Early Complications and Outcomes in Combat Injury Related Invasive Fungal Wound Infections: A Case-Control Analysis

PubMed Central

Lewandowski, Louis R.; Weintrob, Amy C.; Tribble, David R.; Rodriguez, Carlos J.; Petfield, Joseph; Lloyd, Bradley A.; Murray, Clinton K.; Stinner, Daniel; Aggarwal, Deepak; Shaikh, Faraz; Potter, Benjamin K.

2015-01-01

Objective Clinicians have anecdotally noted that combat-related invasive fungal wound infections (IFIs) lead to residual limb shortening, additional days and operative procedures prior to initial wound closure, and high early complication rates. We evaluated the validity of these observations and identified risk factors that may impact time to initial wound closure. Design Retrospective review and case-control analysis. Setting Military hospitals. Patients/Participants United States military personnel injured during combat operations (2009–2011). The IFI cases were identified based upon the presence of recurrent, necrotic extremity wounds with mold growth in culture and/or histopathologic fungal evidence. Non-IFI controls were matched on injury pattern and severity. In a supplemental matching analysis, non-IFI controls were also matched by blood volume transfused within 24 hours of injury. Intervention None. Main Outcome Measurements Amputation revision rate and loss of functional levels. Results Seventy-one IFI cases (112 fungal-infected extremity wounds) were identified and matched to 160 control patients (315 non-IFI extremity wounds). The IFI wounds resulted in significantly more changes in amputation level (p<0.001). Additionally, significantly (p<0.001) higher number of operative procedures and longer duration to initial wound closure was associated with IFI. A shorter duration to initial wound closure was significantly associated with wounds lacking IFIs (Hazard ratio: 1.53; 95% CI: 1.17, 2.01). The supplemental matching analysis found similar results. Conclusions Our analysis indicates that IFIs adversely impact wound healing and patient recovery, requiring more frequent proximal amputation revisions and leading to higher early complication rates. PMID:26360542

TeamSTEPPS Improves Operating Room Efficiency and Patient Safety.

PubMed

Weld, Lancaster R; Stringer, Matthew T; Ebertowski, James S; Baumgartner, Timothy S; Kasprenski, Matthew C; Kelley, Jeremy C; Cho, Doug S; Tieva, Erwin A; Novak, Thomas E

2016-09-01

The objective was to evaluate the effect of TeamSTEPPS on operating room efficiency and patient safety. TeamSTEPPS consisted of briefings attended by all health care personnel assigned to the specific operating room to discuss issues unique to each case scheduled for that day. The operative times, on-time start rates, and turnover times of all cases performed by the urology service during the initial year with TeamSTEPPS were compared to the prior year. Patient safety issues identified during postoperative briefings were analyzed. The mean case time was 12.7 minutes less with TeamSTEPPS (P < .001). The on-time first-start rate improved by 21% with TeamSTEPPS (P < .001). The mean room turnover time did not change. Patient safety issues declined from an initial rate of 16% to 6% at midyear and remained stable (P < 0.001). TeamSTEPPS was associated with improved operating room efficiency and diminished patient safety issues in the operating room. © The Author(s) 2015.

A follow-up study of neonatal interatrial shunt with echocardiography until twelve to fifteen months of age.

PubMed

Ho, Chi-Lin; Jan, Sheng-Ling; Lin, Ming-Chih; Fu, Yun-Ching

2008-12-01

To assess the incidence and natural history of full-term neonates with interatrial shunt (IAS). A follow-up study of 1389 neonates who received screening echocardiography between 2003 and 2006. Babies with IAS at 2 to 4 days of life underwent follow-up echocardiography at 2 to 4 months, 6 to 9 months and 12 to 15 months of age until closure of IAS. The ratio of IAS was 68.3% initially. No significant demographic differences were identified between infants with and without initial IAS. Among 949 neonates with initial IAS, 84.5% infants had a left-to-right interatrial shunt, 13.5% had bidirectional shunt and 2% had predominantly right-to-left shunt. The persistence rate of IAS at 12 to 15 months of age was 3.8% (44/1166). The initial size of IAS ranged from 1.2 to 7.7mm (4.3+/-1.1 mm) detected by color Doppler flow mapping and cases were divided into three groups: small (< or =5 mm), medium (5 to 8 mm) and large group (> or =8 mm). There were 74.6% infants in the small group and 25.4% in the medium group initially. The neonates in the initial small group would always see their IAS close or else they would remain in the small group. Those in the final medium and large size groups always came from the initial medium group. The late closure rate of IAS was 93.9% of infants with initial IAS. The closure curves of initial small and medium sized groups were significantly different, and their late closure rates were 95.1% and 90.4%, respectively. IAS was very common during early neonatal stage, but most cases would close after 1 year. The late closure rate of initial IAS was different if using a cutpoint of 5 mm.

Coccidioidomycosis-associated hospitalizations, California, USA, 2000-2011.

PubMed

Sondermeyer, Gail; Lee, Lauren; Gilliss, Debra; Tabnak, Farzaneh; Vugia, Duc

2013-10-01

In the past decade, state-specific increases in the number of reported cases of coccidioidomycosis have been observed in areas of California and Arizona where the disease is endemic. Although most coccidioidomycosis is asymptomatic or mild, infection can lead to severe pulmonary or disseminated disease requiring hospitalization and costly disease management. To determine the epidemiology of cases and toll of coccidioidomycosis-associated hospitalizations in California, we reviewed hospital discharge data for 2000-2011. During this period, there were 25,217 coccidioidomycosis-associated hospitalizations for 15,747 patients and >$2 billion US in total hospital charges. Annual initial hospitalization rates increased from 2.3 initial hospitalizations/100,000 population in 2000 to 5.0 initial hospitalizations/100,000 population in 2011. During this period, initial hospitalization rates were higher for men than women, African Americans and Hispanics than Whites, and older persons than younger persons. In California, the increasing health- and cost-related effects of coccidioidomycosis-associated hospitalizations are a major public health challenge.

[Treatment of the first episode of spontaneous pneumothorax].

PubMed

Moubachir, H; Zaghba, N; Benjelloun, H; Bakhatar, A; Yassine, N

2016-11-01

The management of a first episode of spontaneous pneumothorax is controversial and the best technique to be used as an initial intervention, aspiration or intercostal drainage, is still debated. We present a retrospective case series during two and a half consecutive years describing the immediate management of spontaneous pneumothoraces, comparing aspiration versus thoracic drainage. One hundred and thirty-three clinical files from patients with spontaneous pneumothoraces were analyzed (17 primary and 116 secondary). The pneumothoraces were of varying size and different etiologies. Patients were initially treated with simple aspiration in 68 cases, with an immediate success rate of 37.5%, intercostal drainage in 49 cases, and by rest alone in 16 cases. In case of secondary pneumothorax, aspiration appeared to offer advantages as an initial strategy over intercostal drainage in terms of hospital stay (11 versus 22 days), and with significant effectiveness (37.5%). Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis*

PubMed Central

Moreira, Graciane Laender; Manzano, Beatriz Martins; Gazzotti, Mariana Rodrigues; Nascimento, Oliver Augusto; Perez-Padilla, Rogelio; Menezes, Ana Maria Baptista; Jardim, José Roberto

2014-01-01

OBJECTIVE: To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated "Projeto Latino-Americano de Investigação em Obstrução Pulmonar" (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase. METHODS: The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase. RESULTS: The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD. CONCLUSIONS: The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention. PMID:24626267

Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction.

PubMed

Turiac, I A; Fortunato, F; Cappelli, M G; Morea, A; Chironna, M; Prato, Rosa; Martinelli, D

2018-04-01

This study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture-recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75-87). Completeness was >98% for mandatory variables and 57% for 'genotyping'. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

Improving Dengue Virus Capture Rates in Humans and Vectors in Kamphaeng Phet Province, Thailand, Using an Enhanced Spatiotemporal Surveillance Strategy

PubMed Central

Thomas, Stephen J.; Aldstadt, Jared; Jarman, Richard G.; Buddhari, Darunee; Yoon, In-Kyu; Richardson, Jason H.; Ponlawat, Alongkot; Iamsirithaworn, Sopon; Scott, Thomas W.; Rothman, Alan L.; Gibbons, Robert V.; Lambrechts, Louis; Endy, Timothy P.

2015-01-01

Dengue is of public health importance in tropical and sub-tropical regions. Dengue virus (DENV) transmission dynamics was studied in Kamphaeng Phet Province, Thailand, using an enhanced spatiotemporal surveillance of 93 hospitalized subjects with confirmed dengue (initiates) and associated cluster individuals (associates) with entomologic sampling. A total of 438 associates were enrolled from 208 houses with household members with a history of fever, located within a 200-m radius of an initiate case. Of 409 associates, 86 (21%) had laboratory-confirmed DENV infection. A total of 63 (1.8%) of the 3,565 mosquitoes collected were dengue polymerase chain reaction positive (PCR+). There was a significant relationship between spatial proximity to the initiate case and likelihood of detecting DENV from associate cases and Aedes mosquitoes. The viral detection rate from human hosts and mosquito vectors in this study was higher than previously observed by the study team in the same geographic area using different methodologies. We propose that the sampling strategy used in this study could support surveillance of DENV transmission and vector interactions. PMID:25986580

Comparing the Daily Versus the Intermittent Regimens of the Anti-Tubercular Chemotherapy in the Initial Intensive Phase in Non-HIV, Sputum Positive, Pulmonary Tuberculosis Patients.

PubMed

Mandal, Pranab Kumar; Mandal, Abhijit; Bhattacharyya, Sujit Kumar

2013-02-01

Tuberculosis (TB) is a major health problem in the universe and India is no longer exempted from this crisis .The emergence of HIV and MDRTB (Multi Drug Resistant Tuberculosis) have further made the situation critical. Our aim was to compare the efficacy of the daily and the intermittent doses of the Anti Tubercular Drug (ATD) therapy which is under the Revised National Tuberculosis Control Programme, amongst the sputum positive pulmonary tuberculosis in terms of the sputum conversion rate at the end of the initial phase , the default rate and the adverse drug reactions. This was an observational prospective study. Eighty three patients were selected from the out patient and the inpatient departments of a tertiary medical centre in India. Forty three cases received an intermittent regimen, where the major age group belonged to the under 40 years age group, the default rate to the therapy was 9.3%, the sputum conversion rate was 94.87% and adverse drug reactions were found in 25.58% of the patients. In the daily regimen, there was an equal proportion of the age group of the patients, both above and below 40 yrs, the sputum conversion rate was 94.74%, a default rate was found in 5% cases and adverse reactions were found in 35% of the cases. Both the intermittent and the daily regimens showed equal sputum conversion rates and the drug default cases were found more in the intermittent group. However, the adverse reactions were found more in the daily regimen category.

Legionnaire's disease surveillance programme (initial survey analysis).

PubMed

O'Neill, K

1990-08-01

In Australia, approximately 150 cases of Legionnaire's Disease are reported annually. Untreated, the mortality rate is estimated at 20%. Australia's largest Legionnaire's Disease epidemic broke out in Wollongong (New South Wales) back in 1987, where some 45 cases required hospitalization and 10 of these died. Local Health Authorities have been advised to conduct initial surveys of their particular municipalities to locate all known water cooling towers and evaporative condensers to establish maintenance standards on such units to overcome possible future outbreaks of this disease with significant mortality.

Pattern of resolution of tachypnoea and fever in childhood pneumonia.

PubMed

Muhe, L

1998-02-01

Acute lower respiratory infections (ALRI) account for one fifth of deaths among children below five years of age and pneumonia is responsible for about 70% of all ALRI deaths. Interventions with antibiotics have shown reduction in pneumonia case-fatality rates. However, there is room for further reduction of deaths from pneumonia through improved monitoring and follow up system. We studied the pattern of resolution of tachypnoea and fever among 108 children who presented to our outpatient clinic with non-severe pneumonia and among 102 children who were admitted for severe pneumonia. We found that tachypnoea was present in 18% and 23% after 72 hours of initiation of antibiotics and fever resolved completely after 48 hours and 72 hours of initiation of therapy in non-severe cases of pneumonia among children two to 11 months and 12 to 59 months of age respectively. Conversely, among cases of severe pneumonia on day 5 of initiation of treatment, tachypnoea and fever were present in 65% and 51% respectively in children two to 11 months old and in 53% and 60% respectively in children 12 to 59 months old. Respiratory rate increased with increase in body temperature at an average rate of four breaths per minute for every 1 degree C rise. Our study suggests that body temperature and respiratory rate can be used to monitor the clinical course of non-severe pneumonia. Further research is needed to identify other clinical signs that will help the health worker to decide improvement in attacks of severe pneumonia.

Dark matter relics and the expansion rate in scalar-tensor theories

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

Dutta, Bhaskar; Jimenez, Esteban; Zavala, Ivonne, E-mail: dutta@physics.tamu.edu, E-mail: este1985@physics.tamu.edu, E-mail: e.i.zavalacarrasco@swansea.ac.uk

We study the impact of a modified expansion rate on the dark matter relic abundance in a class of scalar-tensor theories. The scalar-tensor theories we consider are motivated from string theory constructions, which have conformal as well as disformally coupled matter to the scalar. We investigate the effects of such a conformal coupling to the dark matter relic abundance for a wide range of initial conditions, masses and cross-sections. We find that exploiting all possible initial conditions, the annihilation cross-section required to satisfy the dark matter content can differ from the thermal average cross-section in the standard case. We alsomore » study the expansion rate in the disformal case and find that physically relevant solutions require a nontrivial relation between the conformal and disformal functions. We study the effects of the disformal coupling in an explicit example where the disformal function is quadratic.« less

Smear Conversion, Treatment Outcomes and the Time of Default in Registered Tuberculosis Patients on RNTCP DOTS in Puducherry, Southern India

PubMed Central

Jayakumar, Niranjana; Gnanasekaran, Dhivyalakshmi

2014-01-01

Background: Revised National Tuberculosis Control Programme (RNTCP) in India has achieved improved cure rates. Objectives: This study describes the achievements under RNTCP in terms of conversion rates, treatment outcomes and pattern of time of default in patients on directly observed short-course treatment for Tuberculosis in Puducherry, Southern India. Settings: Retrospective cohort study; Tuberculosis Unit in District Tuberculosis Centre, Puducherry, India. Materials and Methods: Cohort analysis of patients of registered at the Tuberculosis Unit during 1st and 2nd quarter of the year 2011. Details about sputum conversion, treatment outcome and time of default were obtained from the tuberculosis register. Statistical Analysis: Kaplan-Meier plots & log rank tests. Results: RNTCP targets with respect to success rate (85.7%), death rate (2.7%) and failure rate (2.1%) in new cases have been achieved but the sputum conversion rate (88%) and default rate (5.9%) targets have not been achieved. The overall default rate for all registered TB patients was 7.4%; significantly higher in category II. In retreatment cases registered as treatment after default, the default rate was high (9%). The cumulative default rate; though similar in the initial two months of treatment; was consistently higher in category II as compared to that in category I. Nearly 40% of all defaulters interrupted treatment between the second and fourth month after treatment initiation. Conclusion: Defaulting from treatment is more common among the retreatment cases and usually occurs during the transition phase from intensive phase to continuation phase. PMID:25478371

Epidemic meningococcal disease: recommendations for travelers to Nepal.

PubMed

1985-03-08

In the Kathmandu Valley of Nepal, an epidemic of serogroup A meningococcal meningitis resulted in 875 cases and 95 deaths during the 1st 6 months of 1983. The overall annual attack rate was 103 cases/100,000 population; the case fatality ratio was 11%. The highest age-specific attack rate (223/100,000) occurred among children under age 1 year. 3 times as many cases occurred in Kathmandu during December 1983 and January 1984 as in the same period a year previously. A mass vaccination campaign was initiated on February 8, 1984, and 330,000 doses of bivalent A/C meningococcal vaccine were administered, achieving approximately 65% coverage of the target population. A marked decline in the number of meningitis cases occurred coincident with the initiation of the mass campaign. In 1985 meningococcal meningitis is occurring at a much lower rate than in 1984, but meningococcal disease among hikers now is being recognized. Over the January 1984-January 1985 period, 2 culture-confirmed and 4 clinically suspected cases of meningococcal disease were documented among tourists from western countries traveling in Nepal. Patients ranged in age from 16-40 years. 5 patients had evidence of meningococcemia; the other had meningitis alone. 2 patients died, and all became ill during or shortly after hiking outside kathmandu. 3 patients were from the US, 2 from Australia, and 1 from Switzerland. Tables present data on cases of specified notifiable diseases in the US.

Initial Development and Validation of the Youth Internalizing Problems Screener

ERIC Educational Resources Information Center

Renshaw, Tyler L.; Cook, Clayton R.

2018-01-01

The present studies report on the initial development and validation of the Youth Internalizing Problems Screener (YIPS), which is a 10-item self-report rating scale for assessing general internalizing problems and identifying depression and anxiety caseness within the context of school mental health screening. Results from Study 1 (N = 177)…

Technology-Capable Teachers Transitioning to Technology-Challenged Schools

ERIC Educational Resources Information Center

Derbel, Faiza

2017-01-01

Developing countries lacking capabilities, funds and human resources are compelled to improve the digital literacy rates of their task force through educational initiatives. This is the case of Tunisia where a stand-alone in-service teacher education (Ted) initiative was implemented in 2014 and 2015. The aim of this project, the Tech Age Teacher…

Looking for Childhood Schizophrenia: Case Series of False Positives.

ERIC Educational Resources Information Center

Stayer, Catherine; Sporn, Alexandra; Gogtay, Nitin; Tossell, Julia; Lenane, Marge; Gochman, Peter; Rapoport, Judith L.

2004-01-01

Extensive experience with the diagnosis of childhood-onset schizophrenia indicates a high rate of false positives. Most mislabeled patients have chronic disabling, affective, or behavioral disorders. The authors report the cases of three children who passed stringent initial childhood-onset schizophrenia "screens" but had no chronic psychotic…

Introduction of a new Rotavirus vaccine: Initial results of uptake and impact on laboratory confirmed cases in Anglia and Essex, United Kingdom, July 2015.

PubMed

Inns, Thomas; Trindall, Amy; Dunling-Hall, Sara; Shankar, Ananda Giri

2016-04-02

Rotavirus gastroenteritis accounts for an estimated 130,000 GP consultations and 13,000 hospitalisations for children under 5 y old each year in England and Wales. In July 2013, an oral live attenuated rotavirus vaccine (Rotarix®) was introduced into the UK infant immunisation program as a 2 dose schedule at 2 and 3 months of age. We collected vaccination uptake from October 2013 to March 2015 and laboratory confirmed cases data on children under the age of 5 y from 1 January 2004 to 31 May 2015. The vaccine uptake rates and laboratory confirmed cases were compared to provide evidence of the impact of this vaccination program. Vaccine uptake rates were available from sentinel data with between 91-98% of GP practices in Anglia and Essex providing data every month. These data showed from February 2014 to March 2015 between 90-92% of infants received the recommended 2 doses of Rotarix® each month. The numbers of rotavirus cases reported by laboratories decreased on average by 82% in the post vaccination seasons. The mean number of cases reported in weeks 1-22 for 2004-2013 in Anglia and Essex was 1,318. For the same period in 2014, 256 cases were reported and initial data for 2015 report 226 cases. In the first 5 months 2014 the greatest reduction in cases (89%) was seen in those under 1 yr (who would have been directly affected by vaccination) with case numbers falling to 59 from a mean 537 cases in the equivalent period for 2004-2013. Initially data suggests a 92% reduction in 2015 compared to the same pre-vaccination periods. For those aged 1 to <5 y who would not have been vaccinated, a reduction of 75% was also evident in 2014 and 77% in 2015, suggesting indirect protection in this group. In conclusion, initial results following the introduction of the Rotavirus vaccine clearly indicates a very good uptake of the vaccine and a significant reduction in the numbers of laboratory confirmed cases.

Introduction of a new Rotavirus vaccine: Initial results of uptake and impact on laboratory confirmed cases in Anglia and Essex, United Kingdom, July 2015

PubMed Central

Inns, Thomas; Trindall, Amy; Dunling-Hall, Sara; Shankar, Ananda Giri

2016-01-01

abstract Rotavirus gastroenteritis accounts for an estimated 130,000 GP consultations and 13,000 hospitalisations for children under 5 y old each year in England and Wales. In July 2013, an oral live attenuated rotavirus vaccine (Rotarix®) was introduced into the UK infant immunisation program as a 2 dose schedule at 2 and 3 months of age. We collected vaccination uptake from October 2013 to March 2015 and laboratory confirmed cases data on children under the age of 5 y from 1 January 2004 to 31 May 2015. The vaccine uptake rates and laboratory confirmed cases were compared to provide evidence of the impact of this vaccination program. Vaccine uptake rates were available from sentinel data with between 91–98% of GP practices in Anglia and Essex providing data every month. These data showed from February 2014 to March 2015 between 90–92% of infants received the recommended 2 doses of Rotarix® each month. The numbers of rotavirus cases reported by laboratories decreased on average by 82% in the post vaccination seasons. The mean number of cases reported in weeks 1–22 for 2004–2013 in Anglia and Essex was 1,318. For the same period in 2014, 256 cases were reported and initial data for 2015 report 226 cases. In the first 5 months 2014 the greatest reduction in cases (89%) was seen in those under 1 yr (who would have been directly affected by vaccination) with case numbers falling to 59 from a mean 537 cases in the equivalent period for 2004–2013. Initially data suggests a 92% reduction in 2015 compared to the same pre-vaccination periods. For those aged 1 to <5 y who would not have been vaccinated, a reduction of 75% was also evident in 2014 and 77% in 2015, suggesting indirect protection in this group. In conclusion, initial results following the introduction of the Rotavirus vaccine clearly indicates a very good uptake of the vaccine and a significant reduction in the numbers of laboratory confirmed cases. PMID:26618660

Cyanide poisoning in Thailand before and after establishment of the National Antidote Project.

PubMed

Srisuma, Sahaphume; Pradoo, Aimon; Rittilert, Panee; Wongvisavakorn, Sunun; Tongpoo, Achara; Sriapha, Charuwan; Krairojananan, Wannapa; Suchonwanich, Netnapis; Khomvilai, Sumana; Wananukul, Winai

2018-04-01

Antidote shortage is a global problem. In Thailand, the National Antidote Project (NAP) has operated since November 2010 to manage the national antidote stockpile, educate the healthcare providers on appropriate antidote use, and evaluate antidote usage. To evaluate the effect of NAP implementation on mortality rate and antidote use in cyanide poisoning cases arising from ingestion of cyanide or cyanogenic glycoside. This is a retrospective cohort of poisoning cases involving cyanide or cyanogenic glycoside ingestion reported to Ramathibodi Poison Center from 1 January 2007 to 31 December 2015. Mortality rate, antidote use, and appropriateness of antidote use (defined as correct indication, proper dosing regimen, and administration within 90 min) before and after NAP implementation were compared. Association between parameters and fatal outcomes was analyzed. A total of 343 cases involving cyanide or cyanogenic glycoside ingestion were reported to Ramathibodi Poison Center. There were 213 cases (62.1%) during NAP (Project group) and 130 cases (37.9%) pre-NAP implementation (Before group). Implementation of NAP led to increased antidote use (39.9% in Project group versus 24.6% in Before group) and a higher rate of appropriate antidote use (74.1% in Project group versus 50.0% in Before group). All 30 deaths were presented with initial severe symptoms. Cyanide chemical source and self-harm intent were associated with death (OR: 12.919, 95% CI: 4.863-39.761 and OR: 10.747, 95% CI: 3.884-28.514, respectively). No difference in overall mortality rate (13 [10.0%] deaths before versus 17 [8.0%] deaths after NAP) was found. In subgroup analysis of 80 cases with initial severe symptoms, NAP and appropriate antidote use reduced mortality (OR: 0.327, 95% CI: 0.106-0.997 and OR: 0.024, 95% CI: 0.004-0.122, respectively). In the multivariate analysis of the cases with initial severe symptoms, presence of the NAP and appropriate antidote use independently reduced the risk of death (OR: 0.122, 95% CI: 0.023-0.633 and OR: 0.034, 95% CI: 0.007-0.167, respectively), adjusted for intent of exposure, cyanide source, age, and sex. After NAP implementation, both antidote use and appropriate antidote use increased. In cases presenting with severe symptoms, presence of the NAP and appropriate antidote use independently reduced the risk of mortality.

Atmospheric chemical reactions of alternatives of polybrominated diphenyl ethers initiated by OH: A case study on triphenyl phosphate.

PubMed

Yu, Qi; Xie, Hong-Bin; Chen, Jingwen

2016-11-15

Many studies have been performed to evaluate the environmental risk caused by alternative flame retardants (AFRs) of polybrominated diphenyl ethers due to their ubiquitous occurrence in the environment. However, as an indispensable component of the environmental risk assessment, the information on atmospheric fate of AFRs is limited although some AFRs have been frequently and highly detected in the atmosphere. Here, a combined quantum chemical method and kinetics modeling were used to investigate atmospheric transformation mechanism and kinetics of AFRs initiated by OH in the presence of O2, taking triphenyl phosphate (TPhP) as a case. Results show that the pathway involving initial OH addition to phenyl of TPhP to form TPhP-OH adduct, and subsequent reaction of the TPhP-OH adduct with O2 to finally form phenol phosphate, is the most favorable for the titled reaction. The calculated overall reaction rate constant is 1.6×10(-12)cm(3) molecule(-1)s(-1), translating 7.6days atmospheric lifetime of TPhP. This clarifies that gaseous TPhP has atmospheric persistence. In addition, it was found that ice surface, as a case of ubiquitous water in the atmosphere, has little effect on the kinetics of the rate-determining step in the OH-initiated TPhP reaction. Copyright © 2016 Elsevier B.V. All rights reserved.

The pyrolysis of toluene and ethyl benzene

NASA Technical Reports Server (NTRS)

Sokolovskaya, V. G.; Samgin, V. F.; Kalinenko, R. A.; Nametkin, N. S.

1987-01-01

The pyrolysis of toluene at 850 to 950 C gave mainly H2, CH4, and benzene; PhEt at 650 to 750 C gave mainly H2, CH4, styrene, benzene, and toluene. The rate constants for PhEt pyrolysis were 1000 times higher than those for toluene pyrolysis; the chain initiation rate constants differed by the same factor. The activation energy differences were 46 kJ/mole for the total reaction and 54 kJ/mole for chain initiation. The chain length was evaluated for the PhEt case (10 + or - 2).

Fluid management of hypernatraemic dehydration to prevent cerebral oedema: a retrospective case control study of 97 children in China.

