunt or extrahepatic (portosystemic) shunt. It has been posited that the extrahepatic variant carries a poorer prognosis. However, in the absence of associated anomalies there is still a wide variation in outcome. We evaluated the portal system in cases of ADV and aimed to identify parameters that might predict outcome. We conducted a retrospective study of cases of ADV with extrahepatic shunt that had been examined in two centers, and collected new cases prospectively. The route of the shunt was depicted using two-dimensional (2D) and three-dimensional (3D) ultrasound imaging. In an attempt to characterize portal system and shunt developmental variations and their possible impact on outcome, the diameter of the shunt was compared with the diameter of the umbilical vein and the entire portal vasculature was assessed. Poor outcome was defined as persistent morbidity or fetal or neonatal death. Twenty-two cases of ADV were identified: nine retrospectively and 13 prospectively. Aberrant shunts from the umbilical vein were identified to the right atrium, coronary sinus, inferior vena cava (IVC) and iliac vein. In seven of 22 cases (32%) a wide connection was observed. In six of these seven cases (86%) the outcome was poor, including four with severe associated anomalies and two with hepatic dysfunction. In five of these cases, cardiomegaly with tricuspid regurgitation was observed, as well as underdevelopment of the portal system. In only five of 15 cases with a narrow shunt (33%) was the outcome poor, and in all five cases the poor outcome was related to associated anomalies. In cases of ADV with extrahepatic shunt, portal system development is impacted by the diameter of the shunt. If the shunt is narrow, the portal system will have developed normally. A wide shunt is associated with underdevelopment or absence of the portal system. In cases of ADV with extrahepatic shunt, prognosis is determined by the severity of associated anomalies, the diameter of the shunt and development of the portal system. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.

Prospective performance evaluation of selected common virtual screening tools. Case study: Cyclooxygenase (COX) 1 and 2.

PubMed

Kaserer, Teresa; Temml, Veronika; Kutil, Zsofia; Vanek, Tomas; Landa, Premysl; Schuster, Daniela

2015-01-01

Computational methods can be applied in drug development for the identification of novel lead candidates, but also for the prediction of pharmacokinetic properties and potential adverse effects, thereby aiding to prioritize and identify the most promising compounds. In principle, several techniques are available for this purpose, however, which one is the most suitable for a specific research objective still requires further investigation. Within this study, the performance of several programs, representing common virtual screening methods, was compared in a prospective manner. First, we selected top-ranked virtual screening hits from the three methods pharmacophore modeling, shape-based modeling, and docking. For comparison, these hits were then additionally predicted by external pharmacophore- and 2D similarity-based bioactivity profiling tools. Subsequently, the biological activities of the selected hits were assessed in vitro, which allowed for evaluating and comparing the prospective performance of the applied tools. Although all methods performed well, considerable differences were observed concerning hit rates, true positive and true negative hits, and hitlist composition. Our results suggest that a rational selection of the applied method represents a powerful strategy to maximize the success of a research project, tightly linked to its aims. We employed cyclooxygenase as application example, however, the focus of this study lied on highlighting the differences in the virtual screening tool performances and not in the identification of novel COX-inhibitors. Copyright © 2015 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

Distortion of Prospective Time Production Underwater.

PubMed

Hobbs, Malcolm B; Kneller, Wendy

2017-07-01

The few prior studies of time perception underwater have reached contradictory conclusions as to how, and if, time perception becomes distorted when submerged. The current paper expands upon this limited data by describing two studies of prospective time production in scuba divers. Study 1 (N = 32) compared performance on a 30-s interval time production task in deep water (35 m-42 m/∼115-138 ft) with a shallow water control (3-12 m/∼10-39 ft). Using the same task, study 2 (N = 31) tested performance at the surface and at a range of depths underwater (1 m/3 ft; 11 m/36 ft; 20 m/66 ft; 30 m/98 ft; 40 m/131 ft). Study 1 revealed time production to be significantly longer in deep water compared to shallow water. In study 2 time production at the surface was not significantly different from that at 1 m, but productions at 11-40 m were significantly longer than at both 1 m and on the surface. Time productions between 11-40 m did not differ significantly. It was concluded that divers judge less time to have passed underwater than is objectively the case from a depth of 11 m, but that this effect does not deteriorate significantly once past 11 m. The cause of this distortion of time perception underwater was suggested to be the action of gas narcosis.Hobbs MB, Kneller W. Distortion of prospective time production underwater. Aerosp Med Hum Perform. 2017; 88(7):677-681.

Effects of case-based learning on communication skills, problem-solving ability, and learning motivation in nursing students.

PubMed

Yoo, Moon-Sook; Park, Hyung-Ran

2015-06-01

The purpose of this study was to explore the effects of case-based learning on communication skills, problem-solving ability, and learning motivation in sophomore nursing students. In this prospective, quasi-experimental study, we compared the pretest and post-test scores of an experimental group and a nonequivalent, nonsynchronized control group. Both groups were selected using convenience sampling, and consisted of students enrolled in a health communication course in the fall semesters of 2011 (control group) and 2012 (experimental group) at a nursing college in Suwon, South Korea. The two courses covered the same material, but in 2011 the course was lecture-based, while in 2012, lectures were replaced by case-based learning comprising five authentic cases of patient-nurse communication. At post-test, the case-based learning group showed significantly greater communication skills, problem-solving ability, and learning motivation than the lecture-based learning group. This finding suggests that case-based learning is an effective learning and teaching method. © 2014 Wiley Publishing Asia Pty Ltd.

Hypomagnesemia in brachycephalic dogs.

PubMed

Mellema, M S; Hoareau, G L

2014-01-01

Brachycephalic dogs are at risk for arterial hypertension and obstructive sleep apnea, which are both associated with chronic magnesium (Mg) depletion. To compare the period prevalence of hypomagnesemia between Boxers and Bulldogs presented to a referral teaching hospital. To screen a group of Bulldogs for evidence of hypomagnesemia, and to obtain pilot data regarding the utility of parenteral Mg tolerance testing (PMgTT) in the diagnosis of whole-body Mg deficiency. Chemistry laboratory submissions were retrospectively analyzed for serum total Mg (tMg) in Boxers and Bulldogs. Prospectively, 16 healthy client-owned Bulldogs were enrolled. Retrospective case study. tMg concentrations were compared between Boxers and Bulldogs. Dogs with low serum albumin or high serum creatinine concentrations were excluded. Prospectively, ionized Mg (iMg), tMg, and arterial blood pressure were measured and iMg-to-tMg ratio (iMg : tMg) was calculated. Parenteral Mg tolerance testing (PMgTT) was performed in 3/16 dogs. In the retrospective study, period prevalence of hypomagnesemia was 4.7% in Boxers and 15% in Bulldogs (P = .02). The risk ratio for hypomagnesemia in Bulldogs was 1.8 when compared to Boxers (CI: 1.3-2.7). In the prospective study, iMg was [median (interquartile)] 0.43 (0.42-0.46) mmol/L (reference range 0.4-0.52), tMg was 1.9 (1.8-1.9) mg/dL (reference range 1.9-2.5). iMg : tMg was [mean (±SD)] 0.59 ± 0.04. Percentage retention after PMgTT were 55%, 95%, and 67%, respectively. Mg deficiency is common in Bulldogs and could contribute to comorbidities often observed in this breed. iMg : tMg and PMgTT might prove helpful in detecting chronic subclinical Mg deficiency. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Coffee consumption and risk of chronic disease in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study.

PubMed

Floegel, Anna; Pischon, Tobias; Bergmann, Manuela M; Teucher, Birgit; Kaaks, Rudolf; Boeing, Heiner

2012-04-01

Early studies suggested that coffee consumption may increase the risk of chronic disease. We investigated prospectively the association between coffee consumption and the risk of chronic diseases, including type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer. We used data from 42,659 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study. Coffee consumption was assessed by self-administered food-frequency questionnaire at baseline, and data on medically verified incident chronic diseases were collected by active and passive follow-up procedures. HRs and 95% CIs were calculated with multivariate Cox regression models and compared by competing risk analysis. During 8.9 y of follow-up, we observed 1432 cases of T2D, 394 of MI, 310 of stroke, and 1801 of cancer as first qualifying events. Caffeinated (HR: 0.94; 95% CI: 0.84, 1.05) or decaffeinated (HR: 1.05; 95% CI: 0.84, 1.31) coffee consumption (≥4 cups/d compared with <1 cup/d; 1 cup was defined as 150 mL) was not associated with the overall risk of chronic disease. A lower risk of T2D was associated with caffeinated (HR: 0.77; 95% CI: 0.63, 0.94; P-trend 0.009) and decaffeinated (HR: 0.70; 95% CI: 0.46, 1.06; P-trend: 0.043) coffee consumption (≥4 cups/d compared with <1 cup/d), but cardiovascular disease and cancer risk were not. The competing risk analysis showed no significant differences between the risk associations of individual diseases. Our findings suggest that coffee consumption does not increase the risk of chronic disease, but it may be linked to a lower risk of T2D.

Association of Low Levels of Vitamin D with Chronic Stable Angina: A Prospective Case-Control Study

PubMed Central

Raina, Ab Hameed; Allai, Mohammad Sultan; Shah, Zafar Amin; Changal, Khalid Hamid; Raina, Manzoor Ahmad; Bhat, Fayaz Ahmad

2016-01-01

Background: Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Chronic stable angina is the initial manifestation of CAD in approximately 50% of the patients. Recent evidence suggests that vitamin D is crucial for cardiovascular health. The prevalence of vitamin D deficiency in our region is 83%. A low level of vitamin D is associated with chronic stable angina. Aim: This study was aimed at supporting or refuting this hypothesis in our population. Materials and Methods: The study was a prospective case-control study. We studied 100 cases of chronic stable angina and compared them with 100 matched controls. Vitamin D deficiency was defined as <20 ng/mL, vitamin D insufficiency as 20-30 ng/mL and normal vitamin D level as 31-150 ng/mL. Results: The prevalence of vitamin D deficiency among cases and controls was 75% and 10%, respectively. 75% of the cases were vitamin D-deficient (<20 ng/mL); 12% were vitamin D-insufficient (20-30 ng/mL), and 13% had normal vitamin D levels (31-150 ng/mL). None had a toxic level of vitamin D. Among the controls, 10% were vitamin D-deficient, 33% were vitamin D-insufficient, and 57% had normal vitamin D levels. The mean vitamin level among cases and controls was 15.53 ng/mL and 40.95 ng/mL, respectively, with the difference being statistically significant (P ≤ 0.0001). There was no statistically significant relation between the disease severities, i.e., on coronary angiography (CAG) with vitamin D level. Among the cases, we found that an increasing age was inversely related to vitamin D levels (P = 0.027). Conclusion: Our study indicates a correlation between vitamin D deficiency and chronic stable angina. Low levels may be an independent, potentially modifiable cardiovascular risk factor. PMID:27114971

Effect of Medicaid Payment on Rehabilitation Care for Nursing Home Residents

PubMed Central

Wodchis, Walter P.; Hirth, Richard A.; Fries, Brant E.

2007-01-01

There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents. PMID:17645160

Effect of Medicaid payment on rehabilitation care for nursing home residents.

PubMed

Wodchis, Walter P; Hirth, Richard A; Fries, Brant E

2007-01-01

There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents.

Prospective study of proton-beam radiation therapy for limited-stage small cell lung cancer.

PubMed

Rwigema, Jean-Claude M; Verma, Vivek; Lin, Liyong; Berman, Abigail T; Levin, William P; Evans, Tracey L; Aggarwal, Charu; Rengan, Ramesh; Langer, Corey; Cohen, Roger B; Simone, Charles B

2017-11-01

Existing data supporting the use of proton-beam therapy (PBT) for limited-stage small cell lung cancer (LS-SCLC) are limited to a single 6-patient case series. This is the first prospective study to evaluate clinical outcomes and toxicities of PBT for LS-SCLC. This study prospectively analyzed patients with primary, nonrecurrent LS-SCLC definitively treated with PBT and concurrent chemotherapy from 2011 to 2016. Clinical backup intensity-modulated radiotherapy (IMRT) plans were generated for each patient and were compared with PBT plans. Outcome measures included local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates and toxicities. Thirty consecutive patients were enrolled and evaluated. The median dose was 63.9 cobalt gray equivalents (range, 45-66.6 cobalt gray equivalents) in 33 to 37 fractions delivered daily (n = 18 [60.0%]) or twice daily (n = 12 [40.0%]). The concurrent chemotherapy was cisplatin/etoposide (n = 21 [70.0%]) or carboplatin/etoposide (n = 9 [30.0%]). In comparison with the backup IMRT plans, PBT allowed statistically significant reductions in the cord, heart, and lung mean doses and the volume receiving at least 5 Gy but not in the esophagus mean dose or the lung volume receiving at least 20 Gy. At a median follow-up of 14 months, the 1-/2-year LC and RFS rates were 85%/69% and 63%/42%, respectively. The median OS was 28.2 months, and the 1-/2-year OS rates were 72%/58%. There was 1 case each (3.3%) of grade 3 or higher esophagitis, pneumonitis, anorexia, and pericardial effusion. Grade 2 pneumonitis and esophagitis were seen in 10.0% and 43.3% of patients, respectively. In the first prospective registry study and largest analysis to date of PBT for LS-SCLC, PBT was found to be safe with a limited incidence of high-grade toxicities. Cancer 2017;123:4244-4251. © 2017 American Cancer Society. © 2017 American Cancer Society.

A Comparative Study of Problematic Internet Use and Loneliness among Turkish and Korean Prospective Teachers

ERIC Educational Resources Information Center

Tutgun, Aylin; Deniz, Levent; Moon, Man-Ki

2011-01-01

The main aim of this study is to compare the problematic internet use and its relation to loneliness among two nations' prospective teachers, Turkey and South Korea. Five hundred and ninety five prospective teachers from three universities, two from Turkey and one from South Korea participated in the study. Generalized Problematic Internet Use…

Successful gas hydrate prospecting using 3D seismic - A case study for the Mt. Elbert prospect, Milne Point, North Slope Alaska

USGS Publications Warehouse

Inks, T.L.; Agena, W.F.

2008-01-01

In February 2007, the Mt. Elbert Prospect stratigraphic test well, Milne Point, North Slope Alaska encountered thick methane gas hydrate intervals, as predicted by 3D seismic interpretation and modeling. Methane gas hydrate-saturated sediment was found in two intervals, totaling more than 100 ft., identified and mapped based on seismic character and wavelet modeling.

Astronomical Prospecting of Asteroid Resources

NASA Astrophysics Data System (ADS)

Elvis, M.

2017-09-01

To make asteroid mining profitable will require professional astronomers using some of the largest telescopes on Earth to make precision measurements. This "astronomical prospecting" information is cheaper to obtain than flying even one or two spacecraft and will drastically cut the number of space probes that have to be sent to find an ore-bearing rock in space. Astronomical prospecting could make the business case for asteroid mining a solid one.

Minimizing the Disruptive Effects of Prospective Memory in Simulated Air Traffic Control

PubMed Central

Loft, Shayne; Smith, Rebekah E.; Remington, Roger

2015-01-01

Prospective memory refers to remembering to perform an intended action in the future. Failures of prospective memory can occur in air traffic control. In two experiments, we examined the utility of external aids for facilitating air traffic management in a simulated air traffic control task with prospective memory requirements. Participants accepted and handed-off aircraft and detected aircraft conflicts. The prospective memory task involved remembering to deviate from a routine operating procedure when accepting target aircraft. External aids that contained details of the prospective memory task appeared and flashed when target aircraft needed acceptance. In Experiment 1, external aids presented either adjacent or non-adjacent to each of the 20 target aircraft presented over the 40min test phase reduced prospective memory error by 11% compared to a condition without external aids. In Experiment 2, only a single target aircraft was presented a significant time (39min–42min) after presentation of the prospective memory instruction, and the external aids reduced prospective memory error by 34%. In both experiments, costs to the efficiency of non-prospective memory air traffic management (non-target aircraft acceptance response time, conflict detection response time) were reduced by non-adjacent aids compared to no aids or adjacent aids. In contrast, in both experiments, the efficiency of the prospective memory air traffic management (target aircraft acceptance response time) was facilitated by adjacent aids compared to non-adjacent aids. Together, these findings have potential implications for the design of automated alerting systems to maximize multi-task performance in work settings where operators monitor and control demanding perceptual displays. PMID:24059825

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy.

PubMed

Karatzanis, Alexander D; Ierodiakonou, Despo P; Fountakis, Emmanuel S; Velegrakis, Stylianos G; Doulaptsi, Maria V; Prokopakis, Emmanuel P; Daraki, Vasiliki N; Velegrakis, George A

2018-05-01

Hypocalcaemia is a common and serious complication after thyroidectomy. The purpose of this study is to assess the effectiveness of first postoperative day parathyroid hormone (PTH) measurement in order to predict the presence and severity of postthyroidectomy hypocalcaemia. One hundred consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively assessed. Preoperative measurements of PTH were compared with postoperative levels in the first morning after surgery. All cases of hypocalcaemia were recorded and evaluated with regard to preoperative and postoperative levels of PTH. A decrease of 56% of PTH levels on the first postoperative day could accurately predict postoperative hypocalcaemia with a sensitivity and specificity of 80%. Serum PTH levels on the first postoperative day may be used as a reliable predictive marker for calcium supplementation need and even prolonged hospitalization in cases undergoing total thyroidectomy. © 2018 Wiley Periodicals, Inc.

Extraneous tissue in surgical pathology: a College of American Pathologists Q-Probes study of 275 laboratories.

PubMed

Gephardt, G N; Zarbo, R J

1996-11-01

To develop a multi-institutional reference database of extraneous tissue (contaminants) in surgical pathology. In 1994, participants in the College of American Pathologists Q-Probes quality improvement program performed prospective and retrospective evaluations of extraneous tissue found in surgical pathology microscopic sections for a period of 4 weeks or until 1000 slides were reviewed in each participating laboratory. Two hundred seventy-five surgical pathology laboratories institutions, predominantly from North America. Extraneous tissue contamination rate for slides in prospective and retrospective reviews; staffing and practice procedures; location of extraneous tissue on slides; type of extraneous tissue (normal, abnormal, nonneoplastic, neoplasm, microorganisms, etc); class of extraneous tissue (slide or block contaminants); source of extraneous tissue (different or same case); origin of extraneous tissue (pathology laboratory, physician's office or operating room); and degree of diagnostic difficulty caused by extraneous tissue. Three hundred twenty-one thousand seven hundred fifty-seven slides were reviewed in the prospective study and 57083 slides in the retrospective study. There was an overall extraneous tissue rate of 0.6% of slides (2074/321757) in the prospective study and 2.9% of slides (1653/57083) in the retrospective study. Of those slides with extraneous tissue, the extraneous tissue was located near diagnostic tissue sections in 59.5% of the slides reviewed prospectively and in 25.3% of slides reviewed retrospectively; deeper sections were performed to evaluate extraneous tissue in 12.2% of prospective cases and in 3.1% of retrospective cases. Of the laboratories, 98% had written guidelines for changing solution in tissue processors, and 64.9% had guidelines for maintaining water baths free of extraneous tissue. A total of 98.9% used lens paper, filter bags, or sponges for processing fragmented and small specimens. Written protocols for documentation of extraneous tissue in surgical pathology reports were established in 6.1% of laboratories, for removal of extraneous tissue from blocks in 5.7%, and for removal of extraneous tissue from microscopic slides in 4.7%. In 24% of laboratories no comment or record was kept to document extraneous tissue. Extraneous tissue consisted of neoplasm in 12.7% of the prospectively reviewed slides and in 6.0% of the retrospectively reviewed slides. For the prospective study, 59.4% of extraneous tissue was classified as slide contaminants, and 28.4% was found to be contaminants within the paraffin block; for the retrospective study, 72.9% was classified as slide contaminants and 15.9% as block contaminants. For the prospective study, 63.2% of extraneous tissue was presumed to be from a different case, and in the retrospective study, 48.5% was presumed to be from a different case. Over 90% of extraneous tissue was thought to originate from the pathology laboratory. The degree of diagnostic difficulty caused by extraneous tissue was judged to be severe in 0.4% of slides in the prospective study and 0.1% of slides in the retrospective study. In the prospective study, it could not be determined whether the tissue in the diagnostic sections was extraneous in 0.6% of slides, and in the retrospective study, it could not be determined whether tissue in the diagnostic sections was extraneous in 0.1%. This study has documented the frequency, type, origin, source, and diagnostic difficulty of extraneous tissue and presents benchmarks of extraneous tissue experienced in the general practice of surgical pathology.

Plasma Riboflavin and Vitamin B-6, but Not Homocysteine, Folate, or Vitamin B-12, Are Inversely Associated with Breast Cancer Risk in the European Prospective Investigation into Cancer and Nutrition-Varese Cohort.

PubMed

Agnoli, Claudia; Grioni, Sara; Krogh, Vittorio; Pala, Valeria; Allione, Alessandra; Matullo, Giuseppe; Di Gaetano, Cornelia; Tagliabue, Giovanna; Pedraglio, Samuele; Garrone, Giulia; Cancarini, Ilaria; Cavalleri, Adalberto; Sieri, Sabina

2016-06-01

One-carbon metabolism-important for DNA stability and integrity-may play a role in breast carcinogenesis. However, epidemiologic studies addressing this issue have yielded inconsistent results. We prospectively investigated associations between breast cancer and plasma folate, riboflavin, vitamin B-6, vitamin B-12, and homocysteine in women recruited to the Varese (Italy) cohort of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. We performed a nested case-control study on women aged 35-65 y at recruitment with a median body mass index of 25.3 kg/m(2) who gave blood samples in 1987-1992 and again in 1993-1998. Breast cancer cases identified by 31 December 2009 were individually matched to controls. RRs of breast cancer (and subtypes defined by hormone receptor status) with 95% CIs were estimated by unconditional logistic regression, controlling for matching factors and breast cancer risk factors. After a median of 14.9 y, 276 breast cancer cases were identified and matched to 276 controls. Increasing plasma vitamin B-6 was associated with decreased risk of overall (RR: 0.78; 95% CI: 0.63, 0.96 for 1-SD increase), premenopausal (RR: 0.66; 95% CI: 0.48, 0.92 for 1-SD increase), estrogen receptor-positive (RR: 0.79; 95% CI: 0.63, 1.00 for 1-SD increase), and progesterone receptor-positive (RR: 0.72; 95% CI: 0.55, 0.95 for 1-SD increase) breast cancers. Increased plasma vitamin B-6 was also associated with decreased breast cancer risk in alcohol consumers (≥7 g/d) compared with consumption of <7 g/d or nonconsumption (RR: 0.71; 95% CI: 0.51, 0.99). High plasma riboflavin was associated with significantly lower risk in premenopausal women (RR: 0.45; 95% CI: 0.21, 0.94; highest compared with the lowest quartile, P trend = 0.021). Plasma homocysteine, folate, and vitamin B-12 were not associated with breast cancer risk. High plasma vitamin B-6 and riboflavin may lower breast cancer risk, especially in premenopausal women. Additional research is necessary to further explore these associations. © 2016 American Society for Nutrition.

Two-year pilot study of newborn screening for congenital adrenal hyperplasia in New South Wales compared with nationwide case surveillance in Australia.

PubMed

Gleeson, Helena K; Wiley, Veronica; Wilcken, Bridget; Elliott, Elizabeth; Cowell, Christopher; Thonsett, Michael; Byrne, Geoffrey; Ambler, Geoffrey

2008-10-01

To assess the benefits and practicalities of setting up a newborn screening (NBS) program in Australia for congenital adrenal hyperplasia (CAH) through a 2 year pilot screening in ACT/NSW and comparing with case surveillance in other states. The pilot newborn screening occurred between 1/10/95 and 30/9/97 in NSW/ACT. Concurrently, case reporting for all new CAH cases occurred through the Australian Paediatric Surveillance Unit (APSU) across Australia. Details of clinical presentation, re-sampling and laboratory performance were assessed. 185,854 newborn infants were screened for CAH in NSW/ACT. Concurrently, 30 cases of CAH were reported to APSU, twelve of which were from NSW/ACT. CAH incidence was 1 in 15 488 (screened population) vs 1 in 18,034 births (unscreened) (difference not significant). Median age of initial notification was day 8 with confirmed diagnosis at 13(5-23) days in the screened population vs 16(7-37) days in the unscreened population (not significant). Of the 5 clinically unsuspected males in the screened population, one had mild salt-wasting by the time of notification, compared with salt-wasting crisis in all 6 males from the unscreened population. 96% of results were reported by day 10. Resampling was requested in 637 (0.4%) and median re-sampling delay was 11(0-28) days with higher resample rates in males (p < 0.0001). The within-laboratory cost per case of clinically unsuspected cases was A$42 717. There seems good justification for NBS for CAH based on clear prevention of salt-wasting crises and their potential long-term consequences. Also, prospects exist for enhancing screening performance.

The InterAct Project: An Examination of the Interaction of Genetic and Lifestyle Factors on the Incidence of Type 2 Diabetes in the EPIC Study

PubMed Central

Langenberg, C; Sharp, S; Forouhi, NG; Franks, P; Schulze, MB; Kerrison, N; Ekelund, U; Barroso, I; Panico, S; Tormo, M; Spranger, J; Griffin, S; van der Schouw, YT; Amiano, P; Ardanaz, E; Arriola, L; Balkau, B; Barricarte, A; Beulens, JWJ; Boeing, H; Bueno-de-Mesquita, HB; Buijsse, BB; Chirlaque Lopez, MD; Clavel-Chapelon, F; Crowe, FL; de Lauzon-Guillan, B; Deloukas, P; Dorronsoro, M; Drogan, DD; Froguel, P; Gonzalez, C; Grioni, S; Groop, L; Groves, C; Hainaut, P; Halkjaer, J; Hallmans, G; Hansen, T; Kaaks, R; Key, TJ; Khaw, K; Koulman, A; Mattiello, A; Navarro, C; Nilsson, P; Norat, T; Overvad, K; Palla, L; Palli, D; Pedersen, O; Peeters, PH; Quirós, JR; Ramachandran, A; Rodriguez-Suarez, L; Rolandsson, O; Romaguera, D; Romieu, I; Sacerdote, C; Sánchez, M; Sandbaek, A; Slimani, N; Sluijs, I; Spijkerman, AMW; Teucher, B; Tjonneland, A; Tumino, R; van der A, DL; Verschuren, WMM; Tuomilehto, J; Feskens, E; McCarthy, M; Riboli, E; Wareham, NJ

2014-01-01

Background Studying gene-lifestyle interaction may help to identify lifestyle factors that modify genetic susceptibility and uncover genetic loci exerting important subgroup effects. Adequately powered studies with prospective, unbiased, standardised assessment of key behavioural factors for gene-lifestyle studies are lacking. Objective To establish a type 2 diabetes case-cohort study designed to investigate how genetic and potentially modifiable lifestyle and behavioral factors, particularly diet and physical activity, interact in their influence on the risk of developing type 2 diabetes. Methods Funded by the Sixth European Framework Programme, InterAct consortium partners ascertained and verified incident cases of type 2 diabetes occurring in European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts between 1991 and 2007 from 8 of the 10 EPIC countries. A pragmatic, high sensitivity approach was used for case ascertainment including multiple sources at each EPIC centre, followed by diagnostic verification. Prentice-weighted Cox regression and random effects meta-analyses were used to investigate differences in diabetes incidence by age and sex. Results A total of 12,403 verified incident cases of type 2 diabetes occurred during 3.99 million person-years of follow-up of 340,234 EPIC participants eligible for InterAct. We defined a centre stratified subcohort of 16,154 individuals for comparative analyses. Individuals with incident diabetes that were randomly selected into the subcohort (n=778) were included as cases in the analyses. All prevalent diabetes cases were excluded from the study. InterAct cases were followed-up for an average of 6.9 years, 49.7% were men. Mean baseline age and age at diagnosis were 55.6 and 62.5 years, mean BMI and waist were 29.4 kg/m2 and 102.7 cm in men, and 30.1 kg/m2 and 92.8 cm in women, respectively. Risk of type 2 diabetes increased linearly with age, with an overall hazard ratio (95% CI) of 1.56 (1.48; 1.64) for a 10 year age difference, adjusted for sex. A male excess in the risk of incident diabetes was consistently observed across all countries, with a pooled hazard ratio of 1.51 (1.39; 1.64), adjusted for age. Conclusions InterAct is a large, well powered, prospective study which will inform our understanding of the interplay between genes and lifestyle factors on the risk of type 2 diabetes development. PMID:21717116

The incidence and causative organisms of infection in elective shoulder surgery.