PubMed

Fang, Chengqing; Mao, Jianhua; Dai, Yuwen; Xia, Yonghui; Fu, Haidong; Chen, Yifang; Wang, Yaping; Liu, Aimin

2010-06-01

To compare the fluid management of hypernatraemic dehydration in acute gastroenteritis in those who developed cerebral oedema (cases) versus those who did not (controls). A retrospective study of 97 cases of hypernatraemic dehydration at a tertiary children's hospital in China over five years, in which rehydration regimes of 49 children who developed cerebral oedema were compared with 48 children who made an uneventful recovery. Risk factors for cerebral oedema (vs. no cerebral oedema) were an initial fluid bolus (29/49 vs. 15/48, P=0.006), the mean rate of bolus infusion (14.7+/-2.2 vs. 10.8+/-1.4 mL/kg/hr, P<0.001), the severity of hypernatraemia (serum sodium 167.7+/-7.8 vs. 161.3+/-7.9 mmol/L, P<0.001) and the overall rehydration rate (8.2+/-1.1 vs. 6.4+/-0.6 mL/kg/hr, P<0.001). On logistic regression, a rapid rehydration rate was the most significant contributor to cerebral oedema. From receive operating characteristic (ROC) curve analysis, the safe rate of rehydration was <6.8 mL/kg/hr. The key risk factors for the development of cerebral oedema during recovery from hypernatraemic dehydration were too rapid a rate of rehydration, an initial fluid bolus to rapidly expand plasma volume and the severity of the hypernatraemia. Thus, we conclude that a uniformly slow rate of rehydration is the best way of preventing cerebral oedema.

Nonlinear response of hail precipitation rate to environmental moisture content: A real case modeling study of an episodic midlatitude severe convective event

NASA Astrophysics Data System (ADS)

Li, Mingxin; Zhang, Fuqing; Zhang, Qinghong; Harrington, Jerry Y.; Kumjian, Matthew R.

2017-07-01

The dependence of hail production on initial moisture content in a simulated midlatitude episodic convective event occurred in northeast China on 10-11 June 2005 was investigated using the Weather Research and Forecasting (WRF) model with a double-moment microphysics scheme where both graupel and hail are considered. Three sensitivity experiments were performed by modifying the initial water vapor mixing ratio profile to 90% ("Q-10%"), 105% ("Q+5%"), and 110% ("Q+10%") of the initial conditions used for the control simulation. It was found that increasing the initial water vapor content caused the hail and total precipitation rates to increase during the first 5 h. The precipitation response to increasing water vapor content was monotonic for this first episode; however, for the event's second episode, the hail precipitation rate responds to the initial water vapor profile nonlinearly, while the total precipitation rate responds mostly monotonically. In particular, simulation Q+5% achieves the largest hail production rate while simulation Q+10% has the largest total precipitation rate. In contrast, during the second episode simulation Q-10% has the strongest vertical motion, produces the most cloud ice and snow, but has the lowest hail production. Analysis shows that increasing the initial moisture content directly increases the precipitation during the first episode, which subsequently induces a stronger, longer-lasting cold pool that limits the development of deep convection during the second episode.

Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study.

PubMed

Assareh, Hassan; Chen, Jack; Ou, Lixin; Hillman, Ken; Flabouris, Arthas

2016-09-22

Data on hospital-acquired venous thromboembolism (HA-VTE) incidence, case fatality rate and variation amongst patient groups and health providers is lacking. We aim to explore HA-VTE incidences, associated mortality, trends and variations across all acute hospitals in New South Wales (NSW)-Australia. A population-based study using all admitted patients (aged 18-90 with a length of stay of at least two days and not transferred to another acute care facility) in 104 NSW acute public and private hospitals during 2002-2009. Poisson mixed models were used to derive adjusted rate ratios (IRR) in presence of patient and hospital characteristics. Amongst, 3,331,677 patients, the incidence of HA-VTE was 11.45 per 1000 patients and one in ten who developed HA-VTE died in hospital. HA-VTE incidence, initially rose, but subsequently declined, whereas case fatality rate consistently declined by 22 % over the study period. Surgical patients were 128 % (IRR = 2.28, 95 % CI: 2.19-2.38) more likely to develop HA-VTE, but had similar case fatality rates compared to medical patients. Private hospitals, in comparison to public hospitals had a higher incidence of HA-VTE (IRR = 1.76; 95 % CI: 1.42-2.18) for medical patients. However, they had a similar incidence (IRR = 0.91; 95 % CI: 0.75-1.11), but a lower mortality (IRR = 0.59; 95 % CI: 0.47-0.75) amongst surgical patients. Smaller public hospitals had a lower HA-VTE incidence rate compared to larger hospitals (IRR < 0.68) but a higher case fatality rate (IRR > 1.71). Hospitals with a lower reported HA-VTE incidence tended to have a higher HA-VTE case fatality rate. Despite the decline in HA-VTE incidence and case fatality, there were large variations in incidents between medical and surgical patients, public and private hospitals, and different hospital groups. The causes of such differences warrant further investigation and may provide potential for targeted interventions and quality improvement initiatives.

Initiation of Farm Safety Programs in the Arkansas Delta: A Case Study of Participatory Methods

ERIC Educational Resources Information Center

Richter, Jan S.; Hall, Becky G.; Deere, G. David

2007-01-01

Context: Outreach to high-risk communities is one of the goals of Area Health Education Centers. One such population is the farm community, which is known to suffer high rates of traumatic events. Purpose: To describe a participatory methods initiative by the Arkansas Delta Area Health Education Center and other agencies to address farm-related…

Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility

PubMed Central

Murray, Meghan T.; Jackson, Olivia; Cohen, Bevin; Hutcheon, Gordon; Saiman, Lisa; Larson, Elaine; Neu, Natalie

2016-01-01

We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly. PMID:27053088

Risk of thromboembolism in women taking ethinylestradiol/drospirenone and other oral contraceptives.

PubMed

Seeger, John D; Loughlin, Jeanne; Eng, P Mona; Clifford, C Robin; Cutone, Jennifer; Walker, Alexander M

2007-09-01

The oral contraceptive ethinylestradiol 0.03 mg/drospirenone 3 mg contains a progestin component that differs from other oral contraceptives. Case reports and prescription event monitoring suggested that ethinylestradiol/drospirenone might be associated with an elevated risk of thromboembolism. We sought to estimate the association between ethinylestradiol/drospirenone and risk of thromboembolism relative to the association among other oral contraceptives. We identified ethinylestradiol/drospirenone initiators and a twofold larger group of other oral contraceptive initiators between June 2001 and June 2004 within a U.S. health insurer database. The comparison group was selected to have demographic and health care characteristics preceding oral contraceptive initiation that were similar to ethinylestradiol/drospirenone initiators. Thromboembolism during the follow-up of the cohorts was identified through claims for medical services, and only medical record-confirmed cases were included in analyses. The primary (as-matched) analysis used proportional hazards regression, whereas a secondary (as-treated) analysis accounted for changes in oral contraceptives during follow-up using Poisson regression. The 22,429 ethinylestradiol/drospirenone initiators and 44,858 other oral contraceptive initiators were followed for an average of 7.6 months, and there were 18 cases of thromboembolism in ethinylestradiol/drospirenone initiators and 39 in the comparators (rate ratio 0.9, 95% confidence interval 0.5-1.6). More than 9,000 women would need to be prescribed oral contraceptives to observe a difference of one case of thromboembolism. Results of the as-treated analysis were similar to those of the as-matched analysis. Ethinylestradiol/drospirenone initiators and initiators of other oral contraceptives are similarly likely to experience thromboembolism. II.

Missing metastases as a model to challenge current therapeutic algorithms in colorectal liver metastases.

PubMed

Lucidi, Valerio; Hendlisz, Alain; Van Laethem, Jean-Luc; Donckier, Vincent

2016-04-21

In oncosurgical approach to colorectal liver metastases, surgery remains considered as the only potentially curative option, while chemotherapy alone represents a strictly palliative treatment. However, missing metastases, defined as metastases disappearing after chemotherapy, represent a unique model to evaluate the curative potential of chemotherapy and to challenge current therapeutic algorithms. We reviewed recent series on missing colorectal liver metastases to evaluate incidence of this phenomenon, predictive factors and rates of cure defined by complete pathologic response in resected missing metastases and sustained clinical response when they were left unresected. According to the progresses in the efficacy of chemotherapeutic regimen, the incidence of missing liver metastases regularly increases these last years. Main predictive factors are small tumor size, low marker level, duration of chemotherapy, and use of intra-arterial chemotherapy. Initial series showed low rates of complete pathologic response in resected missing metastases and high recurrence rates when unresected. However, recent reports describe complete pathologic responses and sustained clinical responses reaching 50%, suggesting that chemotherapy could be curative in some cases. Accordingly, in case of missing colorectal liver metastases, the classical recommendation to resect initial tumor sites might have become partially obsolete. Furthermore, the curative effect of chemotherapy in selected cases could lead to a change of paradigm in patients with unresectable liver-only metastases, using intensive first-line chemotherapy to intentionally induce missing metastases, followed by adjuvant surgery on remnant chemoresistant tumors and close surveillance of initial sites that have been left unresected.

Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study.

PubMed

Elmore, Joann G; Tosteson, Anna Na; Pepe, Margaret S; Longton, Gary M; Nelson, Heidi D; Geller, Berta; Carney, Patricia A; Onega, Tracy; Allison, Kimberly H; Jackson, Sara L; Weaver, Donald L

2016-06-22

 To evaluate the potential effect of second opinions on improving the accuracy of diagnostic interpretation of breast histopathology.  Simulation study.  12 different strategies for acquiring independent second opinions.  Interpretations of 240 breast biopsy specimens by 115 pathologists, one slide for each case, compared with reference diagnoses derived by expert consensus.  Misclassification rates for individual pathologists and for 12 simulated strategies for second opinions. Simulations compared accuracy of diagnoses from single pathologists with that of diagnoses based on pairing interpretations from first and second independent pathologists, where resolution of disagreements was by an independent third pathologist. 12 strategies were evaluated in which acquisition of second opinions depended on initial diagnoses, assessment of case difficulty or borderline characteristics, pathologists' clinical volumes, or whether a second opinion was required by policy or desired by the pathologists. The 240 cases included benign without atypia (10% non-proliferative, 20% proliferative without atypia), atypia (30%), ductal carcinoma in situ (DCIS, 30%), and invasive cancer (10%). Overall misclassification rates and agreement statistics depended on the composition of the test set, which included a higher prevalence of difficult cases than in typical practice.  Misclassification rates significantly decreased (P<0.001) with all second opinion strategies except for the strategy limiting second opinions only to cases of invasive cancer. The overall misclassification rate decreased from 24.7% to 18.1% when all cases received second opinions (P<0.001). Obtaining both first and second opinions from pathologists with a high volume (≥10 breast biopsy specimens weekly) resulted in the lowest misclassification rate in this test set (14.3%, 95% confidence interval 10.9% to 18.0%). Obtaining second opinions only for cases with initial interpretations of atypia, DCIS, or invasive cancer decreased the over-interpretation of benign cases without atypia from 12.9% to 6.0%. Atypia cases had the highest misclassification rate after single interpretation (52.2%), remaining at more than 34% in all second opinion scenarios.  Second opinions can statistically significantly improve diagnostic agreement for pathologists' interpretations of breast biopsy specimens; however, variability in diagnosis will not be completely eliminated, especially for breast specimens with atypia. 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.

Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study

PubMed Central

Tosteson, Anna NA; Pepe, Margaret S; Longton, Gary M; Nelson, Heidi D; Geller, Berta; Carney, Patricia A; Onega, Tracy; Allison, Kimberly H; Jackson, Sara L; Weaver, Donald L

2016-01-01

Objective To evaluate the potential effect of second opinions on improving the accuracy of diagnostic interpretation of breast histopathology. Design Simulation study. Setting 12 different strategies for acquiring independent second opinions. Participants Interpretations of 240 breast biopsy specimens by 115 pathologists, one slide for each case, compared with reference diagnoses derived by expert consensus. Main outcome measures Misclassification rates for individual pathologists and for 12 simulated strategies for second opinions. Simulations compared accuracy of diagnoses from single pathologists with that of diagnoses based on pairing interpretations from first and second independent pathologists, where resolution of disagreements was by an independent third pathologist. 12 strategies were evaluated in which acquisition of second opinions depended on initial diagnoses, assessment of case difficulty or borderline characteristics, pathologists’ clinical volumes, or whether a second opinion was required by policy or desired by the pathologists. The 240 cases included benign without atypia (10% non-proliferative, 20% proliferative without atypia), atypia (30%), ductal carcinoma in situ (DCIS, 30%), and invasive cancer (10%). Overall misclassification rates and agreement statistics depended on the composition of the test set, which included a higher prevalence of difficult cases than in typical practice. Results Misclassification rates significantly decreased (P<0.001) with all second opinion strategies except for the strategy limiting second opinions only to cases of invasive cancer. The overall misclassification rate decreased from 24.7% to 18.1% when all cases received second opinions (P<0.001). Obtaining both first and second opinions from pathologists with a high volume (≥10 breast biopsy specimens weekly) resulted in the lowest misclassification rate in this test set (14.3%, 95% confidence interval 10.9% to 18.0%). Obtaining second opinions only for cases with initial interpretations of atypia, DCIS, or invasive cancer decreased the over-interpretation of benign cases without atypia from 12.9% to 6.0%. Atypia cases had the highest misclassification rate after single interpretation (52.2%), remaining at more than 34% in all second opinion scenarios. Conclusion Second opinions can statistically significantly improve diagnostic agreement for pathologists’ interpretations of breast biopsy specimens; however, variability in diagnosis will not be completely eliminated, especially for breast specimens with atypia. PMID:27334105

Rating long-term care facilities on pressure ulcer development: importance of case-mix adjustment.

PubMed

Berlowitz, D R; Ash, A S; Brandeis, G H; Brand, H K; Halpern, J L; Moskowitz, M A

1996-03-15

To determine the importance of case-mix adjustment in interpreting differences in rates of pressure ulcer development in Department of Veterans Affairs long- term care facilities. A sample assembled from the Patient Assessment File, a Veterans Affairs administrative database, was used to derive predictors of pressure ulcer development; the resulting model was validated in a separate sample. Facility-level rates of pressure ulcer development, both unadjusted and adjusted for case mix using the predictive model, were compared. Department of Veterans Affairs long-term care facilities. The derivation sample consisted of 31 150 intermediate medicine and nursing home residents who were initially free of pressure ulcers and were institutionalized between October 1991 and April 1993. The validation sample consisted of 17 946 residents institutionalized from April 1993 to October 1993. Development of a stage 2 or greater pressure ulcer. 11 factors predicted pressure ulcer development. Validated performance properties of the resulting model were good. Model-predicted rates of pressure ulcer development at individual long-term care facilities varied from 1.9% to 6.3%, and observed rates ranged from 0% to 10.9%. Case-mix-adjusted rates and ranks of facilities differed considerably from unadjusted ratings. For example, among five facilities that were identified as high outliers on the basis of unadjusted rates, two remained as outliers after adjustment for case mix. Long-term care facilities differ in case mix. Adjustments for case mix result in different judgments about facility performance and should be used when facility incidence rates are compared.

Minimally-aggressive gestational trophoblastic neoplasms.

PubMed

Cole, Laurence A

2012-04-01

We have previously defined a new syndrome "Minimally-aggressive gestational trophoblastic neoplasms" in which choriocarcinoma or persistent hydatidiform mole has a minimal growth rate and becomes chemorefractory. Previously we described a new treatment protocol, waiting for hCG rise to >3000 mIU/ml and disease becomes more advanced, then using combination chemotherapy. Initially we found this treatment successful in 8 of 8 cases, here we find this protocol appropriate in a further 16 cases. Initially we used hyperglycosylated hCG, a limited availability test, to identify this syndrome. Here we propose also using hCG doubling rate to detect this syndrome. Minimally aggressive gestational trophoblastic disease can be detected by chemotherapy resistance or low hyperglycosylated hCG, <40% of total hCG. It can also be identified by hCG doubling rate, with doubling time greater than 2 weeks. Nineteen new cases were identified as having minimally aggressive gestational trophoblastic disease by hyperglycosylated hCG and by hCG doubling test. All were recommended to hold off further chemotherapy until hCG >3000mIU/ml. One case died prior to the start of the study, one case withdrew because of a lung nodule and one withdrew refusing the suggested combination chemotherapy. The remaining 16 women were all successfully treated. A total of 8 plus 16 or 24 of 24 women were successfully treated using the proposed protocol, holding back on chemotherapy until hCG >3000mIU/ml. Copyright © 2011 Elsevier Inc. All rights reserved.

Persistent fluctuations in synchronization rate in globally coupled oscillators with periodic external forcing

NASA Astrophysics Data System (ADS)

Atsumi, Yu; Nakao, Hiroya

2012-05-01

A system of phase oscillators with repulsive global coupling and periodic external forcing undergoing asynchronous rotation is considered. The synchronization rate of the system can exhibit persistent fluctuations depending on parameters and initial phase distributions, and the amplitude of the fluctuations scales with the system size for uniformly random initial phase distributions. Using the Watanabe-Strogatz transformation that reduces the original system to low-dimensional macroscopic equations, we show that the fluctuations are collective dynamics of the system corresponding to low-dimensional trajectories of the reduced equations. It is argued that the amplitude of the fluctuations is determined by the inhomogeneity of the initial phase distribution, resulting in system-size scaling for the random case.

Incidence and timing of cancer in HIV-infected individuals following initiation of combination antiretroviral therapy.

PubMed

Yanik, Elizabeth L; Napravnik, Sonia; Cole, Stephen R; Achenbach, Chad J; Gopal, Satish; Olshan, Andrew; Dittmer, Dirk P; Kitahata, Mari M; Mugavero, Michael J; Saag, Michael; Moore, Richard D; Mayer, Kenneth; Mathews, W Christopher; Hunt, Peter W; Rodriguez, Benigno; Eron, Joseph J

2013-09-01

Cancer is an important cause of morbidity and mortality in individuals infected with human immunodeficiency virus (HIV), but patterns of cancer incidence after combination antiretroviral therapy (ART) initiation remain poorly characterized. We evaluated the incidence and timing of cancer diagnoses among patients initiating ART between 1996 and 2011 in a collaboration of 8 US clinical HIV cohorts. Poisson regression was used to estimate incidence rates. Cox regression was used to identify demographic and clinical characteristics associated with cancer incidence after ART initiation. At initiation of first combination ART among 11 485 patients, median year was 2004 (interquartile range [IQR], 2000-2007) and median CD4 count was 202 cells/mm(3) (IQR, 61-338). Incidence rates for Kaposi sarcoma (KS) and lymphomas were highest in the first 6 months after ART initiation (P < .001) and plateaued thereafter, while incidence rates for all other cancers combined increased from 416 to 615 cases per 100 000 person-years from 1 to 10 years after ART initiation (average 7% increase per year; 95% confidence interval, 2%-13%). Lower CD4 count at ART initiation was associated with greater risk of KS, lymphoma, and human papillomavirus-related cancer. Calendar year of ART initiation was not associated with cancer incidence. KS and lymphoma rates were highest immediately following ART initiation, particularly among patients with low CD4 cell counts, whereas other cancers increased with time on ART, likely reflecting increased cancer risk with aging. Our results underscore recommendations for earlier HIV diagnosis followed by prompt ART initiation along with ongoing aggressive cancer screening and prevention efforts throughout the course of HIV care.

Estimating error rates for firearm evidence identifications in forensic science

PubMed Central

Song, John; Vorburger, Theodore V.; Chu, Wei; Yen, James; Soons, Johannes A.; Ott, Daniel B.; Zhang, Nien Fan

2018-01-01

Estimating error rates for firearm evidence identification is a fundamental challenge in forensic science. This paper describes the recently developed congruent matching cells (CMC) method for image comparisons, its application to firearm evidence identification, and its usage and initial tests for error rate estimation. The CMC method divides compared topography images into correlation cells. Four identification parameters are defined for quantifying both the topography similarity of the correlated cell pairs and the pattern congruency of the registered cell locations. A declared match requires a significant number of CMCs, i.e., cell pairs that meet all similarity and congruency requirements. Initial testing on breech face impressions of a set of 40 cartridge cases fired with consecutively manufactured pistol slides showed wide separation between the distributions of CMC numbers observed for known matching and known non-matching image pairs. Another test on 95 cartridge cases from a different set of slides manufactured by the same process also yielded widely separated distributions. The test results were used to develop two statistical models for the probability mass function of CMC correlation scores. The models were applied to develop a framework for estimating cumulative false positive and false negative error rates and individual error rates of declared matches and non-matches for this population of breech face impressions. The prospect for applying the models to large populations and realistic case work is also discussed. The CMC method can provide a statistical foundation for estimating error rates in firearm evidence identifications, thus emulating methods used for forensic identification of DNA evidence. PMID:29331680

Estimating error rates for firearm evidence identifications in forensic science.

PubMed

Song, John; Vorburger, Theodore V; Chu, Wei; Yen, James; Soons, Johannes A; Ott, Daniel B; Zhang, Nien Fan

2018-03-01

Estimating error rates for firearm evidence identification is a fundamental challenge in forensic science. This paper describes the recently developed congruent matching cells (CMC) method for image comparisons, its application to firearm evidence identification, and its usage and initial tests for error rate estimation. The CMC method divides compared topography images into correlation cells. Four identification parameters are defined for quantifying both the topography similarity of the correlated cell pairs and the pattern congruency of the registered cell locations. A declared match requires a significant number of CMCs, i.e., cell pairs that meet all similarity and congruency requirements. Initial testing on breech face impressions of a set of 40 cartridge cases fired with consecutively manufactured pistol slides showed wide separation between the distributions of CMC numbers observed for known matching and known non-matching image pairs. Another test on 95 cartridge cases from a different set of slides manufactured by the same process also yielded widely separated distributions. The test results were used to develop two statistical models for the probability mass function of CMC correlation scores. The models were applied to develop a framework for estimating cumulative false positive and false negative error rates and individual error rates of declared matches and non-matches for this population of breech face impressions. The prospect for applying the models to large populations and realistic case work is also discussed. The CMC method can provide a statistical foundation for estimating error rates in firearm evidence identifications, thus emulating methods used for forensic identification of DNA evidence. Published by Elsevier B.V.

The epidemiology of tuberculosis in the Pacific, 2000 to 2013.

PubMed

Viney, Kerri; Hoy, Damian; Roth, Adam; Kelly, Paul; Harley, David; Sleigh, Adrian

2015-01-01

Tuberculosis (TB) poses a significant public health challenge in the 22 Pacific island countries and territories. Using TB surveillance data and World Health Organization (WHO) estimates from 2000 to 2013, we summarize the epidemiology of TB in the Pacific. This was a descriptive study of incident TB cases reported annually by Pacific island national TB programmes to WHO. We counted cases and calculated proportions and case notification rates per 100,000 population. We calculated the proportion of TB patients who completed TB treatment and summed estimates of national incidence, prevalence and mortality, provided by WHO, to produce regional incidence, prevalence and mortality rates per 100,000 population. Estimated TB incidence in the Pacific has remained high but stable from 2000 to 2013; estimated prevalence and mortality have fallen by 20% and 47%, respectively. The TB case notification rate increased by 58%, from 146 to 231 per 100,000 population in the same time period. In 2013, 24,145 TB cases were notified, most (94% or 22,657) were from Papua New Guinea. Kiribati had the highest TB case notification rate at 398 cases per 100,000 population. TB case notification rates were also high in Papua New Guinea, the Marshall Islands and Tuvalu (309, 283 and 182, respectively). TB in the Pacific is improving in some areas; however, high rates affect many countries and the estimated regional incidence rate is stable. To further reduce the burden of TB, a combination of dedicated public health and system-wide approaches are required along with poverty reduction and social protection initiatives.

Cost consequences of induced abortion as an attributable risk for preterm birth and impact on informed consent.

PubMed

Calhoun, Byron C; Shadigian, Elizabeth; Rooney, Brent

2007-10-01

To investigate the human and monetary cost consequences of preterm delivery as related to induced abortion (IA), with its impact on informed consent and medical malpractice. A review of the literature in English was performed to assess the effect of IA on preterm delivery rates from 24 to 31 6/7 weeks to assess the risk for preterm birth attributable to IA. After calculating preterm birth risk, the increased initial neonatal hospital costs and cerebral palsy (CP) risks related to IA were calculated. IA increased the early preterm delivery rate by 31.5%, with a yearly increase in initial neonatal hospital costs related to IA of > $1.2 billion. The yearly human cost includes 22,917 excess early preterm births (EPB) (< 32 weeks) and 1096 excess CP cases in very-low-birth-weight newborns, <1500 g. IA contributes to significantly increased neonatal health costs by causing 31.5% of EPB. Providers of obstetric care and abortion should be aware of the risk of preterm birth attributable to induced abortion, with its significant increase in initial neonatal hospital costs and CP cases.

[Tuberculosis outbreak at a public school].

PubMed

Navarro Gracia, J F; Peña Fernández, M; García Abad, I; Gaztambide Ganuza, M; Quiles Durá, J L; Carratalá Torregrosa, J A; Padilla Navas, I; Royo García, G

1997-03-01

At school there are special circumstances of living together and a particular susceptibility, which favour the emergence of tuberculosis microepidemics. We report here the microepidemic occurred at a school among 9-year old children. After ruling out a possible familiar source in a child with pulmonary tuberculosis, we detected a case with high bacillar shedding in a female teacher and conducted a tuberculin search among children and teachers, initially outlining the theoretical groups at risk. Tuberculin positive children underwent chest-X-ray and when abnormalities were found, children were derived to the pediatrician for chemotherapy. All converters received secondary chemoprophylaxis and all non-respondents primary chemoprophylaxis. The classroom where the teacher spent most of het time had a higher rate of converters (70%) than other classroom, where the index teacher spent only a partial time (40%; RR: 1.75; CI: 1.06-2.88) or the collective of teachers (45.4%; RR: 1.45; CI: 0.94-2.23). Three additional cases of secondary disease were detected, all of them children. The initial compliance with chemoprophylaxis was greater among (for) children (97.0%) than among teachers (41.6%). Among children there was one case of tuberculin conversion compared with three cases among teachers. No additional cases were detected; also, an abnormal rate of reactors outside the initially studied groups was also not detected. Our results somehow agree with those reported from other school outbreaks. To note the anergy and lack of symptoms in the index case and the suggestion to delineate the degree of spending hours together to identify groups with a higher theoretical risk of being infected. Thus, an unnecessary expense of resources and a social alarm would be avoided.

Perioperative Care and the Importance of Continuous Quality Improvement—A Controlled Intervention Study in Three Tanzanian Hospitals

PubMed Central

Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus–Dieter; Spies, Claudia

2015-01-01

Introduction Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. Methods All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Results Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Discussion Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Conclusion Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach. PMID:26327392

Perioperative Care and the Importance of Continuous Quality Improvement--A Controlled Intervention Study in Three Tanzanian Hospitals.

PubMed

Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia

2015-01-01

Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes.