PubMed

Mayne, Alistair I W; Bidwai, Amit S; Clifford, Rachael; Smith, Matthew G; Guisasola, Inigo; Brownson, Peter

2018-07-01

Deep infection remains a serious complication of orthopaedic surgery. Knowledge of infection rates and causative organisms is important to guide infection control measures. The aim of the present study was to determine infection rates and causative organisms in elective shoulder surgery. Cases complicated by infection were identified and prospectively recorded over a 2-year period. All patients undergoing elective shoulder surgery in the concurrent period at a single Specialist Upper Limb Unit in the UK were identified from the hospital electronic database. In total, 1574 elective shoulder cases were performed: 1359 arthroscopic (540 with implant insertion) and 215 open (197 with implant insertion). The overall infection rate in open surgery of 2.5% was significantly higher than arthroscopic implant cases at 0.7% ( p  < 0.005). The overall infection rate in implant arthroscopic surgery was significantly higher at 0.7% compared to 0% in non-implant related surgery. ( p  < 0.05). Patients undergoing open shoulder surgery have a significantly higher risk of infection compared to arthroscopic shoulder surgery. Arthroscopic surgery with implant insertion has a statistically significantly higher risk of developing deep infection compared to procedures with no implant insertion. We recommend prophylactic antibiotics in open shoulder surgery and arthroscopic shoulder surgery with implant insertion.

Improving and Measuring Inpatient Documentation of Medical Care within the MS-DRG System: Education, Monitoring, and Normalized Case Mix Index

PubMed Central

Rosenbaum, Benjamin P.; Lorenz, Robert R.; Luther, Ralph B.; Knowles-Ward, Lisa; Kelly, Dianne L.; Weil, Robert J.

2014-01-01

Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the “normalized case mix index,” that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved. PMID:25214820

How recalibration method, pricing, and coding affect DRG weights

PubMed Central

Carter, Grace M.; Rogowski, Jeannette A.

1992-01-01

We compared diagnosis-related group (DRG) weights calculated using the hospital-specific relative-value (HSR V) methodology with those calculated using the standard methodology for each year from 1985 through 1989 and analyzed differences between the two methods in detail for 1989. We provide evidence suggesting that classification error and subsidies of higher weighted cases by lower weighted cases caused compression in the weights used for payment as late as the fifth year of the prospective payment system. However, later weights calculated by the standard method are not compressed because a statistical correlation between high markups and high case-mix indexes offsets the cross-subsidization. HSR V weights from the same files are compressed because this methodology is more sensitive to cross-subsidies. However, both sets of weights produce equally good estimates of hospital-level costs net of those expenses that are paid by outlier payments. The greater compression of the HSR V weights is counterbalanced by the fact that more high-weight cases qualify as outliers. PMID:10127456

Improving and measuring inpatient documentation of medical care within the MS-DRG system: education, monitoring, and normalized case mix index.

PubMed

Rosenbaum, Benjamin P; Lorenz, Robert R; Luther, Ralph B; Knowles-Ward, Lisa; Kelly, Dianne L; Weil, Robert J

2014-01-01

Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the "normalized case mix index," that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved.

Prospective study of the primary evaluation of 1016 horses with clinical signs of abdominal pain by veterinary practitioners, and the differentiation of critical and non-critical cases.

PubMed

Curtis, Laila; Burford, John Harold; Thomas, Jennifer Sara Marian; Curran, Marise Linda; Bayes, Tom Curtis; England, Gary Crane William; Freeman, Sarah Louise

2015-10-06

The majority of research on the evaluation of horses with colic is focused on referral hospital populations. Early identification of critical cases is important to optimise outcome and welfare. The aim of this prospective study was to survey the primary evaluation of horses with clinical signs of abdominal pain by veterinary practitioners, and compare the initial presentation of critical and non-critical cases. Data from 1016 primary evaluations of horses presenting with clinical signs of colic were submitted by 167 veterinary practitioners across the United Kingdom over a 13 month period. The mean age of the study population was 13.5 years (median 12.0, range 0-42). Mean heart rate on primary presentation was 47 beats/min (median 44, range 18-125), mean respiratory rate was 20 breaths/min (median 16, range 6-100), and median gastrointestinal auscultation score (0-12, minimum-maximum) was 5 (range 0-12). Clinical signs assessed using a behavioural severity score (0-17, minimum-maximum), were between 0 and 6 in 70.4 % of cases, and 7-12 for 29.6 % of cases. Rectal examination was performed in 73.8 % of cases. Cases that responded positively to simple medical treatment were categorised retrospectively as 'non-critical'; cases that required intensive medical treatment, surgical intervention, died or were euthanased were categorised as 'critical'. Eight-hundred-and-twenty-two cases met these criteria; 76.4 % were 'non-critical' and 23.6 % were 'critical'. Multivariable logistic regression was used to identify features of the clinical presentation associated with critical cases. Five variables were retained in the final multivariable model: combined pain score: (OR 1.19, P < 0.001, 95 % CI 1.09-1.30), heart rate (OR 1.06, P < 0.001, 95 % CI 1.04-1.08), capillary refill time >2.5 s (OR 3.21, P = 0.046, 95 % CI 1.023-10.09), weak pulse character (OR 2.90, P = 0.004, 95 % CI 1.39-5.99) and absence of gut sounds in ≥1 quadrant (OR 3.65, P < 0.001, 95 % CI 2.08-6.41). This is the first study comparing the primary presentation of critical and non-critical cases of abdominal pain. Pain, heart rate, gastrointestinal borborygmi and simple indicators of hypovolaemia were significant indicators of critical cases, even at the primary veterinary examination, and should be considered essential components of the initial assessment and triage of horses presenting with colic.

Plasma levels of nitrate and risk of prostate cancer: a prospective study.

PubMed

Wu, Tianying; Wang, Yushan; Ho, Shuk-Mei; Giovannucci, Edward

2013-07-01

Nitrate and nitrite supplements have recently been shown to improve cardiovascular health, but there is concern that these supplements could contribute to the development of cancer. Previous small, cross-sectional studies reported positive associations between circulating nitrate/nitrite levels and cancer. Prospective studies examining the association between plasma nitrate and cancer, especially prostate cancer, are lacking. We conducted a nested case-control study within the Health Professionals Follow-up Study. Baseline blood samples were collected in 1994, and incident cases of prostate cancer were identified from 1997 to 2005. Baseline plasma levels of nitrate were measured in the 630 cases and 630 matched controls. We have found that baseline levels of plasma nitrate were not associated with risk of prostate cancer. Compared to quintile 1, the relative risk from quintiles 2 to 5 were 1.13 [95% confidence interval (CI), 0.78-1.63], 0.93 (95% CI, 0.63-1.38), 0.95 (95% CI, 0.65-1.39), and 0.99 (95% CI, 0.68-1.48); Ptrend was 0.9 after adjustment of multivariate risk factors. When analyses were restricted to men fasting more than 6 hours, the trend was similar. Furthermore, plasma nitrate seemed to be inversely associated with advanced-stage prostate cancer. The relative risk across extreme quartiles was 0.44 (95% CI, 0.17-1.12; Ptrend = 0.07) for the whole dataset and 0.30 (95% CI, 0.09-0.99; Ptrend = 0.05) for the fasting dataset. In summary, we did not find an increased risk of prostate cancer associated with higher plasma nitrate levels. A potential protective association between nitrate and aggressive forms of prostate cancer requires confirmation. Nitrate-nitrite-nitric oxide pathway has emerged as a new therapeutic pathway for chronic diseases. The results of this study certainly merit replications in other prospective studies.

Plasma levels of nitrate and risk of prostate cancer: a prospective study

PubMed Central

Wu, Tianying; Wang, Yushan; Ho, Shuk-Mei; Giovannucci, Edward

2013-01-01

Background Nitrate and nitrite supplements have recently been shown to improve cardiovascular health, but there is concern that these supplements could contribute to the development of cancer.Previous small, cross-sectional studies reported positive associations between circulating nitrate/nitrite levels and cancer. Prospective studies examining the association between plasma nitrate and cancer, especially prostate cancer (PCa), are lacking. Methods We conducted a nested case-control study within the Health Professionals Follow-up Study. Baseline blood samples were collected in 1994, and incident cases of PCa were identified from 1997–2005. Baseline plasma levels of nitrate were measured in the 630 cases and 630 matched controls. Results We have found that baseline levels of plasma nitrate were not associated with risk of PCa. Compared to quintile 1, the relative risk from quintiles 2–5 were 1.13 (95% CI, 0.78–1.63), 0.93 (95% CI, 0.63–1.38), 0.95 (95% CI, 0.65–1.39), and 0.99 (95% CI, 0.68–1.48); p for trend was 0.9 after adjustment of multivariate risk factors. When analyses were restricted to men fasting more than 6 hrs, the trend was similar. Further, plasma nitrate appeared to be inversely associated with advanced-stage PCa. The relative risk across extreme quartiles was 0.44 (95% CI, 0.17–1.12; p for trend = 0.07) for the whole data set and 0.30 (95% CI, 0.09–0.99; p for trend = 0.05) for the fasting data set. Conclusions In summary, we did not find an increased risk of PCa associated with higher plasma nitrate levels. A potential protective association between nitrate and aggressive forms of PCa requires confirmation. Impact Nitrate-nitrite-nitric oxide pathway has emerged as a new therapeutic pathway for chronic diseases. The results of this study certainly merit replications in other prospective studies. PMID:23677578

Endogenous estrogens and breast cancer risk: the case for prospective cohort studies.

PubMed Central

Toniolo, P G

1997-01-01

It is generally agreed that estrogens, and possibly androgens, are important in the etiology of breast cancer, but no consensus exists as to the precise estrogenic or androgenic environment that characterizes risk, or the exogenous factors that influence the hormonal milieu. Nearly all the epidemiological studies conducted in the 1970s and 1980s were hospital-based case-control studies in which specimen sampling was performed well after the clinical appearance of the disease. Early prospective cohort studies also had limitations in their small sample sizes or short follow-up periods. However, more recent case-control studies nested within large cohorts, such as the New York University Women's Health Study and the Ormoni e Dieta nell'Eziologia dei Tumori study in Italy, are generating new data indicating that increased levels of estrone, estradiol and bioavailable estradiol, as well as their androgenic precursors, may be associated with a 4- to 6-fold increase in the risk of postmenopausal breast cancer. Further new evidence, which complements and expands the observations from the latter studies, shows that women with the thickest bone density, which may be a surrogate for cumulated exposure to hormones, experience severalfold increased risk of subsequent breast cancer as compared to women with thin bones. These data suggests that endogenous sex hormones are a key factor in the etiology of postmenopausal breast cancer. New prospective cohort studies should be conducted to examine the role of endogenous sex hormones in blood and urine samples obtained early in the natural history of breast cancer jointly with an assessment of bone density and of other important risk factors, such as mammographic density, physical activity, body weight, and markers of individual susceptibility, which may confer increased risk through an effect on the metabolism of endogenous hormones or through specific metabolic responses to Western lifestyle and diet. PMID:9168000

Regular Use of Aspirin or Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs Is Not Associated With Risk of Incident Pancreatic Cancer in Two Large Cohort Studies.

PubMed

Khalaf, Natalia; Yuan, Chen; Hamada, Tsuyoshi; Cao, Yin; Babic, Ana; Morales-Oyarvide, Vicente; Kraft, Peter; Ng, Kimmie; Giovannucci, Edward; Ogino, Shuji; Stampfer, Meir; Cochrane, Barbara B; Manson, JoAnn E; Clish, Clary B; Chan, Andrew T; Fuchs, Charles S; Wolpin, Brian M

2018-04-01

Use of aspirin and/or non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) reduces the risk of several cancers, but it is not clear if use of these drugs is associated with risk of pancreatic cancer. We evaluated aspirin and non-aspirin NSAID use and risk of pancreatic adenocarcinoma in 141,940 participants from the Health Professionals Follow-up Study and Nurses' Health Study using multivariable-adjusted Cox proportional hazards regression. We considered several exposure classifications to model differing lag times between NSAID exposure and cancer development. We also conducted a nested case-control study of participants from 3 prospective cohorts using conditional logistic regression to evaluate pre-diagnosis levels of plasma salicylurate, a major metabolite of aspirin, in 396 pancreatic cancer cases and 784 matched individuals without pancreatic cancer (controls). In the prospective cohort study, 1122 participants developed pancreatic adenocarcinoma over 4.2 million person-years. Use of aspirin or non-aspirin NSAIDs was not associated with pancreatic cancer risk, even after considering several latency exposure classifications. In a pre-planned subgroup analysis, regular aspirin use was associated with reduced pancreatic cancer risk among participants with diabetes (relative risk, 0.71; 95% CI, 0.54-0.94). In the nested case-control study, pre-diagnosis levels of salicylurate were not associated with pancreatic cancer risk (odds ratio, 1.08; 95% CI, 0.72-1.61; P trend 0.81; comparing participants in the highest quintile with those in the lowest quintile of plasma salicylurate). Regular aspirin or non-aspirin NSAID use was not associated with future risk of pancreatic cancer in participants from several large prospective cohort studies. A possible reduction in risk for pancreatic cancer among people with diabetes who regularly use aspirin should be further examined in preclinical and human studies. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Evaluating the association of allergies with multiple sclerosis susceptibility risk and disease activity in a pediatric population.

PubMed

Bourne, Theresa; Waltz, Michael; Casper, T C; Kavak, K; Aaen, G; Belman, A; Benson, L; Candee, M; Chitnis, T; Graves, J; Greenberg, B; Gorman, M; Harris, Y; Krupp, L; Lotze, T; Mar, S; Ness, J; Olsen, C; Roalstad, S; Rodriguez, M; Rose, J; Rubin, J; Schreiner, T; Tillema, J M; Kahn, I; Waldman, A; Barcellos, L; Waubant, E; Weinstock-Guttman, B

2017-04-15

Multiple sclerosis (MS) and allergies are both considered to be related to imbalanced Th1 and Th2 immune responses. Previous studies evaluating the relationship between MS and allergies provide conflicting results. To assess allergies and asthma as risk factors for MS and as predictors of MS relapses in a pediatric cohort. The environment and genetic risk factors for pediatric MS study is a national case-control project with 16 participating US sites. An environmental questionnaire is used that includes history of allergies in the first five years of life. Case-control data are entered in the pediatric MS Network database and cases at 12 of the 16 sites enter relapse data prospectively. Annualized relapse rate was calculated for patients with follow-up and adjusted for age at disease onset, gender, race, ethnicity, and use of disease-modifying therapy (DMT). We included 271 cases (mean age at disease onset of 15.7years and 62% female) and 418 controls. Relapse data were available for 193 cases. There was no difference in prevalence of allergies or asthma between cases and controls. Patients with food allergies had fewer relapses compared to patients without food allergies (0.14 vs 0.48, p=0.01). While allergies and asthma are not associated with pediatric MS, cases with food allergies have fewer relapses compared to those without food allergies. Copyright © 2017 Elsevier B.V. All rights reserved.

A prospective study of the APOA1 XmnI and APOC3 SstI polymorphisms in the APOA1/C3/A4 gene cluster and risk of incident myocardial infarction in men.

PubMed

Liu, Simin; Song, Yiqing; Hu, Frank B; Niu, Tianhua; Ma, Jing; Gaziano, Michael; Stampfer, Meir J

2004-11-01

Apolipoproteins AI/CIII/AIV play important roles in the metabolism of triglycerides (TG) and high-density lipoprotein (HDL) cholesterol. However, whether genetic variations in the APOA1/C3/A4 gene cluster are associated with the risk of myocardial infarction (MI) remains uncertain and prospective data are sparse. In a prospective nested case-control study of 385 incident cases of MI and 373 age- and smoking-matched controls from the Physicians' Health Study, we examined the relationship between 2 common single nucleotide polymorphisms (APOA1 XmnI and APOC3 SstI) in the APOA1/C3/A4 gene cluster and haplotypes defined by these SNPs and risk of incident MI. No significant differences in allele or genotype frequency for the APOA1 XmnI and APOC3 SstI polymorphisms were detected between cases and controls. After adjusting for non-lipid coronary risk factors, the relative risks for incident MI were 1.00 (95% CI 0.68-1.47) for men carrying the X2 allele compared with those homozygous for the X1 allele in the APOA1 XmnI site and 1.07 (95% CI 0.69-1.64) for men carrying the S2 versus those homozygous for the S1 allele in the APOC3 SstI site. Moreover, we did not observe any effect modification by HDL or TG levels for the associations of these APOA1 and APOC3 genotypes with MI risk. There were significant differences in TG levels among men carrying different haplotypes (P=0.01) and men carrying the X1-S2 haplotype had higher levels of TG than those carrying the X2-S1 haplotype (202 mg/dl versus 157 mg/dl, P=0.03); however, haplotype frequencies defined by these two polymorphisms did not differ significantly between cases and controls. In this prospective study of apparently healthy middle-aged US men, carriers of the X1-S2 haplotype in the APOA1 XmnI and APOC3 SstI variants across the APOA1/C3/A4 gene cluster had higher TG levels, but there was no evidence for significant associations between these two common variants or haplotypes defined by them and risk of incident MI in this cohort.

Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study.

PubMed

Thayyil, Sudhin; Sebire, Neil J; Chitty, Lyn S; Wade, Angie; Chong, Wk; Olsen, Oystein; Gunny, Roxana S; Offiah, Amaka C; Owens, Catherine M; Saunders, Dawn E; Scott, Rosemary J; Jones, Rod; Norman, Wendy; Addison, Shea; Bainbridge, Alan; Cady, Ernest B; Vita, Enrico De; Robertson, Nicola J; Taylor, Andrew M

2013-07-20

Post-mortem MRI is a potential diagnostic alternative to conventional autopsy, but few large prospective studies have compared its accuracy with that of conventional autopsy. We assessed the accuracy of whole-body, post-mortem MRI for detection of major pathological lesions associated with death in a prospective cohort of fetuses and children. In this prospective validation study, we did pre-autopsy, post-mortem, whole-body MRI at 1·5 T in an unselected population of fetuses (≤24 weeks' or >24 weeks' gestation) and children (aged <16 years) at two UK centres in London between March 1, 2007 and Sept 30, 2011. With conventional autopsy as the diagnostic gold standard, we assessed MRI findings alone, or in conjunction with other minimally invasive post-mortem investigations (minimally invasive autopsy), for accuracy in detection of cause of death or major pathological abnormalities. A radiologist and pathologist who were masked to the autopsy findings indicated whether the minimally invasive autopsy would have been adequate. The primary outcome was concordance rate between minimally invasive and conventional autopsy. We analysed 400 cases, of which 277 (69%) were fetuses and 123 (31%) were children. Cause of death or major pathological lesion detected by minimally invasive autopsy was concordant with conventional autopsy in 357 (89·3%, 95% CI 85·8-91·9) cases: 175 (94·6%, 90·3-97·0) of 185 fetuses at 24 weeks' gestation or less, 88 (95·7%, 89·3-98·3) of 92 fetuses at more than 24 weeks' gestation, 34 (81·0%, 66·7-90·0) [corrected] of 42 newborns aged 1 month or younger, 45 (84·9%, 72·9-92·1) of 53 infants aged older than 1 month to 1 year or younger, and 15 (53·6%, 35·8-70·5) of 28 children aged older than 1 year to 16 years or younger. The dedicated radiologist or pathologist review of the minimally invasive autopsy showed that in 165 (41%) cases a full autopsy might not have been needed; in these cases, concordance between autopsy and minimally invasive autopsy was 99·4% (96·6-99·9). Minimally invasive autopsy has accuracy similar to that of conventional autopsy for detection of cause of death or major pathological abnormality after death in fetuses, newborns, and infants, but was less accurate in older children. If undertaken jointly by pathologists and radiologists, minimally invasive autopsy could be an acceptable alternative to conventional autopsy in selected cases. Policy research Programme, Department of Health, UK. Copyright © 2013 Elsevier Ltd. All rights reserved.

The clinical epidemiology and malignancies associated with Streptococcus bovis biotypes in 506 cases of bloodstream infections.

PubMed

Corredoira, Juan; Grau, Imma; Garcia-Rodriguez, Jose F; Alonso-Garcia, Pilar; Garcia-Pais, M J; Rabuñal, Ramon; Garcia-Garrote, Fernando; Ardanuy, Carmen; Coira, Amparo; Lopez-Alvarez, M J; Pallares, Roman

2015-09-01

To determine the incidence of Streptococcus bovis (Sb) biotypes causing bacteraemia and associated malignancies. This is a retrospective analysis of patients with Sb bacteraemia, pulled out from a prospective surveillance protocol of bacteraemia cases, in three areas of Spain (1990-2013): a cattle area (Lugo), a fishing area (Ferrol) and an urban area (Barcelona). Colonoscopy and Sb biotypes (Sb-I and Sb-II) were determined in most cases. 506 patients with Sb bacteraemia; mean age 68.1 (±14.1) years, and 66.2% were males. The cattle area, compared with the fishing and urban areas, had higher incidence of bacteraemia by SbI (40.29 vs 9.38 vs 6.15 cases/10(6) person-years, P < 0.001) and bacteraemia by Sb-II (29.07 vs 9.84 vs 13.37 cases/10(6) person-years, P < 0.001). The Sb-I cases (n = 224), compared with Sb-II cases (n = 270), had greater rates of endocarditis (77.6% vs 9.6%, P < 0.001) and colorectal neoplasm (CRN) (50.9% vs 16.6%, P < 0.001), and smaller rates of biliary tract infection (2.2% vs 29.6%, P < 0.001) and non-colorectal malignancy (8.9% vs 31.4%, P < 0.001). There was a link between the cattle area and higher incidence of Sb bacteraemia. Sb-I differed from Sb-II cases in clinical findings and associated malignancies. Colonoscopy is mandatory in cases of endocarditis or bacteraemia caused by Sb-I. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Ultrasonographic findings of placenta lacunae and a lack of a clear zone in cases with placenta previa and normal placenta.

PubMed

Hamada, Shoko; Hasegawa, Junichi; Nakamura, Masamitsu; Matsuoka, Ryu; Ichizuka, Kiyotake; Sekizawa, Akihiko; Okai, Takashi

2011-11-01

To evaluate whether the frequencies of placenta lacunae and lack of a clear zone are higher in cases of placenta previa compared with those without it. Ultrasonographic findings just before delivery, including placenta lacunae and lack of a clear zone were prospectively evaluated in consecutive subjects. After collection, a case-control study with 1:5 matched pairs was conducted. The frequencies of ultrasonographic findings were analyzed in cases with placenta previa and normal placenta. Seventy cases with placenta previa and 350 cases with normal placentas were observed. Five and zero cases with abnormal placental adherence were observed in cases with placenta previa and normal placenta, respectively. Lack of a clear zone was observed in 60 and 1.5% of cases with and without the placental adherence (p = 0.001). Placenta lacunae and lack of a clear zone were observed in 31.4 and 9.7% of cases with and without placenta previa [odds ratio (OR) 4.2]. Lack of a clear zone was observed in 5.7 and 0.9% of cases with and without placenta previa (OR 7.0). Placenta lacunae and lack of a clear zone are frequently observed in placenta previa even when there is no adherence of the placenta. Copyright © 2011 John Wiley & Sons, Ltd.

Eosinophilic drug reactions detected by a prospective pharmacovigilance programme in a tertiary hospital

PubMed Central

Medrano‐Casique, Nicolás; Tong, Hoi Y.; Bellón, Teresa; Cabañas, Rosario; Fiandor, Ana; González‐Ramos, Jessica; Herranz, Pedro; Trigo, Elena; Muñoz, Mario; Borobia, Alberto M.; Carcas, Antonio J.

2016-01-01

Aim We conducted a prospective evaluation of all eosinophilic drug reactions (EDRs) through the Prospective Pharmacovigilance Program from Laboratory Signals at Hospital to find out the incidence and distribution of these entities in our hospital, their causative drugs, and predictors. Methods All peripheral eosinophilia >700 × 106 cells l−1 detected at admission or during hospitalisation, were prospectively monitored over 42 months. The spectrum of the localised or systemic manifestation of EDR, the incidence, the distribution of causative drugs, and the predictors were analysed. Results The incidence of EDR was 16.67 (95% Poisson confidence interval [CI]: 9.90–25.98) per 10 000 admissions. Of 274 cases of EDR, 154 (56.2%) cases in 148 patients were asymptomatic hypereosinophilia. In the remaining 120 (43.8%) cases, there was other involvement. Skin and soft tissue reactions were detected in 36 (13.1%) cases; visceral EDRs in 19(7.0%) cases; and drug‐induced eosinophilic cutaneous and visceral manifestations were detected in the remaining 65 (23.7%) cases, 64 of which were potential drug reaction with eosinophilia and systemic symptoms (DRESS). After adjusting for age, sex, and hospitalisation wards, predictors of symptomatic eosinophilia were earlier onset of eosinophilia (hazard ratio [HR], 10.49; 95%CI: 3.13–35.16) higher eosinophil count (HR, 8.51; 95%CI: 3.28–22.08), and a delayed onset of corticosteroids (HR, 1.34; 95%CI: 1.01–1.73). A higher eosinophil count in patients with DRESS was significantly associated with greater impairment of liver function, prolonged hospitalisation, higher cumulative doses of corticosteroids, and if hypogammaglobinaemia was detected, a reactivation of human‐herpesvirus 6 was subsequently detected. Conclusions Half (53.3%, 64/120 cases) of symptomatic EDRs were potential DRESS. The main predictor of severity of EDR was an early severe eosinophilia. PMID:27543764

42 CFR 413.340 - Transition period.

Code of Federal Regulations, 2014 CFR

2014-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... the facility-specific rate. Allowable costs associated with exemptions, as described in § 413.30(e)(2... minus 1 percentage point. (c) SNFs participating in the Multistate Nursing Home Case-Mix and Quality...

42 CFR 413.340 - Transition period.

Code of Federal Regulations, 2012 CFR

2012-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... the facility-specific rate. Allowable costs associated with exemptions, as described in § 413.30(e)(2... minus 1 percentage point. (c) SNFs participating in the Multistate Nursing Home Case-Mix and Quality...

42 CFR 413.340 - Transition period.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... the facility-specific rate. Allowable costs associated with exemptions, as described in § 413.30(e)(2... minus 1 percentage point. (c) SNFs participating in the Multistate Nursing Home Case-Mix and Quality...

Surging Ahead

ERIC Educational Resources Information Center

Ruda, Tammie L.

2011-01-01

A challenge gift helps fundraisers reach goals by stimulating multiple aspects of a fundraising program. First, the message of a challenge grabs the attention of prospects and generally generates excitement beyond the case for support. It also commands the attention of the prospect managers in an organization, particularly when the challenge…

Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis.

PubMed

Reis, Eliana A G; Hagan, José E; Ribeiro, Guilherme S; Teixeira-Carvalho, Andrea; Martins-Filho, Olindo A; Montgomery, Ruth R; Shaw, Albert C; Ko, Albert I; Reis, Mitermayer G

2013-01-01

The role of the immune response in influencing leptospirosis clinical outcomes is not yet well understood. We hypothesized that acute-phase serum cytokine responses may play a role in disease progression, risk for death, and severe pulmonary hemorrhage syndrome (SPHS). We performed a case-control study design to compare cytokine profiles in patients with mild and severe forms of leptospirosis. Among patients hospitalized with severe disease, we compared those with fatal and nonfatal outcomes. During active outpatient and hospital-based surveillance we prospectively enrolled 172 patients, 23 with mild disease (outpatient) and 149 with severe leptospirosis (hospitalized). Circulating concentrations of pro- and anti-inflammatory cytokines at the time of patient presentation were measured using a multiplex bead array assay. Concentrations of IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, and TNF-α were significantly higher (P<0.05) in severe disease compared to mild disease. Among severe patients, levels of IL-6 (P<0.001), IL-8 (P = 0.0049) and IL-10 (P<0.001), were higher in fatal compared to non-fatal cases. High levels of IL-6 and IL-10 were independently associated (P<0.05) with case fatality after adjustment for age and days of symptoms. IL-6 levels were higher (P = 0.0519) among fatal cases who developed SPHS than among who did not. This study shows that severe cases of leptospirosis are differentiated from mild disease by a "cytokine storm" process, and that IL-6 and IL-10 may play an immunopathogenic role in the development of life-threatening outcomes in human leptospirosis.

Race-dependent association of sulfidogenic bacteria with colorectal cancer.

PubMed

Yazici, Cemal; Wolf, Patricia G; Kim, Hajwa; Cross, Tzu-Wen L; Vermillion, Karin; Carroll, Timothy; Augustus, Gaius J; Mutlu, Ece; Tussing-Humphreys, Lisa; Braunschweig, Carol; Xicola, Rosa M; Jung, Barbara; Llor, Xavier; Ellis, Nathan A; Gaskins, H Rex

2017-11-01

Colorectal cancer (CRC) incidence is higher in African Americans (AAs) compared with non-Hispanic whites (NHWs). A diet high in animal protein and fat is an environmental risk factor for CRC development. The intestinal microbiota is postulated to modulate the effects of diet in promoting or preventing CRC. Hydrogen sulfide, produced by autochthonous sulfidogenic bacteria, triggers proinflammatory pathways and hyperproliferation, and is genotoxic. We hypothesised that sulfidogenic bacterial abundance in colonic mucosa may be an environmental CRC risk factor that distinguishes AA and NHW. Colonic biopsies from uninvolved or healthy mucosa from CRC cases and tumour-free controls were collected prospectively from five medical centres in Chicago for association studies. Sulfidogenic bacterial abundance in uninvolved colonic mucosa of AA and NHW CRC cases was compared with normal mucosa of AA and NHW controls. In addition, 16S rDNA sequencing was performed in AA cases and controls. Correlations were examined among bacterial targets, race, disease status and dietary intake. AAs harboured a greater abundance of sulfidogenic bacteria compared with NHWs regardless of disease status. Bilophila wadsworthia -specific dsrA was more abundant in AA cases than controls. Linear discriminant analysis of 16S rRNA gene sequences revealed five sulfidogenic genera that were more abundant in AA cases. Fat and protein intake and daily servings of meat were significantly higher in AAs compared with NHWs, and multiple dietary components correlated with a higher abundance of sulfidogenic bacteria. These results implicate sulfidogenic bacteria as a potential environmental risk factor contributing to CRC development in AAs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Selecting Cases for Intensive Analysis: A Diversity of Goals and Methods

ERIC Educational Resources Information Center

Gerring, John; Cojocaru, Lee

2016-01-01

This study revisits the task of case selection in case study research, proposing a new typology of strategies that is explicit, disaggregated, and relatively comprehensive. A secondary goal is to explore the prospects for case selection by "algorithm," aka "ex ante," "automatic," "quantitative,"…

The case for improving road safety in Pacific Islands: a population-based study from Fiji (TRIP 6).

PubMed

Herman, Josephine; Ameratunga, Shanthi; Wainiqolo, Iris; Kafoa, Berlin; McCaig, Eddie; Jackson, Rod

2012-10-01

To estimate the incidence and demographic characteristics associated with road traffic injuries (RTIs) resulting in deaths or hospital admission for 12 hours or more in Viti Levu, Fiji. Analysis of the prospective population-based Fiji Injury Surveillance in Hospitals database (October 2005 - September 2006). Of the 374 RTI cases identified (17% of all injuries), 72% were males and one third were aged 15-29 years. RTI fatalities (10.3 per 100,000 per year) were higher among Indians compared to Fijians. Two-thirds of deaths (largely ascribed to head, chest and abdominal trauma) occurred before hospital admission. While the RTI fatality rate was comparable to the global average for high-income countries, the level of motorisation in Fiji is considerably lower. To avert rising RTI rates with increasing motorisation, Fiji requires a robust road safety strategy alongside effective trauma-care services and a reliable population-based RTI surveillance system. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Fostering Entrepreneurship through Business Incubation: The Role and Prospects of Postsecondary Vocational-Technical Education. Report 2: Case Studies.

ERIC Educational Resources Information Center

Hernandez-Gantes, Victor M.; And Others

This report presents nine case studies featuring efforts to foster community development through business incubation and entrepreneurial programs at two-year colleges. A background section discusses case description, and organization and format of case studies. The second section describes the case study design. Each case study is introduced with…

Acute Human Self-Poisoning with the N-Phenylpyrazole Insecticide Fipronil –A GABAA-Gated Chloride Channel Blocker

PubMed Central

Mohamed, Fahim; Senarathna, Lalith; Percy, Adrian; Abeyewardene, Manel; Eaglesham, Geoffrey; Cheng, Ron; Azher, Shifa; Hittarage, Ariyasena; Dissanayake, Wasantha; Sheriff, MH Rezvi; Davies, Willie; Buckley, Nick; Eddleston, Michael

2005-01-01

Objective Fipronil, a broad spectrum N-phenylpyrazole insecticide that inhibits GABAA-gated chloride channels, has been in use since the mid-1990s. A high affinity for insect compared to mammalian GABA receptors results in lower animal toxicity than other insecticides blocking this channel. To date, only two accidental cases of fipronil poisoning in humans have been published. Case series We report seven patients with fipronil self-poisoning seen prospectively in Sri Lanka together with pharmacokinetics for four patients. Non-sustained generalized tonic-clonic seizures were seen in two patients (peak measured plasma fipronil concentrations 1600 and 3744 μg/L); both were managed with diazepam without complications. A patient with a peak measured plasma concentration of 1040 μg/L was asymptomatic throughout his stay. Plasma concentration was still high at discharge 3–4 days post-ingestion when the patients were well. Retrospective review of >1000 pesticide poisoning deaths since 1995 found only one death from fipronil-based products. In contrast to the good outcome of the above cases, this patient required intubation and ventilation and had continuous fits despite therapy with barbiturates and benzodiazepines. Conclusions Our experience with prospectively observed patients suggests that fipronil poisoning is characterized by vomiting, agitation, and seizures, and normally has a favorable outcome. Management should concentrate on supportive care and early treatment of seizures. However, further experience is needed to determine whether increased susceptibility to fipronil or larger doses can produce status epilepticus. PMID:15641641

Association between parental myopia and the risk of myopia in a child

PubMed Central

ZHANG, XIAOYU; QU, XINHUA; ZHOU, XINGTAO

2015-01-01

The association between parental myopia and a child's risk of developing the condition is not well understood. Therefore, the present study conducted a meta-analysis of the results of observational studies in order to investigate the association between myopia in parents and their child's risk of developing the condition. The current study systematically examined the databases MEDLINE, Embase and Ovid for relevant studies. Two reviewers independently evaluated the data and extracted the odds ratios (ORs) and 95% confidence intervals (CIs) from the suitable studies. Heterogeneity, publication bias and subgroup analyses were performed. The present meta-analysis included 31,677 participants from 16 studies with 8,393 cases of myopia (six prospective cohort, eight cross-sectional and two case-control studies). The OR of giving birth to a child with myopia, according to the prospective cohort, cross-sectional and case-control studies, was 1.53 (95% CI, 1.21–1.85), 1.96 (95% CI, 1.53–2.39), and 2.13 (95% CI, 1.79–2.46), respectively, when one parent had myopia, and 2.10 (95% CI, 1.42–2.77), 2.96 (95% CI, 2.21–3.71), and 2.13 (95% CI, 1.79–2.46), respectively, when two parents had myopia. The current study identified a significant positive association between parental myopia and a child's risk of developing myopia. Children of two parents with myopia had a higher risk of developing myopia compared to those with one myopic parent. PMID:26136998

Elevated maternal placental protein 13 serum levels at term of pregnancy in postpartum major hemorrhage (>1000 mLs). A prospective cohort study.

PubMed

Farina, Antonio; Bernabini, Dalila; Zucchini, Cinzia; De Sanctis, Paola; Quezada, Maria Soledad; Mattioli, Mara; Rizzo, Nicola

2017-09-01

To compare placental protein 13 (PP13) levels in the serum of women with primary postpartum hemorrhage (PPH) with a control population. A prospective cohort study was conducted between May 2014 and May 2016 and included 435 pregnant women at term (38 weeks gestation) without any known risk factor and with normal labor. Multiples of median (MoM) were used to evaluate differences of the PP13 values between cases and controls. PP13 concentrations were adjusted for maternal and neonatal weight. Multivariable analysis was used to detect independent contribution of predictors of PPH. Fifteen had a major PPH >1000 mLs and represented the cases of the study. They were matched with 399 controls. Twenty-one patients who had a minor PPH (500-1000 mLs) were excluded. The mean observed rank in the PPH group was higher than that of controls (28.5 vs 13.5, P-value=.01). PP13 MoM values adjusted for maternal weight were higher than expected being 1.44±0.45 in PPH cases and 1.00±0.59 in controls (P-value .008). This difference was still significant even after adjustment for neonatal weight that represented a confounding variable. Higher PP13 levels are independently associated with major PPH >1000 mLs. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

PubMed

Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

2011-11-01

To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for surgical residency education, including advanced surgical critical care management. In addition, creation of an NTE service provides an optimal general surgery case mix, including major abdominal operations, that can augment declining trauma surgery caseloads, maintain acute care faculty surgical skills, and support general and acute care surgery residency training.

Occupation and risk of sudden death in a United States community: a case–control analysis

PubMed Central

Zhang, Lin; Narayanan, Kumar; Suryadevara, Vallabh; Teodorescu, Carmen; Reinier, Kyndaron; Uy-Evanado, Audrey; Chugh, Harpriya; Zheng, Zhi-Jie; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S

2015-01-01

Objective Work environment is said to influence cardiovascular risk. We assessed whether nature of occupation affects risk of sudden cardiac death (SCD) in the general population. Methods In the ongoing, prospective Oregon Sudden Unexpected Death Study (catchment population 1 million), working-age SCD cases (18–65 years) were compared with controls who died from any cause. Usual occupation obtained from death certificates was classified using the US Census Bureau standard occupational classification descriptions and categorised as white collar, blue collar or homemaker. Odds ratio (OR) for SCD by occupation category was obtained and clinical profile of SCD cases was compared by occupation type. Results Among SCD cases (n=646; 74% male) compared to controls (n=622; 73.6% male), the proportion of white collar workers was higher among male SCD cases (52.7% vs 43.7%; p=0.01); the difference in females was smaller (59.5% vs 55%; p=0.62). Adjusting for race and smoking status, male white collar workers had a higher risk of SCD compared to blue collar workers (OR=1.67, (1.26 to 2.23), p<0.001). A similar, non-significant trend was observed among females (OR 1.49 (0.81 to 2.75); p=0.20). White collar SCD cases were less likely to be current smokers (34.7% vs 45.3%, p=0.008), drug misusers (13.1% vs 18.5%) or have diabetes (21.4% vs 28.2%, both p=0.07) compared to blue collar workers. Other cardiac risk factors were similar. Conclusions A white collar occupation was associated with increased risk of SCD, when compared to blue collar occupations. Since differences in conventional risk factors did not explain this elevated risk, work-related behavioural and psychosocial stressors warrant a closer evaluation. PMID:26685031

Seizures in the elderly: Impact on mental status, mood and sleep

PubMed Central

Haut, Sheryl R.; Katz, Mindy; Masur, Jonathan; Lipton, Richard B.

2009-01-01

Co-morbidities of epilepsy have not been well explored in the elderly. Herein, we examined mental status, mood, and sleep in elderly patients with epilepsy, compared to age and gender matched community controls without epilepsy from the Einstein Aging Study. Testing included a mental status test, the Blessed Information Memory and Concentration (BIMC) test; Prime-MD Patient Health Questionnaire (PHQ) Depression and Anxiety Modules; and Medical Outcomes Study Sleep Scale. Persons with epilepsy (n=31) had higher mean BIMC scores than controls (n=31, BIMC 6.3 vs.1.2; p<0.0001). Mean PHQ Depression scores were higher for cases than controls indicating more depressive symptoms (4.2 vs. 0.8; p=0.006); six cases (18%) and no controls met screening criteria for depression. Mean PHQ Anxiety scores were also higher for cases than controls (3.7 vs. 0.0; p=0.001). Cases demonstrated poorer sleep scores in the categories of somnolence (p=0.009) and shortness of breath/headache (p=0.021). Thus, co-morbidities of epilepsy in this elderly population included decreased mental status, a higher prevalence of depression and anxiety, and poorer sleep health when compared to age mates without epilepsy. Mental status impairment was not related to anti-epileptic medication or mood disturbance. Further investigation will explore these associations prospectively. PMID:19189862

Interleukin-10 -1082 G/A promoter polymorphism and pregnancy complications: results of a prospective cohort study in 1,616 pregnant women.

PubMed

Stonek, Felix; Metzenbauer, Martin; Hafner, Erich; Philipp, Karl; Tempfer, Clemens

2008-01-01

To investigate the frequency of the interleukin-10 (IL-10)-1082 G/A single nucleotide polymorphism in women with intrauterine fetal death (IUFD), pre-eclampsia (PE), preterm delivery (PD), and small for gestational age (SGA) infants. In a prospective cohort study, DNA from 1,616 consecutive pregnant women was analyzed for IL-10 -1082 G/A by polymerase chain reaction. Women who developed at least one of the predefined pregnancy complications were used as cases and compared to women without pregnancy complications. Of 1,616 women, 254 (15.7%) developed at least one pregnancy complication. IL-10 -1082 G/A allele frequencies (G: 233/508 [45.9%] and A: 275/508 [54.1%] versus G: 1,143/2,724 [42.0%] and A: 1,581/2,724 [58.0%], respectively; p=0.10; OR 0.85; 95% CI 0.69-1.04) and genotype distributions (A/A+G/A: 201/254 [79.1%] and G/G 53/254 [20.9%] versus A/A+G/A: 1,125/1,362 [82.6%] and G/G 237/1,362 [17.4%], respectively, p=0.19; OR 0.79; 95% CI 0.54-1.15) were not significantly different between cases and controls. We observed no statistically significant difference in IL-10 -1082 G/A genotype distribution comparing controls and women with IUFD, PE, PD <37 weeks gestation, and SGA infants (<10th percentile). IL-10 -1082 G/A polymorphism is not a genetic marker for identifying women at increased risk of common pregnancy complications.

Evaluation of a Clostridium difficile infection management policy with clinical pharmacy and medical microbiology involvement at a major Canadian teaching hospital.

PubMed

Yeung, S S T; Yeung, J K; Lau, T T Y; Forrester, L A; Steiner, T S; Bowie, W R; Bryce, E A

2015-12-01

Clostridium difficile infection (CDI) represents a spectrum of disease and is a significant concern for healthcare institutions. Our study objective was to assess whether implementation of a regional CDI management policy with Clinical Pharmacy and Medical Microbiology and Infection Control involvement would lead to an improvement in concordance in prescribing practices to an evidence-based CDI disease severity assessment and pharmacological treatment algorithm. Conducted at a tertiary care teaching hospital, this two-phase quality assurance study consisted of a baseline retrospective healthcare record review of patients with CDI prior to the implementation of a regional CDI management policy followed by a prospective evaluation post-implementation. One hundred and forty-one CDI episodes in the pre-implementation group were compared to 283 episodes post-implementation. Overall treatment concordance to the CDI treatment algorithm was achieved in 48 of 141 cases (34%) pre-implementation compared with 136 of 283 cases (48·1%) post-implementation (P = 0·01). The median time to treatment with vancomycin was reduced from five days to one day (P < 0·01), with median length of hospital stay decreasing from 30 days to 21 days (P = 0·01) post-implementation. There was no difference in 30-day all-cause mortality. A comprehensive approach with appropriate stakeholder involvement in the development of clinical pathways, education to healthcare workers and prospective audit with intervention and feedback can ensure patients diagnosed with CDI are optimally managed and prescribed the most appropriate therapy based on CDI disease severity. © 2015 John Wiley & Sons Ltd.

Risk markers for both chronic fatigue and irritable bowel syndromes: a prospective case-control study in primary care.

PubMed

Hamilton, W T; Gallagher, A M; Thomas, J M; White, P D

2009-11-01

Fatigue syndromes and irritable bowel syndrome (IBS) often occur together. Explanations include being different manifestations of the same condition and simply sharing some symptoms. A matched case-control study in UK primary care, using data collected prospectively in the General Practice Research Database (GPRD). The main outcome measures were: health-care utilization, specific symptoms and diagnoses. Risk markers were divided into distant (from 3 years to 1 year before diagnosis) and recent (1 year before diagnosis). A total of 4388 patients with any fatigue syndrome were matched to two groups of patients: those attending for IBS and those attending for another reason. Infections were specific risk markers for both syndromes, with viral infections being a risk marker for a fatigue syndrome [odds ratios (ORs) 2.3-6.3], with a higher risk closer to onset, and gastroenteritis a risk for IBS (OR 1.47, compared to a fatigue syndrome). Chronic fatigue syndrome (CFS) shared more distant risk markers with IBS than other fatigue syndromes, particularly other symptom-based disorders (OR 3.8) and depressive disorders (OR 2.3), but depressive disorders were a greater risk for CFS than IBS (OR 2.4). Viral infections were more of a recent risk marker for CFS compared to IBS (OR 2.8), with gastroenteritis a greater risk for IBS (OR 2.4). Both fatigue and irritable bowel syndromes share predisposing risk markers, but triggering risk markers differ. Fatigue syndromes are heterogeneous, with CFS sharing predisposing risks with IBS, suggesting a common predisposing pathophysiology.

Parametric study of prospective early commercial MHD power plants (PSPEC). General Electric Company, task 1: Parametric analysis

NASA Technical Reports Server (NTRS)

Marston, C. H.; Alyea, F. N.; Bender, D. J.; Davis, L. K.; Dellinger, T. C.; Hnat, J. G.; Komito, E. H.; Peterson, C. A.; Rogers, D. A.; Roman, A. J.

1980-01-01

The performance and cost of moderate technology coal-fired open cycle MHD/steam power plant designs which can be expected to require a shorter development time and have a lower development cost than previously considered mature OCMHD/steam plants were determined. Three base cases were considered: an indirectly-fired high temperature air heater (HTAH) subsystem delivering air at 2700 F, fired by a state of the art atmospheric pressure gasifier, and the HTAH subsystem was deleted and oxygen enrichment was used to obtain requisite MHD combustion temperature. Coal pile to bus bar efficiencies in ease case 1 ranged from 41.4% to 42.9%, and cost of electricity (COE) was highest of the three base cases. For base case 2 the efficiency range was 42.0% to 45.6%, and COE was lowest. For base case 3 the efficiency range was 42.9% to 44.4%, and COE was intermediate. The best parametric cases in bases cases 2 and 3 are recommended for conceptual design. Eventual choice between these approaches is dependent on further evaluation of the tradeoffs among HTAH development risk, O2 plant integration, and further refinements of comparative costs.

Recall bias in melanoma risk factors and measurement error effects: a nested case-control study within the Norwegian Women and Cancer Study.

PubMed

Parr, Christine L; Hjartåker, Anette; Laake, Petter; Lund, Eiliv; Veierød, Marit B

2009-02-01

Case-control studies of melanoma have the potential for recall bias after much public information about the relation with ultraviolet radiation. Recall bias has been investigated in few studies and only for some risk factors. A nested case-control study of recall bias was conducted in 2004 within the Norwegian Women and Cancer Study: 208 melanoma cases and 2,080 matched controls were invited. Data were analyzed for 162 cases (response, 78%) and 1,242 controls (response, 77%). Questionnaire responses to several host factors and ultraviolet exposures collected at enrollment in 1991-1997 and in 2004 were compared stratified on case-control status. Shifts in responses were observed among both cases and controls, but a shift in cases was observed only for skin color after chronic sun exposure, and a larger shift in cases was observed for nevi. Weighted kappa was lower for cases than for controls for most age intervals of sunburn, sunbathing vacations, and solarium use. Differences in odds ratio estimates of melanoma based on prospective and retrospective measurements indicate measurement error that is difficult to characterize. The authors conclude that indications of recall bias were found in this sample of Norwegian women, but that the results were inconsistent for the different exposures.

Urinary incontinence at orgasm: relation to detrusor overactivity and treatment efficacy.

PubMed

Serati, Maurizio; Salvatore, Stefano; Uccella, Stefano; Cromi, Antonella; Khullar, Vik; Cardozo, Linda; Bolis, Pierfrancesco

2008-10-01

To understand the pathophysiological mechanism of incontinence during orgasm and to compare women affected by symptomatic detrusor overactivity (DO) with and without incontinence at orgasm in terms of efficacy of antimuscarinic treatment. All consecutive sexually active women with incontinence during intercourse were prospectively included and divided into two groups: women with coital incontinence at orgasm or at penetration. The two forms of coital incontinence were correlated to the urodynamic finding of DO. Women complaining of overactive bladder (OAB) symptoms, with urinary incontinence at orgasm and urodynamically proven DO (cases), were prescribed tolterodine 4 mg extended release for at least 12 wk. The cases were compared in terms of efficacy of treatment on OAB symptoms to consecutive patients with symptomatic DO without coital incontinence (control group). Among the 1133 women who underwent urodynamic testings during the study period, 132 patients were eligible for final analysis. A significant difference in DO was observed in women with incontinence at orgasm (34 of 49; 69.4%) compared with women with incontinence during penetration (24 of 83; 28.9%) (p<0.0001). The 34 women with incontinence at orgasm associated with DO were given antimuscarinics treatment and were compared with 53 controls. Fourteen of 34 (41.2%) and 9 of 53 (17%) women did not respond to antimuscarinics in the cases and in the control group, respectively (p=0.023). Incontinence at orgasm is associated with DO in the majority of cases. This is the first study showing an inferior efficacy of antimuscarinic treatment in women with DO complaining of incontinence at orgasm.

Recreational physical activity and the risk of preeclampsia: a prospective cohort of Norwegian women.

PubMed

Magnus, Per; Trogstad, Lill; Owe, Katrine M; Olsen, Sjurdur F; Nystad, Wenche

2008-10-15

Previous case-control studies suggest that recreational physical activity protects against preeclampsia. Using a prospective design, the authors estimated the risk of preeclampsia for pregnant women according to level of physical activity, taking other variables that influence risk into consideration. The data set comprised 59,573 pregnancies from the Norwegian Mother and Child Cohort Study (1999-2006). Information on physical activity and other exposures was extracted from questionnaire responses given in pregnancy weeks 14-22, whereas diagnosis of preeclampsia was retrieved from the Medical Birth Registry of Norway. Estimation and confounder control was performed with multiple logistic regression. About 24% of pregnant women reported no physical activity, and 7% reported more than 25 such activities per month. The adjusted odds ratio was 0.79 (95% confidence interval: 0.65, 0.96) for preeclampsia when comparing women who exercised 25 times or more per month with inactive women. The association appeared strongest among women whose body mass index was less than 25 kg/m(2) and was absent among women whose body mass index was higher than 30 kg/m(2). These results suggest that the preventive effect of recreational physical activity during pregnancy may be more limited than has been shown in case-control studies and may apply to nonobese women only.

Recreational Physical Activity and the Risk of Preeclampsia: A Prospective Cohort of Norwegian Women

PubMed Central

Trogstad, Lill; Owe, Katrine M.; Olsen, Sjurdur F.; Nystad, Wenche

2008-01-01

Previous case-control studies suggest that recreational physical activity protects against preeclampsia. Using a prospective design, the authors estimated the risk of preeclampsia for pregnant women according to level of physical activity, taking other variables that influence risk into consideration. The data set comprised 59,573 pregnancies from the Norwegian Mother and Child Cohort Study (1999–2006). Information on physical activity and other exposures was extracted from questionnaire responses given in pregnancy weeks 14–22, whereas diagnosis of preeclampsia was retrieved from the Medical Birth Registry of Norway. Estimation and confounder control was performed with multiple logistic regression. About 24% of pregnant women reported no physical activity, and 7% reported more than 25 such activities per month. The adjusted odds ratio was 0.79 (95% confidence interval: 0.65, 0.96) for preeclampsia when comparing women who exercised 25 times or more per month with inactive women. The association appeared strongest among women whose body mass index was less than 25 kg/m2 and was absent among women whose body mass index was higher than 30 kg/m2. These results suggest that the preventive effect of recreational physical activity during pregnancy may be more limited than has been shown in case-control studies and may apply to nonobese women only. PMID:18701444

Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study.

PubMed

Chiu, Tina H T; Pan, Wen-Harn; Lin, Ming-Nan; Lin, Chin-Lon

2018-03-09

Vegetarian diets are inversely associated with diabetes in Westerners but their impact on Asians-whose pathophysiology differ from Westerners-is unknown. We aim to investigate the association between a vegetarian diet, change in dietary patterns and diabetes risk in a Taiwanese Buddhist population. We prospectively followed 2918 non-smoking, non-alcohol drinking Buddhists free of diabetes, cancer, and cardiovascular diseases at baseline, for a median of 5 years, with 183 incident diabetes cases confirmed. Diet was assessed through a validated food frequency questionnaire at baseline and a simple questionnaire during follow-ups. Incident cases of diabetes were ascertained through follow-up questionnaires, fasting glucose and HbA1C. Stratified Cox Proportional Hazards Regression was used to assess the effect of diets on risk of diabetes. Consistent vegetarian diet was associated with 35% lower hazards (HR: 0.65, 95% CI: 0.46, 0.92), while converting from a nonvegetarian to a vegetarian pattern was associated with 53% lower hazards (HR: 0.47, 95% CI: 0.30, 0.71) for diabetes, comparing with nonvegetarians while adjusting for age, gender, education, physical activity, family history of diabetes, follow-up methods, use of lipid-lowering medications, and baseline BMI. Vegetarian diet and converting to vegetarian diet may protect against diabetes independent of BMI among Taiwanese.

Applying Computerized-Scoring Models of Written Biological Explanations across Courses and Colleges: Prospects and Limitations

PubMed Central

Ha, Minsu; Nehm, Ross H.; Urban-Lurain, Mark; Merrill, John E.

2011-01-01

Our study explored the prospects and limitations of using machine-learning software to score introductory biology students’ written explanations of evolutionary change. We investigated three research questions: 1) Do scoring models built using student responses at one university function effectively at another university? 2) How many human-scored student responses are needed to build scoring models suitable for cross-institutional application? 3) What factors limit computer-scoring efficacy, and how can these factors be mitigated? To answer these questions, two biology experts scored a corpus of 2556 short-answer explanations (from biology majors and nonmajors) at two universities for the presence or absence of five key concepts of evolution. Human- and computer-generated scores were compared using kappa agreement statistics. We found that machine-learning software was capable in most cases of accurately evaluating the degree of scientific sophistication in undergraduate majors’ and nonmajors’ written explanations of evolutionary change. In cases in which the software did not perform at the benchmark of “near-perfect” agreement (kappa > 0.80), we located the causes of poor performance and identified a series of strategies for their mitigation. Machine-learning software holds promise as an assessment tool for use in undergraduate biology education, but like most assessment tools, it is also characterized by limitations. PMID:22135372

An Algorithm for Building an Electronic Database.

PubMed

Cohen, Wess A; Gayle, Lloyd B; Patel, Nima P

2016-01-01

We propose an algorithm on how to create a prospectively maintained database, which can then be used to analyze prospective data in a retrospective fashion. Our algorithm provides future researchers a road map on how to set up, maintain, and use an electronic database to improve evidence-based care and future clinical outcomes. The database was created using Microsoft Access and included demographic information, socioeconomic information, and intraoperative and postoperative details via standardized drop-down menus. A printed out form from the Microsoft Access template was given to each surgeon to be completed after each case and a member of the health care team then entered the case information into the database. By utilizing straightforward, HIPAA-compliant data input fields, we permitted data collection and transcription to be easy and efficient. Collecting a wide variety of data allowed us the freedom to evolve our clinical interests, while the platform also permitted new categories to be added at will. We have proposed a reproducible method for institutions to create a database, which will then allow senior and junior surgeons to analyze their outcomes and compare them with others in an effort to improve patient care and outcomes. This is a cost-efficient way to create and maintain a database without additional software.

Restless legs syndrome: an early clinical feature of Parkinson disease in men.

PubMed

Wong, Janice C; Li, Yanping; Schwarzschild, Michael A; Ascherio, Alberto; Gao, Xiang

2014-02-01

The association between restless legs syndrome (RLS) and Parkinson disease has been extensively studied, but the temporal relationship between the two remains unclear. We thus conduct the first prospective study to examine the risk of developing Parkinson disease in RLS. Prospective study from 2002-2010. United States. There were 22,999 US male health professionals age 40-75 y enrolled in the Health Professionals Follow-up Study without Parkinson disease, arthritis, or diabetes mellitus at baseline. RLS was assessed in 2002 using a set of standardized questions recommended by the International RLS Study Group. Incident Parkinson disease was identified by biennial questionnaires and then confirmed by review of participants' medical records by a movement disorder specialist. We documented 200 incident Parkinson disease cases during 8 y of follow-up. Compared to men without RLS, men with RLS symptoms who had symptoms greater than 15 times/mo had higher risk of Parkinson disease development (adjusted relative risk = 1.47; 95% confidence interval: 0.59, 3.65; P = 0.41). This was statistically significant only for cases diagnosed within 4 y of follow-up (adjusted relative risk = 2.77; 95% confidence interval: 1.08, 7.11; P = 0.03). Severe restless legs syndrome may be an early feature of Parkinson disease.