PubMed

Harris, Michael; Frey, Peter; Esteva, Magdalena; Gašparović Babić, Svjetlana; Marzo-Castillejo, Mercè; Petek, Davorina; Petek Ster, Marija; Thulesius, Hans

2017-03-01

European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. A total of 14 countries. Consensus groups of PCPs. Probability of initial presentation to a PCP for four clinical vignettes. There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = -0.16, 95% CI -0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = -0.57, 95% CI -0.83 to -0.12; ovary: r = -0.13, 95% CI -0.57 to 0.38; breast r = 0.14, 95% CI -0.36 to 0.58; bowel: r = 0.20, 95% CI -0.31 to 0.62). There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a "PCP-as-gatekeeper" system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies.

PubMed

Zorn, Kevin C; Wille, Mark A; Thong, Alan E; Katz, Mark H; Shikanov, Sergey A; Razmaria, Aria; Gofrit, Ofer N; Zagaja, Gregory P; Shalhav, Arieh L

2009-08-01

Several robot-assisted radical prostatectomy (RARP) series have reviewed the impact of the initial learning curve on perioperative outcomes. However, little is known about the impact of experience on urinary and sexual outcomes. Herein, we review the perioperative, pathological and functional outcomes of our initial 700 consecutive procedures with at least 1 year follow up. From 2003-2006, 700 consecutive men underwent RARP at a single, academic institution. Perioperative data and pathologic outcomes were prospectively collected. Validated, UCLA-PCI-SF36v2 quality-of-life questionnaires were also obtained at 1, 3, 6 and 12 months following surgery. Outcomes between groups (cases 1-300, 301-500, and 501-700) were compared. Mean operative time (OT) and blood loss significantly decreased during the experience (286, 198, 190 min; p or=7 in 24%, 40%, 44%; p

Fluoroscopic guide wire manipulation of malfunctioning peritoneal dialysis catheters initially placed by interventional radiologists.

PubMed

Kwon, Young Ho; Kwon, Se Hwan; Oh, Joo Hyeong; Jeong, Kyung Hwan; Lee, Tae Won

2014-06-01

To assess the efficacy of fluoroscopic guide wire manipulation in patients with malfunctioning peritoneal dialysis (PD) catheters that were initially placed by interventional radiologists under fluoroscopic guidance. From January 2002 to April 2012, 52 patients (mean age, 52.8 y ± 2.10s; range, 12-79 y) with malfunctioning PD catheters in whom fluoroscopic guide wire manipulation was performed were retrospectively reviewed. Technical success, clinical success, and complications were evaluated. Technical success was defined as fluoroscopically verified, successful catheter repositioning and adequate dialysate drainage after the procedure. Clinical success was defined as maintenance of PD catheter function for at least 30 days after the manipulation. During the study period, 72 manipulations (68 initial manipulations and 4 remanipulations) for malfunctioning PD catheters were done. The technical success rate was 74% (50 of 68) for initial manipulations and 75% (3 of 4) for remanipulations. The overall clinical success rate was 47% (32 of 68) for initial manipulations and 0% (0 of 4) for remanipulations. The primary causes of catheter malfunction were extraluminal obstruction by omental wrapping or adhesions in 43 of 68 cases (63.2%) and catheter malposition in 25 of 68 (36.8%) cases. There were no procedure-related major complications. Fluoroscopic guide wire manipulation in patients with malfunctioning PD catheters initially placed by interventional radiologists is a simple procedure, an effective way of prolonging PD catheter life, and a recommended procedure before invasive surgical procedures. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

[Hyponatremia associated with SSRI/NRSI: Descriptive and comparative epidemiological study of the incidence rates of the notified cases from the data of the French National Pharmacovigilance Database and the French National Health Insurance].

PubMed

Revol, R; Rault, C; Polard, E; Bellet, F; Guy, C

2018-06-01

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are frequently prescribed. These antidepressants can potentially induce serious hyponatremia through the SIADH syndrome. That seems to concern all molecules of these classes but the individual risk of each molecule is not well known. The aims of the study were to compare the incidence rate of each molecule in order to identify the existence of molecules more at risk of inducing hyponatremia and to characterize a profile of patients at risk for hyponatremia during a treatment with a SSRI or a SNRI. The cases of hyponatremia under SSRI/SNRI were extracted from the French pharmacovigilance database (BPNV). The exposition to the different SSRIs/SNRIs in the French population was estimated from the French National Health Insurance database (SNIIRAM) using a sampled database (Echantillon Généralistes des Bénéficiaires). The study ran from 01/01/2011 to 31/12/2013. The primary study endpoint was the incidence rate of notifications of the hyponatremia cases in patients treated by SSRI/SNRI and recorded into the BNPV database, related to the average annual number of corresponding treatments initiated during the same period. The number of cases of hyponatremia included in the study was 169 for 3 749 800 adult patients initiating treatment. The incidence rate of cases was 1.64 for 100 000 persons per year (PY). The standardized incidence rates between the different molecules showed no difference except for duloxetine (2.79/100 000 PY p > 0.03). Identified risk factors were age, with a large increase of incidence rate from 75 years old (incidence 12.5 higher) and female gender. Comparison of the incidence rates from spontaneous reports indicates a greater risk of hyponatremia for duloxetine for 2011-2013. This result needs to be confirmed by other studies. The advanced age and female sex are risk factors, irrespective of the molecule. Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

77 FR 62492 - Steel Wire Garment Hangers From Taiwan: Final Determination of Sales at Less Than Fair Value

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-15

... antidumping duty investigation of hangers from Taiwan.\\1\\ No interested party provided case briefs or rebuttal... others rate is a simple average of these values, which is 69.98 percent.\\5\\ \\5\\ See Initiation Checklist... 10, 2012) (where the Department determined the all others rate using a simple average). Disclosure We...

Remediation of Chlorinated Solvent Plumes Using In-Situ Air Sparging—A 2-D Laboratory Study

PubMed Central

Adams, Jeffrey A.; Reddy, Krishna R.; Tekola, Lue

2011-01-01

In-situ air sparging has evolved as an innovative technique for soil and groundwater remediation impacted with volatile organic compounds (VOCs), including chlorinated solvents. These may exist as non-aqueous phase liquid (NAPL) or dissolved in groundwater. This study assessed: (1) how air injection rate affects the mass removal of dissolved phase contamination, (2) the effect of induced groundwater flow on mass removal and air distribution during air injection, and (3) the effect of initial contaminant concentration on mass removal. Dissolved-phase chlorinated solvents can be effectively removed through the use of air sparging; however, rapid initial rates of contaminant removal are followed by a protracted period of lower removal rates, or a tailing effect. As the air flow rate increases, the rate of contaminant removal also increases, especially during the initial stages of air injection. Increased air injection rates will increase the density of air channel formation, resulting in a larger interfacial mass transfer area through which the dissolved contaminant can partition into the vapor phase. In cases of groundwater flow, increased rates of air injection lessened observed downward contaminant migration effect. The air channel network and increased air saturation reduced relative hydraulic conductivity, resulting in reduced groundwater flow and subsequent downgradient contaminant migration. Finally, when a higher initial TCE concentration was present, a slightly higher mass removal rate was observed due to higher volatilization-induced concentration gradients and subsequent diffusive flux. Once concentrations are reduced, a similar tailing effect occurs. PMID:21776228

Remediation of chlorinated solvent plumes using in-situ air sparging--a 2-D laboratory study.

PubMed

Adams, Jeffrey A; Reddy, Krishna R; Tekola, Lue

2011-06-01

In-situ air sparging has evolved as an innovative technique for soil and groundwater remediation impacted with volatile organic compounds (VOCs), including chlorinated solvents. These may exist as non-aqueous phase liquid (NAPL) or dissolved in groundwater. This study assessed: (1) how air injection rate affects the mass removal of dissolved phase contamination, (2) the effect of induced groundwater flow on mass removal and air distribution during air injection, and (3) the effect of initial contaminant concentration on mass removal. Dissolved-phase chlorinated solvents can be effectively removed through the use of air sparging; however, rapid initial rates of contaminant removal are followed by a protracted period of lower removal rates, or a tailing effect. As the air flow rate increases, the rate of contaminant removal also increases, especially during the initial stages of air injection. Increased air injection rates will increase the density of air channel formation, resulting in a larger interfacial mass transfer area through which the dissolved contaminant can partition into the vapor phase. In cases of groundwater flow, increased rates of air injection lessened observed downward contaminant migration effect. The air channel network and increased air saturation reduced relative hydraulic conductivity, resulting in reduced groundwater flow and subsequent downgradient contaminant migration. Finally, when a higher initial TCE concentration was present, a slightly higher mass removal rate was observed due to higher volatilization-induced concentration gradients and subsequent diffusive flux. Once concentrations are reduced, a similar tailing effect occurs.

Engineering of a highly efficient Xe₂*-excilamp (xenon excimer lamp, λmax=172 nm, η=40%) and qualitative comparison to a low-pressure mercury lamp (LP-Hg, λ=185/254 nm) for water purification.

PubMed

Al-Gharabli, Samer; Engeßer, Patrick; Gera, Diana; Klein, Sandra; Oppenländer, Thomas

2016-02-01

Excilamps are mercury-free gas-discharge sources of non-coherent VUV or UV radiation with high radiant power and a long lifetime. The most efficient excilamp that is currently available on the market is a VUV xenon excilamp system (Xe2(*)-excimer lamp, λ(max) = 172 nm) with a stated radiant efficiency η of 40% at an electrical input power P(el) of 20 W, 50 W or 100 W. In this paper, the use of this highly efficient Xe2(*)-excilamp (P(el) = 20 W) for water treatment is demonstrated using a recirculating laboratory photoreactor system with negative radiation geometry. The efficiency in the 172 nm initiated bleaching of aqueous solutions of Rhodamine B is compared to that initiated by a common low-pressure mercury (LP-Hg) lamp (185 nm, TNN 15/32). The dependence of the pseudo zero order rate constant k´ of decolorization of RhB on the flow rate and on the initial concentration of RhB was investigated. Both lamps exhibited dependences of k´ on the initial concentration of RhB, which represents a typical saturation kinetical behavior. The saturation kinetics was very prominent in the case of the Xe2(*)-excilamp. Also, the Xe2(*)-excilamp treatment exhibited a significant influence on the flow rate of the RhB aqueous solution, which was not the case during the LP-Hg lamp initiated bleaching of RhB. The results of this paper demonstrate that Xe2(*)-excilamps can be used for VUV-initiated water purification. However, to reach the maximum efficacy of the Xe2(*)-excilamp for photo-initiated water purification further engineering optimization of the photoreactor concept is necessary. Copyright © 2015 Elsevier Ltd. All rights reserved.

Management of dental implant fractures. A case history.

PubMed

Al Quran, Firas A M; Rashan, Bashar A; Al-Dwairi, Ziad N

2009-01-01

The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant fracture is one possible complication that results in ultimate failure of the dental implant. Such a complication poses a management crisis even for the most experienced clinician. This article reports on a case of implant fracture, its possible causes, and how the case was managed.

Breast cancer screening programmes: the development of a monitoring and evaluation system.

PubMed

Day, N E; Williams, D R; Khaw, K T

1989-06-01

It is important that the introduction of breast screening is closely monitored. The anticipated effect on breast cancer mortality will take 10 years or more fully to emerge, and will only occur if a succession of more short-term end points are met. Data from the Swedish two-county randomised trial provide targets that should be achieved, following a logical progression of compliance with the initial invitation, prevalence and stage distribution at the prevalence screen, the rate of interval cancers after the initial screen, the pick-up rate and stage distribution at later screening tests, the rate of interval cancers after later tests, the absolute rate of advanced cancer and finally the breast cancer mortality rate. For evaluation purposes, historical data on stage at diagnosis is desirable; it is suggested that tumour size is probably the most relevant variable available in most cases.

Medical knowledge related to Rocky Mountain spotted fever in Sonora, Mexico.

PubMed

Alvarez-Hernandez, Gerardo; Ernst, Kacey; Acuña-Melendrez, Natalia Haydee; Vargas-Ortega, Anabel Patricia; Candia-Plata, Maria Del Carmen

2018-03-01

Rocky Mountain spotted fever (RMSF) is a tick-borne disease with a high case-fatality rate unless diagnosed promptly and treated timely with doxycycline. Physician knowledge about presentation and treatment can improve outcomes of RMSF in endemic regions, such as Sonora in northern Mexico, where RMSF has caused 1348 non-fatal cases and 247 deaths from 2003 to 2016. A cross-sectional study was conducted with 343 physicians working in medical facilities in Sonora, Mexico. A 25-item questionnaire explored physician knowledge of clinical, epidemiological and preventive aspects of RMSF. Only 62% of physicians agreed that doxycycline should be used as the first choice treatment for children under 8 years with suspected RMSF. Additionally, 40% of primary care physicians correctly identified the time to initiate doxycycline, and 32% correctly identified the case-fatality rate of untreated RMSF in all patients. Inadequate medical knowledge may adversely affect how patients infected with Rickettsia rickettsii are diagnosed and treated. Educational programs that improve the risk perception and medical knowledge about RMSF should be targeted at physicians most likely to have initial contact with diseased patients.

Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility.

PubMed

Murray, Meghan T; Jackson, Olivia; Cohen, Bevin; Hutcheon, Gordon; Saiman, Lisa; Larson, Elaine; Neu, Natalie

2016-07-01

We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly. Infect Control Hosp Epidemiol 2016;37:859-862.

Focus for Impact: The PacifiCorp Foundation for Learning's Early Childhood Literacy Initiative. Principles for Effective Education Grantmaking. Case Study Number 5

ERIC Educational Resources Information Center

King, Caroline

2006-01-01

The PacifiCorp Foundation for Learning was at a turning point in August 2006. It had been five years since the corporate foundation had shifted its focus from general-purpose grantmaking to supporting individual and community learning, and its flagship Early Childhood Literacy Initiative--launched in 2003 to raise literacy rates in the communities…

Ribosome flow model with positive feedback

PubMed Central

Margaliot, Michael; Tuller, Tamir

2013-01-01

Eukaryotic mRNAs usually form a circular structure; thus, ribosomes that terminatae translation at the 3′ end can diffuse with increased probability to the 5′ end of the transcript, initiating another cycle of translation. This phenomenon describes ribosomal flow with positive feedback—an increase in the flow of ribosomes terminating translating the open reading frame increases the ribosomal initiation rate. The aim of this paper is to model and rigorously analyse translation with feedback. We suggest a modified version of the ribosome flow model, called the ribosome flow model with input and output. In this model, the input is the initiation rate and the output is the translation rate. We analyse this model after closing the loop with a positive linear feedback. We show that the closed-loop system admits a unique globally asymptotically stable equilibrium point. From a biophysical point of view, this means that there exists a unique steady state of ribosome distributions along the mRNA, and thus a unique steady-state translation rate. The solution from any initial distribution will converge to this steady state. The steady-state distribution demonstrates a decrease in ribosome density along the coding sequence. For the case of constant elongation rates, we obtain expressions relating the model parameters to the equilibrium point. These results may perhaps be used to re-engineer the biological system in order to obtain a desired translation rate. PMID:23720534

Growth rate of a penny-shaped crack in hydraulic fracturing of rocks

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

Abe, H.; Keer, L.M.; Mura, T.

1976-01-01

The deformation and growth of a crack, fractured hydraulically, is investigated when fluid is injected from an inlet into the crack at a constant flow rate. The total flow rate at the inlet is divided as follows: flow rate extracted from an outlet hole; fluid loss rate from the crack surface; and total fluid mass change in the crack. Two cases are considered: (1) inlet flow rate is initially greater than the sum of the outlet flow and fluid loss rates; and (2) the reverse holds true. Ranges are shown for which the crack attains stationary states for given inletmore » flow rate and outlet pressure. For these two cases reasonable outlet flow rates are obtained when the outlet pressure is less than or equal to the difference between the tectonic stress and the fluid head at the inlet. Results are expected to be of use in considerations of heat extraction from hot, dry rock.« less

Clinical Significance of Non-neutropenic Fever in the Management of Diffuse Large B-Cell Lymphoma Patients Treated with Rituximab-CHOP: Comparison with Febrile Neutropenia and Risk Factor Analysis.

PubMed

Park, Silvia; Kang, Cheol-In; Chung, Doo Ryeon; Peck, Kyong Ran; Kim, Won Seog; Kim, Seok Jin

2015-07-01

Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard chemotherapy in diffuse large B-cell lymphoma (DLBCL) patients. Although febrile neutropenia (FN) is the major toxicity of this regimen, non-neutropenic fever (NNF) becomes an emerging issue. We analyzed clinical features and outcomes of febrile complications from 397 patients with newly diagnosed DLBCL who were registered in the prospective cohort study. They had completed R-CHOP between September 2008 and January 2013. Thirty-nine patients (9.8%) had NNF whereas 160 patients (40.3%) had FN. Among them, 24 patients (6.0%) had both during their treatment. Compared to frequent occurrence of initial FN after the first cycle (> 50% of total events), more than 80% of NNF cases occurred after the third cycle. Interstitial pneumonitis comprised the highest proportion of NNF cases (54.8%), although the causative organism was not identified in the majority of cases. Thus, pathogen was identified in a limited number of patients (n=9), and Pneumocystis jiroveci pneumonia (PJP) was the most common. Considering that interstitial pneumonitis without documented pathogen could be clinically diagnosed with PJP, the overall rate of PJP including probable cases was 4.5% (18 cases from 397 patients). The NNF-related mortality rate was 10.3% (four deaths from 39 patients with NNF) while the FN-related mortality rate was only 1.3%. NNF was observed with incidence of 10% during R-CHOP treatment, and showed different clinical manifestations with respect to the time of initial episode and causes.

TB control programmes: the challenges for Africa.

PubMed

Harries, T

1996-11-01

Governmental neglect of tuberculosis (TB), inadequately managed and inaccurately designed TB control programs, population growth, and the HIV epidemic account for the resurgence of TB in sub-Saharan Africa. The World Health Organization and the International Union against TB and Lung Disease have developed a TB control strategy that aims to reduce mortality, morbidity, and transmission of TB. It aims for an 85% cure rate among detected new cases of smear-positive TB and a 70% rate of detecting existing smear-positive TB cases. The strategy involves the provision of short-course chemotherapy (SCC) to all identified smear-positive TB cases through directly observed treatment (DOTS). SCC treatment regimens for smear-positive pulmonary TB recommended for sub-Saharan African countries are: initial phase = daily administration over 2 months of streptomycin, rifampicin, isoniazid, and pyrazinamide; continuation phase = 3 doses over 4 months of isoniazid and rifampicin or daily administration of thiacetazone and isoniazid or of ethambutol and isoniazid. A TB control policy must be implemented to bring about effective TB control. The essential elements of this policy include political commitment, case detection through passive case-finding, SCC, a regular supply of essential drugs, and a monitoring and evaluation system. Political commitment involves establishing a National TB Control Program to be integrated into the existing health structure. Increased awareness of TB in the community and among health workers and a reference laboratory are needed to make case finding successful. A distribution and logistics system is needed to ensure uninterrupted intake of drugs throughout treatment. These regimens have been very successful and cost-effective but pose several disadvantages (e.g., heavy workload of recommended 3 sputum smear tests). A simplified approach involves 1 initial sputum smear for 6 months; 6-months, intermittent rifampicin-based therapy, 100% DOTS throughout entire treatment course, and ascertainment of treatment completion rates and mortality rates in all patients.

Using quality improvement to promote breast-feeding in a local health department.

PubMed

Wright, Sarah S; Lea, C Suzanne; Holloman, Roxanne; Cornett, Amanda; Harrison, Lisa Macon; Randolph, Greg D

2012-01-01

In 2008, breast-feeding initiation and continuation rates in Beaufort County, North Carolina, were lower than statewide rates. A quality improvement (QI) project was initiated to increase breast-feeding rates by enhancing the overall environment that supports breast-feeding at the Beaufort County Health Department. This case study describes one of the first QI initiatives implemented through the North Carolina Center for Public Health Quality QI training program, conducted in 2009. The aim of this project was to improve the health and wellness of mothers and infants in Beaufort County by promoting breast-feeding among Beaufort County Health Department Women, Infants and Children (WIC) clients. Using QI tools, 4 new approaches to breast-feeding promotion were tested and implemented: creating a nurturing location to breast-feed while at the health department, actively telephoning new mothers to provide breast-feeding support, incentivizing adoption of educational messages by providing a breast-feeding tote bag, and promoting new WIC food packages. These enhancements involved staff in QI planning and implementation and correlated with improved breast-feeding initiation for WIC clients during the year following project completion.

Significant reduction of central line-associated bloodstream infection rates in a tertiary neonatal unit.

PubMed

Rallis, Dimitrios; Karagianni, Paraskevi; Papakotoula, Ifigeneia; Nikolaidis, Nikolaos; Tsakalidis, Christos

2016-04-01

To evaluate the effectiveness of a quality initiative in reducing central line-associated bloodstream infections (CLABSIs) in our neonatal intensive care unit, we designed a prospective study (January 2012-September 2013) estimating CLABSI incidence before and after our implementation. CLABSI rates were significantly decreased after our intervention, from 12 cases per 1,000 central vascular catheter (CVC) days during the preinterventional period to 3.4 cases per 1,000 CVC days during the postinterventional period (P = .004). Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Parameter study of r-process lanthanide production and heating rates in kilonovae

NASA Astrophysics Data System (ADS)

Lippuner, Jonas; Roberts, Luke F.

2015-04-01

Explosive r-process nucleosynthesis in material ejected during compact object mergers may lead to radioactively powered transients called kilonovae. The timescale and peak luminosity of these transients are sensitive to the composition of the material after nuclear burning ceases, as the composition determines the local heating rate from nuclear decays and the opacity. The presence of lanthanides in the ejecta can drastically increase the opacity. We use the new general-purpose nuclear reaction network SkyNet to run a parameter study of r-process nucleosynthesis for a range of initial electron fractions Ye, initial entropies s, and density decay timescales τ. We find that the ejecta is lanthanide-free for Ye >~ 0 . 22 - 0 . 3 , depending on s and τ. The heating rate is insensitive to s and τ, but certain, larger values of Ye lead to reduced heating rates, because single nuclides dominate the heating. With a simple model we estimate the luminosity, time, and effective temperature at the peak of the light curve. Since the opacity is much lower in the lanthanide-free case, we find the luminosity peaks much earlier at ~ 1 day vs. ~ 15 days in the lanthanide-rich cases. Although there is significant variation in the heating rate with Ye, changes in the heating rate do not mitigate the effect of the lanthanides. This research is partially supported by NSF under Award Numbers AST-1333520 and AST-1205732.

Rapid on-site defibrillation versus community program.

PubMed

Fedoruk, J C; Paterson, D; Hlynka, M; Fung, K Y; Gobet, Michael; Currie, Wayne

2002-01-01

For patients who suffer out-of-hospital cardiac arrest, the time from collapse to initial defibrillation is the single most important factor that affects survival to hospital discharge. The purpose of this study was to compare the survival rates of cardiac arrest victims within an institution that has a rapid defibrillation program with those of its own urban community, tiered EMS system. A logistic regression analysis of a retrospective data series (n = 23) and comparative analysis to a second retrospective data series (n = 724) were gathered for the study period September 1994 to September 1999. The first data series included all persons at Casino Windsor who suffered a cardiac arrest. Data collected included: age, gender, death/survival (neurologically intact discharge), presenting rhythm (ventricular fibrillation (VF), ventricular tachycardia (VT), or other), time of collapse, time to arrival of security personnel, time to initiation of cardiopulmonary resuscitation (CPR) prior to defibrillation (when applicable), time to arrival of staff nurse, time to initial defibrillation, and time to return of spontaneous circulation (if any). Significantly, all arrests within this series were witnessed by the surveillance camera systems, allowing time of collapse to be accurately determined rather than estimated. These data were compared to those of similar events, times, and intervals for all patients in the greater Windsor area who suffered cardiac arrest. This second series was based upon the Ontario Prehospital Advanced Life Support (OPALS) Study database, as coordinated by the Clinical Epidemiology Unit of the Ottawa Hospital, University of Ottawa. The Casino Windsor had 23 cases of cardiac arrests. Of the cases, 13 (56.5%) were male and 10 (43.5%) were female. All cases (100%) were witnessed. The average of the ages was 61.1 years, of the time to initial defibrillation was 7.7 minutes, and of the time for EMS to reach the patient was 13.3 minutes. The presenting rhythm was VF/VT in 91% of the case. Fifteen patients were discharged alive from hospital for a 65% survival rate. The Greater Windsor Study area included 668 cases of out-of-hospital cardiac arrest: Of these, 410 (61.4%) were male and 258 (38.6%) were female, 365 (54.6%) were witnessed, and 303 (45.4%) were not witnessed. The initial rhythm was VF/VT was in 34.3%. Thirty-seven (5.5%) were discharged alive from the hospital. This study provides further evidence that PAD Programs may enhance cardiac arrest survival rates and should be considered for any venue with large numbers of adults as well as areas with difficult medical access.

The epidemiology of tuberculosis in the Pacific, 2000 to 2013

PubMed Central

Hoy, Damian; Roth, Adam; Kelly, Paul; Harley, David; Sleigh, Adrian

2015-01-01

Objective Tuberculosis (TB) poses a significant public health challenge in the 22 Pacific island countries and territories. Using TB surveillance data and World Health Organization (WHO) estimates from 2000 to 2013, we summarize the epidemiology of TB in the Pacific. Methods This was a descriptive study of incident TB cases reported annually by Pacific island national TB programmes to WHO. We counted cases and calculated proportions and case notification rates per 100 000 population. We calculated the proportion of TB patients who completed TB treatment and summed estimates of national incidence, prevalence and mortality, provided by WHO, to produce regional incidence, prevalence and mortality rates per 100 000 population. Results Estimated TB incidence in the Pacific has remained high but stable from 2000 to 2013; estimated prevalence and mortality have fallen by 20% and 47%, respectively. The TB case notification rate increased by 58%, from 146 to 231 per 100 000 population in the same time period. In 2013, 24 145 TB cases were notified, most (94% or 22 657) were from Papua New Guinea. Kiribati had the highest TB case notification rate at 398 cases per 100 000 population. TB case notification rates were also high in Papua New Guinea, the Marshall Islands and Tuvalu (309, 283 and 182, respectively). Discussion TB in the Pacific is improving in some areas; however, high rates affect many countries and the estimated regional incidence rate is stable. To further reduce the burden of TB, a combination of dedicated public health and system-wide approaches are required along with poverty reduction and social protection initiatives. PMID:26668768

Radiation-induced polymerization of glass-forming systems. IV. Effect of the homogeneity of polymerization phase and polymer concentration on temperature dependence of initial polymerization rate

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

Kaetsu, I.; Ito, A.; Hayashi, K.

1973-06-01

The effect of homogeneity of polymerization phase and monomer concentration on the temperature dependence of initial polymerization rate was studied in the radiation-induced radical polymerization of binary systems consisting of glass-forming monomer and solvent. In the polymerization of a completely homogeneous system such as HEMA-propylene glycol, a maximum and a minimum in polymerization rates as a function of temperature, characteristic of the polymerization in glass-forming systems, were observed for all monomer concentrations. However, in the heterogeneous polymerization systems such as HEMA-triacetin and HEMAisoamyl acetate, maximum and minimum rates were observed in monomer-rich compositions but not at low monomer concentrations. Furthermore,more » in the HEMA-dioctyl phthalate polymerization system, which is extremely heterogeneous, no maximum and minimum rates were observed at any monomer concentration. The effect of conversion on the temperature dependence of polymerization rate in homogeneous bulk polymerization of HEMA and GMA was investigated. Maximum and minimum rates were observed clearly in conversions less than 10% in the case of HEMA and less than 50% in the case of GMA, but the maximum and minimum changed to a mere inflection in the curve at higher conversions. A similar effect of polymer concentration on the temperature dependence of polymerization rate in the GMA-poly(methyl methacrylate) system was also observed. It is deduced that the change in temperature dependence of polymerization rate is attributed to the decrease in contribution of mutual termination reaction of growing chain radicals to the polymerization rate. (auth)« less

Using CFD Techniques to Predict Slosh Force Frequency and Damping Rate

NASA Technical Reports Server (NTRS)

Marsell, Brandon; Gangadharan, Sathya; Chatman, Yadira; Sudermann, James

2009-01-01

Resonant effects and energy dissipation due to sloshing fuel inside propellant tanks are problems that arise in the initial design of any spacecraft or launch vehicle. A faster and more reliable method for calculating these effects during the design stages is needed. Using Computational Fluid Dynamics (CFD) techniques, a model of these fuel tanks can be created and used to predict important parameters such as resonant slosh frequency and damping rate. This initial study addresses the case of free surface slosh. Future studies will focus on creating models for tanks fitted with propellant management devices (PMD) such as diaphragms and baffles.

Incompressible limit of the degenerate quantum compressible Navier-Stokes equations with general initial data

NASA Astrophysics Data System (ADS)

Kwon, Young-Sam; Li, Fucai

2018-03-01

In this paper we study the incompressible limit of the degenerate quantum compressible Navier-Stokes equations in a periodic domain T3 and the whole space R3 with general initial data. In the periodic case, by applying the refined relative entropy method and carrying out the detailed analysis on the oscillations of velocity, we prove rigorously that the gradient part of the weak solutions (velocity) of the degenerate quantum compressible Navier-Stokes equations converge to the strong solution of the incompressible Navier-Stokes equations. Our results improve considerably the ones obtained by Yang, Ju and Yang [25] where only the well-prepared initial data case is considered. While for the whole space case, thanks to the Strichartz's estimates of linear wave equations, we can obtain the convergence of the weak solutions of the degenerate quantum compressible Navier-Stokes equations to the strong solution of the incompressible Navier-Stokes/Euler equations with a linear damping term. Moreover, the convergence rates are also given.

Wildfire Health and Economic Impacts Case Study###

EPA Science Inventory

Since 2008 eastern North Carolina experienced 6 major wildfires, far exceeding the historic 50 year expected rate of return. Initiated by the lighting strikes, these fires spread across multiple feet deep, dry and extremely vulnerable peat bogs. The fires produced massive amounts...

Strategic evaluation states initiative : case studies of Alaska, Georgia, and West Virginia

DOT National Transportation Integrated Search

2008-04-01

In 2002, the National Highway Traffic Safety Administration undertook a new approach that focused strategically on reducing alcohol-related crashes, injuries, and deaths in States with especially high numbers or rates of alcohol-related fatalities. T...

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study.

PubMed

Dunnigan, Matthew G; Pollock, Allyson M

2003-04-26

To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1.

Calculating erosion rates of river bank sediment by combining field measurements of erodibility parameters and small-scale topographic features – A case study at the Danube River

USDA-ARS?s Scientific Manuscript database

This paper examines the application of a method for calculating fluvial erosion on river banks. In the investigated area the determination of potential erosion rates are essential to estimating the initiated river widening processes and their effect on navigation. A mini-jet device was employed, for...

The Impact of a Line Probe Assay Based Diagnostic Algorithm on Time to Treatment Initiation and Treatment Outcomes for Multidrug Resistant TB Patients in Arkhangelsk Region, Russia.

PubMed

Eliseev, Platon; Balantcev, Grigory; Nikishova, Elena; Gaida, Anastasia; Bogdanova, Elena; Enarson, Donald; Ornstein, Tara; Detjen, Anne; Dacombe, Russell; Gospodarevskaya, Elena; Phillips, Patrick P J; Mann, Gillian; Squire, Stephen Bertel; Mariandyshev, Andrei

2016-01-01

In the Arkhangelsk region of Northern Russia, multidrug-resistant (MDR) tuberculosis (TB) rates in new cases are amongst the highest in the world. In 2014, MDR-TB rates reached 31.7% among new cases and 56.9% among retreatment cases. The development of new diagnostic tools allows for faster detection of both TB and MDR-TB and should lead to reduced transmission by earlier initiation of anti-TB therapy. The PROVE-IT (Policy Relevant Outcomes from Validating Evidence on Impact) Russia study aimed to assess the impact of the implementation of line probe assay (LPA) as part of an LPA-based diagnostic algorithm for patients with presumptive MDR-TB focusing on time to treatment initiation with time from first-care seeking visit to the initiation of MDR-TB treatment rather than diagnostic accuracy as the primary outcome, and to assess treatment outcomes. We hypothesized that the implementation of LPA would result in faster time to treatment initiation and better treatment outcomes. A culture-based diagnostic algorithm used prior to LPA implementation was compared to an LPA-based algorithm that replaced BacTAlert and Löwenstein Jensen (LJ) for drug sensitivity testing. A total of 295 MDR-TB patients were included in the study, 163 diagnosed with the culture-based algorithm, 132 with the LPA-based algorithm. Among smear positive patients, the implementation of the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 50 and 66 days compared to the culture-based algorithm (BacTAlert and LJ respectively, p<0.001). In smear negative patients, the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 78 days when compared to the culture-based algorithm (LJ, p<0.001). However, several weeks were still needed for treatment initiation in LPA-based algorithm, 24 days in smear positive, and 62 days in smear negative patients. Overall treatment outcomes were better in LPA-based algorithm compared to culture-based algorithm (p = 0.003). Treatment success rates at 20 months of treatment were higher in patients diagnosed with the LPA-based algorithm (65.2%) as compared to those diagnosed with the culture-based algorithm (44.8%). Mortality was also lower in the LPA-based algorithm group (7.6%) compared to the culture-based algorithm group (15.9%). There was no statistically significant difference in smear and culture conversion rates between the two algorithms. The results of the study suggest that the introduction of LPA leads to faster time to MDR diagnosis and earlier treatment initiation as well as better treatment outcomes for patients with MDR-TB. These findings also highlight the need for further improvements within the health system to reduce both patient and diagnostic delays to truly optimize the impact of new, rapid diagnostics.

Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions.

PubMed

Pelham, William E; Fabiano, Gregory A; Waxmonsky, James G; Greiner, Andrew R; Gnagy, Elizabeth M; Pelham, William E; Coxe, Stefany; Verley, Jessica; Bhatia, Ira; Hart, Katie; Karch, Kathryn; Konijnendijk, Evelien; Tresco, Katy; Nahum-Shani, Inbal; Murphy, Susan A

2016-01-01

Behavioral and pharmacological treatments for children with attention deficit/hyperactivity disorder (ADHD) were evaluated to address whether endpoint outcomes are better depending on which treatment is initiated first and, in case of insufficient response to initial treatment, whether increasing dose of initial treatment or adding the other treatment modality is superior. Children with ADHD (ages 5-12, N = 146, 76% male) were treated for 1 school year. Children were randomized to initiate treatment with low doses of either (a) behavioral parent training (8 group sessions) and brief teacher consultation to establish a Daily Report Card or (b) extended-release methylphenidate (equivalent to .15 mg/kg/dose bid). After 8 weeks or at later monthly intervals as necessary, insufficient responders were rerandomized to secondary interventions that either increased the dose/intensity of the initial treatment or added the other treatment modality, with adaptive adjustments monthly as needed to these secondary treatments. The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations (the primary outcome) at study endpoint and tended to have fewer out-of-class disciplinary events. Further, adding medication secondary to initial behavior modification resulted in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication. Normalization rates on teacher and parent ratings were generally high. Parents who began treatment with behavioral parent training had substantially better attendance than those assigned to receive training following medication. Beginning treatment with behavioral intervention produced better outcomes overall than beginning treatment with medication.

Guidance on the Assessment and Development of Insensitive Munitions (MURAT)

DTIC Science & Technology

2006-05-01

theoretical modelling . For this reason it is the best understood of all the areas on the flowchart. If the charge is already shocked by a previous impact...the initiation of heterogeneous high explosives due to shock waves are finite rate chemical reactions involved in the conversion of solid explosive ... explosive , increasing the chance of shock initiation (N26) Such an impact would have to take account of case material ahead of the fragment

Mesoscale Simulation Data for Initializing Fast-Time Wake Transport and Decay Models

NASA Technical Reports Server (NTRS)

Ahmad, Nashat N.; Proctor, Fred H.; Vanvalkenburg, Randal L.; Pruis, Mathew J.; LimonDuparcmeur, Fanny M.

2012-01-01

The fast-time wake transport and decay models require vertical profiles of crosswinds, potential temperature and the eddy dissipation rate as initial conditions. These inputs are normally obtained from various field sensors. In case of data-denied scenarios or operational use, these initial conditions can be provided by mesoscale model simulations. In this study, the vertical profiles of potential temperature from a mesoscale model were used as initial conditions for the fast-time wake models. The mesoscale model simulations were compared against available observations and the wake model predictions were compared with the Lidar measurements from three wake vortex field experiments.

Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis.

PubMed

Konijeti, Gauree G; Sauk, Jenny; Shrime, Mark G; Gupta, Meera; Ananthakrishnan, Ashwin N

2014-06-01

Clostridium difficile infection (CDI) is an important cause of morbidity and healthcare costs, and is characterized by high rates of disease recurrence. The cost-effectiveness of newer treatments for recurrent CDI has not been examined, yet would be important to inform clinical practice. The aim of this study was to analyze the cost effectiveness of competing strategies for recurrent CDI. We constructed a decision-analytic model comparing 4 treatment strategies for first-line treatment of recurrent CDI in a population with a median age of 65 years: metronidazole, vancomycin, fidaxomicin, and fecal microbiota transplant (FMT). We modeled up to 2 additional recurrences following the initial recurrence. We assumed FMT delivery via colonoscopy as our base case, but conducted sensitivity analyses based on different modes of delivery. Willingness-to-pay threshold was set at $50 000 per quality-adjusted life-year. At our base case estimates, initial treatment of recurrent CDI using FMT colonoscopy was the most cost-effective strategy, with an incremental cost-effectiveness ratio of $17 016 relative to oral vancomycin. Fidaxomicin and metronidazole were both dominated by FMT colonoscopy. On sensitivity analysis, FMT colonoscopy remained the most cost-effective strategy at cure rates >88.4% and CDI recurrence rates <14.9%. Fidaxomicin required a cost <$1359 to meet our cost-effectiveness threshold. In clinical settings where FMT is not available or applicable, the preferred strategy appears to be initial treatment with oral vancomycin. In this decision analysis examining treatment strategies for recurrent CDI, we demonstrate that FMT colonoscopy is the most cost-effective initial strategy for management of recurrent CDI.

Effectiveness of Emergency Department Based Palliative Care for Adults with Advanced Disease: A Systematic Review

PubMed Central

Nunes, Cristina Moura; Gomes, Barbara

2016-01-01

Abstract Background: Emergency departments (EDs) are seeing more patients with palliative care (PC) needs, but evidence on best practice is scarce. Objectives: To examine the effectiveness of ED-based PC interventions on hospital admissions (primary outcome), length of stay (LOS), symptoms, quality of life, use of other health care services, and PC referrals for adults with advanced disease. Methods: We searched five databases until August 2014, checked reference lists/conference abstracts, and contacted experts. Eligible studies were controlled trials, pre-post studies, cohort studies, and case series reporting outcomes of ED-based PC. Results: Five studies with 4374 participants were included: three case series and two cohort studies. Interventions included a screening tool, traditional ED-PC, and integrated ED-PC. Two studies reported on hospital admissions: in one study there was no statistically significant difference in 90-day readmission rates between patients who initiated integrated PC at the ED (11/50 patients, 22%) compared to those who initiated PC after hospital admission (179/1385, 13%); another study showed a high admission rate (90%) in 14 months following ED-PC, but without comparison. One study showed an LOS reduction (mean 4.32 days in ED-initiated PC group versus 8.29 days in postadmission-initiated group; p < 0.01). There was scarce evidence on other outcomes except for conflicting findings on survival: in one study, ED-PC patients were more likely to experience an interval between ED presentation and death >9 hours (OR 2.75, 95% CI 2.21–3.41); another study showed increased mortality risk in the intervention group; and a case series described a higher in-hospital death rate when PC was ED-initiated (62%), compared to ward (16%) or ICU (50%) (unknown p-value). Conclusions: There is yet no evidence that ED-based PC affects patient outcomes except for indication from one study of no association with 90-day hospital readmission but a possible reduction in LOS if integrated PC is introduced early at ED rather than after hospital admission. There is an urgent need for trials to confirm these findings alongside other potential benefits and survival effects. PMID:27115914

Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction.

PubMed

Sabin, C A; d'Arminio Monforte, A; Friis-Moller, N; Weber, R; El-Sadr, W M; Reiss, P; Kirk, O; Mercie, P; Law, M G; De Wit, S; Pradier, C; Phillips, A N; Lundgren, J D

2008-04-01

Because of the known relationship between exposure to combination antiretroviral therapy and cardiovascular disease (CVD), it has become increasingly important to intervene against risk of CVD in human immunodeficiency virus (HIV)-infected patients. We evaluated changes in risk factors for CVD and the use of lipid-lowering therapy in HIV-infected individuals and assessed the impact of any changes on the incidence of myocardial infarction. The Data Collection on Adverse Events of Anti-HIV Drugs Study is a collaboration of 11 cohorts of HIV-infected patients that included follow-up for 33,389 HIV-infected patients from December 1999 through February 2006. The proportion of patients at high risk of CVD increased from 35.3% during 1999-2000 to 41.3% during 2005-2006. Of 28,985 patients, 2801 (9.7%) initiated lipid-lowering therapy; initiation of lipid-lowering therapy was more common for those with abnormal lipid values and those with traditional risk factors for CVD (male sex, older age, higher body mass index [calculated as the weight in kilograms divided by the square of the height in meters], family and personal history of CVD, and diabetes mellitus). After controlling for these, use of lipid-lowering drugs became relatively less common over time. The incidence of myocardial infarction (0.32 cases per 100 person-years [PY]; 95% confidence interval [CI], 0.29-0.35 cases per 100 PY) appeared to remain stable. However, after controlling for changes in risk factors for CVD, the rate decreased over time (relative rate in 2003 [compared with 1999-2000], 0.73 cases per 100 PY [95% CI, 0.50-1.05 cases per 100 PY]; in 2004, 0.64 cases per 100 PY [95% CI, 0.44-0.94 cases per 100 PY]; in 2005-2006, 0.36 cases per 100 PY [95% CI, 0.24-0.56 cases per 100 PY]). Further adjustment for lipid levels attenuated the relative rates towards unity (relative rate in 2003 [compared with 1999-2000], 1.06 cases per 100 PY [95% CI, 0.63-1.77 cases per 100 PY]; in 2004, 1.02 cases per 100 PY [95% CI, 0.61-1.71 cases per 100 PY]; in 2005-2006, 0.63 cases per 100 PY [95% CI, 0.36-1.09 cases per 100 PY]). Although the CVD risk profile among patients in the Data Collection on Adverse Events of Anti-HIV Drugs Study has decreased since 1999, rates have remained relatively stable, possibly as a result of a more aggressive approach towards managing the risk of CVD.

Pneumocystis pneumonia outbreak among renal transplant recipients at a North American transplant center: Risk factors and implications for infection control.

PubMed

Mulpuru, Sunita; Knoll, Greg; Weir, Colleen; Desjardins, Marc; Johnson, Daniel; Gorn, Ivan; Fairhead, Todd; Bissonnette, Janice; Bruce, Natalie; Toye, Baldwin; Suh, Kathryn; Roth, Virginia

2016-04-01

Pneumocystis pneumonia is a severe opportunistic fungal infection. Outbreaks among renal transplant recipients have been reported in Europe and Japan, but never in North America. We conducted a retrospective case-control study among adult renal transplant recipients at a Canadian center, using a 3:1 matching scheme. Ten cases and 30 controls were matched based on initial transplantation date, and all patients received prophylaxis with trimethoprim-sulfamethoxazole for 1 year posttransplantation. The median time between transplantation and infection was 10.2 years, and all patients survived. Compared with controls, case patients had statistically lower estimated glomerular filtration rate (29.3 mL/min vs 66.3 mL/min; P = .028) and lymphopenia (0.51 × 10(9)/L vs 1.25 × 10(9)/L; P = .002). Transmission mapping revealed significant overlap in the clinic and laboratory visits among case vs control patients (P = .0002). One hundred percent of patients (4 out of 4) successfully genotyped had the same strain of Pneumocystis jirovecii. Our study demonstrated an outbreak of pneumocystis more than 10 years following initial transplantation, despite using recommended initial prophylaxis. We identified low estimated glomerular filtration rate and lymphopenia as risk factors for infection. Overlapping ambulatory care visits were identified as important potential sources of infection transmission, suggesting that institutions should re-evaluate policy and infrastructure strategies to interrupt transmission of respiratory pathogens. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Evolving Pedagogical Perceptions of Teachers Integrating Ubiquitous Computing in Their Classrooms: A Case Study of the South Dakota Laptop Program

ERIC Educational Resources Information Center

Pogany, Wade S.

2009-01-01

With technology changing the world at a rapid rate, the impact of ubiquitous computing in the classroom has had an influence on education. As the number of one-to-one laptop initiatives grows, the need for further research on the effects of teaching and learning also increases. This case study sought to examine changes in teaching that resulted…

Comparison of the initial development of shear layers in two-dimensional and axisymmetric ejector configurations

NASA Technical Reports Server (NTRS)

Dufflocq, M.; Benjamin, M. A.; Roan, V. P.

1993-01-01

A two-phase experimental investigation designed to study the development of shear layers in axisymmetric and two-dimensional single-nozzle ejectors has been completed. In this study, combinations of similar and dissimilar gases were used as the supersonic primary and subsonic secondary. Test cases included combinations of air/air, argon/air and helium/air as the supersonic primary and subsonic secondary, respectively. Similar flow conditions were studied for each ejector configuration. Mixing of the gases occurred in a constant-area tube, where the inlet pressure was maintained at 34.5 kPa. The cases studied resulted in convective Mach numbers that range between 0.06 and 1.9. The data gathered shows differences between the initial shear-layer development for the two ejector geometries, and also between the different test cases studied for each ejector configuration. The measured growth rates for the axisymmetric ejector are more than twice those measured for the two-dimensional ejector. However, in both cases the results show that compressibility has a reducing effect on the growth rate. Further, in the region immediately after the inlet to the mixing tube, compressibility seems to affect the ejector shear layers in a manner similar to that of two-stream two-dimensional mixing layers.

ITER Side Correction Coil Quench model and analysis

NASA Astrophysics Data System (ADS)

Nicollet, S.; Bessette, D.; Ciazynski, D.; Duchateau, J. L.; Gauthier, F.; Lacroix, B.

2016-12-01

Previous thermohydraulic studies performed for the ITER TF, CS and PF magnet systems have brought some important information on the detection and consequences of a quench as a function of the initial conditions (deposited energy, heated length). Even if the temperature margin of the Correction Coils is high, their behavior during a quench should also be studied since a quench is likely to be triggered by potential anomalies in joints, ground fault on the instrumentation wires, etc. A model has been developed with the SuperMagnet Code (Bagnasco et al., 2010) for a Side Correction Coil (SCC2) with four pancakes cooled in parallel, each of them represented by a Thea module (with the proper Cable In Conduit Conductor characteristics). All the other coils of the PF cooling loop are hydraulically connected in parallel (top/bottom correction coils and six Poloidal Field Coils) are modeled by Flower modules with equivalent hydraulics properties. The model and the analysis results are presented for five quench initiation cases with/without fast discharge: two quenches initiated by a heat input to the innermost turn of one pancake (case 1 and case 2) and two other quenches initiated at the innermost turns of four pancakes (case 3 and case 4). In the 5th case, the quench is initiated at the middle turn of one pancake. The impact on the cooling circuit, e.g. the exceedance of the opening pressure of the quench relief valves, is detailed in case of an undetected quench (i.e. no discharge of the magnet). Particular attention is also paid to a possible secondary quench detection system based on measured thermohydraulic signals (pressure, temperature and/or helium mass flow rate). The maximum cable temperature achieved in case of a fast current discharge (primary detection by voltage) is compared to the design hot spot criterion of 150 K, which includes the contribution of helium and jacket.

Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.

PubMed

Salvatori, Renata; Rowe, Robert H; Osborne, Raine; Beneciuk, Jason M

2014-06-01

Case report. Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.

The assessment of ionising radiation impact on the cooling pond freshwater ecosystem non-human biota from the Ignalina NPP operation beginning to shut down and initial decommissioning.

PubMed

Mazeika, J; Marciulioniene, D; Nedveckaite, T; Jefanova, O

2016-01-01

The radiological doses to non-human biota of freshwater ecosystem in the Ignalina NPP cooling pond - Lake Druksiai were evaluated for several cases including the plant's operation period and initial decommissioning activities, using the ERICA 1.2 code with IAEA SRS-19 models integrated approach and tool. Among the Lake Druksiai freshwater ecosystem reference organisms investigated the highest exposure dose rate was determined for bottom fauna - benthic organisms (mollusc-bivalves, crustaceans, mollusc-gastropods, insect larvae), and among the other reference organisms - for vascular plants. The mean and maximum total dose rate values due to anthropogenic radionuclide ionising radiation impact in all investigated cases were lower than the ERICA screening dose rate value of 10 μGy/h. The main exposure of reference organisms as a result of Ignalina NPP former effluent to Lake Druksiai is due to ionizing radiation of radionuclides (60)Co and (137)Cs, of predicted releases to Lake Druksiai during initial decommissioning period - due to radionuclides (60)Co, (134)Cs and (137)Cs, and as a result of predicted releases to Lake Druksiai from low- and intermediate-level short-lived radioactive waste disposal site in 30-100 year period - due to radionuclides (99)Tc and (3)H. The risk quotient expected values in all investigated cases were <1, and therefore the risk to non-human biota can be considered negligible with the exception of a conservative risk quotient for insect larvae. Radiological protection of non-human biota in Lake Druksiai, the Ignalina NPP cooling pond, is both feasible and acceptable. Copyright © 2015 Elsevier Ltd. All rights reserved.

Success rates for initial eradication of peri-prosthetic knee infection treated with a two-stage procedure.

PubMed

Kaminski, Andrzej; Citak, Mustafa; Schildhauer, Thomas Armin; Fehmer, Tobias

2014-01-01

In Germany, rates of primary total knee arthroplasty procedures and exchange arthroplasty procedures continue to rise. Late-onset peri-prosthetic infection constitutes a serious complication whose management may be dependent upon the spectrum of micro-organisms involved. The aim of this study was to provide a retrospective analysis of the effectiveness of initial eradication measures performed as part of a two-stage procedure. Between 2002 and 2008, a total of 328 patients who had received a first-time diagnosis of chronic peri-prosthetic knee infection following total knee arthroplasty (TKA) subsequently underwent surgery at our clinic. The surgical approach consisted of a two-stage procedure, with the initial procedure consisting of the removal of the prosthesis and radical debridement, followed by insertion of an antibiotic-loaded static spacer. The effectiveness of the procedure was assessed after six weeks, with each patient undergoing a number of clinical and laboratory-based tests, including knee joint aspiration. Staphylococcus aureus strains were responsible for 68% (n=223) of the total number of cases of peri-prosthetic knee infection. 19% of cases (n=62) showed evidence of gram-negative bacteria, while MRSA accounted for 15% (n=49) of cases. Six weeks after completion of the above-named treatment regimen, eradication of infection was considered successful in 289 patients (88.1%). Eradication was unsuccessful in 22% of MRSA infections (n=11) and 7% of MSSA infections (n=23). The treatment regimen outlined in this report is capable of achieving satisfactory results in the management of late-onset peri-prosthetic knee infection, with one exception: patients with infections caused by MRSA showed high failure rates.

Building a model for day case hiatal surgery - Lessons learnt over a 10 year period in a high volume unit: A case series.

PubMed

Mistry, Pritesh; Zaman, Shafquat; Shapey, Iestyn; Daskalakis, Markos; Nijjar, Rajwinder; Richardson, Martin; Super, Paul; Singhal, Rishi

2018-06-01

Laparoscopic anti-reflux surgery has become the standard treatment for symptomatic gastro-oesophageal reflux disease refractory to medical therapy. Successful anti-reflux surgery involves safe, minimally invasive surgery, resulting in symptom resolution with minimal side effects. This study aims to assess the feasibility and safety of day case anti-reflux surgery focussing on peri- and post-operative outcomes as a measure of success. Data was collected from the hospital database from 2003 to 2012. Data collection included demographics, surgeon, mode of admission, length of stay and complications. Electronic records were independently scrutinised for all patients with a length of stay of more than two nights. 723 patients underwent laparoscopic fundoplication ± small hiatus hernia repair (<5 cm) with a day case rate of 67.1%. The 30 day readmission rate in these patients was 2.9% (21/723 patients). Nine patients had a failure of their initial laparoscopic fundoplication (defined as recurrence of symptoms). Three patients required a re-operation within 12 months of their initial procedure (re-operation rate = 0.41% (3/723 patients)). Laparoscopic hiatal surgery can be performed safely as a day case in high volume specialist centres with good outcomes. Raising the national standard for day case fundoplication promotes good practice and should be the model for future commissioning. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

A multi-institutional survey of interventional radiology for type II endoleaks after endovascular aortic repair: questionnaire results from the Japanese Society of Endoluminal Metallic Stents and Grafts in Japan.