Client characteristics and the cost of home care in the prospective payment system.

PubMed

Livesay, Jody L; Hanson, Kathleen S; Anderson, Mary Ann; Oelschlaeger, Mary

2003-01-01

There has been much speculation in the literature about the effect of the prospective payment system (PPS) on the home care industry but few reports of systematic investigation. Clearly, comprehension of client characteristics is essential for categorizing home care clients into the correct Home Health Resource Groups, for allocating resources appropriately, and for implementing necessary organizational changes to accommodate clients who require variations in the amount of resources predicted by the PPS. The purposes of this study were to compare the characteristics of home health clients that resulted in a financial gain or a financial loss for one agency under the PPS with those of the interim payment system. A secondary data analysis of 140 cases compiled by one not-for-profit hospital-affiliated home care organization was completed. Results suggested that client characteristics of the projected loss group had more recertifications on admission and at the end of the 60-day episode, a longer stay (3 weeks), and more visits, particularly from skilled nursing. Comprehension of client characteristics and the subsequent ability to adjust for the proper case mix will be crucial if home care agencies are to remain financially viable under the PPS. Replication of this project needs to be done using more variables and multiple sites.

Applying computerized-scoring models of written biological explanations across courses and colleges: prospects and limitations.

PubMed

Ha, Minsu; Nehm, Ross H; Urban-Lurain, Mark; Merrill, John E

2011-01-01

Our study explored the prospects and limitations of using machine-learning software to score introductory biology students' written explanations of evolutionary change. We investigated three research questions: 1) Do scoring models built using student responses at one university function effectively at another university? 2) How many human-scored student responses are needed to build scoring models suitable for cross-institutional application? 3) What factors limit computer-scoring efficacy, and how can these factors be mitigated? To answer these questions, two biology experts scored a corpus of 2556 short-answer explanations (from biology majors and nonmajors) at two universities for the presence or absence of five key concepts of evolution. Human- and computer-generated scores were compared using kappa agreement statistics. We found that machine-learning software was capable in most cases of accurately evaluating the degree of scientific sophistication in undergraduate majors' and nonmajors' written explanations of evolutionary change. In cases in which the software did not perform at the benchmark of "near-perfect" agreement (kappa > 0.80), we located the causes of poor performance and identified a series of strategies for their mitigation. Machine-learning software holds promise as an assessment tool for use in undergraduate biology education, but like most assessment tools, it is also characterized by limitations.

A prospective evaluation of serum kynurenine metabolites and risk of pancreatic cancer.

PubMed

Huang, Joyce Y; Butler, Lesley M; Midttun, Øivind; Ulvik, Arve; Wang, Renwei; Jin, Aizhen; Gao, Yu-Tang; Ueland, Per M; Koh, Woon-Puay; Yuan, Jian-Min

2018-01-01

Serum pyridoxal 5'-phosphate (PLP), the active form of vitamin B6, is associated with reduced risk of pancreatic cancer. Data on functional measures of vitamin B6 status and risk of pancreatic cancer is lacking. A nested case-control study involving 187 incident cases of pancreatic cancer and 362 individually matched controls were conducted within two prospective cohorts to evaluate the associations between kynurenine metabolites in pre-diagnostic serum samples and risk of pancreatic cancer. Higher serum concentrations of 3-hydroxyanthranilic acid (HAA) and the HAA:3-hydroxykynurenine (HK) ratio (a measure for in vivo functional status of PLP) were significantly associated with reduced risk of pancreatic cancer. Compared with the lowest tertile, odds ratios (95% confidence intervals) of pancreatic cancer for the highest tertile was 0.62 (0.39, 1.01) for HAA, and 0.59 (0.35-0.98) for the HAA:HK ratio, after adjustment for potential confounders and serum PLP (both Ps for trend<0.05). The kynurenine:tryptophan ratio or neopterin was not significantly associated with pancreatic cancer risk. The inverse association between HAA or the HAA:HK ratio and risk of pancreatic cancer supports the notion that functional status of PLP may be a more important measure than circulating PLP alone for the development of pancreatic cancer.

Prospective randomized comparison of laparoscopic peritoneal vaginoplasty with laparoscopic sigmoid vaginoplasty for treating congenital vaginal agenesis.

PubMed

Cao, Lili; Wang, Yanzhou; Li, Yudi; Xu, Huicheng

2013-07-01

The aim of this study was to compare the effectiveness and long-term anatomic and functional results of laparoscopic peritoneal vaginoplasty and laparoscopic sigmoid vaginoplasty. From January 2002 to December 2010, 40 patients with congenital vaginal agenesis were prospectively randomized to undergo either laparoscopic peritoneal vaginoplasty (26 cases) or laparoscopic sigmoid vaginoplasty (14 cases) in 2:1 ratio. Pre- and postoperative examination findings, Female Sexual Function Index (FSFI) questionnaire responses, and sexual satisfaction rates are reported. All surgical procedures were performed successfully, with no intraoperative complications. The laparoscopic peritoneal vaginoplasty group had significantly less blood loss and a surgery shorter on average than the laparoscopic sigmoid colovaginoplasty group. Postoperative course was uneventful for all patients in both groups, though postoperative retention time and hospital stay were less for peritoneal vaginoplasty patients than for sigmoid vaginoplasty patients. Mean neovaginal length, excessive mucous production, sexual life initiation time, and sexual satisfaction rate were similar between groups. Patient complaints of abdominal discomfort, unusual odor from vaginal secretions, and vaginal contraction during intercourse were higher in the sigmoid colovaginoplasty group (p < 0.005 vs. peritoneal vaginoplasty). Postoperative FSFI scores did not differ significantly between groups. Relative to laparoscopic sigmoid colovaginoplasty, laparoscopic peritoneal vaginoplasty provides good anatomic and functional results and excellent patient satisfaction.

Cost per case or total cost? The potential of prevention of hand injuries in young children – Retrospective and prospective studies

PubMed Central

Ljungberg, Elinor M; Carlsson, Katarina Steen; Dahlin, Lars B

2008-01-01

Background Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996–2003. Methods Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategies were constructed. Results Over time, diminishing number of ward days reduced the health-care cost per case. Among children, the cost of lost productivity due to parental leave was 14 percent of total cost. Fingertip injuries had low median costs but high total costs due to their frequency. Complex injuries by machine or rifle had high costs per case, and despite a low number of cases, total cost was high. Type of injury, surgery and physiotherapy sessions were associated with variations in health-care cost. Low age and ethnic background had a significant effect on number of ward days. Conclusion The costs per hand injury for children were lower compared to adults due to both lower health-care costs and to the fact that parents had comparatively short periods of absence from work. Frequent simple fingertip injuries and rare complex injuries induce high costs for society. Such costs should be related to costs for prevention of these injuries. PMID:18606018

Travel health preparation and travel-related morbidity of splenectomised individuals.

PubMed

Boeddha, Christien; de Graaf, Wilmar; Overbosch, David; van Genderen, Perry J J

2012-07-01

Asplenic or hyposplenic patients are at an increased risk of encapsulated bacterial and intraerythrocytic parasitic infections, which are endemic at many travel destinations. With proper travel health advice and preparation splenectomised individuals could have comparable travel-related morbidity as healthy control subjects. We conducted a prospective case-control study with 21 travel pairs. Each pair consisted of a splenectomised patient (case) and a healthy, non-splenectomised travel companion (control) in order to match for travel destination, duration and potential exposures to travel-related health risks. All participants filled out a questionnaire detailing travel health preparation including vaccination and malaria prophylaxis as well as travel-related morbidity. Cases and controls were comparable for age and gender. Cases received significantly more information about on demand use of antibiotics in case of fever. Immunisation coverage against encapsulated bacteria and adherence to malaria prophylaxis guidelines was suboptimal. There were no significant differences in the occurrence of travel-related ailments nor differences in severity of ailments. The immunisation coverage against encapsulated bacteria and adherence to malaria prophylaxis guidelines was suboptimal in some splenectomised patients and should be improved. Strict adherence to national travel health advice guidelines and specific guidelines for asplenic patients is advisable. However, with regard to travel-related morbidity there are no significant differences in morbidity between splenectomised patients and healthy controls, at least in the setting of short-term travel. Copyright © 2012 Elsevier Ltd. All rights reserved.

Blended learning in surgery using the Inmedea Simulator.

PubMed

Funke, Katrin; Bonrath, Esther; Mardin, Wolf Arif; Becker, Jan Carl; Haier, Joerg; Senninger, Norbert; Vowinkel, Thorsten; Hoelzen, Jens Peter; Mees, Soeren Torge

2013-02-01

Recently, medical education in surgery has experienced several modifications. We have implemented a blended learning module in our teaching curriculum to evaluate its effectiveness, applicability, and acceptance in surgical education. In this prospective study, the traditional face-to-face learning of our teaching curriculum for fourth-year medical students (n = 116) was augmented by the Inmedea Simulator, a web-based E-learning system, with six virtual patient cases. Student results were documented by the system and learning success was determined by comparing patient cases with comparable diseases (second and sixth case). The acceptance among the students was evaluated with a questionnaire. After using the Inmedea Simulator, correct diagnoses were found significantly (P < 0.05) more often, while an incomplete diagnostic was seen significantly (P < 0.05) less often. Significant overall improvement (P < 0.05) was seen in sixth case (62.3 ± 5.6 %) vs. second case (53.9 ± 5.6 %). The questionnaire revealed that our students enjoyed the surgical seminar (score 2.1 ± 1.5) and preferred blended learning (score 2.5 ± 1.2) to conventional teaching. The blended learning approach using the Inmedea Simulator was highly appreciated by our medical students and resulted in a significant learning success. Blended learning appears to be a suitable tool to complement traditional teaching in surgery.

Teaching corner: the prospective case study : a pedagogical innovation for teaching global health ethics.

PubMed

Stewart, Kearsley A

2015-03-01

Over the past decade, global health has emerged as one of the fastest growing academic programs in the United States. Ethics training is cited widely as an essential feature of U.S. global health programs, but generally it is not deeply integrated into the global health teaching and training curricula. A discussion about the pedagogy of teaching global health ethics is long overdue; to date, only a few papers specifically engage with pedagogy rather than competencies or content. This paper explores the value of case study pedagogy for a full-semester graduate course in global health ethics at an American university. I address some of the pedagogical challenges of teaching global health ethics through my innovative use of case study methodology-the "prospective case study" (PSC).

Percutaneous pedicle screw placement under single dimensional fluoroscopy with a designed pedicle finder-a technical note and case series.

PubMed

Tsuang, Fon-Yih; Chen, Chia-Hsien; Kuo, Yi-Jie; Tseng, Wei-Lung; Chen, Yuan-Shen; Lin, Chin-Jung; Liao, Chun-Jen; Lin, Feng-Huei; Chiang, Chang-Jung

2017-09-01

Minimally invasive spine surgery has become increasingly popular in clinical practice, and it offers patients the potential benefits of reduced blood loss, wound pain, and infection risk, and it also diminishes the loss of working time and length of hospital stay. However, surgeons require more intraoperative fluoroscopy and ionizing radiation exposure during minimally invasive spine surgery for localization, especially for guidance in instrumentation placement. In addition, computer navigation is not accessible in some facility-limited institutions. This study aimed to demonstrate a method for percutaneous screws placement using only the anterior-posterior (AP) trajectory of intraoperative fluoroscopy. A technical report (a retrospective and prospective case series) was carried out. Patients who received posterior fixation with percutaneous pedicle screws for thoracolumbar degenerative disease or trauma comprised the patient sample. We retrospectively reviewed the charts of consecutive 670 patients who received 4,072 pedicle screws between December 2010 and August 2015. Another case series study was conducted prospectively in three additional hospitals, and 88 consecutive patients with 413 pedicle screws were enrolled from February 2014 to July 2016. The fluoroscopy shot number and radiation dose were recorded. In the prospective study, 78 patients with 371 screws received computed tomography at 3 months postoperatively to evaluate the fusion condition and screw positions. In the retrospective series, the placement of a percutaneous screw required 5.1 shots (2-14, standard deviation [SD]=2.366) of AP fluoroscopy. One screw was revised because of a medialwall breach of the pedicle. In the prospective series, 5.8 shots (2-16, SD=2.669) were required forone percutaneous pedicle screw placement. There were two screws with a Grade 1 breach (8.6%), both at the lateral wall of the pedicle, out of 23 screws placed at the thoracic spine at T9-T12. Forthe lumbar and sacral areas, there were 15 Grade 1 breaches (4.3%), 1 Grade 2 breach (0.3%), and 1 Grade 3 breach (0.3%). No revision surgery was necessary. This method avoids lateral shots of fluoroscopy during screw placement and thus decreases the operation time and exposes surgeons to less radiation. At the same time, compared with the computer-navigated procedure, it is less facility-demanding, and provides satisfactory reliability and accuracy. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations.

PubMed

Barth, J; Duparc, F; Baverel, L; Bahurel, J; Toussaint, B; Bertiaux, S; Clavert, P; Gastaud, O; Brassart, N; Beaudouin, E; De Mourgues, P; Berne, D; Duport, M; Najihi, N; Boyer, P; Faivre, B; Meyer, A; Nourissat, G; Poulain, S; Bruchou, F; Ménard, J F

2015-12-01

Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients' mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10(-3)) and the horizontal plane (p=0.022). In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. Level II prospective non-randomized comparative study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

PubMed

Lara-Smalling, Agueda; Cakiner-Egilmez, Tulay; Miller, Dawn; Redshirt, Ella; Williams, Dale

2011-01-01

Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123 VA medical centers by Khuri et al., the 30-day mortality and morbidity rates for major surgeries had decreased by 9% and 30%, respectively. 5 Recently renamed the VA Surgical Quality Improvement Program (VASQIP) in 2010, the quality of surgical outcomes has continued to improve among all documented surgical specialties. Ophthalmic surgery is presumed to have a very low mortality rate and therefore has not been included in the VASQIP database.

Prospectively-Identified Incident Testicular Cancer Risk in a Familial Testicular Cancer Cohort

PubMed Central

Pathak, Anand; Adams, Charleen D.; Loud, Jennifer T.; Nichols, Kathryn; Stewart, Douglas R.; Greene, Mark H.

2015-01-01

Background Human testicular germ cell tumors (TGCT) have a strong genetic component and a high familial relative risk. However, linkage analyses have not identified a rare, highly-penetrant familial TGCT (FTGCT) susceptibility locus. Currently, multiple low-penetrance genes are hypothesized to underlie the familial multiple-case phenotype. The observation that two is the most common number of affected individuals per family presents an impediment to FTGCT gene discovery. Clinically, the prospective TGCT risk in the multiple-case family context is unknown. Methods We performed a prospective analysis of TGCT incidence in a cohort of multiple-affected-person families and sporadic-bilateral-case families; 1,260 men from 140 families (10,207 person-years of follow-up) met our inclusion criteria. Age-, gender-, and calendar time-specific standardized incidence ratios (SIR) for TGCT relative to the general population were calculated using SEER*Stat. Results Eight incident TGCTs occurred during prospective FTGCT cohort follow-up (versus 0.67 expected; SIR=11.9; 95% confidence interval [CI]=5.1–23.4; excess absolute risk=7.2/10,000). We demonstrate that the incidence rate of TGCT is greater among bloodline male relatives from multiple-case testicular cancer families than that expected in the general population, a pattern characteristic of adult-onset Mendelian cancer susceptibility disorders. Two of these incident TGCTs occurred in relatives of sporadic-bilateral cases (0.15 expected; SIR=13.4; 95%CI=1.6–48.6). Conclusions Our data are the first indicating that despite relatively low numbers of affected individuals per family, members of both multiple-affected-person FTGCT families and sporadic-bilateral TGCT families comprise high-risk groups for incident testicular cancer. Impact Men at high TGCT risk might benefit from tailored risk stratification and surveillance strategies. PMID:26265202

Prospectively Identified Incident Testicular Cancer Risk in a Familial Testicular Cancer Cohort.

PubMed

Pathak, Anand; Adams, Charleen D; Loud, Jennifer T; Nichols, Kathryn; Stewart, Douglas R; Greene, Mark H

2015-10-01

Human testicular germ cell tumors (TGCT) have a strong genetic component and a high familial relative risk. However, linkage analyses have not identified a rare, highly penetrant familial TGCT (FTGCT) susceptibility locus. Currently, multiple low-penetrance genes are hypothesized to underlie the familial multiple-case phenotype. The observation that two is the most common number of affected individuals per family presents an impediment to FTGCT gene discovery. Clinically, the prospective TGCT risk in the multiple-case family context is unknown. We performed a prospective analysis of TGCT incidence in a cohort of multiple-affected-person families and sporadic-bilateral-case families; 1,260 men from 140 families (10,207 person-years of follow-up) met our inclusion criteria. Age-, gender-, and calendar time-specific standardized incidence ratios (SIR) for TGCT relative to the general population were calculated using SEER*Stat. Eight incident TGCTs occurred during prospective FTGCT cohort follow-up (versus 0.67 expected; SIR = 11.9; 95% CI, 5.1-23.4; excess absolute risk = 7.2/10,000). We demonstrate that the incidence rate of TGCT is greater among bloodline male relatives from multiple-case testicular cancer families than that expected in the general population, a pattern characteristic of adult-onset Mendelian cancer susceptibility disorders. Two of these incident TGCTs occurred in relatives of sporadic-bilateral cases (0.15 expected; SIR = 13.4; 95% CI, 1.6-48.6). Our data are the first to indicate that despite relatively low numbers of affected individuals per family, members of both multiple-affected-person FTGCT families and sporadic-bilateral TGCT families comprise high-risk groups for incident testicular cancer. Men at high TGCT risk might benefit from tailored risk stratification and surveillance strategies. ©2015 American Association for Cancer Research.

High field strength magnetic resonance imaging in paediatric brain tumour surgery--its role in prevention of early repeat resections.

PubMed

Avula, Shivaram; Pettorini, Benedetta; Abernethy, Laurence; Pizer, Barry; Williams, Dawn; Mallucci, Conor

2013-10-01

The purpose of this study is to compare the surgical and imaging outcome in children who underwent brain tumour surgery with intention of complete tumour resection, prior to and following the start of intra-operative MRI (ioMRI) service. ioMRI service for brain tumour resection commenced in October 2009. A cohort of patients operated between June 2007 and September 2009 with a pre-surgical intention of complete tumour resection were selected (Group A). A similar number of consecutive cases were selected from a prospective database of patients undergoing ioMRI (Group B). The demographics, imaging, pathology and surgical outcome of both groups were compared. Thirty-six of 47 cases from Group A met the inclusion criterion and 36 cases were selected from Group B; 7 of the 36 cases in Group A had unequivocal evidence of residual tumour on the post-operative scan; 5 (14%) of them underwent repeat resection within 6 months post-surgery. In Group B, ioMRI revealed unequivocal evidence of residual tumour in 11 of the 36 cases following initial resection. In 10 of these 11 cases, repeat resections were performed during the same surgical episode and none of these 11 cases required repeat surgery in the following 6 months. Early repeat resection rate was significantly different between both groups (p = 0.003). Following the advent of ioMRI at our institution, the need for repeat resection within 6 months has been prevented in cases where ioMRI revealed unequivocal evidence of residual tumour.

Chronic case management: Clinical governance with cost reductions.

PubMed

Costa, Élide Sbardellotto Mariano da; Hyeda, Adriano

2016-01-01

With increasing global impact of chronic degenerative non-communicable diseases (CDNCD), multidisciplinary chronic disease management care programs (CDMCP) come as a solution to improve the quality of patients care. We conducted a cross-sectional epidemiologic prospective cohort study with data comparing a group of patients monitored by a CDMCP with subjects without CDMCP care, from 2010 to 2012. The patients monitored in this program were selected because they presented CDNCD with frequent hospitalization and/or emergency care in the year prior to study selection. Also, the patients could be referred to the program by their physicians and/or other programs such as HomeCare or family medicine. All costs related to the program were included and compared with the costs of users with the same epidemiological profile who opted for not participating in the CDMCP. We analyzed data from 1,256 cases, including 639 (51%) men and 617 (49%) women. The mean age was 56.99 years and 73% were older than 50 years. There was a prevalence of 34% (428) cases with ischemic heart disease (myocardial infarction and stroke) and 17% (210) with neoplasms. The cases studied showed a reduction of 79% in the number of days of hospitalization compared with the cases without CDMCP monitoring. The average reduction of total costs (hospitalizations, emergency room visits and/or disease complications) was 31.94%, with average reduction of 8.36% in monthly costs. Multidisciplinary monitoring carried out by CDNCD patient management programs can reduce hospitalizations, emergency room visits and complications, positively impacting the costs with health care.

Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports.

PubMed

Drezner, Jonathan A; Toresdahl, Brett G; Rao, Ashwin L; Huszti, Ella; Harmon, Kimberly G

2013-12-01

Sudden cardiac arrest (SCA) is the leading cause of death in athletes during exercise. The effectiveness of school-based automated external defibrillator (AED) programmes has not been established through a prospective study. A total of 2149 high schools participated in a prospective observational study beginning 1 August 2009, through 31 July 2011. Schools were contacted quarterly and reported all cases of SCA. Of these 95% of schools confirmed their participation for the entire 2-year study period. Cases of SCA were reviewed to confirm the details of the resuscitation. The primary outcome was survival to hospital discharge. School-based AED programmes were present in 87% of participating schools and in all but one of the schools reporting a case of SCA. Fifty nine cases of SCA were confirmed during the study period including 26 (44%) cases in students and 33 (56%) in adults; 39 (66%) cases occurred at an athletic facility during training or competition; 55 (93%) cases were witnessed and 54 (92%) received prompt cardiopulmonary resuscitation. A defibrillator was applied in 50 (85%) cases and a shock delivered onsite in 39 (66%). Overall, 42 of 59 (71%) SCA victims survived to hospital discharge, including 22 of 26 (85%) students and 20 of 33 (61%) adults. Of 18 student-athletes 16 (89%) and 8 of 9 (89%) adults who arrested during physical activity survived to hospital discharge. High school AED programmes demonstrate a high survival rate for students and adults who suffer SCA on school campus. School-based AED programmes are strongly encouraged.

Mortality experience of glass fibre workers.

PubMed Central

Shannon, H S; Hayes, M; Julian, J A; Muir, D C

1984-01-01

A historical prospective mortality study was conducted at an insulating wool plant in Ontario, Canada, on 2576 men who had worked for at least 90 days and were employed between 1955 and 1977. Eighty eight deaths were found in the 97.2% of men traced. Mortality was compared by the person-years method with that of the Ontario population. Measurements taken since 1977 show very low fibre concentrations. The overall standardised mortality ratio (SMR) was 78%, significantly below 100. Among plant only employees, seven deaths were attributed to lung cancer compared with 4.22 expected, a non-significant excess (SMR = 166; 95% confidence limits 67 to 342). No confirmed cases of mesothelioma were observed and no other disease was significantly increased in plant workers. PMID:6691934

443 paediatric cases of malignant melanoma registered with the German Central Malignant Melanoma Registry between 1983 and 2011.

PubMed

Brecht, Ines B; Garbe, Claus; Gefeller, Olaf; Pfahlberg, Annette; Bauer, Jürgen; Eigentler, Thomas K; Offenmueller, Sonja; Schneider, Dominik T; Leiter, Ulrike

2015-05-01

Malignant melanoma is a very rare paediatric tumour. This study was performed in order to understand clinical features and prognosis of malignant melanoma in children and adolescents. 443 patients ⩽ 18 years of age with malignant melanoma were prospectively registered with the German Central Malignant Melanoma Registry between 1983 and 2011. Cases were collected from 58 participating centres. 276 paediatric cases with a follow-up >3 months were evaluated for survival probabilities and prognostic factors by Kaplan-Meier method. Age of diagnosis ranged from 3 months to 18 years (median age 16 years). The male to female ratio was 0.8 (202 male, 240 female). Most melanoma were located at the trunk (n = 195) and the lower extremity (n = 114). Patients with >3 months of follow-up (median 55 months) showed an overall survival (OS) of 94.8% in 5 years. Survival according to tumour stage was 98.5% for stage I (n = 190), 91.1% for stage II (n = 39) and 53.0% for stage III/IV tumours (n = 11). Worse outcome was seen in patients with nodular melanoma (OS 77.9%, n = 42) compared to superficial spread histotype (OS 100%, n = 138) or other histotype (OS 96.9%, n = 88) (p < 0.0001), in case of thicker tumours (Clark level IV or V, OS 87.1%, n = 84) compared to thinner tumours (Clark level I, II, III, OS 99.1%, n = 164) (p = 0.0008) and in case of ulceration (OS 65.6%, n = 17) compared to no ulceration (OS 99.2%, n = 182). Patient and tumour characteristics in paediatric melanoma patients show no evident differences to adult melanoma cases. The same clinical approach as in adults should be used. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical profile, predisposing factors, and associated co-morbidities of children with cerebral palsy in South India

PubMed Central

Gowda, Vykuntaraju K.; Kumar, Anil; Shivappa, Sanjay K.; Srikanteswara, Praveen Kumar; Shivananda; Mahadeviah, M. S.; Govindraj, M.; Ramaswamy, Premalatha

2015-01-01

Introduction: Cerebral palsy (CP) is the most common physical disorder of children. Causes like jaundice and birth injury though are decreasing; complications resulting from the survival of low birth weight babies are replacing some of the older etiologies. Hence, this study was planned. Objectives: The objective was to study the clinical patterns, predisposing factors, and co-morbidities in children with CP. Materials and Methods: The present study is a hospital based prospective study conducted from January 2012 to January 2013 in children presenting to neurodevelopmental clinic at a tertiary care teaching hospital in India. Hundred cases with clinical features suggestive of CP were included in the study. Cases were evaluated by history, clinical examination, and necessary investigations. Results: Results of the study showed 81% of spastic, 12% of hypotonic, 5% of dystonic, and 2% of mixed CP cases. The mean age of presentation was 2 year, 2 month, and male to female ratio of 1:2. Pregnancy-induced hypertension (PIH) was the most common antenatal complication observed in 6%. Four percent had neonatal sepsis and 19% were born premature. Associated co-morbidities were mental retardation (55%), seizure disorder (46%), visual problems (26%), hearing problems (19%), and failure to thrive (47%). Discussion: Sex distribution observed in our study was male to female ratio of 1.2, which was comparable with a multicenter study in Europe. PIH was observed in 6% of cases, which was comparable with prior studies. Birth asphyxia was observed in 43% of cases. Eighty-one percent of the cases constituted a spastic variety of CP which was comparable to other studies. Conclusion: Perinatal asphyxia was the important etiological factor. We found preventable intranatal causes (60%) and antenatal causes (20%) forming a significant proportion. Co-morbidities were significantly observed in our study. PMID:26167210

Multiple Intelligence Distribution of Prospective Teachers: The Case at Yildiz Technical University

ERIC Educational Resources Information Center

Çeliköz, Mine

2017-01-01

The aim of this study is to find out whether intelligence distributions differ or not according to gender and departmental variables by determining the dominant intelligence (Multiple Intelligence) distributions of prospective teachers studying at Yildiz Technical University Education Faculty. The population of the research constitutes the…

Do Prospective Mathematics Teachers Teach Who They Say They Are?

ERIC Educational Resources Information Center

van Putten, Sonja; Stols, Gerrit; Howie, Sarah

2014-01-01

In this case study, the professional mathematics teacher identity (PMTI) of final year mathematics education students is investigated in terms of their self-perceived and actualised identity. These prospective teachers were required to discuss and describe their own PMTI in terms of three aspects: mathematics specialisation, teaching-and-learning…

22 CFR 96.48 - Preparation and training of prospective adoptive parent(s) in incoming cases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... particular child. This includes counseling on: (1) The child's history and cultural, racial, religious... share resources to meet the training needs of prospective adoptive parents; (2) Group seminars offered by the agency or person or other agencies or training entities; (3) Individual counseling sessions...

Evaluating the social and economic impact of community-based prenatal care.