PubMed

Ogawa, Yukihisa; Nishimaki, Hiroshi; Osuga, Keigo; Ikeda, Osamu; Hongo, Norio; Iwakoshi, Shinichi; Kawasaki, Ryota; Woodhams, Reiko; Yamaguchi, Masato; Kamiya, Mika; Kanematsu, Masayuki; Honda, Masanori; Kaminou, Toshio; Koizumi, Jun; Kichikawa, Kimihiko

2016-08-01

To investigate the current status of interventional radiology (IR) procedures for a type II endoleak (T2EL) in Japan, and to identify the technical aspects that affect treatment results. A retrospective survey was conducted by distributing questionnaires to 25 institutions. The eligibility criteria were endovascular aortic repair (EVAR) performed using commercial stent grafts and IR performed for T2EL between January 2007 and December 2013. Technical success was defined as disappearance of the EL on digital subtraction angiography immediately after embolization, and imaging success was defined as no EL on contrast-enhanced computed tomography within 6 months. Statistical comparisons of the number of involved branches, embolization level, embolic material, and changes in aneurysm size were made between the imaging success and imaging failure groups. The technical and imaging success rates were also compared between the initial therapy and repeat groups. A total of 166 cases were investigated. Initial therapy was performed in 147 cases (88.6 %), with repeat therapy in 19 cases (11.4 %). Transcatheter arterial embolization (TAE) was used most frequently, in 161 cases (97 %), with direct puncture (DP) used in 5 cases (3 %). Both coil embolization for the branches and NBCA embolization for the sac were frequently chosen. The technical success rate was 83.2 % (TAE group), and the imaging success rate was 46.5 % (TAE + DP groups). Branch + sac embolization was performed more frequently in the imaging success group. There was no significant difference in the number of involved branches or embolic material between the imaging success and imaging failure groups. Enlargement of the aneurysm was more frequently seen in the imaging failure group. There were no significant differences in the technical success and imaging success rates between the initial therapy and repeat groups. This is the first report of a multi-institutional questionnaire survey of IR procedures for T2EL after EVAR in Japan that was conducted to determine the current status. Enlargement of aneurysm size after embolization was more frequently seen in the imaging failure group. It is important to embolize both branch and sac to achieve imaging success, regardless of embolic material. Long-term outcomes need to be investigated.

[Usefulness of sputum Gram staining in community-acquired pneumonia].

PubMed

Sato, Tadashi; Aoshima, Masahiro; Ohmagari, Norio; Tada, Hiroshi; Chohnabayashi, Naohiko

2002-07-01

To evaluate the usefulness of sputum gram staining in community-acquired pneumonia (CAP), we reviewed 144 cases requiring hospitalization in the last 4 years. The sensitivity was 75.5%, specificity 68.2%, positive predictive value 74.1%, negative predictive value 69.8%, positive likelihood ratio 2.37, negative likelihood ratio 0.36 and accuracy 72.2% in 97 cases. Both sputum gram staining and culture were performed. Concerning bacterial pneumonia (65 cases), we compared the Gram staining group (n = 33), which received initial antibiotic treatment, based on sputum gram staining with the Empiric group (n = 32) that received antibiotics empirically. The success rates of the initial antibiotic treatment were 87.9% vs. 78.1% (P = 0.473); mean hospitalization periods were 9.67 vs. 11.75 days (P = 0.053); and periods of intravenous therapy were 6.73 vs. 7.91 days (P = 0.044), respectively. As for initial treatment, penicillins were used in the Gram staining group more frequently (P < 0.01). We conclude that sputum gram staining is useful for the shortening of the treatment period and the appropriate selection of initial antibiotics in bacterial pneumonia. We believe, therefore, that sputum gram staining is indispensable as a diagnostic tool CAP.

[Spontaneous splenic rupture in the course of infectious mononucleosis].

PubMed

Irga, Ninela; Mierzejewska, Marta; Balcerska, Anna

2006-01-01

Spontaneous splenic rupture (SSR) in the course of infectious mononucleosis (IM) is a rare but potentially fatal complication. Mortality rate is relatively high, therefore emergency splenectomy is a life-saving intervention. In case of undergoing urgent operation there is no possibility to initiate proper prophylaxis of overwhelming infection. The humoral and cellular immunologic response impairment is a reason for life-threatening complications of splenectomised person. Asplenic children should receive infection prophylaxis immediately post splenectomy. We report two cases of splenic rupture inpatients with IM. The prevention of infection was initiated in both children. The mainstays of prophylaxis are: immunization, chemoprophylaxis and education. Complex information concerning asplenia-related subjects should be provided for patients and their parents.

Massive Hemorrhage from Ectopic Duodenal Varices: Importance of a Multidisciplinary Approach

PubMed Central

House, Tyler; Webb, Patrick; Baarson, Chad

2017-01-01

Duodenal variceal bleeding is an uncommon complication of portal hypertension that can easily go unrecognized and reach mortality rates as high as 40%. Cirrhosis is the most common cause of duodenal varices. In most cases, duodenal varices occur concomitantly with esophageal varices, further complicating identification with initial endoscopy. Although many modalities have been explored with respect to management and treatment approaches, guidelines have yet to be established owing to the infrequency in which bleeding occurs from ectopic duodenal varices. We present a case of massive duodenal variceal hemorrhage that highlights the complexity of initial diagnosis and ultimately required a transesophageal intrahepatic portosystemic shunt with coil embolization for control of bleeding. PMID:28203136

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes

PubMed Central

Harris, Michael; Frey, Peter; Esteva, Magdalena; Gašparović Babić, Svjetlana; Marzo-Castillejo, Mercè; Petek, Davorina; Petek Ster, Marija; Thulesius, Hans

2017-01-01

Objective European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting A total of 14 countries. Subjects Consensus groups of PCPs. Main outcome measures Probability of initial presentation to a PCP for four clinical vignettes. Results There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = −0.16, 95% CI −0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI −0.83 to −0.12; ovary: r = −0.13, 95% CI −0.57 to 0.38; breast r = 0.14, 95% CI −0.36 to 0.58; bowel: r = 0.20, 95% CI −0.31 to 0.62). Conclusions There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. Key points European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival. PMID:28277044

Transient Effects in Planar Solidification of Dilute Binary Alloys

NASA Technical Reports Server (NTRS)

Mazuruk, Konstantin; Volz, Martin P.

2008-01-01

The initial transient during planar solidification of dilute binary alloys is studied in the framework of the boundary integral method that leads to the non-linear Volterra integral governing equation. An analytical solution of this equation is obtained for the case of a constant growth rate which constitutes the well-known Tiller's formula for the solute transient. The more physically relevant, constant ramping down temperature case has been studied both numerically and analytically. In particular, an asymptotic analytical solution is obtained for the initial transient behavior. A numerical technique to solve the non-linear Volterra equation is developed and the solution is obtained for a family of the governing parameters. For the rapid solidification condition, growth rate spikes have been observed even for the infinite kinetics model. When recirculating fluid flow is included into the analysis, the spike feature is dramatically diminished. Finally, we have investigated planar solidification with a fluctuating temperature field as a possible mechanism for frequently observed solute trapping bands.

Human papillomavirus vaccine initiation in Asian Indians and Asian subpopulations: a case for examining disaggregated data in public health research.

PubMed

Budhwani, H; De, P

2017-12-01

Vaccine disparities research often focuses on differences between the five main racial and ethnic classifications, ignoring heterogeneity of subpopulations. Considering this knowledge gap, we examined human papillomavirus (HPV) vaccine initiation in Asian Indians and Asian subpopulations. National Health Interview Survey data (2008-2013), collected by the National Center for Health Statistics, were analyzed. Multiple logistic regression analysis was conducted on adults aged 18-26 years (n = 20,040). Asian Indians had high income, education, and health insurance coverage, all positive predictors of preventative health engagement and vaccine uptake. However, we find that Asian Indians had comparatively lower rates of HPV vaccine initiation (odds ratio = 0.41; 95% confidence interval = 0.207-0.832), and foreign-born Asian Indians had the lowest rate HPV vaccination of all subpopulations (2.3%). Findings substantiate the need for research on disaggregated data rather than evaluating vaccination behaviors solely across standard racial and ethnic categories. We identified two populations that were initiating HPV vaccine at abysmal levels: foreign-born persons and Asian Indians. Development of culturally appropriate messaging has the potential to improve these initiation rates and improve population health. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Long-term observation after radiotherapy for nasopharyngeal carcinoma (NPC).

PubMed

Chen, W Z; Zhou, D L; Luo, K S

1989-02-01

One thousand one hundred twenty-seven cases of nasopharyngeal carcinoma were treated with routine radiotherapy from October 1969 to March 1976, of which 436 cases have survived for more than 5 years, 323 cases have survived for over 10 years. The follow-up rate was 98.4%. The present paper analyzes the factors involved in these 436 cases. All patients were treated with tele60Co unit, and in the neck some cases were treated with orthovoltage therapy. The total dose to the primary lesion was 60-75 Gy in 6-8 weeks and in a few cases over 80 Gy were needed, and 50 Gy were applied bilateral cervical lymphatic chain. In this series of cases the 10-year overall survival rate was 28.7%, with Stage I being 66.7%, Stage II 46.5%, Stage III 28.0%, and Stage IV 18.6%, respectively. Statistically, 68 cases died of cardiovascular and other diseases and should be eliminated for net survival calculations. Therefore, we could obtain an actual 10-year survival rate of 30.5%. However, it should be noted that most of these cases were advanced, with Stage III, IV accounting for 82.3%, thus at Stage I, II the 10-year survival rate was 48%, while at Stage III, IV rate was down to 24.5%, which was statistically significant (p less than 0.01). Local and cervical recurrence as well as distant spread of diseases, for these cases started from the fifth to the tenth year after radiotherapy, the mortality caused by the above-mentioned three sites together was 76.9%. According to these findings, we propose that follow-up after radiotherapy in NPC exceeds 10-years. Of the 323 NPC cases, 10 were nasopharyngeal local recurrence which were re-irradiated, accounting for 3.1%. This paper shows that the 3-year survival rate in the local recurrence which were re-irradiated was 34.5%, the 5-year survival rate was 14.8%, and the 10-year survival rate was 11.5%. The failure after re-irradiation was caused by local recurrence and metastasis with a mortality of 83.6%. These results emphasize that the success of initial irradiation is important.

The interplay of climate, intervention and imported cases as determinants of the 2014 dengue outbreak in Guangzhou.

PubMed

Cheng, Qu; Jing, Qinlong; Spear, Robert C; Marshall, John M; Yang, Zhicong; Gong, Peng

2017-06-01

Dengue is a fast spreading mosquito-borne disease that affects more than half of the population worldwide. An unprecedented outbreak happened in Guangzhou, China in 2014, which contributed 52 percent of all dengue cases that occurred in mainland China between 1990 and 2015. Our previous analysis, based on a deterministic model, concluded that the early timing of the first imported case that triggered local transmission and the excessive rainfall thereafter were the most important determinants of the large final epidemic size in 2014. However, the deterministic model did not allow us to explore the driving force of the early local transmission. Here, we expand the model to include stochastic elements and calculate the successful invasion rate of cases that entered Guangzhou at different times under different climate and intervention scenarios. The conclusion is that the higher number of imported cases in May and June was responsible for the early outbreak instead of climate. Although the excessive rainfall in 2014 did increase the success rate, this effect was offset by the low initial water level caused by interventions in late 2013. The success rate is strongly dependent on mosquito abundance during the recovery period of the imported case, since the first step of a successful invasion is infecting at least one local mosquito. The average final epidemic size of successful invasion decreases exponentially with introduction time, which means if an imported case in early summer initiates the infection process, the final number infected can be extremely large. Therefore, dengue outbreaks occurring in Thailand, Singapore, Malaysia and Vietnam in early summer merit greater attention, since the travel volumes between Guangzhou and these countries are large. As the climate changes, destroying mosquito breeding sites in Guangzhou can mitigate the detrimental effects of the probable increase in rainfall in spring and summer.

The interplay of climate, intervention and imported cases as determinants of the 2014 dengue outbreak in Guangzhou

PubMed Central

Spear, Robert C.; Marshall, John M.; Yang, Zhicong

2017-01-01

Dengue is a fast spreading mosquito-borne disease that affects more than half of the population worldwide. An unprecedented outbreak happened in Guangzhou, China in 2014, which contributed 52 percent of all dengue cases that occurred in mainland China between 1990 and 2015. Our previous analysis, based on a deterministic model, concluded that the early timing of the first imported case that triggered local transmission and the excessive rainfall thereafter were the most important determinants of the large final epidemic size in 2014. However, the deterministic model did not allow us to explore the driving force of the early local transmission. Here, we expand the model to include stochastic elements and calculate the successful invasion rate of cases that entered Guangzhou at different times under different climate and intervention scenarios. The conclusion is that the higher number of imported cases in May and June was responsible for the early outbreak instead of climate. Although the excessive rainfall in 2014 did increase the success rate, this effect was offset by the low initial water level caused by interventions in late 2013. The success rate is strongly dependent on mosquito abundance during the recovery period of the imported case, since the first step of a successful invasion is infecting at least one local mosquito. The average final epidemic size of successful invasion decreases exponentially with introduction time, which means if an imported case in early summer initiates the infection process, the final number infected can be extremely large. Therefore, dengue outbreaks occurring in Thailand, Singapore, Malaysia and Vietnam in early summer merit greater attention, since the travel volumes between Guangzhou and these countries are large. As the climate changes, destroying mosquito breeding sites in Guangzhou can mitigate the detrimental effects of the probable increase in rainfall in spring and summer. PMID:28640895

Seminoma at Roswell Park, 1970 to 1979. An analysis of treatment failures.

PubMed

Huben, R P; Williams, P D; Pontes, J E; Panahon, A M; Murphy, G P

1984-04-01

A retrospective study of all cases of seminoma treated at Roswell Park Memorial Institute from 1970 through 1979 was conducted. Fifty-six evaluable patients treated initially with radiation therapy were seen during this period, and the overall survival rate at an average follow-up period of 52 months was 82%. The survival rate in patients with bulky abdominal or supradiaphragmatic metastases was only 33% (4 of 12 patients). Treatment failures were analyzed to determine their apparent causes and the implication of such failures to the future management of seminoma. The use of combination chemotherapy as the initial treatment modality in advanced seminoma is discussed in light of these results.

Products of the direct reaction of the diazonium ion of a metabolite of the carcinogen N-nitrosomorpholine with purines of nucleosides and DNA.

PubMed

Zink, Charles N; Soissons, Nicolas; Fishbein, James C

2010-07-19

A number of putative purine nucleoside and nucleobase adducts of the diazonium ion derived from 3-hydroxy-N-nitrosomorpholine have been synthesized as dimethylacetals. These are converted, in most cases nearly quantitatively, to the aldehydes, or in two cases to their derivatives, on treatment with mild acid to yield standards for a quantitative investigation of alkylation of purine nucleosides and DNA by the above metabolite of the powerful carcinogen N-nitrosomorpholine. The stability of the resulting nucleobase ethoxyacetaldehyde (EA) adducts has been characterized under a number of conditions with respect to their propensity to decompose. The stabilities, compared to that of the previously characterized adduct of the model benzimidazole, are generally unexceptional. Deposition of adducts on purine nucleosides and DNA were quantified in reactions in which 3-hydroperoxy-N-nitrosomorpholine was reduced to the hydroxy metabolite by a water-soluble phosphine at 21 +/- 2 degrees C. The adduct profile is highly similar to that observed from simpler alpha-hydroxy metabolites of acyclic dialkylnitrosamines, with the three most abundant ethoxyacetaldehyde (EA) adducts in reactions of duplex DNA being N7-EA-Gua approximately O(6)-EA-Gua > N3-EA-Ade. The initial rate kinetics of formation of hydroxyethyl (HE) lesions from the initially formed EA lesions have been determined in the case of the major products in the cases of both the nucleoside and DNA adducts. The rates of formation of HE adducts are accelerated in DNA, relative to the nucleosides in the cases of the N7-EA-Ade, N7-EA-Gua, and O(6)-EA-Gua adducts by factors of 7, 14, and 54, respectively. The initial rates of depurination of the N3-EA-Ade, N7-EA-Gua, and N7-EA-Gua adducts have also been quantified, and they are unexceptional in comparison with what has been previously reported for simple alkyl adducts. The adduct profiles reported here stand in significant contrast to what has been reported previously for structurally closely related alpha-substituted cyclic nitrosamines. In part or whole, this may be due to methodological differences in the conduct of the present and previous reports.

NGO Partnerships in Using Ecotourism for Conservation: Systematic Review and Meta-Analysis.

PubMed

Romero-Brito, Tania P; Buckley, Ralf C; Byrne, Jason

2016-01-01

We analyse 214 cases worldwide where non-governmental organisations (NGOs) use ecotourism for conservation. Other stakeholders in these initiatives include local communities, the private sector, and government agencies. Stakeholder relationships determine NGO roles and project management structures and governance. We classified cases into 10 structural categories based on the initiating stakeholder and the NGO role, and used these categories to analyze geographic patterns and success factors. Most of the 214 cases are community-based (~170; 79%); most are in developing countries (190; 89%); and most are in protected areas (196; 91%). Frequencies of structural categories differ between continents. More cases in Latin America and Asia are initiated by NGOs and local communities, and more in Africa by the private sector. Case-study authors used a range of economic, socio-cultural and environmental criteria to judge whether projects were successful. At global scale, we found no significant association between project success and the involvement of private tourism entrepreneurs. Projects involving either local or international NGOs had higher success rates than those that involved both simultaneously. Future research could adopt political ecology approaches to examine: the factors that lead NGOs to adopt ecotourism enterprises; their internal decision-making processes and strategies; their interactions with the stakeholders involved; and their conservation goals and outcomes.

NGO Partnerships in Using Ecotourism for Conservation: Systematic Review and Meta-Analysis

PubMed Central

Romero-Brito, Tania P.; Byrne, Jason

2016-01-01

We analyse 214 cases worldwide where non-governmental organisations (NGOs) use ecotourism for conservation. Other stakeholders in these initiatives include local communities, the private sector, and government agencies. Stakeholder relationships determine NGO roles and project management structures and governance. We classified cases into 10 structural categories based on the initiating stakeholder and the NGO role, and used these categories to analyze geographic patterns and success factors. Most of the 214 cases are community-based (~170; 79%); most are in developing countries (190; 89%); and most are in protected areas (196; 91%). Frequencies of structural categories differ between continents. More cases in Latin America and Asia are initiated by NGOs and local communities, and more in Africa by the private sector. Case-study authors used a range of economic, socio-cultural and environmental criteria to judge whether projects were successful. At global scale, we found no significant association between project success and the involvement of private tourism entrepreneurs. Projects involving either local or international NGOs had higher success rates than those that involved both simultaneously. Future research could adopt political ecology approaches to examine: the factors that lead NGOs to adopt ecotourism enterprises; their internal decision-making processes and strategies; their interactions with the stakeholders involved; and their conservation goals and outcomes. PMID:27893800

Practical use of bone scan in patients with an osteoporotic vertebral compression fracture.

PubMed

Jun, Deuk Soo; An, Byoung Keun; Yu, Chang Hun; Hwang, Kyung Hoon; Paik, Je Won

2015-02-01

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

Ebola viral disease outbreak--West Africa, 2014.

PubMed

Dixon, Meredith G; Schafer, Ilana J

2014-06-27

On March 21, 2014, the Guinea Ministry of Health reported the outbreak of an illness characterized by fever, severe diarrhea, vomiting, and a high case-fatality rate (59%) among 49 persons. Specimens from 15 of 20 persons tested at Institut Pasteur in Lyon, France, were positive for an Ebola virus by polymerase chain reaction. Viral sequencing identified Ebola virus (species Zaïre ebolavirus), one of five viruses in the genus Ebolavirus, as the cause. Cases of Ebola viral disease (EVD) were initially reported in three southeastern districts (Gueckedou, Macenta, and Kissidougou) of Guinea and in the capital city of Conakry. By March 30, cases had been reported in Foya district in neighboring Liberia (1), and in May, the first cases identified in Sierra Leone were reported. As of June 18, the outbreak was the largest EVD outbreak ever documented, with a combined total of 528 cases (including laboratory-confirmed, probable, and suspected cases) and 337 deaths (case-fatality rate = 64%) reported in the three countries. The largest previous outbreak occurred in Uganda during 2000-2001, when 425 cases were reported with 224 deaths (case-fatality rate = 53%). The current outbreak also represents the first outbreak of EVD in West Africa (a single case caused by Taï Forest virus was reported in Côte d'Ivoire in 1994 [3]) and marks the first time that Ebola virus transmission has been reported in a capital city.

Transmission patterns of smallpox: systematic review of natural outbreaks in Europe and North America since World War II.

PubMed

Bhatnagar, Vibha; Stoto, Michael A; Morton, Sally C; Boer, Rob; Bozzette, Samuel A

2006-05-05

Because smallpox (variola major) may be used as a biological weapon, we reviewed outbreaks in post-World War II Europe and North America in order to understand smallpox transmission patterns. A systematic review was used to identify papers from the National Library of Medicine, Embase, Biosis, Cochrane Library, Defense Technical Information Center, WorldCat, and reference lists of included publications. Two authors reviewed selected papers for smallpox outbreaks. 51 relevant outbreaks were identified from 1,389 publications. The median for the effective first generation reproduction rate (initial R) was 2 (range 0-38). The majority outbreaks were small (less than 5 cases) and contained within one generation. Outbreaks with few hospitalized patients had low initial R values (median of 1) and were prolonged if not initially recognized (median of 3 generations); outbreaks with mostly hospitalized patients had higher initial R values (median 12) and were shorter (median of 3 generations). Index cases with an atypical presentation of smallpox were less likely to have been diagnosed with smallpox; outbreaks in which the index case was not correctly diagnosed were larger (median of 27.5 cases) and longer (median of 3 generations) compared to outbreaks in which the index case was correctly diagnosed (median of 3 cases and 1 generation). Patterns of spread during Smallpox outbreaks varied with circumstances, but early detection and implementation of control measures is a most important influence on the magnitude of outbreaks. The majority of outbreaks studied in Europe and North America were controlled within a few generations if detected early.

Modelling of the hole-initiated impact ionization current in the framework of hydrodynamic equations

NASA Astrophysics Data System (ADS)

Lorenzini, Martino; Van Houdt, Jan

2002-02-01

Several research papers have shown the feasibility of the hydrodynamic transport model to investigate impact ionization in semiconductor devices by means of mean-energy-dependent generation rates. However, the analysis has been usually carried out for the case of the electron-initiated impact ionization process and less attention has been paid to the modelling of the generation rate due to impact ionization events initiated by holes. This paper therefore presents an original model for the hole-initiated impact ionization in silicon and validates it by comparing simulation results with substrate currents taken from p-channel transistors manufactured in a 0.35 μm CMOS technology having three different channel lengths. The experimental data are successfully reproduced over a wide range of applied voltages using only one fitting parameter. Since the impact ionization of holes triggers the mechanism responsible for the back-bias enhanced gate current in deep submicron nMOS devices, the model can be exploited in the development of non-volatile memories programmed by secondary electron injection.

Overview of Medicaid capitation and case-management initiatives

PubMed Central

Freund, Deborah A.; Neuschler, Edward

1986-01-01

Case-management programs have grown in number and in acceptance in the Medicaid program since 1981. In this article, we review their structure and incentives as well as what is known about their impact on cost and use. These programs also have been difficult to implement, posing myriad management challenges for prepaid program managers and State administrators. We highlight the problems in the following areas: eligibility, enrollment, rate setting, and management information systems. PMID:10311923

Impact of treatment with pioglitazone on stroke outcomes: a real world database analysis.

PubMed

Morgan, Christopher Ll; Inzucchi, Silvio E; Puelles, Jorge; Jenkins-Jones, Sara; Currie, Craig J

2018-05-07

Randomised controlled trials have reported an association between pioglitazone and reduced incidence of stroke in type 2 diabetic (T2DM) and insulin-resistant populations. We investigated this association within a real-world database. T2DM patients initiating pioglitazone between 2000-2012 were extracted from the Clinical Practice Research Datalink (CPRD); a UK routine. Two non-exposed control cohorts were matched on age, gender, HbA1c, diabetes duration, stroke history, co-morbidities and prior T2DM regimen. Control cohort-1 comprised patients initiating a new T2DM therapy as their respective case initiated pioglitazone. Control cohort-2 remained on the same T2DM regimen as their respective case prior to the case initiating pioglitazone. The primary outcome was incident stroke; other outcomes included mortality, hospital length of stay and stroke recurrence. 4,234 pioglitazone patients matched to controls in cohort-1 and 3,604 in cohort-2. For the primary outcome there were significantly reduced hazard ratios (HRs) for cases:controls. Cohort 1, the HR was 0.627 (95% CI, 0.404-0.972) during the therapy period and 0.640 (0.485-0.843) over the entire observation period; respective HRs were 0.516 (0.336-0.794) and 0.773 (0.611-0.978) for cohort 2. There was no significant difference in 30-day mortality rate or rate of recurrent stroke. For hospitalised stroke events there was a significant difference in length of stay for patients discharged to usual residence (median 3.0 days versus 7.0 days; p=0.008) for control cohort-2 whilst on-treatment. In support of evidence from two large randomized trials, these observational data show that pioglitazone has a potent effect in reducing stroke events in patients with type 2 diabetes. This article is protected by copyright. All rights reserved.

Myotonic Dystrophy Initially Presenting as Tachycardiomyopathy Successful Catheter Ablation of Atrial Flutter

PubMed Central

Asbach, S.; Gutleben, K. J.; Dahlem, P.; Brachmann, J.; Nölker, G.

2010-01-01

Myotonic dystrophy is a genetic muscular disease that is frequently associated with cardiac arrhythmias. Bradyarrhythmias, such as sinus bradycardia and atrioventricular block, are more common than tachyarrhythmias. Rarely, previously undiagnosed patients with myotonic dystrophy initially present with a tachyarrhythmia. We describe the case of a 14-year-old boy, who was admitted to the hospital with clinical signs and symptoms of decompensated heart failure and severely reduced left ventricular function. Electrocardiography showed common-type atrial flutter with 2 : 1 conduction resulting in a heart rate of 160 bpm. Initiation of medical therapy for heart failure as well as electrical cardioversion led to a marked clinical improvement. Catheter ablation of atrial flutter was performed to prevent future cardiac decompensations and to prevent development of tachymyopathy. Left ventricular function normalized during followup. Genetic analysis confirmed the clinical suspicion of myotonic dystrophy as known in other family members in this case. PMID:20871860

High Rate of Awarding Compensation for Claims of Injuries Related to Clinical Trials by Pharmaceutical Companies in Japan: A Questionnaire Survey

PubMed Central

Kurihara, Chieko; Kusuoka, Hideo; Ono, Shunsuke; Kakee, Naoko; Saito, Kazuyuki; Takehara, Kenji; Tsujide, Kiyokazu; Nabeoka, Yuzo; Sakuhiro, Takuya; Aoki, Hiroshi; Morishita, Noriko; Suzuki, Chieko; Kachi, Shigeo; Kondo, Emiko; Komori, Yukiko; Isobe, Tetsu; Kageyama, Shigeru; Watanabe, Hiroshi

2014-01-01

Introduction International norms and ethical standards have suggested that compensation for research-related injury should be provided to injured research volunteers. However, statistical data of incidence of compensation claims and the rate of awarding them have been rarely reported. Method Questionnaire surveys were sent to pharmaceutical companies and medical institutions, focusing on industry-initiated clinical trials aiming at new drug applications (NDAs) on patient volunteers in Japan. Results With the answers from pharmaceutical companies, the incidence of compensation was 0.8%, including 0.06% of monetary compensation. Of the cases of compensation claims, 99% were awarded. In turn, with the answers from medical institutions, the incidence of compensation was 0.6%, including 0.4% of serious but not death cases, and 0.04% of death cases. Furthermore, most claims for compensation were initiated by medical institutions, rather than by the patients. On the other hand, with the answers from clinical trial volunteers, 3% of respondents received compensations. These compensated cases were 25% of the injuries which cannot be ruled out from the scope of compensation. Conclusion Our study results demonstrated that Japanese pharmaceutical companies have provided a high rate of compensation for clinical trial-related injuries despite the possibility of overestimation. In the era of global clinical development, our study indicates the importance of further surveys to find each country's compensation policy by determining how it is being implemented based on a survey of the actual status of compensation coming from statistical data. PMID:24416332

Reporting of Perioperative Adverse Events by Pediatric Anesthesiologists at a Tertiary Children's Hospital: Targeted Interventions to Increase the Rate of Reporting.

PubMed

Williams, Glyn D; Muffly, Matthew K; Mendoza, Julianne M; Wixson, Nina; Leong, Kit; Claure, Rebecca E

2017-11-01

Incident reporting systems (IRSs) are important patient safety tools for identifying risks and opportunities for improvement. A major IRS limitation is underreporting of incidents. Perioperative anesthesia IRSs have been established at multiple pediatric institutions and a national pediatric anesthesia IRS for perioperative serious adverse events (SAEs) is maintained by Wake Up Safe (WUS), a patient safety organization dedicated to pediatric anesthesia quality improvement. A confidential, electronic, perioperative IRS was instituted at our tertiary children's hospital, which is a WUS member. The primary study aim was to increase the rate of incident reporting by anesthesiologists at our institution through a series of interventions. The secondary aim was to characterize our reporting behavior relative to national practice by referencing SAE data from WUS. Perioperative adverse events reported over a 71-month period (November 2010 to September 2016) were categorized and the monthly reporting rates determined. Effects of 6 interventions targeted to increase the reporting rate were analyzed using control charts. Intervention 5 involved interviewing pediatric anesthesiologists to ascertain incident reporting barriers and motivators. A key driver diagram was developed and used to guide an improvement initiative. Incidents that fulfilled WUS criteria for SAEs were identified and categorized. SAE reporting rates over a 27-month period for 12 WUS member institutions were determined. 2689 perioperative adverse events were noted in 1980 of 72,384 anesthetics. Mean monthly adverse event case rate was 273 (95% confidence interval, 250-297) per 10,000 anesthetics. A subgroup involving 54,469 cases had 529 SAEs in 440 anesthetics; a mean monthly SAE case rate of 80 (95% confidence interval, 69-91) per 10,000 anesthetics. Cardiac, respiratory, and airway events predominated. Relative to WUS peer members, our institution is a high-reporting outlier. The rate of incident reporting per 10,000 anesthetics was sustainably increased from 149 ± 35 to 387 ± 73 (mean ± SD) after implementing mandatory IRS data entry and Intervention 5 quality improvement initiative. Barriers to reporting included concern for punitive repercussions, feelings of incompetence, poor education about what constitutes an event, lack of feedback, and the perception that reporting had no value. These were addressed by IRS education, cultivation of a culture of safety where reporting is encouraged, reporter feedback, and better inclusion of anesthesiologists in patient safety work. Electronic mandatory IRS data entry and an initiative to understand and address reporting barriers and motivators were associated with sustained increases in the adverse event reporting rate. These strategies to minimize underreporting enhance IRS value for learning and may be generalizable.

[Epidemiologic background and changes in patients infected with human papilloma virus].

PubMed

Ohta, M; Casanova, H; Mizuno, K; Kaseki, H; Niwa, K; Ishiko, H

1991-05-01

Contagion with certain types of HPV was supposed to have a causal relationship with cervical neoplasia of the uterus. The rate of prevalence of HPV was investigated in pre-cancer and cancer patients with uterine cervical smear using virapap or viratype. According to the cytologic classification, among those whose cytology was diagnosed as class I or II, were found a few positive HPV, however, in cases in classes cytology IIIa, III and IIIb, the positive rate turned out to be 22.5, 41 and 72.4%, respectively. About 65% of patients whose post-operative diagnosis was cervical carcinoma, had been found positive in the pre-operative HPV.DNA check up. The statistical profiles of virally infected subjects were regarded as slightly younger females with early onset of menarche. A higher positive rate was found in such groups such as unmarried single and divorced single women, career employees with special skills, housewives and dwellers in residential and commercial sections. The follow up study of HPV infection was checked with subjects with dysplasia, and no case was recognized in which initially HPV negative dysplasia turned to positive during the observation period. But, in about 50% of those checked, initially HPV positive dysplasia turned to negative, during the follow up period. In the cases with long term (more than 8 years) dysplasia which was followed up, only one out of 10 was found to be HPV positive, while in middle term (more than 2 years but less than 8 years) followed up dysplasia, the positive rate was calculated as 47.8%.

Air Defense Initiative Air-to-Air Engagement Analysis. Volume 2. Error Models and Simulation for Case I: Pre-Launch Coordination Without Post-Launch Updates

DTIC Science & Technology

1991-03-08

acceleration and angular rates (produced by roll, pitch. and yaw motions) experienced by the LP. 12 ___________________________________ Synetics Table 3 2...at time tlP,INIT. The corresponding n-frame to b-frame D(’NI is: Cb(t) = L.q(Y’LP,INIT). (A.30) 41). (’onipute angular rates: The angular rates with...respect to inertial space (p, q, and r) are computed from the angular rates with respect to the n-frame (P, Q, and R), which in turn are computed from

Case-mix adjustment and the comparison of community health center performance on patient experience measures.

PubMed

Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

2010-06-01

To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

Initial Investigation on the Aerodynamic Performance of Flapping Wings for Nano Air Vehicles

DTIC Science & Technology

2008-02-01

Experiments with Primitive Equations”, Monthly Weather Review, 93:99-164, 1963. 36. Yuan, W., Schilling, R., “Numerical Simulation of the Draft Tube and...LE and TE wake vorticity – Fully flexible wake – Linear approximation of Kutta condition yields a linear system of equations at each time step...all cases one must consider the drain rate. High drain rates substantially diminish capacity! Some batteries simply not capable of delivering

Cost-effectiveness of Competing Strategies for Management of Recurrent Clostridium difficile Infection: A Decision Analysis

PubMed Central

Konijeti, Gauree G.; Sauk, Jenny; Shrime, Mark G.; Gupta, Meera; Ananthakrishnan, Ashwin N.

2014-01-01

Background. Clostridium difficile infection (CDI) is an important cause of morbidity and healthcare costs, and is characterized by high rates of disease recurrence. The cost-effectiveness of newer treatments for recurrent CDI has not been examined, yet would be important to inform clinical practice. The aim of this study was to analyze the cost effectiveness of competing strategies for recurrent CDI. Methods. We constructed a decision-analytic model comparing 4 treatment strategies for first-line treatment of recurrent CDI in a population with a median age of 65 years: metronidazole, vancomycin, fidaxomicin, and fecal microbiota transplant (FMT). We modeled up to 2 additional recurrences following the initial recurrence. We assumed FMT delivery via colonoscopy as our base case, but conducted sensitivity analyses based on different modes of delivery. Willingness-to-pay threshold was set at $50 000 per quality-adjusted life-year. Results. At our base case estimates, initial treatment of recurrent CDI using FMT colonoscopy was the most cost-effective strategy, with an incremental cost-effectiveness ratio of $17 016 relative to oral vancomycin. Fidaxomicin and metronidazole were both dominated by FMT colonoscopy. On sensitivity analysis, FMT colonoscopy remained the most cost-effective strategy at cure rates >88.4% and CDI recurrence rates <14.9%. Fidaxomicin required a cost <$1359 to meet our cost-effectiveness threshold. In clinical settings where FMT is not available or applicable, the preferred strategy appears to be initial treatment with oral vancomycin. Conclusions. In this decision analysis examining treatment strategies for recurrent CDI, we demonstrate that FMT colonoscopy is the most cost-effective initial strategy for management of recurrent CDI. PMID:24692533

Attitude determination with three-axis accelerometer for emergency atmospheric entry

NASA Technical Reports Server (NTRS)

Garcia-Llama, Eduardo (Inventor)

2012-01-01

Two algorithms are disclosed that, with the use of a 3-axis accelerometer, will be able to determine the angles of attack, sideslip and roll of a capsule-type spacecraft prior to entry (at very high altitudes, where the atmospheric density is still very low) and during entry. The invention relates to emergency situations in which no reliable attitude and attitude rate are available. Provided that the spacecraft would not attempt a guided entry without reliable attitude information, the objective of the entry system in such case would be to attempt a safe ballistic entry. A ballistic entry requires three controlled phases to be executed in sequence: First, cancel initial rates in case the spacecraft is tumbling; second, maneuver the capsule to a heat-shield-forward attitude, preferably to the trim attitude, to counteract the heat rate and heat load build up; and third, impart a ballistic bank or roll rate to null the average lift vector in order to prevent prolonged lift down situations. Being able to know the attitude, hence the attitude rate, will allow the control system (nominal or backup, automatic or manual) to cancel any initial angular rates. Also, since a heat-shield forward attitude and the trim attitude can be specified in terms of the angles of attack and sideslip, being able to determine the current attitude in terms of these angles will allow the control system to maneuver the vehicle to the desired attitude. Finally, being able to determine the roll angle will allow for the control of the roll ballistic rate during entry.

Characteristics of Endophthalmitis after Cataract Surgery in the United States Medicare Population.

PubMed

Gower, Emily W; Keay, Lisa J; Stare, Dianne E; Arora, Pallavi; Cassard, Sandra D; Behrens, Ashley; Tielsch, James M; Schein, Oliver D

2015-08-01

Endophthalmitis is a rare but sight-threatening infection after cataract surgery. Roughly one third of eyes remain blind after treatment. We report United States population-based data on microbiological investigations and treatment patterns plus risk factors for poor outcomes. Retrospective cohort study. Medicare beneficiaries from 5 states in whom endophthalmitis developed within 6 weeks after cataract surgery in 2003 and 2004. We identified endophthalmitis cases occurring after cataract surgery using Medicare billing claims. We contacted treating physicians and requested they complete a questionnaire on clinical and microbiological data and submit relevant medical records. Two independent observers reviewed materials to confirm that cases met a standardized definition. Positive culture results, vitrectomy status, microbiology spectrum, and final visual acuity. In total, 615 cases met our case definition. Initial visual acuity was counting fingers or worse for 72%. Among 502 cases with known culture results, 291 (58%) had culture positive results. Twelve percent had positive results for streptococci. More than 99% of cases were treated with intravitreal vancomycin. Vitrectomy was performed in 279 cases (45%), including 201 cases with initial acuity better than light perception. Rates of vitrectomy varied across states, with California having the highest rate and Michigan having the lowest (56% and 19% of cases, respectively). Overall, 43% of individuals achieved visual acuity of 20/40 or better. Poor initial acuity (adjusted odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12 per 0.10 logarithm of the minimum angle of resolution units), older age at diagnosis (OR, 1.22; 95% CI, 1.03-1.45 per 5-year increase), and more virulent organisms were important predictors of poor final visual acuity. Cases with streptococci infection were 10 times more likely to have poor final acuity than coagulase-negative staphylococci cases (adjusted OR, 11.28; 95% CI, 3.63-35.03). Vitrectomy was not predictive of final visual acuity (adjusted OR, 1.26; 95% CI, 0.78-2.04). Population-based data on the microbiology of acute postoperative endophthalmitis in the United States after cataract surgery are consistent with prior reports. Vitrectomy usage is higher than that recommended from the Endophthalmitis Vitrectomy Study, with no evidence of increased benefit. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Recommended de minimis radiation dose rates for Canada. Report No. INFO-0355

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

Not Available

1990-01-01

A de minimis dose or dose rate as used in this report represents a level of risk which is generally accepted as being of no significance to an individual, or in the case of a population, of no significance to society. The report describes the risk of biological effects from radiation; radiation from natural and man-made sources; normal incidences of cancer and genetic defects; initiatives by other agencies in the U.S., the U.K. and internationally; the importance of collective dose and dose rate; assigning values to the de minimis dose rates; and application of the de minimis dose rates.

Effect of a relative phase of waves constituting the initial perturbation and the wave interference on the dynamics of strong-shock-driven Richtmyer-Meshkov flows

NASA Astrophysics Data System (ADS)

Pandian, Arun; Stellingwerf, Robert F.; Abarzhi, Snezhana I.

2017-07-01

While it is a common wisdom that initial conditions influence the evolution of the Richtmyer-Meshkov instability (RMI), the research in this area is focused primarily on the effects of the wavelength and amplitude of the interface perturbation. The information has hitherto largely ignored the influences on RMI dynamics of the relative phase of waves constituting a multiwave initial perturbation and the interference of the perturbation waves. In this work we systematically study the influence of the relative phase and the interference of waves constituting a multiwave initial perturbation on a strong-shock-driven Richtmyer-Meshkov unstable interface separating ideal fluids with contrast densities. We apply group theory analysis and smoothed particle hydrodynamics numerical simulations. For verification and validation of the simulations, qualitative and quantitative comparisons are performed with rigorous zeroth-order, linear, and nonlinear theories as well as with gas dynamics experiments achieving good agreement. For a sample case of a two-wave (two-mode) initial perturbation we select the first-wave amplitude enabling the maximum initial growth rate of the RMI and we vary the second-wave amplitude from 1% to 100% of the first-wave amplitude. We also vary the relative phase of the first and second waves and consider the in-phase, the antiphase and the random-phase cases. We find that the relative phase and the interference of waves are important factors of RMI dynamics influencing qualitatively and quantitatively the symmetry, morphology, and growth rate of the Richtmyer-Meshkov unstable interface, as well as the order and disorder in strong-shock-driven RMI.

Quantum walks of two interacting particles on percolation graphs

NASA Astrophysics Data System (ADS)

Siloi, Ilaria; Benedetti, Claudia; Piccinini, Enrico; Paris, Matteo G. A.; Bordone, Paolo

2017-10-01

We address the dynamics of two indistinguishable interacting particles moving on a dynamical percolation graph, i.e., a graph where the edges are independent random telegraph processes whose values jump between 0 and 1, thus mimicking percolation. The interplay between the particle interaction strength, initial state and the percolation rate determine different dynamical regimes for the walkers. We show that, whenever the walkers are initially localised within the interaction range, fast noise enhances the particle spread compared to the noiseless case.

3-ω damage threshold evaluation of final optics components using Beamlet Mule and off-line testing

NASA Astrophysics Data System (ADS)

Kozlowski, Mark R.; Maricle, Stephen M.; Mouser, Ron P.; Schwartz, Sheldon; Wegner, Paul J.; Weiland, Timothy L.

1999-07-01

A statistics-based model is being develop to predict the laser-damage-limited lifetime of UV optical components on the NIF laser. In order to provide data for the mode, laser damage experiments were performed on the Beamlet laser system at LLNL. An early protoype NIF focus lens was exposed to twenty 351 nm pulses at an average fluence of 5 J/cm2, 3ns. Using a high resolution optic inspection inspection system a total of 353 damage sites was detected within the 1160 cm2 beam aperture. Through inspections of the lens before, after and, in some cases, during the campaign, pulse to pulse damage growth rates were measured for damage initiating both on the surface and at bulk inclusions. Growth rates as high as 79 micrometers /pulse were observed for damage initiating at pre-existing scratches in the surface. For most damage sites on the optic, both on the surface and at bulk inclusions. Growth rates as high as 79 micrometers /pulse were observed for damage initiating at per- existing scratches in the surface. For most damage sites on the optic, both surface and bulk, the damage growth rate was approximately 10(Mu) m/pulse.

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

Kozlowski, M.F.; Maricle, S.; Mouser, R.

A statistics-based model is being developed to predict the laser-damage-limited lifetime of UV optical components on the NIF laser. In order to provide data for the model, laser damage experiments were performed on the Beamlet laser system at LLNL. An early prototype NIF focus lens was exposed to twenty 35 1 nm pulses at an average fluence of 5 J/cm{sup 2}, 3ns. Using a high resolution optic inspection system a total of 353 damage sites was detected within the 1160 cm{sup 2} beam aperture. Through inspections of the lens before, after and, in some cases, during the campaign, pulse tomore » pulse damage growth rates were measured for damage initiating both on the surface and at bulk inclusions. Growth rates as high as 79 {micro}m/pulse (surface diameter) were observed for damage initiating at pre-existing scratches in the surface. For most damage sites on the optic, both surface and bulk, the damage growth rate was approximately l0{micro}m/pulse. The lens was also used in Beamlet for a subsequent 1053 {micro}m/526 {micro}m campaign. The 352 {micro}m-initiated damage continued to grow during that campaign although at generally lower growth rate.« less

Heart rate changes during electroconvulsive therapy

PubMed Central

2013-01-01

Background This observational study documented heart rate over the entire course of electrically induced seizures and aimed to evaluate the effects of stimulus electrode placement, patients' age, stimulus dose, and additional predictors. Method In 119 consecutive patients with 64 right unilateral (RUL) and 55 bifrontal (BF) electroconvulsive treatments, heart rate graphs based on beat-to-beat measurements were plotted up to durations of 130 s. Results In RUL stimulation, the initial drop in heart rate lasted for 12.5 ± 2.6 s (mean ± standard deviation). This depended on stimulus train duration, age, and baseline heart rate. In seizures induced with BF electrode placement, a sympathetic response was observed within the first few seconds of the stimulation phase (median 3.5 s). This was also the case with subconvulsive stimulations. The mean peak heart rate in all 119 treatments amounted to 135 ± 20 bpm and depended on baseline heart rate and seizure duration; electrode placement, charge dose, and age were insignificant in regression analysis. A marked decline in heart rate in connection with seizure cessation occurred in 71% of treatments. Conclusions A significant independent effect of stimulus electrode positioning on cardiac action was evident only in the initial phase of the seizures. Electrical stimulation rather than the seizure causes the initial heart rate increase in BF treatments. The data reveal no rationale for setting the stimulus doses as a function of intraictal peak heart rates (‘benchmark method’). The marked decline in heart rate at the end of most seizures is probably mediated by a baroreceptor reflex. PMID:23764036

Non-equilibrium reactive flux: A unified framework for slow and fast reaction kinetics.

PubMed

Bose, Amartya; Makri, Nancy

2017-10-21

The flux formulation of reaction rate theory is recast in terms of the expectation value of the reactive flux with an initial condition that corresponds to a non-equilibrium, factorized reactant density. In the common case of slow reactive processes, the non-equilibrium expression reaches the plateau regime only slightly slower than the equilibrium flux form. When the reactants are described by a single quantum state, as in the case of electron transfer reactions, the factorized reactant density describes the true initial condition of the reactive process. In such cases, the time integral of the non-equilibrium flux expression yields the reactant population as a function of time, allowing characterization of the dynamics in cases where there is no clear separation of time scales and thus a plateau regime cannot be identified. The non-equilibrium flux offers a unified approach to the kinetics of slow and fast chemical reactions and is ideally suited to mixed quantum-classical methods.

Construction of social value or utility-based health indices: the usefulness of factorial experimental design plans.

PubMed

Cadman, D; Goldsmith, C

1986-01-01

Global indices, which aggregate multiple health or function attributes into a single summary indicator, are useful measures in health research. Two key issues must be addressed in the initial stages of index construction from the universe of possible health and function attributes, which ones should be included in a new index? and how simple can the statistical model be to combine attributes into a single numeric index value? Factorial experimental designs were used in the initial stages of developing a function index for evaluating a program for the care of young handicapped children. Beginning with eight attributes judged important to the goals of the program by clinicians, social preference values for different function states were obtained from 32 parents of handicapped children and 32 members of the community. Using category rating methods each rater scored 16 written multi-attribute case descriptions which contained information about a child's status for all eight attributes. Either a good or poor level of each function attribute and age 3 or 5 years were described in each case. Thus, 2(8) = 256 different cases were rated. Two factorial design plans were selected and used to allocate case descriptions to raters. Analysis of variance determined that seven of the eight clinician selected attributes were required in a social value based index for handicapped children. Most importantly, the subsequent steps of index construction could be greatly simplified by the finding that a simple additive statistical model without complex attribute interaction terms was adequate for the index. We conclude that factorial experimental designs are an efficient, feasible and powerful tool for the initial stages of constructing a multi-attribute health index.

Roles of human papillomavirus infection and stathmin in the pathogenesis of sinonasal inverted papilloma.

PubMed

Lin, Hai; Lin, Dong; Xiong, Xi-Sheng

2016-02-01

The purpose of this study was to investigate roles of human papillomavirus (HPV) infection and stathmin in sinonasal inverted papilloma (SNIP). HPV DNA detection was performed by the fluorescence-based polymerase chain reaction (PCR) method. Stathmin protein expression was investigated by the immunohistochemistry method and mRNA expression of stathmin, Kif2a, and cyclin D1 were assessed by real-time PCR in SNIP and control subjects. The positive rate of HPV DNA detected in SNIP was about 53.6% (15 of 28). Recurrent cases showed a higher rate of HPV infection compared with initial cases and higher Krouse stage (T3 + T4) cases showed higher rate of HPV infection than lower Krouse stage (T1 + T2) cases. Stronger expression of stathmin, Kif2a, and cyclin D1 were observed in SNIP, especially HPV(+) SNIP. HPV infection was closely associated with recurrence and progression of SNIP. Stathmin is a valuable prognostic marker and could be considered as a therapeutic target in patients with SNIP. © 2015 Wiley Periodicals, Inc.

Solute partitioning under continuous cooling conditions as a cooling rate indicator. [in lunar rocks

NASA Technical Reports Server (NTRS)

Onorato, P. I. K.; Hopper, R. W.; Yinnon, H.; Uhlmann, D. R.; Taylor, L. A.; Garrison, J. R.; Hunter, R.

1981-01-01

A model of solute partitioning in a finite body under conditions of continuous cooling is developed for the determination of cooling rates from concentration profile data, and applied to the partitioning of zirconium between ilmenite and ulvospinel in the Apollo 15 Elbow Crater rocks. Partitioning in a layered composite solid is described numerically in terms of concentration profiles and diffusion coefficients which are functions of time and temperature, respectively; a program based on the model can be used to calculate concentration profiles for various assumed cooling rates given the diffusion coefficients in the two phases and the equilibrium partitioning ratio over a range of temperatures. In the case of the Elbow Rock gabbros, the cooling rates are calculated from measured concentration ratios 10 microns from the interphase boundaries under the assumptions of uniform and equilibrium initial conditions at various starting temperatures. It is shown that the specimens could not have had uniform concentrations profiles at the previously suggested initial temperature of 1350 K. It is concluded that even under conditions where the initial temperature, grain sizes and solute diffusion coefficients are not well characterized, the model can be used to estimate the cooling rate of a grain assemblage to within an order of magnitude.

Association between outcome and changes in plasma lactate concentration during presurgical treatment in dogs with gastric dilatation-volvulus: 64 cases (2002-2008).

PubMed

Zacher, Laurie A; Berg, John; Shaw, Scott P; Kudej, Raymond K

2010-04-15

To determine whether changes in presurgical plasma lactate concentration (before and after initial fluid resuscitation and gastric decompression) were associated with short-term outcome for dogs with gastric dilatation-volvulus (GDV). Retrospective case series. 64 dogs. Medical records were reviewed, and signalment, history, resuscitative treatments, serial presurgical lactate concentrations, surgical findings, and short-term outcome were obtained for dogs with confirmed GDV. 36 of 40 (90%) dogs with an initial lactate concentration 9.0 mmol/L). Within HIL dogs, there was no difference in mean +/- SD initial lactate concentration between survivors and nonsurvivors (10.6 +/- 2.3 mmol/L vs 11.2 +/- 2.3 mmol/L, respectively); however, there were significant differences in post-treatment lactate concentration, absolute change in lactate concentration, and percentage change in lactate concentration following resuscitative treatment. By use of optimal cutoff values within HIL dogs, survival rates for dogs with final lactate concentration > 6.4 mmol/L (23%), absolute change in lactate concentration 4 mmol/L (86%), or percentage change in lactate concentration > 42.5% (100%). Calculating changes in plasma lactate concentration following initial treatment in dogs with GDV may assist in determining prognosis and identifying patients that require more aggressive treatment.

Effect of moisture content on fed batch composting reactor of vegetable and fruit wastes.

PubMed

Jolanun, B; Tripetchkul, S; Chiemchaisri, C; Chaiprasert, P; Towprayoon, S

2005-03-01

Vegetable and fruit wastes mixed with sawdust were composted in a laboratory scale reactor by controlling the waste feeding rate at 21 kg m(-3) day(-1) and aeration rate at 10.6 l m(-3) min(-1). The effects of initial moisture content on organic matter degradation and process performance of fed batch composting were investigated. The absolute amount of removal, removal percentage, and removal rate of dry mass obtained were substantially different among the initial moisture contents. The rapid rise of moisture content and the lowest absolute amount of removal observed were achieved in the 50% condition. The initial moisture content yielding the largest absolute amount of removal in both feeding and curing stage was 30% whereas the removal percentage and rate constant of waste decomposition were highest in the 50% condition. Examined by traditional soil physics method, the moisture content at 50-55% was suitable for satisfying the degree of free air space (65-70%) of compost during the fed batch composting. Most degradable organic matter was mainly consumed in the feeding stage as indicated by a higher removal rate of dry mass in all cases. It is recommended that the initial moisture content of 30% and mode of aeration and agitation should be adopted for achieving practical fed batch composting of vegetable and fruit wastes. The study also demonstrated that the composting kinetics of vegetable and fruit wastes mixed with sawdust can be described by a first order model.

Remission of relapsing polychondritis after successful treatment of myelodysplastic syndrome with azacitidine: a case and review of the literature.

PubMed

Erden, Abdulsamet; Bilgin, Emre; Kılıç, Levent; Sarı, Alper; Armağan, Berkan; Büyükaşık, Yahya; Kalyoncu, Umut

2018-05-01

Relapsing polychondritis (RP) is a rare autoimmune disorder, and myelodysplastic syndrome (MDS) is accompanied by RP at variable rates. Herein, we report a case with RP and MDS who responded dramatically to 5-azacitidine for MDS. With conventional immunosuppressive treatment, our patient had several episodes of different side effects, including infections. With the diagnosis of MDS and initiation of azacitidine treatment, all the manifestations of RP disappeared, and remission was achieved for MDS. Although he had relapses of either RP or MDS after several years of azacitidine treatment, all relapses were controlled well with the initiation of azacitidine treatment every time. Azacitidine should be kept in mind as a treatment option for RP patients with MDS.