PubMed

Cramer, Mary E; Chen, Li-Wu; Roberts, Sara; Clute, Dorothea

2007-01-01

This article describes the evaluation and findings of a community-based prenatal care program, Omaha Healthy Start (OHS), designed to reduce local racial disparities in birth outcomes. This evaluative study used a comparative descriptive design, and Targeting Outcomes of Programs was the conceptual framework for evaluation. The evaluation followed 3 groups for 2 years: OHS birth mothers (N=79; N=157); non-OHS participant birth mothers (N=746; N=774); and Douglas County birth mothers (N=7,962; N=7,987). OHS provided case management, home visits, screening, referral, transportation, and health education to participants. Program outcome measures included low birth weight, infant mortality, adequacy of care, trimester of care, and costs of care. OHS birth outcomes improved during year 2, and there was a 31% cost saving in the average hospital expenditure compared with the nonparticipant groups. Preliminary evaluative analysis indicates that prenatal case management and community outreach can improve birth outcomes for minority women, while producing cost savings. Further prospective study is needed to document trends over a longer period of time regarding the relationship between community-based case management programs for minority populations, birth outcomes, and costs of care.

Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort.

PubMed

Goulart, Alessandra C; Fernandes, Tiotrefis G; Santos, Itamar S; Alencar, Airlane P; Bensenor, Isabela M; Lotufo, Paulo A

2013-05-24

Few studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival. We investigated long-term survival and predictors that could adversely influence ischemic and hemorrhagic first-ever stroke prognosis. We prospectively ascertained 665 consecutive first-ever ischemic and hemorrhagic stroke cases from "The Study of Stroke Mortality and Morbidity" (The EMMA Study) in a community hospital in São Paulo, Brazil. We evaluated cardiovascular risk factors and sociodemographic characteristics (age, gender, race and educational level). We found a lower survival rate among hemorrhagic cases compared to ischemic stroke cases at the end of 4 years of follow-up (52% vs. 44%, p = 0.04). The risk of death was two times higher among people with ischemic stroke without formal education. Also, we found consistently higher risk of death for diabetics with ischemic stroke (HR = 1.45; 95% CI = 1.07-1.97) compared to no diabetics. As expected, age equally influenced on the high risk of poor survival, regardless of stroke subtype. For ischemic stroke, the lack of formal education and diabetes were significant independent predictors of poor long-term survival.

Real-time compound sonography of the rotator-cuff: evaluation of artefact reduction and image definition.

PubMed

De Candia, Alessandro; Doratiotto, Stefsano; Paschina, Elio; Segatto, Enrica; Pelizzo, Francesco; Bazzocchi, Massimo

2003-04-01

The aim of this study was to compare real time compound sonography with conventional sonography in the evaluation of rotator cuff tears. A prospective study was performed on 50 supraspinatus tendons in 101 patients treated by surgical acromioplasty. The surgeon described 33 (66%) full-thickness tears and 17 (34%) partial-thickness tears. All tendons were examined by conventional sonography and real time compound sonography on the day before surgery. The techniques were compared by evaluating the images for freedom from artefacts, contrast resolution and overall image definition. Real time compound sonography proved to be superior to conventional sonography as regards freedom from artefacts in 50 cases out of 50 (100%). It was superior to conventional sonography in evaluating the image contrast resolution in 45 cases out of 50 (90%), and superior to conventional sonography in overall image definition in 45 out of 50 cases (90%). Real-time compound sonography reduces the intrinsic artefacts of conventional sonography and allows better overall image definition. In particular, the digital technique allowed us to study the rotator cuff with better contrast resolution and sharper and more detailed images than did conventional sonography.

A Comparative Study between Universal Eclectic Septoplasty Technique and Cottle

PubMed Central

Amaral Neto, Odim Ferreira do; Mizoguchi, Flavio Massao; Freitas, Renato da Silva; Maniglia, João Jairney; Maniglia, Fábio Fabrício; Maniglia, Ricardo Fabrício

2017-01-01

Introduction  Since the last century surgical correction of nasal septum deviation has been improved. The Universal Eclectic Technique was recently reported and there are still few studies dedicated to address this surgical approach. Objective  The objective of this study is to compare the results of septal deviation correction achieved using the Universal Eclectic Technique (UET) with those obtained through Cottle's Technique. Methods  This is a prospective study with two consecutive case series totaling 90 patients (40 women and 50 men), aged between 18 and 55 years. We divided patients into two groups according to the surgical approach. Fifty-three patients underwent septoplasty through Universal Eclectic Technique (UET) and thirty-seven patients were submitted to classical Cottle's septoplasty technique. All patients have answered the Nasal Obstruction Symptom Evaluation Scale (NOSE) questionnaire to assess pre and postoperative nasal obstruction. Results  Statistical analysis showed a significantly shorter operating time for the UET group. Nasal edema assessment performed seven days after the surgery showed a prevalence of mild edema in UET group and moderate edema in Cottle's technique group. In regard to complication rates, UET presented a single case of septal hematoma while in Cottle's technique group we observed: 02 cases of severe edemas, 01 case of incapacitating headache, and 01 complaint of nasal pain. Conclusion  The Universal Eclectic Technique (UET) has proven to be a safe and effective surgical technique with faster symptomatic improvement, low complication rates, and reduced surgical time when compared with classical Cottle's technique. PMID:28680499

Evaluation of Xpert C. difficile, BD MAX Cdiff, IMDx C. difficile for Abbott m2000, and Illumigene C. difficile Assays for Direct Detection of Toxigenic Clostridium difficile in Stool Specimens.

PubMed

Shin, Bo-Moon; Yoo, Sun Mee; Shin, Won Chang

2016-03-01

We evaluated the performance of four commercial nucleic acid amplification tests (NAATs: Xpert C. difficile, BD MAX Cdiff, IMDx C. difficile for Abbott m2000, and Illumigene C. difficile) for direct and rapid detection of Clostridium difficile toxin genes. We compared four NAATs on the same set of 339 stool specimens (303 prospective and 36 retrospective specimens) with toxigenic culture (TC). Concordance rate among four NAATs was 90.3% (306/339). Based on TC results, the sensitivity and specificity were 90.0% and 92.9% for Xpert; 86.3% and 89.3% for Max; 84.3% and 94.4% for IMDx; and 82.4% and 93.7% for Illumigene, respectively. For 306 concordant cases, there were 11 TC-negative/NAATs co-positive cases and 6 TC-positive/NAATs co-negative cases. Among 33 discordant cases, 18 were only single positive in each NAAT (Xpert, 1; Max, 12; IMDx, 1; Illumigene, 4). Positivity rates of the four NAATs were associated with those of semi-quantitative cultures, which were maximized in grade 3 (>100 colony-forming unit [CFU]) compared with grade 1 (<10 CFU). Commercial NAATs may be rapid and reliable methods for direct detection of tcdA and/or tcdB in stool specimens compared with TC. Some differences in the sensitivity of the NAATs may partly depend on the number of toxigenic C. difficile in stool specimens.

Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

PubMed

Singal, Rikki; Dhar, Siddharth

2018-01-01

The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

Improving everyday prospective memory performance in older adults: comparing cognitive process and strategy training.

PubMed

Brom, Sarah Susanne; Kliegel, Matthias

2014-09-01

Considering the importance of prospective memory for independence in old age recently, research has started to examine interventions to reduce prospective memory errors. Two general approaches can be proposed: (a) process training of executive control associated with prospective memory functioning, and/or (b) strategy training to reduce executive task demands. The present study was the first to combine and compare both training methods in a sample of 62 community-dwelling older adults (60-86 years) and to explore their effects on an ecologically valid everyday life prospective memory task (here: regular blood pressure monitoring). Even though the training of executive control was successful in enhancing the trained ability, clear transfer effects on prospective memory performance could only be found for the strategy training. However, participants with low executive abilities benefited particularly from the implementation intention strategy. Conceptually, this supports models suggesting interactions between task demands and individual differences in executive control in explaining individual differences in prospective memory performance. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Comparison of Estimates between Cohort and Case-Control Studies in Meta-Analyses of Therapeutic Interventions: A Meta-Epidemiological Study.

PubMed

Lanza, Amy; Ravaud, Philippe; Riveros, Carolina; Dechartres, Agnes

2016-01-01

Observational studies are increasingly being used for assessing therapeutic interventions. Case-control studies are generally considered to have greater risk of bias than cohort studies, but we lack evidence of differences in effect estimates between the 2 study types. We aimed to compare estimates between cohort and case-control studies in meta-analyses of observational studies of therapeutic interventions by using a meta-epidemiological study. We used a random sample of meta-analyses of therapeutic interventions published in 2013 that included both cohort and case-control studies assessing a binary outcome. For each meta-analysis, the ratio of estimates (RE) was calculated by comparing the estimate in case-control studies to that in cohort studies. Then, we used random-effects meta-analysis to estimate a combined RE across meta-analyses. An RE < 1 indicated that case-control studies yielded larger estimates than cohort studies. The final analysis included 23 meta-analyses: 138 cohort and 133 case-control studies. Treatment effect estimates did not significantly differ between case-control and cohort studies (combined RE 0.97 [95% CI 0.86-1.09]). Heterogeneity was low, with between-meta-analysis variance τ2 = 0.0049. Estimates did not differ between case-control and prospective or retrospective cohort studies (RE = 1.05 [95% CI 0.96-1.15] and RE = 0.99 [95% CI, 0.83-1.19], respectively). Sensitivity analysis of studies reporting adjusted estimates also revealed no significant difference (RE = 1.03 [95% CI 0.91-1.16]). Heterogeneity was also low for these analyses. We found no significant difference in treatment effect estimates between case-control and cohort studies assessing therapeutic interventions.

25-hydroxyvitamin D levels and risk of stroke: A prospective study and meta-analysis

PubMed Central

Sun, Qi; Pan, An; Hu, Frank B.; Manson, JoAnn E.; Rexrode, Kathryn M.

2012-01-01

Background and Purpose Despite evidence suggesting that vitamin D deficiency may lead to elevated cardiovascular disease risk, results regarding the association of 25(OH)D levels with stroke risk are inconclusive. We aimed to examine this association in a prospective study in women and to summarize all existing data in a meta-analysis. Methods We measured 25(OH)D levels among 464 women who developed ischemic stroke and an equal number of controls who were free of stroke through 2006 in the Nurses’ Health Study (NHS). We searched MEDLINE and EMBASE for articles published through March 2011 that prospectively evaluated 25(OH)D levels in relation to stroke. Results After multivariable adjustment for lifestyle and dietary covariates, lower 25(OH)D levels were associated with an elevated risk of ischemic stroke in the NHS: the odds ratio (95% CI) comparing women in the lowest vs. highest tertiles was 1.49 (1.01, 2.18; Ptrend=0.04). We found 6 other prospective studies that examined 25(OH)D in relation to stroke outcomes. After pooling our results with these prospective studies that included 1,214 stroke cases in total, low 25(OH)D levels were associated with increased risk of developing stroke outcomes in comparison to high levels: the pooled relative risk (95% CI) was 1.52 (1.20, 1.85; I2 = 0.0%, Pheterogeneity=0.63). In two studies that explicitly examined ischemic stroke, this association was 1.59 (1.07, 2.12; I2 = 0.0%, Pheterogeneity=0.80). Conclusions These data provide evidence that low vitamin D levels are modestly associated with risk of stroke. Maintaining adequate vitamin D status may lower risk of stroke in women. PMID:22442173

Multisample adjusted U-statistics that account for confounding covariates.

PubMed

Satten, Glen A; Kong, Maiying; Datta, Somnath

2018-06-19

Multisample U-statistics encompass a wide class of test statistics that allow the comparison of 2 or more distributions. U-statistics are especially powerful because they can be applied to both numeric and nonnumeric data, eg, ordinal and categorical data where a pairwise similarity or distance-like measure between categories is available. However, when comparing the distribution of a variable across 2 or more groups, observed differences may be due to confounding covariates. For example, in a case-control study, the distribution of exposure in cases may differ from that in controls entirely because of variables that are related to both exposure and case status and are distributed differently among case and control participants. We propose to use individually reweighted data (ie, using the stratification score for retrospective data or the propensity score for prospective data) to construct adjusted U-statistics that can test the equality of distributions across 2 (or more) groups in the presence of confounding covariates. Asymptotic normality of our adjusted U-statistics is established and a closed form expression of their asymptotic variance is presented. The utility of our approach is demonstrated through simulation studies, as well as in an analysis of data from a case-control study conducted among African-Americans, comparing whether the similarity in haplotypes (ie, sets of adjacent genetic loci inherited from the same parent) occurring in a case and a control participant differs from the similarity in haplotypes occurring in 2 control participants. Copyright © 2018 John Wiley & Sons, Ltd.

Methodology Series Module 2: Case-control Studies.

PubMed

Setia, Maninder Singh

2016-01-01

Case-Control study design is a type of observational study. In this design, participants are selected for the study based on their outcome status. Thus, some participants have the outcome of interest (referred to as cases), whereas others do not have the outcome of interest (referred to as controls). The investigator then assesses the exposure in both these groups. The investigator should define the cases as specifically as possible. Sometimes, definition of a disease may be based on multiple criteria; thus, all these points should be explicitly stated in case definition. An important aspect of selecting a control is that they should be from the same 'study base' as that of the cases. We can select controls from a variety of groups. Some of them are: General population; relatives or friends; and hospital patients. Matching is often used in case-control control studies to ensure that the cases and controls are similar in certain characteristics, and it is a useful technique to increase the efficiency of the study. Case-Control studies can usually be conducted relatively faster and are inexpensive - particularly when compared with cohort studies (prospective). It is useful to study rare outcomes and outcomes with long latent periods. This design is not very useful to study rare exposures. Furthermore, they may also be prone to certain biases - selection bias and recall bias.

Intra-patient comparison of parietal pleural biopsies by rigid forceps, flexible forceps and cryoprobe obtained during medical thoracoscopy: a prospective series of 80 cases with pleural effusion.

PubMed

Wurps, H; Schönfeld, N; Bauer, T T; Bock, M; Duve, C; Sauer, R; Mairinger, T; Griff, S

2016-07-07

There is only few data available on the use of cryotechnique during medical thoracoscopy. Medical thoracoscopy was performed in consecutive patients with pleural effusion. Prospectively, biopsies were taken by rigid forceps, flexible forceps and cryoprobe. Specimen size, depth and diagnostic yield were compared. 80 Patients were included. 408 biopsies were taken (205 rigid biopsies, 104 flexible biopsies, 99 cryobiopsies). Mean surface area of rigid biopsies was 22.6 ± 20.4 mm(2) (flexible biopsies: 7.1 ± 9.3 mm(2), cryobiopsies: 14.4 ± 12.8 mm(2)). Rigid biopsies were significantly larger than cryobiopsies (p < 0.001) and flexible biopsies (p < 0.001), crybiopsies were significantly larger than flexible biopsies (p < 0.01). A deep biopsy containing fatty tissue was harvested in 63 % of rigid biopsies (cryobiopsy: 49.5 % flexible biopsy: 39.5 %). In 79/80 cases (98.7 % 95 % CI cannot be calculated) a diagnosis was obtained by rigid biopsy (cryobiopsy: 73/80 cases (91.3 % 95 % CI 86.0 - 96.5 %), flexible biopsy: 74/80 cases (92.5 % 95 % CI 88.6 - 97.4 %)). Diagnostic yield achieved with cryobiopsies was inferior to the yield of rigid biopsies (Difference: 12.7 %), but non-inferior to flexible biopsies (Difference: 6.5 %). Cryobiopsies in medical thoracoscopy are safe with high diagnostic yield, non-inferior to flexible biopsies with increased tissue quantity and quality. Cryotechnique can develop an important role in medical thoracoscopy in the near future when rigid thoracoscopy is not available.

Incidence of human T cell lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis in a long-term prospective cohort study of initially asymptomatic individuals in Brazil.

PubMed

Romanelli, Luiz Cláudio Ferreira; Caramelli, Paulo; Martins, Marina Lobato; Gonçalves, Denise Utsch; Proietti, Fernando Augusto; Ribas, João Gabriel Ramos; Araújo, Marcelo Grossi; Carneiro-Proietti, Anna Bárbara de Freitas

2013-09-01

The incidence of human T cell lymphotropic virus type 1 (HLTV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is not well defined in the literature. Several studies have reported different incidence rates, and recent publications suggest a higher incidence and prevalence of HAM/TSP. The interdisciplinary HTLV Research Group (GIPH) is a prospective open cohort study of individuals infected with HTLV-1/2. This study describes the demographic data and HAM/TSP incidence rate observed in 181 HTLV-1-seropositive individuals and compares the results with previous reports in the literature. HAM/TSP was diagnosed on the basis of the World Health Organization diagnostic criteria and De Castro-Costa et al. [Proposal for diagnostic criteria of tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). AIDS Res Hum Retroviruses 2006;22:931-935]. Seven HAM/TSP incident cases were observed during the follow-up. The HAM/TSP incidence density was 5.3 cases per 1,000 HTLV-1-seropositive cases per year (95% confidence interval: 2.6-10.9), with a mean follow-up of 7±4 years (range: 1 month to 15 years). HAM/TSP was more frequent in women in their 40s and 50s with probable infection via the sexual route. The HAM/TSP incidence density among HTLV-1-seropositive cases observed in the present study is higher than that in previous studies. HAM/TSP may be underdiagnosed in countries like Brazil where HTLV infection is prevalent. Orientation and prevent transmission of HTLV programs are needed. Currently, preventing HTLV-1 transmission is the most effective way to reduce the impact of HAM/TSP on society.

Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study.

PubMed

Crowe, Francesca L; Appleby, Paul N; Travis, Ruth C; Key, Timothy J

2013-03-01

Few previous prospective studies have examined differences in incident ischemic heart disease (IHD) risk between vegetarians and nonvegetarians. The objective was to examine the association of a vegetarian diet with risk of incident (nonfatal and fatal) IHD. A total of 44,561 men and women living in England and Scotland who were enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, of whom 34% consumed a vegetarian diet at baseline, were part of the analysis. Incident cases of IHD were identified through linkage with hospital records and death certificates. Serum lipids and blood pressure measurements were available for 1519 non cases, who were matched to IHD cases by sex and age. IHD risk by vegetarian status was estimated by using multivariate Cox proportional hazards models. After an average follow-up of 11.6 y, there were 1235 IHD cases (1066 hospital admissions and 169 deaths). Compared with nonvegetarians, vegetarians had a lower mean BMI [in kg/m(2); -1.2 (95% CI: -1.3, -1.1)], non-HDL-cholesterol concentration [-0.45 (95% CI: -0.60, -0.30) mmol/L], and systolic blood pressure [-3.3 (95% CI: -5.9, -0.7) mm Hg]. Vegetarians had a 32% lower risk (HR: 0.68; 95% CI: 0.58, 0.81) of IHD than did nonvegetarians, which was only slightly attenuated after adjustment for BMI and did not differ materially by sex, age, BMI, smoking, or the presence of IHD risk factors. Consuming a vegetarian diet was associated with lower IHD risk, a finding that is probably mediated by differences in non-HDL cholesterol, and systolic blood pressure.

A prospective cohort study of the clinical presentation of non-traumatic osteonecrosis of the femoral head: spine and knee symptoms as clinical presentation of hip osteonecrosis.

PubMed

Hauzeur, Jean-Philippe; Malaise, Michel; de Maertelaer, Viviane

2016-07-01

To study the clinical presentation of femoral head osteonecrosis (ONFH). Publications dedicated to this aspect of ONFH are rare. Our aim was to systematically collect and describe the clinical data. A prospective survey was conducted in a cohort of ONFH recruited from a dedicated clinic for osteonecrosis. The history of symptoms, medical management, and physical findings were obtained from 88 patients suffering from 125 ONFH. Subgroups were formed: bilateral versus unilateral ONFH, radiological stages 1-2 (pre-fractured) versus fractured stage 3 versus stage 4. ONFH was bilateral in 63 %, especially in corticosteroid users and in sickle-cell cases. These patients were younger but had similar BMIs compared to the unilateral cases. The pain was mechanical in 79 % of hips and inflammatory in 21 %. Acute pain at the onset was present in 55 % of hips. The localization of this pain was variable, including in the groin, the buttocks, or diffused in the lower limbs. A limp was present in 50 % of the patients, only when one hip was painful. The physical examination of the hip was normal in 31 %, especially in stages 1-2 (55 %). The diagnosis delay was 12 months, with inadequate medical management in 51 % of patients. In ONFH cases, no typical clinical pattern was found. The clinical presentation was very variable, sometimes having spine or knee symptoms with a normal physical examination of the hip. ONFH should be systematically suspected in cases of onset of pain in the pelvis, buttocks, groin, and lower limbs.

Development and initial validation of the Bedside Paediatric Early Warning System score

PubMed Central

2009-01-01

Introduction Adverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable. Identification of children for referral to critical care experts remains problematic. Our objective was to develop and validate a simple bedside score to quantify severity of illness in hospitalized children. Methods A case-control design was used to evaluate 11 candidate items and identify a pragmatic score for routine bedside use. Case-patients were urgently admitted to the intensive care unit (ICU). Control-patients had no 'code blue', ICU admission or care restrictions. Validation was performed using two prospectively collected datasets. Results Data from 60 case and 120 control-patients was obtained. Four out of eleven candidate-items were removed. The seven-item Bedside Paediatric Early Warning System (PEWS) score ranges from 0–26. The mean maximum scores were 10.1 in case-patients and 3.4 in control-patients. The area under the receiver operating characteristics curve was 0.91, compared with 0.84 for the retrospective nurse-rating of patient risk for near or actual cardiopulmonary arrest. At a score of 8 the sensitivity and specificity were 82% and 93%, respectively. The score increased over 24 hours preceding urgent paediatric intensive care unit (PICU) admission (P < 0.0001). In 436 urgent consultations, the Bedside PEWS score was higher in patients admitted to the ICU than patients who were not admitted (P < 0.0001). Conclusions We developed and performed the initial validation of the Bedside PEWS score. This 7-item score can quantify severity of illness in hospitalized children and identify critically ill children with at least one hours notice. Prospective validation in other populations is required before clinical application. PMID:19678924

Musculoskeletal training: are GP trainees exposed to the right case mix for independent practice?

PubMed

Goff, Iain; Wise, Elspeth Mary; Coady, David; Walker, David

2016-02-01

Musculoskeletal conditions are common in general practice, but clinicians express poor self confidence in dealing with them. Training in general practice relies on clinical exposure to a range of presentations in order to gain competence. It has been suggested that trainees are exposed to a different case mix from qualified general practices (GPs), due to seeing more minor illness and less chronic disease and that this may be responsible in part for their subsequent lack of confidence. The aims of this study were to analyse the case mix of musculoskeletal conditions encountered by general practice trainees and to compare this to the overall population consulting behaviour. This is a prospective observational study. Thirteen general practices in North East England were recruited. Musculoskeletal disorders encountered by 13 GP trainees (7 junior and 6 senior) were prospectively recorded using a handheld diary. Disorders were classified according to working diagnosis or body region if diagnosis was unclear. Musculoskeletal (MSK) disorders comprised 17 % of consultations, and the distribution of diagnoses of these was in proportion to epidemiological studies of MSK disorders in the UK as they present in primary care. Back pain was the most frequent label with 141 (29 %) consultations with a further 43 (9 %) for neck pain. Inflammatory arthritis accounted for the same number 43 (9 %). Individual joint problems were 115 (24 %) with knee being most common. A specific diagnosis was more likely to be applied when symptoms were more distal and less likely when axial. Trainees are exposed to the same spectrum of MSK disorders as are present in the population as a whole. Case mix does not appear to be a significant factor in low confidence levels in dealing with MSK disorders.

Bleeding and infection with external ventricular drainage: a systematic review in comparison with adjudicated adverse events in the ongoing Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III (CLEAR-III IHV) trial.

PubMed

Dey, Mahua; Stadnik, Agnieszka; Riad, Fady; Zhang, Lingjiao; McBee, Nichol; Kase, Carlos; Carhuapoma, J Ricardo; Ram, Malathi; Lane, Karen; Ostapkovich, Noeleen; Aldrich, Francois; Aldrich, Charlene; Jallo, Jack; Butcher, Ken; Snider, Ryan; Hanley, Daniel; Ziai, Wendy; Awad, Issam A

2015-03-01

Retrospective series report varied rates of bleeding and infection with external ventricular drainage (EVD). There have been no prospective studies of these risks with systematic surveillance, threshold definitions, or independent adjudication. To analyze the rate of complications in the ongoing Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III (CLEAR III) trial, providing a comparison with a systematic review of complications of EVD in the literature. Patients were prospectively enrolled in the CLEAR III trial after placement of an EVD for obstructive intraventricular hemorrhage and randomized to receive recombinant tissue-type plasminogen activator or placebo. We counted any detected new hemorrhage (catheter tract hemorrhage or any other distant hemorrhage) on computed tomography scan within 30 days from the randomization. Meta-analysis of published series of EVD placement was compiled with STATA software. Growing or unstable hemorrhage was reported as a cause of exclusion from the trial in 74 of 5707 cases (1.3%) screened for CLEAR III. The first 250 patients enrolled have completed adjudication of adverse events. Forty-two subjects (16.8%) experienced ≥1 new bleeds or expansions, and 6 of 250 subjects (2.4%) suffered symptomatic hemorrhages. Eleven cases (4.4%) had culture-proven bacterial meningitis or ventriculitis. Risks of bleeding and infection in the ongoing CLEAR III trial are comparable to those previously reported in EVD case series. In the present study, rates of new bleeds and bacterial meningitis/ventriculitis are very low despite multiple daily injections, blood in the ventricles, the use of thrombolysis in half the cases, and generalization to >60 trial sites.

Type 2 Diabetes in Relation to the Risk of Renal Cell Carcinoma Among Men and Women in Two Large Prospective Cohort Studies.

PubMed

Graff, Rebecca E; Sanchez, Alejandro; Tobias, Deirdre K; Rodríguez, Dayron; Barrisford, Glen W; Blute, Michael L; Li, Yanping; Sun, Qi; Preston, Mark A; Wilson, Kathryn M; Cho, Eunyoung

2018-04-20

We assessed whether type 2 diabetes is associated with renal cell carcinoma (RCC), independent of key potential confounders, in two large prospective cohorts with biennially updated covariate data. A total of 117,570 women from the Nurses' Health Study (NHS) and 48,866 men from the Health Professionals Follow-up Study (HPFS) were followed from 1976 and 1986, respectively, through 2014. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs for associations between type 2 diabetes and pathology-confirmed RCC, overall and by stage, grade, and histological subtype. During 38 years of follow-up in the NHS, we confirmed 418 RCC cases, including 120 fatal cases. Over 28 years in the HPFS, we confirmed 302 RCC cases, including 87 fatal cases. Women with type 2 diabetes had a significantly increased risk of RCC compared with women without type 2 diabetes (multivariable HR 1.53; 95% CI 1.14-2.04), with some evidence that the association was stronger for ≤5 (HR 2.15; 95% CI 1.44-3.23) than >5 (HR 1.22; 95% CI 0.84-1.78) years' duration of type 2 diabetes ( P difference 0.03). Among men, type 2 diabetes was not associated with total RCC (HR 0.89; 95% CI 0.56-1.41) or with RCC defined by stage, grade, or subtype. Sample sizes for analyses by stage, grade, and subtype were limited. We found that type 2 diabetes was independently associated with a greater risk of RCC in women but not in men. © 2018 by the American Diabetes Association.

Exogenous thyrotoxicosis in dogs attributable to consumption of all-meat commercial dog food or treats containing excessive thyroid hormone: 14 cases (2008-2013).

PubMed

Broome, Michael R; Peterson, Mark E; Kemppainen, Robert J; Parker, Valerie J; Richter, Keith P

2015-01-01

To describe findings in dogs with exogenous thyrotoxicosis attributable to consumption of commercially available dog foods or treats containing high concentrations of thyroid hormone. Retrospective and prospective case series. 14 dogs. Medical records were retrospectively searched to identify dogs with exogenous thyrotoxicosis attributable to dietary intake. One case was found, and subsequent cases were identified prospectively. Serum thyroid hormone concentrations were evaluated before and after feeding meat-based products suspected to contain excessive thyroid hormone was discontinued. Scintigraphy was performed to evaluate thyroid tissue in 13 of 14 dogs before and 1 of 13 dogs after discontinuation of suspect foods or treats. Seven samples of 5 commercially available products fed to 6 affected dogs were analyzed for thyroxine concentration; results were subjectively compared with findings for 10 other commercial foods and 6 beef muscle or liver samples. Total serum thyroxine concentrations were high (median, 8.8 μg/dL; range, 4.65 to 17.4 μg/dL) in all dogs at initial evaluation; scintigraphy revealed subjectively decreased thyroid gland radionuclide in 13 of 13 dogs examined. At ≥ 4 weeks after feeding of suspect food or treats was discontinued, total thyroxine concentrations were within the reference range for all dogs and signs associated with thyrotoxicosis, if present, had resolved. Analysis of tested food or treat samples revealed a median thyroxine concentration for suspect products of 1.52 μg of thyroxine/g, whereas that of unrelated commercial foods was 0.38 μg of thyroxine/g. Results indicated that thyrotoxicosis can occur secondary to consumption of meat-based products presumably contaminated by thyroid tissue, and can be reversed by identification and elimination of suspect products from the diet.

PLA2G7 genotype, Lp-PLA2 activity and coronary heart disease risk in 10,494 cases and 15,624 controls of European ancestry

PubMed Central

Casas, Juan P.; Ninio, Ewa; Panayiotou, Andrie; Palmen, Jutta; Cooper, Jackie A; Ricketts, Sally L; Sofat, Reecha; Nicolaides, Andrew N; Corsetti, James P; Fowkes, F Gerry R; Tzoulaki, Ioanna; Kumari, Meena; Brunner, Eric J; Kivimaki, Mika; Marmot, Michael G; Hoffmann, Michael M; Winkler, Karl; März, Winfred; Ye, Shu; Stirnadel, Heide A; MBBChir, Kay-Tee Khaw; Humphries, Steve E; Sandhu, Manjinder S; Hingorani, Aroon D; Talmud, Philippa J

2012-01-01

Background Higher Lp-PLA2 activity is associated with increased risk of coronary heart disease (CHD), making Lp-PLA2 a potential therapeutic target. PLA2G7 variants associated with Lp-PLA2 activity could evaluate whether this relationship is causal. Methods and Results A meta-analysis including a total of 12 studies (5 prospective, 4 case-control, 1 case-only and 2 cross-sectional, n=26,118) was undertaken to examine the association of: (i) LpPLA2 activity vs. cardiovascular biomarkers and risk factors and CHD events (two prospective studies; n=4884); ii) PLA2G7 SNPs and Lp-PLA2 activity (3 prospective, 2 case-control, 2 cross-sectional studies; up to n=6094); and iii) PLA2G7 SNPs and angiographic coronary artery disease (2 case-control, 1 case-only study; n=4971 cases) and CHD events (5 prospective, 2 case-control studies; n=5523). Lp-PLA2 activity correlated with several CHD risk markers. Hazard ratio for CHD events top vs. bottom quartile of Lp-PLA2 activity was 1.61 (95%CI: 1.31, 1.99) and 1.17 (95%CI: 0.91, 1.51) after adjustment for baseline traits. Of seven SNPs, rs1051931 (A379V) showed the strongest association with Lp-PLA2 activity, VV subjects having 7.2% higher activity than AAs. Genotype was not associated with risk markers, angiographic coronary disease (OR 1.03 (95%CI 0.80, 1.32), or CHD events (OR 0.98 (95%CI 0.82, 1.17). Conclusions Unlike Lp-PLA2 activity, PLA2G7 variants associated with modest effects on Lp-PLA2 activity were not associated with cardiovascular risk markers, coronary atheroma or CHD. Larger association studies, identification of SNPs with larger effects, or randomised trials of specific Lp-PLA2 inhibitors are needed to confirm/refute a contributory role for Lp-PLA2 in CHD. PMID:20479152

Image guided versus palpation guided core needle biopsy of palpable breast masses: a prospective study

PubMed Central

Hari, Smriti; Kumari, Swati; Srivastava, Anurag; Thulkar, Sanjay; Mathur, Sandeep; Veedu, Prasad Thotton

2016-01-01

Background & objectives: Biopsy of palpable breast masses can be performed manually by palpation guidance or under imaging guidance. Based on retrospective studies, image guided biopsy is considered more accurate than palpation guided breast biopsy; however, these techniques have not been compared prospectively. We conducted this prospective study to verify the superiority and determine the size of beneficial effect of image guided biopsy over palpation guided biopsy. Methods: Over a period of 18 months, 36 patients each with palpable breast masses were randomized into palpation guided and image guided breast biopsy arms. Ultrasound was used for image guidance in 33 patients and mammographic (stereotactic) guidance in three patients. All biopsies were performed using 14 gauge automated core biopsy needles. Inconclusive, suspicious or imaging-histologic discordant biopsies were repeated. Results: Malignancy was found in 30 of 36 women in palpation guided biopsy arm and 27 of 36 women in image guided biopsy arm. Palpation guided biopsy had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 46.7, 100, 100, 27.3 per cent, respectively, for diagnosing breast cancer. Nineteen of 36 women (52.8%) required repeat biopsy because of inadequate samples (7 of 19), suspicious findings (2 of 19) or imaging-histologic discordance (10 of 19). On repeat biopsy, malignancy was found in all cases of imaging-histologic discordance. Image guided biopsy had 96.3 per cent sensitivity and 100 per cent specificity. There was no case of inadequate sample or imaging-histologic discordance with image guided biopsy. Interpretation & conclusions: Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates. PMID:27488003

Multimodal Navigation in Endoscopic Transsphenoidal Resection of Pituitary Tumors Using Image-Based Vascular and Cranial Nerve Segmentation: A Prospective Validation Study.

PubMed

Dolati, Parviz; Eichberg, Daniel; Golby, Alexandra; Zamani, Amir; Laws, Edward

2016-11-01

Transsphenoidal surgery (TSS) is the most common approach for the treatment of pituitary tumors. However, misdirection, vascular damage, intraoperative cerebrospinal fluid leakage, and optic nerve injuries are all well-known complications, and the risk of adverse events is more likely in less-experienced hands. This prospective study was conducted to validate the accuracy of image-based segmentation coupled with neuronavigation in localizing neurovascular structures during TSS. Twenty-five patients with a pituitary tumor underwent preoperative 3-T magnetic resonance imaging (MRI), and MRI images loaded into the navigation platform were used for segmentation and preoperative planning. After patient registration and subsequent surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe or Doppler probe on or as close as possible to the target. Preoperative segmentation of the internal carotid artery and cavernous sinus matched with the intraoperative endoscopic and micro-Doppler findings in all cases. Excellent correspondence between image-based segmentation and the endoscopic view was also evident at the surface of the tumor and at the tumor-normal gland interfaces. Image guidance assisted the surgeons in localizing the optic nerve and chiasm in 64% of cases. The mean accuracy of the measurements was 1.20 ± 0.21 mm. Image-based preoperative vascular and neural element segmentation, especially with 3-dimensional reconstruction, is highly informative preoperatively and potentially could assist less-experienced neurosurgeons in preventing vascular and neural injury during TSS. In addition, the accuracy found in this study is comparable to previously reported neuronavigation measurements. This preliminary study is encouraging for future prospective intraoperative validation with larger numbers of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

[Cost analysis of radiotherapy provided in inpatient setting -  testing potential predictors for a new prospective payment system].

PubMed

Sedo, J; Bláha, M; Pavlík, T; Klika, P; Dušek, L; Büchler, T; Abrahámová, J; Srámek, V; Slampa, P; Komínek, L; Pospíšil, P; Sláma, O; Vyzula, R

2014-01-01

As a part of the development of a new prospective payment model for radiotherapy we analyzed data on costs of care provided by three comprehensive cancer centers in the Czech Republic. Our aim was to find a combination of variables (predictors) which could be used to sort hospitalization cases into groups according to their costs, with each group having the same reimbursement rate. We tested four variables as possible predictors -  number of fractions, stage of disease, radiotherapy technique and diagnostic group. We analyzed 7,440 hospitalization cases treated in three comprehensive cancer centers from 2007 to 2011. We acquired data from the I COP database developed by Institute of Biostatistics and Analyses of Masaryk University in cooperation with oncology centers that contains records from the National Oncological Registry along with data supplied by healthcare providers to insurance companies for the purpose of retrospective reimbursement. When comparing the four variables mentioned above we found that number of fractions and radiotherapy technique were much stronger predictors than the other two variables. Stage of disease did not prove to be a relevant indicator of cost distinction. There were significant differences in costs among diagnostic groups but these were mostly driven by the technique of radiotherapy and the number of fractions. Within the diagnostic groups, the distribution of costs was too heterogeneous for the purpose of the new payment model. The combination of number of fractions and radiotherapy technique appears to be the most appropriate cost predictors to be involved in the prospective payment model proposal. Further analysis is planned to test the predictive value of intention of radiotherapy in order to determine differences in costs between palliative and curative treatment.

New insights on diabetes in Turner syndrome: results from an observational study in adulthood.

PubMed

Ibarra-Gasparini, Daniela; Altieri, Paola; Scarano, Emanuela; Perri, Annamaria; Morselli-Labate, Antonio M; Pagotto, Uberto; Mazzanti, Laura; Pasquali, Renato; Gambineri, Alessandra

2018-03-01

To explore the characteristics of diabetes mellitus in adults with Turner syndrome. Observational study consisting of a prospective phase after the access of adults with Turner syndrome to the Endocrinology Unit (median period of follow-up 15.6, interquartile range: 12.0-24.5 months) and a retrospective collection of data from the diagnosis of Turner syndrome until the time of access to the Endocrinology Unit. A total of 113 Italian Turner syndrome patients were included in the study. During the prospective phase of the study, each patient underwent physical examination, fasting blood sampling, and an oral glucose tolerance test on a yearly basis. Oral glucose tolerance test was used to perform the diagnosis of diabetes mellitus. Before access to the Endocrinology Unit, diabetes mellitus was diagnosed in two Turner syndrome patients. Another five cases of diabetes mellitus were diagnosed at the first access to the Endocrinology Unit, whereas seven new cases of diabetes mellitus were diagnosed during the prospective phase of the study. At the diagnosis of diabetes mellitus, only one patient had fasting glucose above 126 mg/dL, and only two had an HbA1c value >6.5% (48 mmol/mol). When compared to normo-glucose tolerant patients, the diabetic patients had a significantly lower insulin-to-glucose ratio at 30 and 60 min of the oral glucose tolerance test. In the regression analyses, only age was associated with the development of diabetes mellitus. This study confirms that diabetes mellitus is frequent in Turner syndrome and suggests that it is specific to the syndrome. In addition, this study demonstrates that oral glucose tolerance test is a more sensitive test than HbA1c for the diagnosis of diabetes mellitus in Turner syndrome.

Dietary vitamin D intake and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition: the EPIC-InterAct study.

PubMed

Abbas, S; Linseisen, J; Rohrmann, S; Beulens, J W J; Buijsse, B; Amiano, P; Ardanaz, E; Balkau, B; Boeing, H; Clavel-Chapelon, F; Fagherazzi, G; Franks, P W; Gavrila, D; Grioni, S; Kaaks, R; Key, T J; Khaw, K T; Kühn, T; Mattiello, A; Molina-Montes, E; Nilsson, P M; Overvad, K; Quirós, J R; Rolandsson, O; Sacerdote, C; Saieva, C; Slimani, N; Sluijs, I; Spijkerman, A M W; Tjonneland, A; Tumino, R; van der A, D L; Zamora-Ros, R; Sharp, S J; Langenberg, C; Forouhi, N G; Riboli, E; Wareham, N J

2014-02-01

Prospective cohort studies have indicated that serum vitamin D levels are inversely related to risk of type 2 diabetes. However, such studies cannot determine the source of vitamin D. Therefore, we examined the association of dietary vitamin D intake with incident type 2 diabetes within the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study in a heterogeneous European population including eight countries with large geographical variation. Using a case-cohort design, 11,245 incident cases of type 2 diabetes and a representative subcohort (N=15,798) were included in the analyses. Hazard ratios (HR) and 95% confidence intervals (CIs) for type 2 diabetes were calculated using a Prentice-weighted Cox regression adjusted for potential confounders. Twenty-four-hour diet-recall data from a subsample (N=2347) were used to calibrate habitual intake data derived from dietary questionnaires. Median follow-up time was 10.8 years. Dietary vitamin D intake was not significantly associated with the risk of type 2 diabetes. HR and 95% CIs for the highest compared to the lowest quintile of uncalibrated vitamin D intake was 1.09 (0.97-1.22) (Ptrend=0.17). No associations were observed in a sex-specific analysis. The overall pooled effect (HR (95% CI)) using the continuous calibrated variable was 1.00 (0.97-1.03) per increase of 1 μg/day dietary vitamin D. This observational study does not support an association between higher dietary vitamin D intake and type 2 diabetes incidence. This result has to be interpreted in light of the limited contribution of dietary vitamin D on the overall vitamin D status of a person.

Application of the Rosner-Wei Risk-Prediction Model to Estimate Sexual Orientation Patterns in Colon Cancer Risk in a Prospective Cohort of U.S. Women

PubMed Central

Austin, S. Bryn; Pazaris, Mathew J.; Wei, Esther K.; Rosner, Bernard; Kennedy, Grace A.; Bowen, Deborah; Spiegelman, Donna

2014-01-01

Purpose We examined whether lesbian and bisexual women may be at greater risk of colon cancer (CC) than heterosexual women. Methods Working with a large cohort of U.S. women ages 25-64 years, we analyzed 20 years of prospective data to estimate CC incidence, based on known risk factors by applying the Rosner-Wei CC risk-prediction model. Comparing to heterosexual women, we calculated for lesbian and bisexual women the predicted one-year incidence rate (IR) per 100,000 person-years and estimated incidence rate ratios (IRR) and 95% confidence intervals (CI), based on each woman’s comprehensive risk factor profile. Results Analyses included 1,373,817 person-years of data from 66,257 women. For each sexual orientation group, mean predicted one-year CC IR per 100,000 person-years was slightly over 12 cases for each of the sexual orientation groups. After controlling for confounders in fully adjusted models and compared to heterosexuals, no significant differences in IRR were observed for lesbians (IRR 1.01; 95% CI 0.99, 1.04) or bisexuals (IRR 1.01; 95% CI 0.98, 1.04). Conclusions CC risk is similar across all sexual orientation subgroups, with all groups comparably affected. Health professionals must ensure that prevention, screening, and treatment programs are adequately reaching each of these communities. PMID:24852207

A prospective comparison of performance during back-to-back, anterograde manual spiral enteroscopy and double-balloon enteroscopy.

PubMed

Despott, Edward J; Murino, Alberto; Bourikas, Leonidas; Nakamura, Masanao; Ramachandra, Vino; Fraser, Chris

2015-05-01

Spiral enteroscopy is a recently introduced technology alternative to balloon-assisted enteroscopy for examination of the small bowel. To compare small bowel insertion depths and procedure duration by spiral enteroscopy and double-balloon enteroscopy performed in the same cohort of patients, in immediate succession, using the same method of insertion depth estimation. A prospective, back-to-back comparative study was performed in 15 patients. Spiral enteroscopy procedures were performed first and a tattoo was placed to mark the most distal point. Double-balloon enteroscopy passed the tattoo placed at spiral enteroscopy in 14/15 cases (93%). Median insertion depths for double-balloon enteroscopy and spiral enteroscopy were 265cm and 175cm, respectively (P=0.004). Median time to achieve maximal depth of insertion was significantly shorter for spiral enteroscopy compared with double-balloon enteroscopy (24min vs. 45min, respectively; P=0.0005). However, in 14 patients no differences were found in median time to reach the same insertion depth (P=0.28). Double-balloon enteroscopy achieved significantly greater small bowel insertion depth than spiral enteroscopy. Although overall double-balloon enteroscopy procedure duration was longer, the time taken to reach the same small bowel insertion depth by both spiral enteroscopy and double-balloon enteroscopy was similar. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Icodextrin does not impact infectious and culture-negative peritonitis rates in peritoneal dialysis patients: a 2-year multicentre, comparative, prospective cohort study

PubMed Central

Vychytil, Andreas; Remón, César; Michel, Catherine; Williams, Paul; Rodríguez-Carmona, Ana; Marrón, Belén; Vonesh, Ed; van der Heyden, Synke; Filho, Jose C. Divino

2008-01-01

Background. Icodextrin is a glucose polymer derived by hydrolysis of cornstarch. The different biocompatibility profile of icodextrin-containing peritoneal dialysis (PD) solutions may have a positive influence on peritoneal host defence. Furthermore, cases of sterile peritonitis potentially associated with icodextrin have been reported. Methods. The primary objective of this multicentre, longitudinal, observational, non-interventional, prospective cohort study, which included 722 PD patients, was to evaluate the incidence of overall peritonitis in patients treated with icodextrin-containing PD solutions (Extraneal™) used during one long-dwell exchange/day compared with those treated with non-icodextrin-containing PD solutions. The secondary objective was to determine if culture-negative peritonitis rates differed between patients treated with icodextrin from two independent manufacturers. All peritonitis episodes were assessed by a Steering Committee in a blind manner. Results. There was no significant difference between icodextrin-treated and control patients in the adjusted overall, culture-positive or culture-negative peritonitis rates. When stratified by the icodextrin supplier, there was no significant difference in the adjusted rate of culture-negative peritonitis episodes between groups. Conclusion. Subjects receiving icodextrin as part of their PD regimen experienced neither a higher rate of culture-negative peritonitis nor a lower rate of infectious peritonitis compared with non-icodextrin users. There was no significant influence of the icodextrin raw material supplier on peritonitis rates. PMID:18556747

How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological Prospective Multicenter Study

PubMed Central

Léger, Julie; Tandé, Didier; Plouzeau, Chloé; Valentin, Anne Sophie; Jolivet-Gougeon, Anne; Lemarié, Carole; Kempf, Marie; Héry-Arnaud, Geneviève; Bret, Laurent; Juvin, Marie Emmanuelle; Giraudeau, Bruno; Burucoa, Christophe

2015-01-01

Although numerous perioperative samples and culture media are required to diagnose prosthetic joint infection (PJI), their exact number and types have not yet been definitely determined with a high level of proof. We conducted a prospective multicenter study to determine the minimal number of samples and culture media required for accurate diagnosis of PJI. Over a 2-year period, consecutive patients with clinical signs suggesting PJI were included, with five perioperative samples per patient. The bacteriological and PJI diagnosis criteria were assessed using a random selection of two, three, or four samples and compared with those obtained using the recommended five samples (references guidelines). The results obtained with two or three culture media were then compared with those obtained with five culture media for both criteria. The times-to-positivity of the different culture media were calculated. PJI was confirmed in 215/264 suspected cases, with a bacteriological criterion in 192 (89%). The PJI was monomicrobial (85%) or polymicrobial (15%). Percentages of agreement of 98.1% and 99.7%, respectively, for the bacteriological criterion and confirmed PJI diagnosis were obtained when four perioperative samples were considered. The highest percentages of agreement were obtained with the association of three culture media, a blood culture bottle, a chocolate agar plate, and Schaedler broth, incubated for 5, 7, and 14 days, respectively. This new procedure leads to significant cost saving. Our prospective multicenter study showed that four samples seeded on three culture media are sufficient for diagnosing PJI. PMID:26637380

How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological Prospective Multicenter Study.

PubMed

Bémer, Pascale; Léger, Julie; Tandé, Didier; Plouzeau, Chloé; Valentin, Anne Sophie; Jolivet-Gougeon, Anne; Lemarié, Carole; Kempf, Marie; Héry-Arnaud, Geneviève; Bret, Laurent; Juvin, Marie Emmanuelle; Giraudeau, Bruno; Corvec, Stéphane; Burucoa, Christophe

2016-02-01

Although numerous perioperative samples and culture media are required to diagnose prosthetic joint infection (PJI), their exact number and types have not yet been definitely determined with a high level of proof. We conducted a prospective multicenter study to determine the minimal number of samples and culture media required for accurate diagnosis of PJI. Over a 2-year period, consecutive patients with clinical signs suggesting PJI were included, with five perioperative samples per patient. The bacteriological and PJI diagnosis criteria were assessed using a random selection of two, three, or four samples and compared with those obtained using the recommended five samples (references guidelines). The results obtained with two or three culture media were then compared with those obtained with five culture media for both criteria. The times-to-positivity of the different culture media were calculated. PJI was confirmed in 215/264 suspected cases, with a bacteriological criterion in 192 (89%). The PJI was monomicrobial (85%) or polymicrobial (15%). Percentages of agreement of 98.1% and 99.7%, respectively, for the bacteriological criterion and confirmed PJI diagnosis were obtained when four perioperative samples were considered. The highest percentages of agreement were obtained with the association of three culture media, a blood culture bottle, a chocolate agar plate, and Schaedler broth, incubated for 5, 7, and 14 days, respectively. This new procedure leads to significant cost saving. Our prospective multicenter study showed that four samples seeded on three culture media are sufficient for diagnosing PJI. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Electrophysiological evidence during episodic prospection implicates medial prefrontal and bilateral middle temporal gyrus.

PubMed

Hsu, Chia-Fen; Sonuga-Barke, Edmund J S

2016-08-01

fMRI studies have implicated the medial prefrontal cortex and medial temporal lobe, components of the default mode network (DMN), in episodic prospection. This study compared quantitative EEG localized to these DMN regions during prospection and during resting and while waiting for rewards. EEG was recorded in twenty-two adults while they were asked to (i) envision future monetary episodes; (ii) wait for rewards and (iii) rest. Activation sources were localized to core DMN regions. EEG power and phase coherence were compared across conditions. Prospection, compared to resting and waiting, was associated with reduced power in the medial prefrontal gyrus and increased power in the bilateral medial temporal gyrus across frequency bands as well as greater phase synchrony between these regions in the delta band. The current quantitative EEG analysis confirms prior fMRI research suggesting that medial prefrontal and medial temporal gyrus interactions are central to the capacity for episodic prospection. Copyright © 2016 Elsevier B.V. All rights reserved.

Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis.

PubMed

Lassale, Camille; Tzoulaki, Ioanna; Moons, Karel G M; Sweeting, Michael; Boer, Jolanda; Johnson, Laura; Huerta, José María; Agnoli, Claudia; Freisling, Heinz; Weiderpass, Elisabete; Wennberg, Patrik; van der A, Daphne L; Arriola, Larraitz; Benetou, Vassiliki; Boeing, Heiner; Bonnet, Fabrice; Colorado-Yohar, Sandra M; Engström, Gunnar; Eriksen, Anne K; Ferrari, Pietro; Grioni, Sara; Johansson, Matthias; Kaaks, Rudolf; Katsoulis, Michail; Katzke, Verena; Key, Timothy J; Matullo, Giuseppe; Melander, Olle; Molina-Portillo, Elena; Moreno-Iribas, Concepción; Norberg, Margareta; Overvad, Kim; Panico, Salvatore; Quirós, J Ramón; Saieva, Calogero; Skeie, Guri; Steffen, Annika; Stepien, Magdalena; Tjønneland, Anne; Trichopoulou, Antonia; Tumino, Rosario; van der Schouw, Yvonne T; Verschuren, W M Monique; Langenberg, Claudia; Di Angelantonio, Emanuele; Riboli, Elio; Wareham, Nicholas J; Danesh, John; Butterworth, Adam S

2018-02-01

The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study. We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses. Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Hospital-based surveillance for acute pesticide poisoning caused by neurotoxic and other pesticides in Tanzania.

PubMed

Lekei, Elikana; Ngowi, Aiwerasia V; London, Leslie

2014-12-01

Acute pesticide poisoning (APP), particularly with neurotoxic agents, is often under-reported in developing countries. This study aimed to estimate the burden of APP in Tanzania due to neurotoxic and other pesticides in order to propose a surveillance system. The study reviewed hospital admission data for APP retrospectively (2000-2005) in 30 facilities in four regions of Tanzania. A prospective follow-up over 12 months in 2006 focused on 10 facilities with the highest reporting of APP. The majority of known poisoning agents were organophosphates or WHO class I and II pesticides. APP involving suicide was significantly more likely to be fatal in both retrospective (PRR fatal/non-fatal=3.8; 95% CI=1.8-8.0) and in prospective (PRR=8.7; 95% CI=1.1-65) studies. There was a significant association between suicide and gender (PRR female/male=1.5; 95% CI=1.1-2.0) in the prospective study. Occupational circumstances as a cause of APP, which was relatively small in both studies (8.5% in the retrospective and 10.2% in the prospective study) was less common amongst men compared to women (6.1% for males versus 12.0% for females) in the retrospective study but almost equal in prospective study (10.2% for males versus 10.1% for females). Contrasting retrospective to prospective studies, the annual incidence rate almost tripled (from 1.43 to 4.05 per 100,000) and mortality rate doubled (from 0.11 to 0.22 per 100,000). Case fatality declined accordingly from 7.8% to 5.6% in prospective study. The study revealed a substantial improvement in the completeness of data with prospective data collection. Missing data for circumstances and agents declined by 24.1% and 9.9%, respectively. Despite this improvement, routine reporting could only generate 33-50% of the information needed for a notification of banned or severely restricted chemicals under the Prior Informed Consent (PIC) convention. The two to threefold increase in rates with prospective data collection suggests significant under-reporting of APP by neurotoxic and other pesticides. Routine reporting is likely to under-estimate the burden from pesticides, particularly for women in occupational settings. The burden of APP and the specific pesticides causing serious problems in Tanzania would continue to be missed without improved surveillance systems. Copyright © 2014 Elsevier Inc. All rights reserved.

Processed and unprocessed red meat consumption and incident type 2 diabetes among French women.

PubMed

Lajous, Martin; Tondeur, Laura; Fagherazzi, Guy; de Lauzon-Guillain, Blandine; Boutron-Ruaualt, Marie-Christine; Clavel-Chapelon, Françoise

2012-01-01

To evaluate the relation of processed and unprocessed red meat and incident type 2 diabetes. We conducted a prospective study among 66,118 disease-free French women with dietary information from a validated questionnaire. Between 1993 and 2007, we identified 1,369 cases of incident diabetes. Multivariate analyses were adjusted for age, education, region, smoking, BMI, hypertension, hypercholesterolemia, physical activity, parental history of diabetes, menopause, hormone replacement therapy, alcohol, calories, n-3 fatty acids, carbohydrates, coffee, fiber, and fruits and vegetables. Comparing the highest category of processed meat intake, ≥5 servings/week (median, 48 g/day), to the lowest, <1 serving/week (median, 5 g/day), processed meat was significantly associated with incident diabetes (hazard ratio 1.30 [95% CI 1.07-1.59], P trend = 0.0007; for 1 serving/day, 1.29 [1.14-1.45]). Unprocessed red meat was not associated with diabetes. In this large prospective cohort of French women, a direct association was observed only for processed red meat and type 2 diabetes.

Ethnicity, Sex Work, and Incident HIV/STI Among Transgender Women in New York City: A Three Year Prospective Study.

PubMed

Nuttbrock, Larry A; Hwahng, Sel J

2017-12-01

In conjunction with a 3-year prospective study of 199 transgender women from the New York City Area, we attempted to better understand why non-Whites are much more likely than Whites to become HIV infected. We first assessed associations of ethnicity with sex work, sexual risk behavior for HIV, and biologically-determined HIV/STI, and then assessed the extent to which these ethnic differences are explained by socioeconomic factors, immigration status, and sexual orientation. Statistical techniques included generalized estimating equations and Cox proportional hazards. As expected, compared to Whites, Blacks and Hispanics were more involved in the sex trade, more likely to report unprotected receptive anal intercourse, and as a result, more likely to become HIV/STI infected. All of these associations were mediated by androphilia, and to a lesser extent androphilia/gynephilia. Sexual orientation is a significant but little recognized factors associated with new cases of HIV/STI among transgender women of color.

Using Case-Based Pedagogy in the Philippines: A Narrative Inquiry

NASA Astrophysics Data System (ADS)

Arellano, Elvira L.; Barcenal, Tessie L.; Bilbao, Purita P.; Castellano, Merilin A.; Nichols, Sharon E.; Tippins, Deborah J.

2001-04-01

This study features use of case-based pedagogy as a context for exploring science teacher education reform. A central premise of the study is that science teacher education reform is a complex process characterised by the individual and collective narrative histories of teachers. The study was conducted at West Visayas State University in the Philippines as a collaborative research endeavour involving two US and four Filipino science teacher educators. The centrepiece of this study was a case experience prompted by reflection on prospective and practicing elementary teachers' written cases. Results of the study are presented here as a layered narrative. An initial layer explores how a case, written by a prospective teacher, was interwoven with her past and future life history. A second layer looks at sociocultural and professional tensions that mediated the participants' case experience. A third layer represents how the case experience provided a community that supported critical reflection among the research team members. Implications from the study emphasise that case-based pedagogy can serve as a basis for critical reflection to inform community-based approaches to science teacher education pedagogical and research reform.