Decay of solutions of the wave equation with arbitrary localized nonlinear damping

NASA Astrophysics Data System (ADS)

Bellassoued, Mourad

We study the problem of decay rate for the solutions of the initial-boundary value problem to the wave equation, governed by localized nonlinear dissipation and without any assumption on the dynamics (i.e., the control geometric condition is not satisfied). We treat separately the autonomous and the non-autonomous cases. Providing regular initial data, without any assumption on an observation subdomain, we prove that the energy decays at last, as fast as the logarithm of time. Our result is a generalization of Lebeau (in: A. Boutet de Monvel, V. Marchenko (Eds.), Algebraic and Geometric Methods in Mathematical Physics, Kluwer Academic Publishers, Dordrecht, the Netherlands, 1996, pp. 73) result in the autonomous case and Nakao (Adv. Math. Sci. Appl. 7 (1) (1997) 317) work in the non-autonomous case. In order to prove that result we use a new method based on the Fourier-Bross-Iaglintzer (FBI) transform.

Factors That Influence the Attrition of Mentors in Rural Areas

ERIC Educational Resources Information Center

Givens, Sharon Leenese

2012-01-01

This research is a qualitative case study exploring the factors that influence the attrition of mentors in rural areas. Mentoring initiatives and programs have proliferated throughout schools in an effort to provide students with positive role models, increase graduation rates and improve overall performance Mentoring programs are an increasingly…

Lymphogranuloma venereum rates increased and Chlamydia trachomatis genotypes changed among men who have sex with men in Sweden 2004-2016.

PubMed

Isaksson, Jenny; Carlsson, Ola; Airell, Åsa; Strömdahl, Susanne; Bratt, Göran; Herrmann, Björn

2017-11-01

This study aimed to determine the incidence of lymphogranuloma venereum (LGV) in Sweden since 2004 and to study in detail a consecutive number of Chlamydia trachomatis cases in men who have sex with men (MSM) during a 10 month period (September 2014 to July 2015). LGV increased from sporadic import cases in 2004 to comprise a spread within Sweden in 2016. Initially, only the L2b ompA genotype was detected, but in 2015 half of the genotyped LGV cases were L2 genotype. The changing genotype distribution in Sweden is linked to increased LGV spread in Europe. High-resolution multilocus sequence typing of 168 C. trachomatis cases from MSM in 2015 resulted in 29 sequence types, of which 3 accounted for 49 % of cases. The increased rates and different genotypes of LGV indicate that more concern for high-risk taking MSM is needed to avoid further spread of this invasive infection.

Graft survival of diabetic versus nondiabetic donor tissue after initial keratoplasty.

PubMed

Vislisel, Jesse M; Liaboe, Chase A; Wagoner, Michael D; Goins, Kenneth M; Sutphin, John E; Schmidt, Gregory A; Zimmerman, M Bridget; Greiner, Mark A

2015-04-01

To compare corneal graft survival using tissue from diabetic and nondiabetic donors in patients undergoing initial Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP). A retrospective chart review of pseudophakic eyes that underwent DSAEK or PKP was performed. The primary outcome measure was graft failure. Cox proportional hazard regression and Kaplan-Meier survival analyses were used to compare diabetic versus nondiabetic donor tissue for all keratoplasty cases. A total of 183 eyes (136 DSAEK, 47 PKP) were included in the statistical analysis. Among 24 procedures performed using diabetic donor tissue, there were 4 cases (16.7%) of graft failure (3 DSAEK, 1 PKP), and among 159 procedures performed using nondiabetic donor tissue, there were 18 cases (11.3%) of graft failure (12 DSAEK, 6 PKP). Cox proportional hazard ratio of graft failure for all cases comparing diabetic with nondiabetic donor tissue was 1.69, but this difference was not statistically significant (95% confidence interval, 0.56-5.06; P = 0.348). There were no significant differences in Kaplan-Meier curves comparing diabetic with nondiabetic donor tissue for all cases (P = 0.380). Statistical analysis of graft failure by donor diabetes status within each procedure type was not possible because of the small number of graft failure events involving diabetic tissue. We found similar rates of graft failure in all keratoplasty cases when comparing tissue from diabetic and nondiabetic donors, but further investigation is needed to determine whether diabetic donor tissue results in different graft failure rates after DSAEK compared with PKP.

A physician-led initiative to improve clinical documentation results in improved health care documentation, case mix index, and increased contribution margin.

PubMed

Aiello, Francesco A; Judelson, Dejah R; Durgin, Jonathan M; Doucet, Danielle R; Simons, Jessica P; Durocher, Dawn M; Flahive, Julie M; Schanzer, Andres

2018-05-04

Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin. A physician-led coding initiative to educate physicians on the documentation of comorbidities and conditions was initiated with concurrent chart review sessions with coding specialists for 3 months, and then as needed, after the creation of a vascular surgery documentation guide. Clinical documentation and billing for all carotid endarterectomy (CEA) and open infrainguinal procedures (OIPs) performed between January 2013 and July 2016 were stratified into precoding and postcoding initiative groups. Age, duration of stay, direct costs, actual reimbursements, contribution margin (CM), CMI, rate of complication or comorbidity, major complication or comorbidity, severity of illness, and risk of mortality assigned to each discharge were abstracted. Data were compared over time by standardizing Centers for Medicare and Medicaid Services (CMS) values for each diagnosis related group and using a CMS base rate reimbursement. Among 458 CEA admissions, postcoding initiative CEA patients (n = 253) had a significantly higher CMI (1.36 vs 1.25; P = .03), CM ($7859 vs $6650; P = .048), and CMS base rate reimbursement ($8955 vs $8258; P = .03) than precoding initiative CEA patients (n = 205). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (43% vs 27%; P < .01). Among 504 OIPs, postcoding initiative patients (n = 227) had a significantly higher CMI (2.23 vs 2.05; P < .01), actual reimbursement ($23,203 vs $19,909; P < .01), CM ($12,165 vs $8840; P < .01), and CMS base rate reimbursement ($14,649 vs $13,496; P < .01) than precoding initiative patients (n = 277). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (61% vs 43%; P < .01). For both CEA and OIPs, there were no differences in age, duration of stay, total direct costs, or primary insurance status between the precoding and postcoding patient groups. Accurate and detailed clinical documentation is required for key stakeholders to characterize the acuity of inpatient admissions and ensure appropriate reimbursement; it is also a key component of risk-adjustment methods for assessing quality of care. A physician-led documentation initiative significantly increased CMI and CM. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

[Abdominopelvic recurrence of leiomyosarcoma. Echographic aspects apropos of 19 cases].

PubMed

Capelle, J; Leclère, J

1986-01-01

The recurrence rate after initial surgery of pelvis and abdominal leiomyosarcomas is significant. Quick but silent growth of these tumors requires a regular and frequent follow-up in order to improve the prognosis. Ultrasonography is the simplest way for such a follow-up. We present our experience about 23 operated cases of leiomyosarcomas followed by ultrason; 19 of them recurred with 1 to 6 abdominal and/or pelvic masses. The echographic patterns of recurrences are detailed.

Nasopharyngeal carcinoma with headaches as the main symptom: A potential diagnostic pitfall.

PubMed

Wu, Zhou-Xue; Xiang, Li; Rong, Jin-Feng; He, Huai-Lin; Li, Dan

2016-01-01

The aim of this study was to investigate medical-related reasons for misdiagnosis of nasopharyngeal carcinoma. (NPC) patients presenting with headaches alone or accompanied by other symptoms. Two-hundred and nineteen NPC cases describing headaches as one of the initial symptoms during primary treatment were selected for this prospective study. Medical records were carefully collected and all data were summarized for final analyses. Distributions of NPC stage in the patients were: Stage II, 1.4%; stage III, 46.6%; stage IVA, 36.1%; stage IVB, 7.7%; and stage IVC, 8.2%. The ratio of men to women was 2.42:1 (155/64 cases). The total misdiagnosis rate was 43.4%. Patients that only complained of headaches had the highest misdiagnosis rate of 86.4% (19/22 cases). The lowest misdiagnosis rate of 10.9% (5/46 cases) was observed in patients with both headaches and epistaxis. The misdiagnosis rate in rural hospitals was more than two times that in provincial hospitals. Neurosurgery departments had a 100% misdiagnosis rate. Frequently, headaches are the only prominent symptom of NPC. Due to the various clinical manifestations, NPC patients encounter a high misdiagnosis rate, which leads to unsatisfactory treatment outcomes. Improved awareness of the various nonspecific symptoms of NPC by nonspecialist physicians will be a pivotal step in decreasing the misdiagnosis rate. Mini Abstract: The misdiagnosis rate of nasopharyngeal carcinoma (NPC) patients with headaches was 43.4%. Improved awareness of the various nonspecific symptoms of NPC is a pivotal step in decreasing the misdiagnosis rate.

Three years of experience: the Italian registry and safety data update.

PubMed

Mancardi, G L; Tedeschi, G; Amato, M P; D'Alessandro, R; Drago, F; Milanese, C; Popoli, P; Rossi, P; Savettieri, G; Tola, M R; Comi, G; Pozzilli, C; Bertolotto, A; Marrosu, M G; Grimaldi, L M E; Laroni, A; Vanacore, N; Covezzoli, A; De Rosa, M; Piccinni, C; Montanaro, N; Periotto, L; Iommelli, R; Tomino, C; Provinciali, L

2011-01-01

At the end of 2006, a pharmacovigilance program on natalizumab was settled by the Italian Pharmaceutical Agency, and on January 2007, multiple sclerosis patients poorly responding to the immunomodulating therapies or with an aggressive clinical form of disease from onset initiated to be registered and to receive the medication. On February 2010, almost 3,000 cases have been treated with natalizumab. The drop-out rate is 10%. Almost 800 cases received cycles of natalizumab for more than 18 months. One case of PML was reported and other adverse events are similar to those described in phase III studies. The majority of cases remained stable, while in 25% of cases, an improvement of disability was documented.

[Clinical, epidemiological, and etiological studies of adult aseptic meningitis: a report of 12 cases of herpes simplex meningitis, and a comparison with cases of herpes simplex encephalitis].

PubMed

Himeno, Takahiro; Shiga, Yuji; Takeshima, Shinichi; Tachiyama, Keisuke; Kamimura, Teppei; Kono, Ryuhei; Takemaru, Makoto; Takeshita, Jun; Shimoe, Yutaka; Kuriyama, Masaru

2018-01-26

We treated 437 cases of adult aseptic meningitis and 12 cases (including 2 recurrent patients; age, 31.8 ± 8.9 years; 7 females) of herpes simplex meningitis from 2004 to 2016. The incidence rate of adult herpes simplex meningitis in the cases with aseptic meningitis was 2.7%. One patient was admitted during treatment of genital herpes, but no association was observed between genital herpes and herpes simplex meningitis in the other cases. The diagnoses were confirmed in all cases as the cerebrospinal fluid (CSF) was positive for herpes simplex virus (HSV)-DNA. For diagnosis confirmation, the DNA test was useful after 2-7 days following initial disease onset. Among other types of aseptic meningitis, the patients with herpes simplex meningitis showed relatively high white blood cell counts and relatively high CSF protein and high CSF cell counts. CSF cells showed mononuclear cell dominance from the initial stage of the disease. During same period, we also experienced 12 cases of herpes simplex encephalitis and 21 cases of non-hepatic acute limbic encephalitis. Notably, the patients with herpes simplex meningitis were younger and their CSF protein and cells counts were higher than those of the patients with herpes simplex encephalitis.

Clinical and radiographic assessment of various predictors for healing outcome 1 year after periapical surgery.

PubMed

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

2007-02-01

This clinical study prospectively evaluated the influence of various predictors on healing outcome 1 year after periapical surgery. The study cohort included 194 teeth in an equal number of patients. Three teeth were lost for the follow-up (1.5% drop-out rate). Clinical and radiographic measures were used to determine the healing outcome. For statistical analysis, results were dichotomized (healed versus nonhealed). The overall success rate was 83.8% (healed cases). The only individual predictors to prove significant for the outcome were pain at initial examination (p=0.030) and other clinical signs or symptoms at initial examination (p=0.042), meaning that such teeth had lower healing rates 1 year after periapical surgery compared with teeth without such signs or symptoms. Logistic regression revealed that pain at initial examination (odds ratio=2.59, confidence interval=1.2-5.6, p=0.04) was the only predictor reaching significance. Several predictors almost reached statistical significance: lesion size (p=0.06), retrofilling material (p=0.06), and postoperative healing course (p=0.06).

Dissolution of Fe(III) (hydr) oxides by metal-EDTA complexes

NASA Astrophysics Data System (ADS)

Ngwack, Bernd; Sigg, Laura

1997-03-01

The dissolution of Fe(III)(hydr)oxides (goethite and hydrous ferric oxide) by metal-EDTA complexes occurs by ligand-promoted dissolution. The process is initiated by the adsorption of metal-EDTA complexes to the surface and is followed by the dissociation of the complex at the surface and the release of Fe(III)EDTA into solution. The dissolution rate is decreased to a great extent if EDTA is complexed by metals in comparison to the uncomplexed EDTA. The rate decreases in the order EDTA CaEDTA ≫ PbEDTA > ZnEDTA > CuEDTA > Co(II)EDTA > NiEDTA. Two different rate-limiting steps determine the dissolution process: (1) detachment of Fe(III) from the oxide-structure and (2) dissociation of the metal-EDTA complexes. In the case of goethite, step 1 is slower than step 2 and the dissolution rates by various metals are similar. In the case of hydrous ferric oxide, step 2 is rate-limiting and the effect of the complexed metal is very pronounced.

The temporal evolution of the resistive pressure-gradient-driven turbulence and anomalous transport in shear flow across the magnetic field

NASA Astrophysics Data System (ADS)

Lee, Hae June; Mikhailenko, Vladmir; Mikhailenko, Vladimir

2017-10-01

The temporal evolution of the resistive pressure-gradient-driven mode in the sheared flow is investigated by employing the shearing modes approach. It reveals an essential difference in the processes, which occur in the case of the flows with velocity shearing rate less than the growth rate of the instability in the steady plasmas, and in the case of the flows with velocity shear larger than the instability growth rate in steady plasmas. It displays the physical content of the empirical ``quench rule'' which predicts the suppression of the turbulence in the sheared flows when the velocity shearing rate becomes larger than the maximum growth rate of the possible instability. We found that the distortion of the perturbations by the sheared flow with such velocity shear introduces the time dependencies into the governing equations, which prohibits the application of the eigenmodes formalism and requires the solution of the initial value problem.

Recurrent tuberculosis in an urban area in China: Relapse or exogenous reinfection?

PubMed

Shen, Xin; Yang, Chongguang; Wu, Jie; Lin, Senlin; Gao, Xu; Wu, Zheyuan; Tian, Jiyun; Gan, Mingyu; Luo, Tao; Wang, Lili; Yu, Chenlei; Mei, Jian; Pan, Qichao; DeRiemer, Kathryn; Yuan, ZhengAn; Gao, Qian

2017-03-01

Recurrent tuberculosis is an important indicator of the effectiveness of tuberculosis control and can occur by relapse or exogenous reinfection. We conducted a retrospective cohort study on all bacteriologically confirmed tuberculosis cases that were successfully treated between 2000 and 2012 in Shanghai, an urban area with a high number but a low prevalence rate of tuberculosis cases and a low prevalence of HIV infection. Genotyping the Mycobacterium tuberculosis from clinical isolates was used to distinguish between relapse and reinfection. In total, 5.3% (710/13,417) of successfully treated cases had a recurrence, a rate of 7.55 (95% CI 7.01-8.13) episodes per 1000 person-years, more than 18 times the rate of tuberculosis in the general population. Patients who were male, age 30-59, retreatment cases, had cavitation, diabetes, drug-resistant or multidrug-resistant tuberculosis in their initial episode of tuberculosis, were at high risk for a recurrence. Among 141 recurrent cases that had paired isolates, 59 (41.8%) had different genotypes, indicating reinfection with a different strain. Patients who completed treatment were still at high risk of another episode of tuberculosis and exogenous reinfection contributed a significant proportion of the recurrent tuberculosis cases. Targeted control strategies are needed to prevent new tuberculosis infections in this setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

Recurrent tuberculosis in an urban area in China: relapse or exogenous reinfection?

PubMed Central

Shen, Xin; Yang, Chongguang; Wu, Jie; Lin, Senlin; Gao, Xu; Wu, Zheyuan; Tian, Jiyun; Gan, Mingyu; Luo, Tao; Wang, Lili; Yu, Chenlei; Mei, Jian; Pan, Qichao; DeRiemer, Kathryn; Yuan, ZhengAn; Gao, Qian

2017-01-01

Recurrent tuberculosis is an important indicator of the effectiveness of tuberculosis control and can occur by relapse or exogenous reinfection. We conducted a retrospective cohort study on all bacteriologically confirmed tuberculosis cases that were successfully treated between 2000 and 2012 in Shanghai, an urban area with a high number but a low prevalence rate of tuberculosis cases and a low prevalence of HIV infection. Genotyping the Mycobacterium tuberculosis from clinical isolates was used to distinguish between relapse and reinfection. In total, 5.3% (710/13,417) of successfully treated cases had a recurrence, a rate of 7.55 (95% CI 7.01–8.13) episodes per 1000 person-years, more than 18 times the rate of tuberculosis in the general population. Patients who were male, age 30–59, retreatment cases, had cavitation, diabetes, drug-resistant or multidrug-resistant tuberculosis in their initial episode of tuberculosis, were at high risk for a recurrence. Among 141 recurrent cases that had paired isolates, 59 (41.8%) had different genotypes, indicating reinfection with a different strain. Patients who completed treatment were still at high risk of another episode of tuberculosis and exogenous reinfection contributed a significant proportion of the recurrent tuberculosis cases. Targeted control strategies are needed to prevent new tuberculosis infections in this setting. PMID:28237039

Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms.

PubMed

O'Kelly, C J; Spears, J; Chow, M; Wong, J; Boulton, M; Weill, A; Willinsky, R A; Kelly, M; Marotta, T R

2013-02-01

Flow-diverting stents, such as the PED, have emerged as a novel means of treating complex intracranial aneurysms. This retrospective analysis of the initial Canadian experience provides insight into technical challenges, clinical and radiographic outcomes, and complication rates after the use of flow-diverting stents for unruptured aneurysms. Cases were compiled from 7 Canadian centers between July 2008 and December 2010. Each center prospectively tracked their initial experience; these data were retrospectively updated and pooled for analysis. During the defined study period, 97 cases of unruptured aneurysm were treated with the PED, with successful stent deployment in 94 cases. The overall complete or near-complete occlusion rate was 83%, with a median follow-up at 1.25 years (range 0.25-2.5 years). Progressive occlusion was witnessed over time, with complete or near-complete occlusion in 65% of aneurysms followed through 6 months, and 90% of aneurysms followed through 1 year. Multivariate analysis found previous aneurysm treatment and female sex predictive of persistent aneurysm filling. Most patients were stable or improved (88%), with the most favorable outcomes observed in patients with cavernous carotid aneurysms. The overall mortality rate was 6%. Postprocedural aneurysm hemorrhage occurred in 3 patients (3%), while ipsilateral distal territory hemorrhage was observed in 4 patients (3.4%). Flow-diverting stents represent an important tool in the treatment of complex intracranial aneurysms. The relative efficacy and morbidity of this treatment must be considered in the context of available alternate interventions.

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

Aykutalp, Aycin; Wise, John H.; Spaans, Marco

In the last decade, the growth of supermassive black holes (SMBHs) has been intricately linked to galaxy formation and evolution and is a key ingredient in the assembly of galaxies. To investigate the origin of SMBHs, we perform cosmological simulations that target the direct collapse black hole seed formation scenario in the presence of two different strong Lyman-Werner (LW) background fields. These simulations include the X-ray irradiation from a central massive black hole (MBH), H{sub 2} self-shielding, and stellar feedback from metal-free and metal-enriched stars. We find in both simulations that local X-ray feedback induces metal-free star formation ∼0.5 Myrmore » after the MBH forms. The MBH accretion rate reaches a maximum of 10{sup –3} M {sub ☉} yr{sup –1} in both simulations. However, the duty cycle differs and is derived to be 6% and 50% for the high and low LW cases, respectively. The MBH in the high LW case grows only ∼6% in 100 Myr compared to 16% in the low LW case. We find that the maximum accretion rate is determined by the local gas thermodynamics, whereas the duty cycle is determined by the large-scale gas dynamics and gas reservoir. We conclude that radiative feedback from the central MBH plays an important role in star formation in the nuclear regions and stifling initial MBH growth relative to the typical Eddington rate argument, and that initial MBH growth might be affected by the local LW radiation field.« less

[HIV/AIDS related mortality in southern Shanxi province and its risk factors].

PubMed

Ning, Shaoping; Xue, Zidong; Wei, Jun; Mu, Shengcai; Xu, Yajuan; Jia, Shaoxian; Qiu, Chao; Xu, Jianqing

2015-03-01

To explore factors influencing mortality rate of HIV/AIDS and to improve the effectiveness of antiretroviral therapy (ART). By means of retrospective cohort study and the AIDS control information system, HIV/AIDS case reports and antiviral treatment information of 4 cities in southern Shanxi province up to end of December 2012 were selected, to calculate the mortality rate and treatment coverage based on further data collected, along with analysis using the Cox proportional hazards survival regression. 4 040 cases confirmed of HIV/AIDS were included in this study. The average age was (36.0 ± 12.9) years, with 65.3% being male, 56.5% being married, 73.5% having junior high school education or lower, 58.4% being peasants, 54.3% with sexually transmitted infection (40.1% were heterosexual, 14.2% were homosexual), and 38.9% were infected via blood transmission (20.2% were former plasma donors, 16.2% blood transfusion or products recipients, 2.4% were injection drug users). Overall mortality decreased from 40.2 per 100 person/year in 2004 to 6.3 per 100 person/year in 2012, with treatment coverage concomitantly increasing from almost 14.8% to 63.4%. Cox proportional hazards survival regression was used on 4 040 qualified cases, demonstrating the top mortality risk factor was without antiretroviral therapy (RR = 14.9, 95% CI: 12.7-17.4). Cox proportional hazards survival regression was made on 1 938 cases of antiviral treatment, demonstrating that the mortality risk of underweight or obese before treatment was higher than those of normal and overweight cases (RR = 2.7, 95% CI: 1.6-4.5), and the mortality of those having a CD4(+) T-lymphocyte count ≤ 50 cells per µl before treatment was more than 50 cases (RR = 2.6, 95% CI: 1.5-4.5); Cox proportional hazards survival regression was made on 2 102 cases of untreated cases, demonstrating the mortality risk of those initially diagnosed as AIDS was higher than those initially diagnosed as HIV (RR = 3.4, 95% CI: 2.9-4.0). The ART could successfully make lower HIV/AIDS mortality rate, indicating effective ART can further decrease mortality.

Assessing Police Classifications of Sexual Assault Reports: A Meta-Analysis of False Reporting Rates.

PubMed

Ferguson, Claire E; Malouff, John M

2016-07-01

The objective of the study was to determine, through meta-analysis, the rate of confirmed false reports of sexual assault to police. The meta-analysis initially involved a search for relevant articles. The search identified seven studies where researchers or their trained helpers evaluated reported sexual assault cases to determine the rate of confirmed false reports. The meta-analysis calculated an overall rate and tested for possible moderators of effect size. The meta-analytic rate of false reports of sexual assault was .052 (95 % CI .030, .089). The rates for the individual studies were heterogeneous, suggesting the possibility of moderators of rate. However, the four possible moderators examined-year of publication, whether the data set used had information in addition to police reports, whether the study was completed in the U.S. or elsewhere, and whether inter-rater reliabilities were reported-were all not significant. The meta-analysis of seven relevant studies shows that confirmed false allegations of sexual assault made to police occur at a significant rate. The total false reporting rate, including both confirmed and equivocal cases, would be greater than the 5 % rate found here.

Initial experience with a donor egg bank.

PubMed

Akin, James W; Bell, Katrina A; Thomas, Diana; Boldt, Jeffrey

2007-08-01

To report on the establishment of a commercial donor egg bank (CryoEggs International, LP) and to present our initial experience from the first four patients to receive eggs. Case report. Private fertility clinic. The four recipient women were aged 43, 43, 40, and 33 years. All had cycle day FSH levels greater than 25 mIU/mL. All were given the option of fresh donor egg IVF but opted to use frozen donor oocytes. Purchased and quarantined frozen donor eggs were thawed and inseminated using intracytoplasmic sperm injection (ICSI). Subsequent embryos were transferred on day 3. Clinical pregnancy as defined by presence of cardiac activity. There was a thawed egg survival rate of 76%, a fertilization rate of 74%, a pregnancy rate (PR) of 50%, with an average of 2.75 embryos per transfer and an implantation rate of 27%. Although very preliminary, these results indicate that more widespread use of frozen donor eggs obtained from a commercial egg bank may be feasible in the future, changing the landscape of donor egg IVF.

Risk factors for mortality in a south Indian population on generic antiretroviral therapy.

PubMed

Rupali, Priscilla; Mannam, Sam; Bella, Annie; John, Lydia; Rajkumar, S; Clarence, Peace; Pulimood, Susanne A; Samuel, Prasanna; Karthik, Rajiv; Abraham, Ooriapadickal Cherian; Mathai, Dilip

2012-12-01

Antiretroviral treatment (ART) programs from low-income countries utilizing standardized ART regimens, simplified approaches to clinical decision making and basic lab monitoring have reported high mortality rates. We determined the risk factors for mortality among HIV-infected adults following the initiation of ART from a single center in south India. ART-naive HIV-infected south Indian adults attending the Infectious Diseases clinic in a 2000-bed academic medical center in south India who were initiated on ART (generic, fixed-dose combinations) as per the national guidelines were followed up. Cases (32 patients who died) were compared with age and sex matched controls. Eight-hundred and twenty-two patients were started on ART from January 1, 2000 to December 31, 2008. The cumulative mortality was 6.8% (56/822). Among the cases mean age was 44 years, 18% were women and mean CD4 counts was 107 cells/microl. Among the controls mean age was 41 years, 18% were women and mean CD4 counts were 113 cells/microl. Stavudine based ART was predominant 62.5% in the cases vs 37.5% in the controls, followed by zidovudine based therapy in 31.2% of cases and 43.7% in the controls. Tenofovir based therapy was used in 6.2% of cases vs 18.7% in the controls. The commonest causes of death were drug toxicity 19%, advanced Acquired Immunodeficiency Syndrome (AIDS) in 37%, Immune Reconstitution Inflammatory Syndrome (IRIS) in 16%, non AIDS related deaths in 22% and malignancies 6%. In a univariate analysis, absolute lymphocyte count <1200 cells/cmm (p=0.03), development of immune reconstitution inflammatory syndrome (IRIS) (p=0.000) and mean CD4 cell count increase <75 cells/microl after 1 year of ART (p=0.001) were significantly associated with mortality. The mortality among our patients was comparable to that reported from other low-income countries. Earlier initiation of ART may reduce the high mortality rates observed.

Low hospital referral rates of school scoliosis screening positives in an urban district of mainland China.