Challenges of Estimating the Annual Caseload of Severe Acute Malnutrition: The Case of Niger

PubMed Central

Hallarou, Mahaman; Gérard, Jean-Christophe; Donnen, Philippe; Macq, Jean

2016-01-01

Introduction Reliable prospective estimates of annual severe acute malnutrition (SAM) caseloads for treatment are needed for policy decisions and planning of quality services in the context of competing public health priorities and limited resources. This paper compares the reliability of SAM caseloads of children 6–59 months of age in Niger estimated from prevalence at the start of the year and counted from incidence at the end of the year. Methods Secondary data from two health districts for 2012 and the country overall for 2013 were used to calculate annual caseload of SAM. Prevalence and coverage were extracted from survey reports, and incidence from weekly surveillance systems. Results The prospective caseload estimate derived from prevalence and duration of illness underestimated the true burden. Similar incidence was derived from two weekly surveillance systems, but differed from that obtained from the monthly system. Incidence conversion factors were two to five times higher than recommended. Discussion Obtaining reliable prospective caseloads was challenging because prevalence is unsuitable for estimating incidence of SAM. Different SAM indicators identified different SAM populations, and duration of illness, expected contact coverage and population figures were inaccurate. The quality of primary data measurement, recording and reporting affected incidence numbers from surveillance. Coverage estimated in population surveys was rarely available, and coverage obtained by comparing admissions with prospective caseload estimates was unrealistic or impractical. Conclusions Caseload estimates derived from prevalence are unreliable and should be used with caution. Policy and service decisions that depend on these numbers may weaken performance of service delivery. Niger may improve SAM surveillance by simplifying and improving primary data collection and methods using innovative information technologies for single data entry at the first contact with the health system. Lessons may be relevant for countries with a high burden of SAM, including for targeted emergency responses. PMID:27606677

Noble gas isotopes as low-budget exploration and monitoring tool for high- and low-temperature geothermal systems in extensional tectonic regimes

NASA Astrophysics Data System (ADS)

Kraml, Michael; Jodocy, Marco; Aeschbach, Werner; Kreuter, Horst

2017-04-01

Since viable geothermal systems in extensional settings are sparse compared to those situated in subduction zone environments, a specifically adapted exploration methodology of the former is currently not fully established. Standardized exploration methods applicable to geothermal systems related to subduction zones do not always deliver reliable or even deliver misleading results (e.g. Ochmann et al. 2010). The identification of promising prospects at the beginning of surface exploration studies is saving time and money of the project developer and investor. Noble gas isotope analyses can provide a low-budget tool for assessing the quality of the prospect in a very early exploration phase. Case studies of high- and low-temperature prospects situated in the East African Rift System and the Upper Rhine Graben, Germany will be presented and compared to other extensional areas like the Basin and Range Province, U.S.A. (Kraml et al. 2016a,b). Noble gas isotopes are also a versatile tool for monitoring of geothermal reservoirs during the production/exploitation phase. References Kraml, M., Jodocy, M., Reinecker, J., Leible, D., Freundt, F., Al Najem, S., Schmidt, G., Aeschbach, W., and Isenbeck-Schroeter, M. (2016a): TRACE: Detection of Permeable Deep-Reaching Fault Zone Sections in the Upper Rhine Graben, Germany, During Low-Budget Isotope-Geochemical Surface Exploration. Proceedings European Geothermal Congress 2016, Strasbourg, France, 19-24 Sept 2016 Kraml, M., Kaudse, T., Aeschbach, W. and Tanzanian Exploration Team (2016b): The search for volcanic heat sources in Tanzania: A helium isotope perspective. Proceedings 6th African Rift Geothermal Conference, Addis Ababa, Ethiopia, 2nd-4th November 2016 Ochmann, N., Kraml, M., Lindenfeld, M., Yakovlev, A., Rümpker, G., Babirye, P. (2010): Microearthquake Survey at the Buranga Geothermal Prospect (Western Uganda). Proceedings World Geothermal Congress, 25-29 April 2010, Bali, Indonesia (paper number 1126)

Inhibitor development in patients receiving recombinant factor VIII (Recombinate rAHF/Bioclate): a prospective pharmacovigilance study.

PubMed

Ewenstein, B M; Gomperts, E D; Pearson, S; O'Banion, M E

2004-09-01

Clinical trials to date have not been adequately powered to assess comparatively infrequent events such as inhibitor development in previously treated patients (PTPs). Comprehensive large-scale pharmacovigilance studies can be useful for this purpose. We prospectively collected inhibitor development reports worldwide among recipients of Recombinate rAHF recombinant factor VIII (rFVIII), also formerly distributed under the product name Bioclate, for the entire postlicensure period from 1993 through 2002. To determine level of exposure to rFVIII we also compiled the Recombinate rAHF/Bioclate International Units (IU) distributed annually. To estimate inhibitor incidence separately for previously untreated or minimally treated patients (PUPs) with 1-50 exposure days and PTPs with >50 exposure days, we used haemophilia A incidence and prevalence data and pooled mean annual rFVIII consumption per PUP and PTP from international multicentre prospective clinical trials. Documented inhibitor cases totalled 89, and the total quantity of Recombinate rAHF/Bioclate rFVIII distributed was 6.48 x10(9) IU. No lot association or other clustering of inhibitor events was evident in PTPs. The incidence of all reported inhibitors, expressed as a percentage of patients treated, was 11.9% (CI: 5.05-28.0%) for PUPs when compared with 0.123% (CI: 0.030-0.512%) for PTPs. The rates for high-titre inhibitors (>5 BU) only were 5.96% (CI: 3.00-11.8%) for PUPs and 0.0554% (CI: 0.0113-0.271%) for PTPs. Thus, incidence rates for both all inhibitors and high-titre inhibitors in PTPs were 1% of the corresponding rates in PUPs. Data from prospective PUP clinical trials involving intensive active monitoring suggest that true inhibitor incidence may be approximately twice that estimated in this pharmacovigilance study. Nevertheless, inhibitor development in PTPs receiving Recombinate rAHF/Bioclate is infrequent.

Asperger syndrome in males over two decades: stability and predictors of diagnosis.

PubMed

Helles, Adam; Gillberg, Carina I; Gillberg, Christopher; Billstedt, Eva

2015-06-01

To examine the diagnostic stability of a childhood diagnosis of Asperger Syndrome (AS) into adulthood in a prospective longitudinal study, and identify the predictors of stability. One hundred males with AS diagnosed in childhood (T0) according to Gillberg's AS criteria, were followed up prospectively into adulthood over an average of 19 years (range 13-26 years). Fifty males (mean age 30 years) participated in this second follow-up (T2) of the cohort. Seventy-six had participated in a previous follow-up (T1) at mean age 22 years (47 participated in both follow-ups). Diagnosis at T2 was assessed using three sets of diagnostic criteria (Gillberg's AS criteria, DSM-IV Pervasive Developmental Disorder (PDD) and DSM-5 Autism Spectrum Disorder (ASD) criteria) and compared to previous assessments. Background predictors of diagnostic stability were analyzed. General functioning at T2 was assessed and compared to T1. There was a decline in the stability of AS diagnosis over time, the rate dropping from 82% at T1 to 44% at T2, when using the Gillberg criteria. There was also a significant decrease in the rate of cases fulfilling any PDD diagnosis according to the DSM-IV, from 91% at T1 to 76% at T2 in the 47 cases followed up twice. Severity of autism spectrum symptoms at T1 was the main predictor of diagnostic stability at T2. Twenty percent of those meeting criteria for a PDD diagnosis according to DSM-IV, did not meet DSM-5 ASD criteria although they had marked difficulties in everyday life. Asperger Syndrome, when considered as an ASD/PDD diagnosis, was fairly stable into adulthood, but there was a significant increase over time in cases no longer meeting criteria for an ASD diagnosis according to the DSM-IV, or AS according to the Gillberg criteria. Cases with a stable diagnosis showed significantly more core ASD symptoms in adolescence/young adulthood. © 2014 Association for Child and Adolescent Mental Health.

Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum.

PubMed

Koren, G; Maltepe, Caroline

2004-08-01

Nausea and vomiting of pregnancy (NVP) affects 80% of pregnancies. Its severe form, hyperemesis gravidarum (HG), results in dehydration, electrolyte imbalance, the need for hospitalisation and can, rarely, be fatal. This was a prospective, open-labelled, controlled, interventional study to evaluate the effectiveness of pre-emptive treatment of NVP symptoms in women who experienced severe NVP or HG in their previous pregnancy. Twenty-five women who reported severe symptoms of NVP with or without HG in their previous pregnancy were recruited and counselled to commence the use of antiemetics as soon as they became aware of the present pregnancy, and no later than the beginning of symptoms. They were followed-up prospectively through the index pregnancy for symptoms of NVP, and were counselled continuously as to how to modify antiemetic doses based on symptoms. A comparison group consisted of randomly selected women also counselled by us for NVP, who had also had severe NVP in the previous pregnancy, but who did not call before a planned pregnancy and thus could not be offered pre-emptive therapy. The recruited women commenced pre-emptive drug therapy for NVP before conception or up to 7 weeks' gestation, before the appearance of NVP symptoms in all cases. In comparison to the previous pregnancy, only eight of these 18 women experienced a HG again in the index pregnancy (P = 0.01). The majority of study the women had an improvement in severity of NVP symptoms compared to the previous pregnancy. In the comparison group (n = 35), symptoms in the index pregnancy remained severe in 28 cases (80%), decreased to moderate in six (16.6%) and decreased to mild in five cases (13.9%). There were five cases of HG in the previous pregnancy and three in the index pregnancy. The pre-emptive group was improved significantly compared to the control group (P = 0.01). Pre-emptive symptom management appears to be effective in preventing severe NVP in general, and HG in particular. Women who have experienced severe NVP in a previous pregnancy may benefit from taking antiemetics before, or immediately at the start of symptoms in a subsequent pregnancy.

Selective intrapartum anti-bioprophylaxy of group B streptococci infection of neonates: a prospective study in 2454 subsequent deliveries.

PubMed

Poulain, P; Betremieux, P; Donnio, P Y; Proudhon, J F; Karege, G; Giraud, J R

1997-04-01

To investigate the efficacy of a selective intrapartum prophylaxy of group B streptococci (GBS) infection of the neonates. A prospective protocol of universal antepartum screening of GBS and selective intrapartum treatment from the 1st February 1994 to the 31st December 1995, on 2454 subsequent deliveries was designed. Our policy included: (1) antepartum screening as soon as possible after 28 weeks by a single vaginal and perianal sample for culture; (2) intrapartum recognition of one condition of high risk of fetal contamination during labor (these conditions included: a temperature of 38 degrees C during labor, rupture of membranes for more than 12 h or prolonged labor for more than 12 h with rupture of membranes, prematurity, twins, maternal diabetes, previous pregnancy with GBS infection of the neonate); and (3) intrapartum anti-bioprophylaxy (amoxicillin) for women with positive screening during pregnancy and one condition of high risk of fetal contamination during labor. We studied the outcome of neonates during this period to look for immediate GBS severe infection of the neonates in the form of bacteraemia or meningitis and compared the results with the rate of neonatal infection before this protocol (4.5/1000 live births in 1993). We noted that 11% of pregnant women were carriers, 25% of which led to antibiotic chemoprophylaxis during the labor. We noticed four cases of neonatal bacteraemia of GBS. One case arose from the group of carriers (but no condition of risk of fetal contamination during the labor and no chemoprophylaxy). The three other cases were from women with a negative antepartum screening. There was no case of meningitis and all four babies were in good health at day 10 of life. Comparing with results prior to the study, we noticed that the rate of neonatal bacteraemia dropped from 4.5 to 1.6 per 1000 livebirths (P < 0.0001). This protocol of intrapartum anti-bioprophylaxy significantly decreases the rate of GBS neonatal sepsis. We propose to improve the efficacy of this prevention program, especially with regard to the method of antepartum screening of pregnant women colonized with GBS.

[Prognostic scores for pulmonary embolism].

PubMed

Junod, Alain

2016-03-23

Nine prognostic scores for pulmonary embolism (PE), based on retrospective and prospective studies, published between 2000 and 2014, have been analyzed and compared. Most of them aim at identifying PE cases with a low risk to validate their ambulatory care. Important differences in the considered outcomes: global mortality, PE-specific mortality, other complications, sizes of low risk groups, exist between these scores. The most popular score appears to be the PESI and its simplified version. Few good quality studies have tested the applicability of these scores to PE outpatient care, although this approach tends to already generalize in the medical practice.

A voyage to Mars: A challenge to collaboration between man and machines

NASA Technical Reports Server (NTRS)

Statler, Irving C.

1991-01-01

A speech addressing the design of man machine systems for exploration of space beyond Earth orbit from the human factors perspective is presented. Concerns relative to the design of automated and intelligent systems for the NASA Space Exploration Initiative (SEI) missions are largely based on experiences with integrating humans and comparable systems in aviation. The history, present status, and future prospect, of human factors in machine design are discussed in relation to a manned voyage to Mars. Three different cases for design philosophy are presented. The use of simulation is discussed. Recommendations for required research are given.

The yield of different pleural fluid volumes for Mycobacterium tuberculosis culture.

PubMed

von Groote-Bidlingmaier, Florian; Koegelenberg, Coenraad Frederik; Bolliger, Chris T; Chung, Pui Khi; Rautenbach, Cornelia; Wasserman, Elizabeth; Bernasconi, Maurizio; Friedrich, Sven Olaf; Diacon, Andreas Henri

2013-03-01

We prospectively compared the culture yields of two pleural fluid volumes (5 and 100 ml) inoculated in liquid culture medium in 77 patients of whom 58 (75.3%) were diagnosed with pleural tuberculosis. The overall fluid culture yield was high (60.3% of cases with pleural tuberculosis). The larger volume had a faster time to positivity (329 vs 376 h, p=0.055) but its yield was not significantly higher (53.5% vs 50%; p=0.75). HIV-positive patients were more likely to have positive cultures (78.9% vs 51.5%; p=0.002).

Electrolysis-needle cauterization of corneal vessels in patients with lipid keratopathy.

PubMed

Wertheim, Michael S; Cook, Stuart D; Knox-Cartwright, Nathaniel E; Van, Dung Le; Tole, Derek M

2007-02-01

To describe a technique of corneal vessel occlusion by using electrolysis-needle cautery. A prospective case series of three patients. Corneal vessels were successfully occluded in all patients. Vessels remained occluded during the first 8 months post-cautery follow up. Two patients needed repeat cautery at 9 and 10 months respectively. Patients found the procedure comfortable. There was no post-operative induced astigmatism. The technique of ENC is simple, effective and controlled. This technique compares favorably and may prove to be more versatile than Fine Needle Diathermy in the occlusion of corneal vessels that lead to lipid keratopathy.

Case–control and prospective studies of dietary α-linolenic acid intake and prostate cancer risk: a meta-analysis

PubMed Central

Carleton, Amanda J; Sievenpiper, John L; de Souza, Russell; McKeown-Eyssen, Gail; Jenkins, David J A

2013-01-01

Objective α-Linolenic acid (ALA) is considered to be a cardioprotective nutrient; however, some epidemiological studies have suggested that dietary ALA intake increases the risk of prostate cancer. The main objective was to conduct a systematic review and meta-analysis of case–control and prospective studies investigating the association between dietary ALA intake and prostate cancer risk. Design A systematic review and meta-analysis were conducted by searching MEDLINE and EMBASE for relevant prospective and case–control studies. Included studies We included all prospective cohort, case–control, nested case-cohort and nested case–control studies that investigated the effect of dietary ALA intake on the incidence (or diagnosis) of prostate cancer and provided relative risk (RR), HR or OR estimates. Primary outcome measure Data were pooled using the generic inverse variance method with a random effects model from studies that compared the highest ALA quantile with the lowest ALA quantile. Risk estimates were expressed as RR with 95% CIs. Heterogeneity was assessed by χ2 and quantified by I2. Results Data from five prospective and seven case–control studies were pooled. The overall RR estimate showed ALA intake to be positively but non-significantly associated with prostate cancer risk (1.08 (0.90 to 1.29), p=0.40; I2=85%), but the interpretation was complicated by evidence of heterogeneity not explained by study design. A weak, non-significant protective effect of ALA intake on prostate cancer risk in the prospective studies became significant (0.91 (0.83 to 0.99), p=0.02) without evidence of heterogeneity (I2=8%, p=0.35) on removal of one study during sensitivity analyses. Conclusions This analysis failed to confirm an association between dietary ALA intake and prostate cancer risk. Larger and longer observational and interventional studies are needed to define the role of ALA and prostate cancer. PMID:23674441

Arthroscopic repair of traumatic isolated subscapularis tendon lesions (Lafosse Type III or IV): a prospective magnetic resonance imaging-controlled case series with 1 year of follow-up.

PubMed

Grueninger, Patrick; Nikolic, Nikola; Schneider, Joerg; Lattmann, Thomas; Platz, Andreas; Chmiel, Corinne; Meier, Christoph

2014-06-01

The purpose of this study was to prospectively assess the efficacy of arthroscopic repair of isolated high-grade subscapularis (SSC) tendon lesions by means of clinical follow-up combined with magnetic resonance imaging investigations. Between January 2008 and September 2010, 11 patients (9 men and 2 women; mean age, 45 ± 10 years) with Lafosse type III or IV traumatic isolated SSC tendon lesions underwent arthroscopic repair including tenodesis of the long head of the biceps tendon. All patients were preoperatively assessed by clinical examination (Constant-Murley score [CMS]) and contrast-enhanced magnetic resonance arthrography. At 1 year of follow-up, specific clinical SSC tests, the CMS, and the loss of external rotation were evaluated. A native magnetic resonance investigation was performed to assess the structural integrity of the repair. The SSC muscle was compared with its preoperative condition regarding fatty infiltration and size (cross-sectional area). Patient satisfaction was graded from 1 (poor) to 4 (excellent). The mean time interval from trauma to surgery was 3.7 months. A concomitant lesion of the biceps tendon was observed in 10 patients (91%). The mean CMS improved from 44 to 89 points (P < .001). The functional tests showed a significant increase in strength (P < .05) (belly-press test, 4.8 v 2.9; lift-off test, 4.8 v 2.9). The mean loss of external rotation at 0° of abduction was 10° compared with the contralateral side (P < .05). Patient satisfaction was high. Magnetic resonance imaging evaluation showed complete structural integrity of the tendon repair in all studies. The SSC showed a significant decrease in fatty infiltration and increase in the cross-sectional area. Arthroscopic repair of higher-grade isolated SSC lesions provides reliable tendon healing accompanied by excellent functional results 1 year after surgery. Level IV, prospective therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Prospective memory: A comparative perspective

PubMed Central

Crystal, Jonathon D.; Wilson, A. George

2014-01-01

Prospective memory consists of forming a representation of a future action, temporarily storing that representation in memory, and retrieving it at a future time point. Here we review the recent development of animal models of prospective memory. We review experiments using rats that focus on the development of time-based and event-based prospective memory. Next, we review a number of prospective-memory approaches that have been used with a variety of non-human primates. Finally, we review selected approaches from the human literature on prospective memory to identify targets for development of animal models of prospective memory. PMID:25101562

COMPARISON BETWEEN COMPUTED TOMOGRAPHIC ARTHROGRAPHY, RADIOGRAPHY, ULTRASONOGRAPHY, AND ARTHROSCOPY FOR THE DIAGNOSIS OF FEMOROTIBIAL JOINT DISEASE IN WESTERN PERFORMANCE HORSES.

PubMed

Nelson, Brad B; Kawcak, Chris E; Goodrich, Laurie R; Werpy, Natasha M; Valdés-Martínez, Alejandro; McIlwraith, C Wayne

2016-07-01

The femorotibial joints are a common source of lameness in Western performance horses. The objective of this prospective study was to compare the radiography, ultrasonography, computed tomographic arthrography (CTA), and arthroscopy findings in horses with lameness localized to the femorotibial joints. Twenty-five stifles in 24 horses were included and were evaluated with all four of these diagnostic methods. Defects detected in femorotibial joint structures were compared between diagnostic methods using a McNemar's test to evaluate for disagreement. Cranial medial meniscotibial desmopathy was most detected on arthroscopy (in 14/25 cases) and was only detected on ultrasonography in three out of 11 (27.3%) arthroscopically observed cases, but was detected on CTA in nine out of 12 (75%) arthroscopically observed cases. Medial meniscal injury located on the craniolateral border was most detected on arthroscopy (n = 9) and was detected on CTA in five cases, but on ultrasonography in 0 cases. Detection of articular cartilage defects on the medial femoral condyle was most detected with arthroscopy (24/25, 96% cases) and was also detected on CTA in 12/20 (60%) cases with a significant disagreement identified between modalities (P = 0.02). Cranial and caudal cruciate ligament defects were detected on CTA in 6/22 (27.3%) and 7/19 (36.8%) cases, respectively, and with arthroscopy in 3/25 (12%) and 2/25 (8%) cases, respectively. The use of CTA detected more defects in the cruciate ligaments, proximal tibia, and ligament entheses than the other diagnostic methods, but was not reliable for detection of articular cartilage damage on the medial femoral condyle. © 2016 American College of Veterinary Radiology.

Sphingolipid metabolism potential in fecal microbiome and bronchiolitis in infants: a case-control study.

PubMed

Hasegawa, Kohei; Stewart, Christopher J; Mansbach, Jonathan M; Linnemann, Rachel W; Ajami, Nadim J; Petrosino, Joseph F; Camargo, Carlos A

2017-07-26

Emerging evidence demonstrated that the structure of fecal microbiome is associated with the likelihood of bronchiolitis in infants. However, no study has examined functional profiles of fecal microbiome in infants with bronchiolitis. In this context, we conducted a case-control study. As a part of multicenter prospective study, we collected stool samples from 40 infants hospitalized with bronchiolitis (cases). We concurrently enrolled 115 age-matched healthy controls. First, by applying 16S rRNA gene sequencing to these 155 fecal samples, we identified the taxonomic profiles of fecal microbiome. Next, based on the taxonomy data, we inferred the functional capabilities of fecal microbiome and tested for differences in the functional capabilities between cases and controls. Overall, the median age was 3 months and 45% were female. Among 274 metabolic pathways surveyed, there were significant differences between bronchiolitis cases and healthy controls for 37 pathways, including lipid metabolic pathways (false discovery rate [FDR] <0.05). Particularly, the fecal microbiome of bronchiolitis cases had consistently higher abundances of gene function related to the sphingolipid metabolic pathways compared to that of controls (FDR <0.05). These pathways were more abundant in infants with Bacteroides-dominant microbiome profile compared to the others (FDR <0.001). On the basis of the predicted metagenome in this case-control study, we found significant differences in the functional potential of fecal microbiome between infants with bronchiolitis and healthy controls. Although causal inferences remain premature, our data suggest a potential link between the bacteria-derived metabolites, modulations of host immune response, and development of bronchiolitis.

Prospective Science Teachers' Perception Related to Formative Assessment Approaches in Turkey

ERIC Educational Resources Information Center

Yasar, M. Diyaddin

2017-01-01

In this study, it was aimed to investigate the perceptions and competences of prospective science teachers about formative assessment approaches. Qualitative case study methodology was used in the study. Research group consisted of 17 senior students of science education. As a data collection tool, a semi-structured "Formative Assessment…

Prospective Conversion: Data Transfer between Fossil and New Microcomputer Technologies in Libraries.

ERIC Educational Resources Information Center

Vratny-Watts, Janet; Valauskas, Edward J.

1989-01-01

Discusses the technological changes that will necessitate the prospective conversion of library data over the next decade and addresses the problems of converting data from obsolete personal computers to newer models that feature radically different operating systems. Three case studies are used to illustrate possible scenarios. (11 references)…

Millennial Teacher: A Storied Landscape of Diversity in "New Times"

ERIC Educational Resources Information Center

Rodriguez, Terri L.; Hallman, Heidi L.

2013-01-01

In this article the authors explore the ways in which the historical location of millennial prospective teachers is markedly distinct from that of previous generations. Through a case study of one prospective teacher's life history, millenial themes of globalization and shape-shifting are highlighted and analyzed in relation to one prospective…

Primary Mathematics Teacher Education Encountering Difficult Terrain: A Personal Perspective

ERIC Educational Resources Information Center

Norton, Stephen

2016-01-01

This paper is a case study in preparing prospective primary teachers to teach mathematics at one Australian university. The paper describes the content knowledge of prospective teachers, pre and post a final mathematics curriculum subject. The teaching approach which attempts to account for both content and pedagogical content knowledge is…

An International Study of Prospective Teachers' Initial Teaching Conceptions and Concerns: The Case of Teaching "Combustion."

ERIC Educational Resources Information Center

De Jong, Onno; Ahtee, Maija; Goodwin, Alan; Hatzinikita, Vassilia; Koulaidis, Vasilis

1999-01-01

Investigated Dutch, Finnish, English, and Greek preservice science teachers' conceptions of and concerns about how to teach the concept of combustion. Participants prepared lessons for junior secondary students, then completed interviews and questionnaires. Results revealed many important and similar characteristics of prospective teachers' views…

Academia-Industry-Government Linkages in Tanzania: Trends, Challenges and Prospects

ERIC Educational Resources Information Center

Mpehongwa, Gasper

2013-01-01

This paper analyzed trends, challenges and prospects of academia-industry-government linkages in Tanzania. Using case study design, and documentary review to gather the required data, the study sought to answer three research questions: (1) what are the trends of academia-industry-government linkages in Tanzania?, (2) what are the challenges…

24 CFR 884.106 - Housing assistance payments to owners.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., based on the owner's statement and other evidence, there is not a reasonable prospect that the project...-ASIDE FOR SECTION 515 RURAL RENTAL HOUSING PROJECTS Applicability, Scope and Basic Policies § 884.106... learning of the vacancy, has notified HUD or the PHA, as the case may be, of the vacancy or prospective...

The Animal Experimentation Controversy: Ethical Views of Prospective Teachers

ERIC Educational Resources Information Center

de Villiers, Rian

2012-01-01

Vivisection (live animal experimentation) is a controversial issue for many people. The purpose of this case study is to examine the attitudes of prospective teachers toward vivisection in education and research, to determine if gender has an influence on these attitudes, and to discuss the implications of these attitudes with regard to teaching…

Asthma and Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Prospective Cohort Study

ERIC Educational Resources Information Center

Chen, Mu-Hong; Su, Tung-Ping; Chen, Ying-Sheue; Hsu, Ju-Wei; Huang, Kai-Lin; Chang, Wen-Han; Chen, Tzeng-Ji; Bai, Ya-Mei

2013-01-01

Background: Previous cross-sectional studies have suggested an association between asthma and attention-deficit/hyperactivity disorder (ADHD), but the temporal relationship was not determined. Using a nationwide population-based prospective case-control cohort study (1:4, age-/gender-matched), we hypothesized that asthma in infanthood or early…

Prospective Teachers' Problem Solving in Online Peer-Led Dialogues

ERIC Educational Resources Information Center

Wade, Suzanne E.; Fauske, Janice R.; Thompson, Audrey

2008-01-01

In this self-study of a secondary teacher education course, the authors investigated whether there was evidence of critically reflective problem solving on the part of prospective teachers who participated in a peer-led online discussion of a teaching case about English-language learners. They also examined what approaches to multicultural…

Final inpatient rehabilitation PPS rule improves on proposed rule.

PubMed

Reynolds, M

2001-10-01

On August 7, 2001, the Centers for Medicare and Medicaid Services (CMS--formerly HCFA) released the final rule for a new prospective payment system (PPS) for inpatient rehabilitation services describing the process that must be used to receive payment for such services provided to Medicare beneficiaries. The process consists of five steps: First, a clinician performs assessments of the patient upon admission and at discharge. Second, the patient is classified into a case-mix group (CMG) with an assigned relative-value weight within that CMG. Third, the Federal prospective payment rate is determined by multiplying the relative-value weight by an annually updated, budget-neutral conversion factor. Fourth, the Federal prospective payment rate is adjusted to account for facility-specific factors. Finally, the facility-adjusted payment rate may be adjusted for case-specific factors. The final rule eliminates three deficiencies in the proposed rule by providing increased payment for treating any comorbidities documented prior to the second day before discharge, providing more appropriate payment for transfer cases, and minimizing the paperwork associated with patient assessment.

Tea consumption and the risk of five major cancers: a dose–response meta-analysis of prospective studies

PubMed Central

2014-01-01

Background We conducted a dose–response meta-analysis of prospective studies to summarize evidence of the association between tea consumption and the risk of breast, colorectal, liver, prostate, and stomach cancer. Methods We searched PubMed and two other databases. Prospective studies that reported risk ratios (RRs) with 95% confidence intervals (CIs) of cancer risk for ≥3 categories of tea consumption were included. We estimated an overall RR with 95% CI for an increase of three cups/day of tea consumption, and, usingrestricted cubic splines, we examined a nonlinear association between tea consumption and cancer risk. Results Forty-one prospective studies, with a total of 3,027,702 participants and 49,103 cancer cases, were included. From the pooled overall RRs, no inverse association between tea consumption and risk of five major cancers was observed. However, subgroup analysis showed that increase in consumption of three cups of black tea per day was a significant risk factor for breast cancer (RR, 1.18; 95% CI, 1.05-1.32). Conclusion Ourresults did not show a protective role of tea in five major cancers. Additional large prospective cohort studies are needed to make a convincing case for associations. PMID:24636229

A personal experience of 2-year general thoracic surgery training programs in Japan and the United States.

PubMed

Hamaji, Masatsugu; Tanaka, Toru

2013-03-01

The objective of the study is to review and compare two countries' thoracic surgery training programs. Retrospective review of the first author's prospectively maintained operative case logs in two countries was performed. Each training program was established in a teaching hospital for its country's board requirement. Preoperative diagnosis, operative procedures and postoperative diagnosis were reviewed. The case volume (overall and in each category) was also reviewed. The ratio of each category and overall case volume was compared between the two programs by Chi-square test. p value was considered significant if it is <0.05. The overall case volumes were 169 cases in the Japanese institution and 456 cases in the United States' institution. The number ratio of each category's procedures and overall procedures was as follows: pleural cases, Japan 19.2 % versus the Unites States 20.6 % (p = 0.782), pulmonary cases, Japan 72.7 % versus the United States 36.8 % (p < 0.0001), mediastinal cases, Japan 8.1 % versus the United States 8.6 % (p = 0.678), diaphragm cases, Japan 0.62 % versus the United States 13.2 % (p = 0.0001), chest wall cases, Japan 1.2 % versus the United States 3.5 % (p = 0.0858), tracheobronchial cases, Japan 1.2 % versus the United States 1.8 % (p = 0.583). Regarding the approach, the ratios of each approach and overall cases are as follows: minimally invasive approach, Japan 78.3 % versus the United States 45.8 % (p < 0.0001), reoperative cases, Japan 0.62 % versus the United States 3.1 % (p = 0.0411). Case variety is different between the two countries. Our findings suggest that thoracic surgery training in the United States may be beneficial for Japanese medical graduates.

Epidemiology of Myocardial Infarction Caused by Presumed Paradoxical Embolism via a Patent Foramen Ovale.

PubMed

Kleber, Franz X; Hauschild, Telse; Schulz, Antonia; Winkelmann, Anne; Bruch, Leonhard

2017-09-25

Despite several negative prospective randomized trials on the efficacy of patent foramen ovale (PFO) occlusion, the discussion on indications is ongoing. Because the incidence of paradoxical coronary embolism through a PFO is unknown, we investigated the risk of paradoxical embolic myocardial infarction over a period of 13 years.Methods and Results:We conducted a retrospective and a prospective study. In the former, we searched the hospital database of a tertiary referral center for cases of acute myocardial infarction (AMI) during the past 10 years and screened them for possible paradoxical MIs. On this basis we started a prospective evaluation over 39 months in another tertiary referral center. All patients with AMI and normal coronary arteries were screened for PFO and if no other reason for the AMI could be found, the case was judged as presumed paradoxical embolism. In the retrospective analysis we found 22 cases (0.45%) of presumed paradoxical coronary artery embolism under 4,848 AMI. In the prospective study there were 11 presumed paradoxical coronary artery embolisms among 1,654 patients with AMI, representing an incidence of 0.67%. Our findings demonstrated that well below 1% of AMIs are caused by paradoxical embolism via an interatrial communication. Although this percentage appears low, it is not a negligible number of patients based on the huge number of MIs occurring in the industrialized world.

DJ-1 is a reliable serum biomarker for discriminating high-risk endometrial cancer.

PubMed

Di Cello, Annalisa; Di Sanzo, Maddalena; Perrone, Francesca Marta; Santamaria, Gianluca; Rania, Erika; Angotti, Elvira; Venturella, Roberta; Mancuso, Serafina; Zullo, Fulvio; Cuda, Giovanni; Costanzo, Francesco

2017-06-01

New reliable approaches to stratify patients with endometrial cancer into risk categories are highly needed. We have recently demonstrated that DJ-1 is overexpressed in endometrial cancer, showing significantly higher levels both in serum and tissue of patients with high-risk endometrial cancer compared with low-risk endometrial cancer. In this experimental study, we further extended our observation, evaluating the role of DJ-1 as an accurate serum biomarker for high-risk endometrial cancer. A total of 101 endometrial cancer patients and 44 healthy subjects were prospectively recruited. DJ-1 serum levels were evaluated comparing cases and controls and, among endometrial cancer patients, between high- and low-risk patients. The results demonstrate that DJ-1 levels are significantly higher in cases versus controls and in high- versus low-risk patients. The receiver operating characteristic curve analysis shows that DJ-1 has a very good diagnostic accuracy in discriminating endometrial cancer patients versus controls and an excellent accuracy in distinguishing, among endometrial cancer patients, low- from high-risk cases. DJ-1 sensitivity and specificity are the highest when high- and low-risk patients are compared, reaching the value of 95% and 99%, respectively. Moreover, DJ-1 serum levels seem to be correlated with worsening of the endometrial cancer grade and histotype, making it a reliable tool in the preoperative decision-making process.

Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

PubMed Central

Pai, Vishwas D.; Engineer, Reena; Patil, Prachi S.; Arya, Supreeta; Desouza, Ashwin L.

2016-01-01

Background To compare extra levator abdomino perineal resection (ELAPER) with conventional abdominoperineal resection (APER) in terms of short-term oncological and clinical outcomes. Methods This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent APER at Tata Memorial Center between July 1, 2013, and January 31, 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), tumor site perforation, and number of nodes harvested. Peri operative outcomes included blood loss, length of hospital stay, postoperative perineal wound complications, and 30-day mortality. The χ2-test was used to compare the results between the two groups. Results Forty-two cases of ELAPER and 78 cases of conventional APER were included in the study. Levator involvement was significantly higher in the ELAPER compared with the conventional group; otherwise, the two groups were comparable in all the aspects. CRM involvement was seen in seven patients (8.9%) in the conventional group compared with three patients (7.14%) in the ELAPER group. Median hospital stay was significantly longer with ELAPER. The univariate analysis of the factors influencing CRM positivity did not show any significance. Conclusions ELAPER should be the preferred approach for low rectal tumors with involvement of levators. For those cases in which levators are not involved, as shown in preoperative magnetic resonance imaging (MRI), the current evidence is insufficient to recommend ELAPER over conventional APER. This stresses the importance of preoperative MRI in determining the best approach for an individual patient. PMID:27284466

Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study.

PubMed

Rivadeneira, Fernando; Zillikens, M Carola; De Laet, Chris Edh; Hofman, Albert; Uitterlinden, André G; Beck, Thomas J; Pols, Huibert Ap

2007-11-01

We studied HSA measurements in relation to hip fracture risk in 4,806 individuals (2,740 women). Hip fractures (n = 147) occurred at the same absolute levels of bone instability in both sexes. Cortical instability (propensity of thinner cortices in wide diameters to buckle) explains why hip fracture risk at different BMD levels is the same across sexes. Despite the sexual dimorphism of bone, hip fracture risk is very similar in men and women at the same absolute BMD. We aimed to elucidate the main structural properties of bone that underlie the measured BMD and that ultimately determines the risk of hip fracture in elderly men and women. This study is part of the Rotterdam Study (a large prospective population-based cohort) and included 147 incident hip fracture cases in 4,806 participants with DXA-derived hip structural analysis (mean follow-up, 8.6 yr). Indices compared in relation to fracture included neck width, cortical thickness, section modulus (an index of bending strength), and buckling ratio (an index of cortical bone instability). We used a mathematical model to calculate the hip fracture distribution by femoral neck BMD, BMC, bone area, and hip structure analysis (HSA) parameters (cortical thickness, section modulus narrow neck width, and buckling ratio) and compared it with prospective data from the Rotterdam Study. In the prospective data, hip fracture cases in both sexes had lower BMD, thinner cortices, greater bone width, lower strength, and higher instability at baseline. In fractured individuals, men had an average BMD that was 0.09 g/cm(2) higher than women (p < 0.00001), whereas no significant difference in buckling ratios was seen. Modeled fracture distribution by BMD and buckling ratio levels were in concordance to the prospective data and showed that hip fractures seem to occur at the same absolute levels of bone instability (buckling ratio) in both men and women. No significant differences were observed between the areas under the ROC curves of BMD (0.8146 in women and 0.8048 in men) and the buckling ratio (0.8161 in women and 0.7759 in men). The buckling ratio (an index of bone instability) portrays in both sexes the critical balance between cortical thickness and bone width. Our findings suggest that extreme thinning of cortices in expanded bones plays a key role on local susceptibility to fracture. Even though the buckling ratio does not offer additional predictive value, these findings improve our understanding of why low BMD is a good predictor of fragility fractures.

Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women.

PubMed

Journy, Neige M Y; Bernier, Marie-Odile; Doody, Michele M; Alexander, Bruce H; Linet, Martha S; Kitahara, Cari M

2017-08-01

The prevalence of hyperthyroidism and hypothyroidism is 0.5-4% in iodine-replete communities, but it is 5-10 times higher in women than in men. Those conditions are associated with a broad range of metabolic disorders and cardiovascular diseases. Biological evidence of a role of thyroid hormones in carcinogenesis also exists. However, the association between thyroid dysfunction and cardiovascular disease or cancer mortality risk remains controversial. In a large cohort of women, the associations of hyperthyroidism and hypothyroidism with cause-specific mortality were evaluated after nearly 30 years of follow-up. The prospective study included 75,076 women aged 20-89 years who were certified as radiologic technologists in the United States in 1926-1982, completed baseline questionnaires in 1983-1998 from which medical history was ascertained, and reported no malignant disease or benign thyroid disease except thyroid dysfunction. A passive follow-up of this cohort was performed through the Social Security Administration database and the National Death Index-Plus. Cause-specific mortality risks were compared according to self-reported thyroid status, with proportional hazards models adjusted for baseline year and age, race/ethnicity, body mass index, family history of breast cancer, and life-style and reproductive factors. During a median follow-up of 28 years, 2609 cancer, 1789 cardiovascular or cerebrovascular, and 2442 other non-cancer deaths were recorded. Women with hyperthyroidism had an elevated risk of breast cancer mortality after 60 years of age (hazard ratio [HR] = 2.04 [confidence interval (CI) 1.16-3.60], 13 cases in hyperthyroid women) compared to women without thyroid disease. Hypothyroid women had increased mortality risks for diabetes mellitus (HR = 1.58 [CI 1.03-2.41], 27 cases in hypothyroid women), cardiovascular disease (HR = 1.20 [CI 1.01-1.42], 179 cases), and cerebrovascular disease (HR = 1.45 [CI 1.01-2.08], 35 cases, when restricting the follow-up to ≥10 years after baseline). Other causes of death were not associated with hyperthyroidism or hypothyroidism, though there was a suggestion of an elevated risk of ovarian cancer mortality in hyperthyroid women based on very few cases. The excess mortality risks observed in a large, prospective 30-year follow-up of patients with thyroid dysfunction require confirmation, and, if replicated, further investigation will be needed because of the clinical implications.

Effect of HIV Infection and Highly Active Antiretroviral Therapy on Hearing Function: A Prospective Case-Control Study From Cameroon.

PubMed

Fokouo, Jean Valentin F; Vokwely, Jean Espoir E; Noubiap, Jean Jacques N; Nouthe, Brice Enid; Zafack, Joseline; Minka Ngom, Esthelle Stéphanie; Dalil, Asmaou Bouba; Ngo Nyeki, Adèle-Rose; Bengono, Géneviève; Njock, Richard

2015-05-01

Human immunodeficiency virus (HIV) infection remains a major cause of morbidity and mortality worldwide. Many studies have found a higher prevalence of hearing impairment among HIV-positive individuals. To investigate the effect of HIV and highly active antiretroviral treatment (HAART) on the hearing function in a Cameroonian population. We conducted a prospective case-control study from March 1, 2012, through January 31, 2013. The study took place at the National Social Insurance Fund Hospital in Yaoundé, Cameroon, a public health facility. We included 90 HIV-positive case patients and 90 HIV-negative control patients aged 15 to 49 years without any history of hearing loss or treatment with a known ototoxic drug. The case group was further divided into 3 subgroups: 30 HAART-naive patients, 30 patients receiving first-line HAART, and 30 patients receiving second-line HAART. Hearing function was assessed by pure-tone audiometry and classified according to the criteria of the Bureau International d'Audio-Phonologie. Hearing loss due to HIV and HAART. The HIV-positive patients had more otologic symptoms (hearing loss, dizziness, tinnitus, and otalgia) than HIV-negative patients (41 vs 13, P = .04). There were 49 cases (27.2%) of hearing loss in the HIV-positive group vs 10 (5.6%) in the HIV-negative group (P = .04). Compared with HIV-negative individuals, the odds of hearing loss were higher among HIV-infected HAART-naive patients (right ear: odds ratio [OR], 6.7; 95% CI, 4.3-9.7; P = .004; left ear: OR, 6.2; 95% CI, 3.5-8.3; P = .006), patients receiving first-line HAART (right ear: OR, 5.6; 95% CI, 1.9-10.5; P = .01; left ear: OR, 12.5; 95% CI, 8.5-15.4; P < .001), and patients receiving second-line HAART (right ear: OR, 6.7; 95% CI, 3.3-9.6; P = .004; left ear: OR, 3.7; 95% CI, 3.0-5.0; P = .08). Hearing loss is more frequent in HIV-infected patients compared with uninfected patients. Therefore, HIV-infected patients need special audiologic care. Further studies are needed because controversy remains regarding the factors that lead to ear damage.

Detailed prospective peer review in a community radiation oncology clinic.

PubMed

Mitchell, James D; Chesnut, Thomas J; Eastham, David V; Demandante, Carlo N; Hoopes, David J

In 2012, we instituted detailed prospective peer review of new cases. We present the outcomes of peer review on patient management and time required for peer review. Peer review rounds were held 3 to 4 days weekly and required 2 physicians to review pertinent information from the electronic medical record and treatment planning system. Eight aspects were reviewed for each case: 1) workup and staging; 2) treatment intent and prescription; 3) position, immobilization, and simulation; 4) motion assessment and management; 5) target contours; 6) normal tissue contours; 7) target dosimetry; and 8) normal tissue dosimetry. Cases were marked as, "Meets standard of care," "Variation," or "Major deviation." Changes in treatment plan were noted. As our process evolved, we recorded the time spent reviewing each case. From 2012 to 2014, we collected peer review data on 442 of 465 (95%) radiation therapy patients treated in our hospital-based clinic. Overall, 91 (20.6%) of the cases were marked as having a variation, and 3 (0.7%) as major deviation. Forty-two (9.5%) of the cases were altered after peer review. An overall peer review score of "Variation" or "Major deviation" was highly associated with a change in treatment plan (P < .01). Changes in target contours were recommended in 10% of cases. Gastrointestinal cases were significantly associated with a change in treatment plan after peer review. Indicators on position, immobilization, simulation, target contours, target dosimetry, motion management, normal tissue contours, and normal tissue dosimetry were significantly associated with a change in treatment plan. The mean time spent on each case was 7 minutes. Prospective peer review is feasible in a community radiation oncology practice. Our process led to changes in 9.5% of cases. Peer review should focus on technical factors such as target contours and dosimetry. Peer review required 7 minutes per case. Published by Elsevier Inc.

22 CFR 96.14 - Providing adoption services using other providers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (3) A public domestic authority. (c) Pursuant to § 96.44 of subpart F, in the case of accredited...); or (ii) Has prepared or is preparing a background study on a child in a case involving immigration to the United States (incoming case) or a home study on prospective adoptive parent(s) in a case...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

[Comparing case management care models for people with dementia and their caregivers: the design of the COMPAS study].

PubMed

van Hout, H P J; Macneil Vroomen, J L; Van Mierlo, L D; Meiland, F J M; Moll van Charante, E P; Joling, K J; van den Dungen, P; Dröes, R M; van der Horst, H E; de Rooij, S E J A

2014-04-01

Dementia care in The Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalized care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in The Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered. Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of The Netherlands with and without case management including a qualitative process evaluation. Community-dwelling individuals with a dementia diagnosis with an informal caregiver are included. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Costs are measured from a societal perspective. Semi-structured interviews with stakeholders based on the theoretical model of adaptive implementation are planned. 521 pairs of persons with dementia and their primary informal caregiver were included and are followed over two years. In the linked model substantially more impeding factors for implementation were identified compared with the model. This article describes the design of an evaluation study of two case management models along with clinical and economic data from persons with dementia and caregivers. The impeding and facilitating factors differed substantially between the two models. Further results on cost-effectiveness are expected by the beginning of 2015. This is a Dutch adaptation of MacNeil Vroomen et al., Comparing Dutch case management care models for people with dementia and their caregivers: The design of the COMPAS study.

Barrett's Esophagus Methylation Profiles — EDRN Public Portal

Cancer.gov

We propose a nested case-control study of biomarkers in the setting of BE. By bringing together research institutions with large populations of patients with BE, we will perform a multi-center study of FISH and hypermethylation markers as possible prognostic factors in BE. The centers will select from their cohorts who have progressed to HGD or to adenocarcinoma of the esophagus ("progressors"), and who also donated samples prior to the development of cancer, when their histology was felt to be benign. These subjects will be compared to individuals who have been under endoscopic surveillance, but who have not progressed to HGD or EAC ("non-progressors"). Using this approach, we hope to identify promising markers for risk stratification in BE. We expect to be able to make successful application for a prospective study of markers identified in this case-control study.

Probabilistic population aging

PubMed Central

2017-01-01

We merge two methodologies, prospective measures of population aging and probabilistic population forecasts. We compare the speed of change and variability in forecasts of the old age dependency ratio and the prospective old age dependency ratio as well as the same comparison for the median age and the prospective median age. While conventional measures of population aging are computed on the basis of the number of years people have already lived, prospective measures are computed also taking account of the expected number of years they have left to live. Those remaining life expectancies change over time and differ from place to place. We compare the probabilistic distributions of the conventional and prospective measures using examples from China, Germany, Iran, and the United States. The changes over time and the variability of the prospective indicators are smaller than those that are observed in the conventional ones. A wide variety of new results emerge from the combination of methodologies. For example, for Germany, Iran, and the United States the likelihood that the prospective median age of the population in 2098 will be lower than it is today is close to 100 percent. PMID:28636675

Medial tibial pain. A prospective study of its cause among military recruits.

PubMed

Milgrom, C; Giladi, M; Stein, M; Kashtan, H; Margulies, J; Chisin, R; Steinberg, R; Swissa, A; Aharonson, Z

1986-12-01

In a prospective study of 295 infantry recruits during 14 weeks of basic training, 41% had medial tibial pain. Routine scintigraphic evaluation in cases of medial tibial bone pain showed that 63% had abnormalities. A stress fracture was found in 46%. Only two patients had periostitis. None had ischemic medial compartment syndrome. Physical examination could not differentiate between cases with medial tibial bone pain secondary to stress fractures and those with scintigraphically normal tibias. When both pain and swelling were localized in the middle one-third of the tibia, the lesion most likely proved to be a stress fracture.

Adult neurobehavioral outcome of hyperbilirubinemia in full term neonates-a 30 year prospective follow-up study.

PubMed

Hokkanen, Laura; Launes, Jyrki; Michelsson, Katarina

2014-01-01

Background. Neonatal hyperbilirubinemia (HB) may cause severe neurological damage, but serious consequences are effectively controlled by phototherapy and blood exchange transfusion. HB is still a serious health problem in economically compromised parts of the world. The long term outcome has been regarded favorable based on epidemiological data, but has not been confirmed in prospective follow-up studies extending to adulthood. Methods. We studied the long term consequences of HB in a prospective birth cohort of 128 HB cases and 82 controls. The cases are part of a neonatal at-risk cohort (n = 1196) that has been followed up to 30 years of age. HB cases were newborns ≥ 2500 g birth weight and ≥ 37 weeks of gestation who had bilirubin concentrations > 340 µmol/l or required blood exchange transfusion. Subjects with HB were divided into subgroups based on the presence (affected HB) or absence (unaffected HB) of diagnosed neurobehavioral disorders in childhood, and compared with healthy controls. Subjects were seen at discharge, 5, 9 and 16 years of life and parent's and teacher's assessments were recorded. At 30 years they filled a questionnaire about academic and occupational achievement, life satisfaction, somatic and psychiatric symptoms including a ADHD self-rating score. Cognitive functioning was tested using ITPA, WISC, and reading and writing tests at 9 years of life. Results. Compared to controls, the odds for a child with HB having neurobehavioral symptoms at 9 years was elevated (OR = 4.68). Forty-five per cent of the HB group were affected by cognitive abnormalities in childhood and continued to experience problems in adulthood. This was apparent in academic achievement (p < 0.0001) and the ability to complete secondary (p < 0.0001) and tertiary (p < 0.004) education. Also, the subgroup of affected HB reported persisting cognitive complaints e.g., problems with reading, writing and mathematics. Childhood symptoms of hyperactivity/impulsivity (p < 0.0001) and inattention (p < 0.02) were more common in HB groups, but in adulthood the symptoms were equal. The affected HB had lower scores in parameters reflecting life satisfaction, less controlled drinking, but not increased substance abuse. Discussion. Our results indicate that neonatal HB has negative consequences in adult age. A prospectively collected cohort with strict inclusion criteria enables to control most of the bias factors involved with retrospective data. The control and HB groups were remarkably similar at birth in terms of medical data, and the growth environment of the children, as well as the parents' social groups, education, size of family, type of housing at birth and at 9 years of age. Our findings bear resemblance to disorders of the fronto-striatal network, and also symptoms of the ADHD spectrum were frequent in the HB group suggesting a link of HB to other neurodevelopmental disorders.

Adult neurobehavioral outcome of hyperbilirubinemia in full term neonates—a 30 year prospective follow-up study

PubMed Central

Launes, Jyrki; Michelsson, Katarina

2014-01-01

Background. Neonatal hyperbilirubinemia (HB) may cause severe neurological damage, but serious consequences are effectively controlled by phototherapy and blood exchange transfusion. HB is still a serious health problem in economically compromised parts of the world. The long term outcome has been regarded favorable based on epidemiological data, but has not been confirmed in prospective follow-up studies extending to adulthood. Methods. We studied the long term consequences of HB in a prospective birth cohort of 128 HB cases and 82 controls. The cases are part of a neonatal at-risk cohort (n = 1196) that has been followed up to 30 years of age. HB cases were newborns ≥ 2500 g birth weight and ≥ 37 weeks of gestation who had bilirubin concentrations > 340 µmol/l or required blood exchange transfusion. Subjects with HB were divided into subgroups based on the presence (affected HB) or absence (unaffected HB) of diagnosed neurobehavioral disorders in childhood, and compared with healthy controls. Subjects were seen at discharge, 5, 9 and 16 years of life and parent’s and teacher’s assessments were recorded. At 30 years they filled a questionnaire about academic and occupational achievement, life satisfaction, somatic and psychiatric symptoms including a ADHD self-rating score. Cognitive functioning was tested using ITPA, WISC, and reading and writing tests at 9 years of life. Results. Compared to controls, the odds for a child with HB having neurobehavioral symptoms at 9 years was elevated (OR = 4.68). Forty-five per cent of the HB group were affected by cognitive abnormalities in childhood and continued to experience problems in adulthood. This was apparent in academic achievement (p < 0.0001) and the ability to complete secondary (p < 0.0001) and tertiary (p < 0.004) education. Also, the subgroup of affected HB reported persisting cognitive complaints e.g., problems with reading, writing and mathematics. Childhood symptoms of hyperactivity/impulsivity (p < 0.0001) and inattention (p < 0.02) were more common in HB groups, but in adulthood the symptoms were equal. The affected HB had lower scores in parameters reflecting life satisfaction, less controlled drinking, but not increased substance abuse. Discussion. Our results indicate that neonatal HB has negative consequences in adult age. A prospectively collected cohort with strict inclusion criteria enables to control most of the bias factors involved with retrospective data. The control and HB groups were remarkably similar at birth in terms of medical data, and the growth environment of the children, as well as the parents’ social groups, education, size of family, type of housing at birth and at 9 years of age. Our findings bear resemblance to disorders of the fronto-striatal network, and also symptoms of the ADHD spectrum were frequent in the HB group suggesting a link of HB to other neurodevelopmental disorders. PMID:24688870

Potential Psychosocial Risk Factors for Chronic TMD: Descriptive Data and Empirically Identified Domains from the OPPERA Case-Control Study

PubMed Central

Fillingim, Roger B.; Ohrbach, Richard; Greenspan, Joel D.; Knott, Charles; Dubner, Ronald; Bair, Eric; Baraian, Cristina; Slade, Gary D.; Maixner, William

2011-01-01

Case-control studies have consistently associated psychosocial factors with chronic pain in general, and with temporomandibular disorders (TMD) specifically. Moreover, a handful of prospective studies suggest that pre-existing psychosocial characteristics represent risk factors for new onset TMD. The current study presents psychosocial findings from the baseline case-control study of the Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) cooperative agreement. For this study, 1,633 TMD-free controls and 185 TMD cases completed a battery of psychosocial instruments assessing general psychosocial adjustment and personality, affective distress, psychosocial stress, somatic awareness, and pain coping and catastrophizing. In bivariate and demographically-adjusted analyses, odds of TMD were associated with higher levels of psychosocial symptoms, affective distress, somatic awareness, and pain catastrophizing. Among controls, significant gender and ethnic group differences in psychosocial measures were observed, consistent with previous findings. Principal component analysis was undertaken to identify latent constructs revealing four components: stress and negative affectivity, global psychosocial symptoms, passive pain coping, and active pain coping. These findings provide further evidence of associations between psychosocial factors and TMD. Future prospective analyses in the OPPERA cohort will determine if the premorbid presence of these psychosocial factors predicts increased risk for developing new-onset TMD. PMID:22074752

A Prospective Observation Study of Medical Toxicology Consultation in a U.S. Combat Theater.

PubMed

Maddry, Joseph K; Ng, Patrick C; Sessions, Daniel; Bebarta, Vikhyat S

2016-11-01

Since 2001, U.S. military personnel and active duty, uniformed physicians providing medical support have been deployed to Afghanistan. Medical toxicologists are among the physicians deployed. There is a paucity of information present in the literature that has documented cases treated by toxicologists in theater. This prospective observational study describes 15 male patients treated in theater by a military medical toxicologist. We performed a prospective observational study in which a medical toxicologist consulted and reported on deployed toxicology cases occurring during a 5-month deployment to Bagram, Afghanistan. Fifteen toxicology cases were collected during the 5-month period. The patients included three Afghan civilians, three U.S. civilians, and nine U.S. military personnel. Eight cases were attempts at recreational euphoria, two were self-harm attempts, two were from performance-enhancing supplements, two were accidental occupational exposures and one was alcohol withdrawal. Methanol was the most common exposure followed by dextromethorphan, supplements, opiates, and chlorine gas. In our study, we found that toxic alcohols and nonprescription medications were the most common exposures. In addition, this is the first study to describe bedside toxicology consults for U.S. combat forces in theater and the use of an observation unit for critically ill patients. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Enhanced physical health screening for people with severe mental illness in Hong Kong: results from a one-year prospective case series study.

PubMed

Bressington, Daniel; Mui, Jolene; Hulbert, Sabina; Cheung, Eric; Bradford, Stephen; Gray, Richard

2014-02-27

People with severe mental illness have significantly poorer physical health compared to the general population; previous health screening studies conducted outside Asian countries have demonstrated the potential in addressing this issue. This case series aimed to explore the effects and utility of integrating an enhanced physical health screening programme for community dwelling patients with severe mental illness into routine clinical practice in Hong Kong. This study utilises a consecutive prospective case series design. The serious mental illness Health Improvement Profile (HIP) was used as a screening tool at baseline and repeated at 12 months follow-up. A total of 148 community-based patients with severe mental illness completed the study. At one year follow-up analysis showed a significant improvement in self-reported levels of exercise and a reduction in the numbers of patients prescribed medications for diabetes However, mean waist circumference increased at follow-up. In addition to the statistically significant results some general trends were observed, including: a lack of deterioration in most areas of cardiovascular risk; a reduction in medicines prescribed for physical health problems; and general improvements in health behaviours over the 12 month period. The findings demonstrate that using the HIP is feasible and acceptable in Hong Kong. The results of the enhanced physical health-screening programme are promising, but require further testing using a randomised controlled trial design in order to more confidently attribute the improvements in well-being and health behaviours to the HIP. ISRCTN12582470.