PubMed

Guo, Yawen; Jiang, Qingwu; Tanimoto, Tetsuya; Kami, Masahiro; Luo, Chunyan; Leppold, Claire; Nishimura, Koichi; He, Yongpin; Kato, Shigeaki; Ding, Xiaocang

2017-04-01

Significant prevalence rates of adolescent scoliosis in China were suggested in previous studies. However, school screenings for adolescent scoliosis have been suspended due to low rates of positive detection under the past screening system in China. The present study was undertaken to screen for adolescent scoliosis in middle school students under a modern assessment system in a district of Shanghai. We performed a population-based, cross-sectional study of a middle school scoliosis screening program in the Jingan district. In 2015, schoolchildren were initially screened by visual inspection of clinical signs and the forward-bending test. Suspected cases were referred for radiography in hospital for scoliosis diagnosis. A total of 5327 middle school students (grades 6-8) were screened with 520 (9.76%) positives (the positive rates of girls and boys at 15.28% and 4.59%, respectively) and no statistically significant difference among grades. Only 301 positives (57.9%) followed the referral for hospital radiography. There were 102 cases (33.9%) that were diagnosed with scoliosis by radiography criteria (Cobb angle ≥10°) including mild scoliosis (Cobb 10-25) for 94 cases and moderate scoliosis (Cobb 25-40) for 8 cases, and false-positives (Cobb 0) for 39 cases. The putative prevalence rate was estimated as 1.9% from the referred students. Under an accurate and modern assessment system, school screenings can detect scoliosis at a significant rate, but awareness of scoliosis risks is needed for residents in China to take up referrals for hospital diagnosis after school screenings.

Trends in infective endocarditis hospitalisations at United States children's hospitals from 2003 to 2014: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines.

PubMed

Bates, Katherine E; Hall, Matthew; Shah, Samir S; Hill, Kevin D; Pasquali, Sara K

2017-05-01

National organisations in several countries have recently released more restrictive guidelines for infective endocarditis prophylaxis, including the American Heart Association 2007 guidelines. Initial studies demonstrated no change in infective endocarditis rates over time; however, a recent United Kingdom study suggested an increase; current paediatric trends are unknown. Children (5 years of age. Interrupted time series analysis was used to evaluate rates over time indexed to total hospitalisations. A total of 841 cases were identified. The median age was 13 years (interquartile range 9-15 years). In the pre-guideline period, there was a slight increase in the rate of infective endocarditis by 0.13 cases/10,000 hospitalisations per semi-annual period. In the post-guideline period, the rate of infective endocarditis increased by 0.12 cases/10,000 hospitalisations per semi-annual period. There was no significant difference in the rate of change in the pre- versus post-guidelines period (p=0.895). Secondary analyses in children >5 years of age with CHD and in children hospitalised with any type of infective endocarditis at any age revealed similar results. We found no significant change in infective endocarditis hospitalisation rates associated with revised prophylaxis guidelines over 11 years across 29 United States children's hospitals.

Introducing universal ultrasound screening for developmental dysplasia of the hip doubled the treatment rate.

PubMed

Olsen, Stine F; Blom, Hans C; Rosendahl, Karen

2018-02-01

There is no evidence on the effect of universal ultrasound screening on developmental dysplasia of the hip. We examined the impact of adding an ultrasound examination to a one examiner clinical screening strategy on treatment, follow-up rates and the number of cases detected late in a low-prevalence population. All eligible babies born at Kongsberg Hospital, Norway, from 1998 to 2006 (n = 4245) underwent both clinical and ultrasound hip examinations within three days of life. Indications for immediate treatment were positive Barlow or Ortolani manoeuvres and, or, sonographic dysplasia. Sonographic immature hips were followed until normalisation. Treatment rates and rates from the 1989 to 1997 prestudy period (n = 3594), including late diagnoses, were collected from hospital records. Treatment was initiated in 90 (2.1%) infants (74 girls), 63 (70%) from birth, compared to 33 (0.9%) during the prestudy period. The follow-up rate did not change (11%). There were two (0.5/1000) and four (1.0/1000) cases detected late, respectively. No one underwent surgery during the first year of life and no avascular necrosis was seen. Adding universal ultrasound to clinical screening performed by the same, experienced paediatrician doubled the treatment rate, without influencing the already low numbers of late cases. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

DRG Watchdog highlights new financial dimensions of laboratory diagnostics.

PubMed

2003-01-01

As nebulous as the details of the German diagnosis-oriented case reimbursement rate (G-DRGs) might be, one thing is obvious: rapid and accurate diagnostics will be vital in future to the reimbursement of standard cases that reflect the actual outlay. The laboratory that up to now has always been categorized as a potential for savings, now becomes a source of revenue for hospitals. A study initiated by the VDGH provides evidence for this (Clinical Laboratory 2002, 48, 327).

Follow-up of patients with localized breast cancer and first indicators of advanced breast cancer recurrence: A retrospective study.

PubMed

Viot, Julien; Bachour, Martin; Meurisse, Aurélia; Pivot, Xavier; Fiteni, Frédéric

2017-08-01

We conducted a retrospective study to assess the follow-up of patients with localized breast cancer and the first indicators of advanced breast cancer recurrence. All patients with advanced breast cancer recurrence treated between January 2010 and June 2016 in our institution were registered. Among these patients, 303 patients initially treated for early breast cancer with curative intent were identified. After initial curative treatment, follow-up involved the oncologist, the general practitioner and the gynecologist in 68.0%, 48.9% and 19.1% of cases, respectively. The median DFI was 4 years for luminal A, 3.8 years for luminal B, 3.7 years for HER2-positive and 1.5 years for TNBC (p = 0.07). Breast cancer tumor marker was prescribed for 164 patients (54.1%). No difference in terms of follow-up was observed according to the molecular subtype. Symptoms were the primary indicator of relapse for 143 patients (47.2%). Breast cancer recurrence was discovered by CA 15.3 elevation in 57 patients (18.8%) and by CAE elevation in 3 patients (1%). The rate of relapse diagnosed by elevation of CA 15.3 or CAE was not statistically associated with the molecular subtype (p = 0.65). Luminal A cases showed a significantly higher rate of bone metastases (p = 0.0003). TNBC cases showed a significantly higher rate of local recurrence (p = 0.002) and a borderline statistical significant higher rate of lung/pleural metastases (p = 0.07). Follow-up recommendations could be adapted in clinical practice according to the molecular subtype. General practitioners should be more involved by the specialists in breast cancer follow-up. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using Cultural Capital as a Resource for Negotiating Participation in a Teacher Community of Practice: A Case Study

ERIC Educational Resources Information Center

Maistry, Suriamurthee

2010-01-01

Continuing professional development (CPD) initiatives for teachers in South Africa take on various forms, ranging from formalised, structured, credit-bearing certification programmes to informal, relatively unstructured, situated learning programmes. While many formal programmes can claim success by measuring throughput rates, there is still much…

3 CFR - The Presidential POWER Initiative: Protecting Our Workers and Ensuring Reemployment

Code of Federal Regulations, 2011 CFR

2011-01-01

... workers' compensation payments in fiscal year 2009. Many of these work-related injuries and illnesses are... and health, reduce the financial burden of injury on taxpayers, and relieve unnecessary suffering by... claims; (vi) reducing lost production day rates; and (vii) speeding employees' return to work in cases of...

Initial Teacher Certification Testing in Massachusetts: A Case of the Tail Wagging the Dog.

ERIC Educational Resources Information Center

Flippo, Rona F.; Riccards, Michael P.

2000-01-01

An evaluation of the Massachusetts Educator Certification Test has revealed unforeseen, counterproductive consequences. Teacher preparation colleges are adjusting curricular emphases to teach to a test of dubious validity and are inadvertently excluding substantial portions of enrollees to boost test scores. Minorities are failing at higher rates.…

Outbreak of Sporotrichosis, Western Australia

PubMed Central

Feeney, Kynan T.; Whittle, Amanda J.; Altman, Shelley A.; Speers, David J.

2007-01-01

A cluster of sporotrichosis cases occurred in the Busselton-Margaret River region of Western Australia from 2000 to 2003. Epidemiologic investigation and mycologic culture for Sporothrix schenckii implicated hay initially distributed through a commercial hay supplier as the source of the outbreak. Declining infection rates have occurred after various community measures were instigated. PMID:17953099

Propagation of a laser beam in a time-varying waveguide. [plasma heating for controlled fusion

NASA Technical Reports Server (NTRS)

Chapman, J. M.; Kevorkian, J.

1978-01-01

The propagation of an axisymmetric laser beam in a plasma column having a radially parabolic electron density distribution is reported. For the case of an axially uniform waveguide it is found that the basic characteristics of alternating focusing and defocusing beams are maintained. However, the intensity distribution is changed at the foci and outer-beam regions. The features of paraxial beam propagation are discussed with reference to axially varying waveguides. Laser plasma coupling is considered noting the case where laser heating produces a density distribution radially parabolic near the axis and the energy absorbed over the focal length of the plasma is small. It is found that: (1) beam-propagation stability is governed by the relative magnitude of the density fluctuations existing in the axial variation of the waveguides due to laser heating, and (2) for beam propagation in a time-varying waveguide, the global instability of the propagation is a function of the initial fluctuation growth rate as compared to the initial time rate of change in the radial curvature of the waveguide.

Use of partnership strategies to build radiation oncology disparities research programs in five Western Pennsylvania communities: an organizational case study.

PubMed

Morgenlander, Keith H; Heron, Dwight E; Schenken, Larry L

2009-01-01

Many cancer treatment and prevention trials as well as surveillance programs suffer from a disproportionately low rate of accrual and a high rate of noncompliance or dropouts of racial minorities and the poor. One suggested strategy to help remediate this trend is to directly involve those targeted populations within the development, implementation, and evaluation of these services. The Radiation Oncology Community Outreach Group (ROCOG) and Neighborhood Cancer Care Cooperative (NCCC) are designed based upon this type of highly collaborative organizational structure, consistent with the general principles of community-based participatory research. Funded by the National Cancer Institute Cancer Disparities Research Partnership program, ROCOG/NCCC provide oncology-focused, community hospital-based initiatives intended to help close the cancer disparities gap. This article presents a descriptive case study of the organizational and political process that preceded our grant proposal submission, the potential benefits and difficulties associated with our extensive collaborative model, and an example of how highly competitive health care organizations can become partners in narrowly focused initiatives aimed at a greater social good.

Development of ambient temperature secondary lithium cells

NASA Technical Reports Server (NTRS)

Subbarao, S.; Shen, D. H.; Dawson, S.; Deligiannis, F.; Taraszkiewicz, J.; Halpert, G.

1988-01-01

JPL is developing ambient temperature secondary lithium cells for future spacecraft applications. Prior studies on experimental laboratory type Li-TiS2 cells yielded promising results in terms of cycle life and rate capability. To further assess the performance of this cell, 5 Ah engineering model cells were developed. Initially baseline cells were designed and fabricated. Each cell had 15 cathodes and 16 anodes and the ratio of anode to cathode capacity is 6:1. A solution of 1.5 molar LiAsF6 in 2Me-THF was used as the electrolyte. Cells were evaluated for their cycle life at C/1 and C/5 discharge rates and 100 percent depth of discharge. The cells were cycled between voltage limits 1.7 and 2.8 volts. The rate of charge in all cases is C/10. The results obtained indicate that cells can operate at C/10 to C/2 discharge rates and have an initial energy density of 70 Wh/kg. Cells delivered more than 100 cycles at C/2 discharge rate. The details of cell design, the test program, and the results obtained are described.

Development of ambient temperature secondary lithium cells

NASA Technical Reports Server (NTRS)

Subbarao, S.; Shen, D. H.; Dawson, S.; Deligiannis, F.; Taraszkiewicz, J.; Halpert, Gerald

1987-01-01

JPL is developing ambient temperature secondary lithium cells for future spacecraft applications. Prior studies on experimental laboratory type Li-TiS2 cells yielded promising results in terms of cycle life and rate capability. To further assess the performance of this cell, 5 Ah engineering model cells were developed. Initially baseline cells were designed and fabricated. Each cell had 15 cathodes and 16 anodes and the ratio of anode to cathode capacity is 6:1. A solution of 1.5 molar LiAsF6 in 2Me-THF was used as the electrolyte. Cells were evaluated for their cycle life at C/1 and C/5 discharge rates and 100 percent depth of discharge. The cells were cycled between voltage limits 1.7 and 2.8 volts. The rate of charge in all cases is C/10. The results obtained indicate that cells can operate at C/10 to C/2 discharge rates and have an initial energy density of 70 Wh/kg. Cells delivered more than 100 cycles at C/2 discharge rate. The details of cell design, the test program, and the results obtained are described.

Changing Operating Room Culture: Implementation of a Postoperative Debrief and Improved Safety Culture.

PubMed

Magill, Stephen T; Wang, Doris D; Rutledge, W Caleb; Lau, Darryl; Berger, Mitchel S; Sankaran, Sujatha; Lau, Catherine Y; Imershein, Sarah G

2017-11-01

Patient safety is foundational to neurosurgical care. Postprocedural "debrief" checklists have been proposed to improve patient safety, but data about their use in neurosurgery are limited. Here, we implemented an initiative to routinely perform postoperative debriefs and evaluated the impact of debriefing on operating room (OR) safety culture. A 10-question safety attitude questionnaire (SAQ) was sent to neurosurgical OR staff at a major academic medical center before and 18 months after the implementation of a postoperative debriefing initiative. Rates of debrief compliance and changes in attitudes before and after the survey were evaluated. The survey used a Likert scale and analyzed with standard statistical methods. After the debrief initiative, the rate of debriefing increased from 51% to 86% of cases for the neurosurgery service. Baseline SAQ responses found that neurosurgeons had a more favorable perception of OR safety than did anesthesiologists and nurses. After implementation of the postoperative debriefing process, perceptions of OR safety significantly improved for neurosurgeons, anesthesiologists, and nurses. Furthermore, the disparity between nurses and surgeons was no longer significant. After debrief implementation, neurosurgical OR staff had improved perceptions of patient safety compared with surgical services that did not commonly perform debriefing. Debriefing identified OR efficiency concerns in 26.9% of cases, and prevention of potential adverse events/near misses was reported in 8% of cases. Postoperative debriefing can be effectively introduced into the OR and improves the safety culture after implementation. Debriefing is an effective tool to identify OR inefficiencies and potential adverse events. Copyright © 2017 Elsevier Inc. All rights reserved.

Sentinel lymph node biopsy in clinically detected ductal carcinoma in situ.

PubMed

Al-Ameer, Ahmed Yahia; Al Nefaie, Sahar; Al Johani, Badria; Anwar, Ihab; Al Tweigeri, Taher; Tulbah, Asma; Alshabanah, Mohmmed; Al Malik, Osama

2016-04-10

To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS). A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital. The accuracy of performing SLNB in CD-DCIS, the rate of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an image-guided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive. Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33%. SLNB in CD-DCIS is technically feasible and highly accurate. We recommend limiting SLNB to patients undergoing a mastectomy.

Pros and cons of estimating the reproduction number from early epidemic growth rate of influenza A (H1N1) 2009.

PubMed

Nishiura, Hiroshi; Chowell, Gerardo; Safan, Muntaser; Castillo-Chavez, Carlos

2010-01-07

In many parts of the world, the exponential growth rate of infections during the initial epidemic phase has been used to make statistical inferences on the reproduction number, R, a summary measure of the transmission potential for the novel influenza A (H1N1) 2009. The growth rate at the initial stage of the epidemic in Japan led to estimates for R in the range 2.0 to 2.6, capturing the intensity of the initial outbreak among school-age children in May 2009. An updated estimate of R that takes into account the epidemic data from 29 May to 14 July is provided. An age-structured renewal process is employed to capture the age-dependent transmission dynamics, jointly estimating the reproduction number, the age-dependent susceptibility and the relative contribution of imported cases to secondary transmission. Pitfalls in estimating epidemic growth rates are identified and used for scrutinizing and re-assessing the results of our earlier estimate of R. Maximum likelihood estimates of R using the data from 29 May to 14 July ranged from 1.21 to 1.35. The next-generation matrix, based on our age-structured model, predicts that only 17.5% of the population will experience infection by the end of the first pandemic wave. Our earlier estimate of R did not fully capture the population-wide epidemic in quantifying the next-generation matrix from the estimated growth rate during the initial stage of the pandemic in Japan. In order to quantify R from the growth rate of cases, it is essential that the selected model captures the underlying transmission dynamics embedded in the data. Exploring additional epidemiological information will be useful for assessing the temporal dynamics. Although the simple concept of R is more easily grasped by the general public than that of the next-generation matrix, the matrix incorporating detailed information (e.g., age-specificity) is essential for reducing the levels of uncertainty in predictions and for assisting public health policymaking. Model-based prediction and policymaking are best described by sharing fundamental notions of heterogeneous risks of infection and death with non-experts to avoid potential confusion and/or possible misuse of modelling results.

Sulfonated poly(ether ether ketone)/poly(vinyl alcohol) sensitizing system for solution photogeneration of small Ag, Au, and Cu crystallites.

PubMed

Korchev, A S; Shulyak, T S; Slaten, B L; Gale, W F; Mills, G

2005-04-28

Illumination of air-free aqueous solutions containing sulfonated poly(ether ether ketone) and poly(vinyl alcohol) with 350 nm light results in benzophenone ketyl radicals of the polyketone. The polymer radicals form with a quantum yield 0.02 and decay with a second-order rate constant 6 orders of magnitude lower than that of typical alpha-hydroxy radicals. Evidence is presented that the polymeric benzophenone ketyl radicals reduce Ag+, Cu2+, and AuCl4- to metal particles of nanometer dimensions. Decreases in the reduction rates with increasing Ag(I), Cu(II), and Au(III) concentrations are explained using a kinetic model in which the metal ions quench the excited state of the polymeric benzophenone groups, which forms the macromolecular radicals. Quenching is fastest for Ag+, whereas Cu2+ and AuCl4- exhibit similar rate constants. Particle formation becomes more complex as the number of equivalents needed to reduce the metal ions increases; the Au(III) system is an extreme case where the radical reactions operate in parallel with secondary light-initiated and thermal reduction channels. For each metal ion, the polymer-initiated photoreactions produce crystallites possessing distinct properties, such as a very strong plasmon in the Ag case or the narrow size distribution exhibited by Au particles.

Viscous propulsion in active transversely isotropic media

NASA Astrophysics Data System (ADS)

Cupples, Gemma; Dyson, Rosemary; Smith, David

2017-11-01

Taylor's swimming sheet is a classical model of microscale propulsion and pumping. Many biological fluids and substances are fibrous, having a preferred direction in their microstructure; for example cervical mucus. To understand how these effects modify viscous propulsion, we extend Taylor's classical model of small-amplitude viscous propulsion of a `swimming sheet' via the transversely-isotropic fluid model of Ericksen, which is linear in strain rate and possesses a distinguished direction. The energetic costs of swimming are significantly altered by all rheological parameters and the initial fibre angle. Propulsion in a passive transversely-isotropic fluid enhances mean rate of working, independent of the initial fibre orientation. In this regime the mean swimming velocity is unchanged from the Newtonian case. The effect of fibre tension, or alternatively a stresslet characterising an active fluid, is also considered. This stress introduces an angular dependence and dramatically changes the streamlines and flow field; fibres aligned with the swimming direction increase the energetic demands of the sheet. The constant fibre stress may result in a reversal of the mean swimming velocity and a negative mean rate of working if sufficiently large relative to the other parameters. Funding is provided by a Biotechnology and Biological Sciences Research Council (BBSRC) Industrial CASE Studentship (BB/L015587/1).

The Impact of Menthol Cigarettes on Smoking Initiation among Non-Smoking Young Females in Japan

PubMed Central

Connolly, Gregory N.; Behm, Ilan; Osaki, Yoneatsu; Wayne, Geoffrey F.

2011-01-01

Japan presents an excellent case-study of a nation with low female smoking rates and a negligible menthol market which changed after the cigarette market was opened to foreign competition. Internal tobacco industry documents demonstrate the intent of tobacco manufacturers to increase initiation among young females through development and marketing of menthol brands. Japanese menthol market share rose rapidly from less than 1% in 1980 to 20% in 2008. Menthol brand use was dominated by younger and female smokers, in contrast with non-menthol brands which were used primarily by male smokers. Nationally representative surveys confirm industry surveys of brand use and provide further evidence of the end results of the tobacco industry’s actions—increased female smoking in Japan. These findings suggest that female populations may be encouraged to initiate into smoking, particularly in developing nations or where female smoking rates remain low, if the tobacco industry can successfully tailor brands to them. The Japanese experience provides a warning to public health officials who wish to prevent smoking initiation among young females. PMID:21318010

The impact of menthol cigarettes on smoking initiation among non-smoking young females in Japan.

PubMed

Connolly, Gregory N; Behm, Ilan; Osaki, Yoneatsu; Wayne, Geoffrey F

2011-01-01

Japan presents an excellent case-study of a nation with low female smoking rates and a negligible menthol market which changed after the cigarette market was opened to foreign competition. Internal tobacco industry documents demonstrate the intent of tobacco manufacturers to increase initiation among young females through development and marketing of menthol brands. Japanese menthol market share rose rapidly from less than 1% in 1980 to 20% in 2008. Menthol brand use was dominated by younger and female smokers, in contrast with non-menthol brands which were used primarily by male smokers. Nationally representative surveys confirm industry surveys of brand use and provide further evidence of the end results of the tobacco industry's actions-increased female smoking in Japan. These findings suggest that female populations may be encouraged to initiate into smoking, particularly in developing nations or where female smoking rates remain low, if the tobacco industry can successfully tailor brands to them. The Japanese experience provides a warning to public health officials who wish to prevent smoking initiation among young females.

Risk Factors for Fatal Outcome From Rocky Mountain Spotted Fever in a Highly Endemic Area—Arizona, 2002–2011

PubMed Central

Regan, Joanna J.; Traeger, Marc S.; Humpherys, Dwight; Mahoney, Dianna L.; Martinez, Michelle; Emerson, Ginny L.; Tack, Danielle M.; Geissler, Aimee; Yasmin, Seema; Lawson, Regina; Williams, Velda; Hamilton, Charlene; Levy, Craig; Komatsu, Ken; Yost, David A.; McQuiston, Jennifer H.

2016-01-01

Background Rocky Mountain spotted fever (RMSF) is a disease that now causes significant morbidity and mortality on several American Indian reservations in Arizona. Although the disease is treatable, reported RMSF case fatality rates from this region are high (7%) compared to the rest of the nation (<1%), suggesting a need to identify clinical points for intervention. Methods The first 205 cases from this region were reviewed and fatal RMSF cases were compared to nonfatal cases to determine clinical risk factors for fatal outcome. Results Doxycycline was initiated significantly later in fatal cases (median, day 7) than nonfatal cases (median, day 3), although both groups of case patients presented for care early (median, day 2). Multiple factors increased the risk of doxycycline delay and fatal outcome, such as early symptoms of nausea and diarrhea, history of alcoholism or chronic lung disease, and abnormal laboratory results such as elevated liver aminotransferases. Rash, history of tick bite, thrombocytopenia, and hyponatremia were often absent at initial presentation. Conclusions Earlier treatment with doxycycline can decrease morbidity and mortality from RMSF in this region. Recognition of risk factors associated with doxycycline delay and fatal outcome, such as early gastrointestinal symptoms and a history of alcoholism or chronic lung disease, may be useful in guiding early treatment decisions. Healthcare providers should have a low threshold for initiating doxycycline whenever treating febrile or potentially septic patients from tribal lands in Arizona, even if an alternative diagnosis seems more likely and classic findings of RMSF are absent. PMID:25697742

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.

Ice nucleation rates of single protein complexes and single macromolecules

NASA Astrophysics Data System (ADS)

Stratmann, F.; Wex, H.; Niedermeier, D.; Hartmann, S.; Augustin, S.; Clauss, T.; Voigtlaender, J.; Pummer, B.; Grothe, H.

2012-12-01

With our flow-tube LACIS (Leipzig Aerosol cloud Interaction Simulator), we measured immersion freezing of droplets containing biological ice nucleating (IN) agents. From our measurements, we were able to deduce ice nucleation rates for single IN protein complexes (for Snomax) and for IN macromolecules (in the case of Birch pollen). For the measurements, aerosol particles were produced from solutions/suspensions of either Snomax (deadened and partly fractionalized pseudomonas syringae bacteria) or of Birch pollen washing water (BW in the following). All particles were dried and size selected before entering LACIS. In LACIS, particles were activated to droplets, and we measured the fraction of all droplets that froze (F(ice)) as function of temperature. For Snomax, a strong increase in F(ice) was observed around -7 to -10°C, for BW around -19 to -25°C, respectively. After this initial steep increase, F(ice) stayed constant for both examined substances down to -35°C. We found that the values of F(ice) in the plateau region depended on the dry particle size. The initial solution used to generate the particles contained parts of bacteria with ice active protein complexes on them in the case of Snomax, or IN macromolecules in the case of BW (Pummer et al., 2011). We show that the distribution of the IN proteins or IN molecules in the aerosol particles follows the Poisson distribution. With this knowledge, derivation of the ice nucleation rates for single IN protein complexes or for single IN macromolecules is possible. Combining the Poisson distribution with a stochastic model and using the derived nucleation rates, we can reproduce not only our measurements for both examined substances, but also past measurements done for Snomax and even pseudomonas syringae bacteria. As an additional peculiarity, we seem to observe two different macromolecules being ice active for Birch trees growing in Central Europe or Northern Europe, with the latter initiating freezing at slightly warmer temperatures. Pummer, B. G. et al. (2012), Suspendable macromolecules are responsible for ice nucleation activity of birch and conifer pollen, Aerosol Chem. Phys., 12, 2541-2550.

Strategic Policy for Pandemic Vaccine Distribution

DTIC Science & Technology

2010-09-01

Act (PREP Act) was passed as part of the “Department of Defense, Emergency Supplemental Appropriations to address hurricanes in the Gulf of Mexico ...few respondents stated, “It caught us by surprise!” The next pandemic was to have come over from Asia. H1N1 came up quickly through Mexico . It was...discussion. The severity of H1N1 in Mexico was extremely high initially, in addition to the attack rate. The case fatality rate exceeded 65 percent.9 A

Poly(n-hexyl methacrylate) polymerization in three-component microemulsion stabilized by a cationic surfactant.

PubMed

Katime, Issa; Arellano, Jesús; Schulz, Pablo

2006-04-15

The polymerization of n-hexyl methacrylate (n-HMA) in three-component microemulsion stabilized with dodecyltrimethylammonium bromide (DTAB) is reported as a function of monomer and initiator concentrations and temperature. The obtained latices were bluish, transparent, and translucent. Particle sizes and molar masses were on the order of 20 nm and 3 x 10(6) g/mol, respectively. In all cases, high reaction rates and final conversions of 98% were obtained. Polymerization temperature has a strong effect on reaction rate and conversion.

The Choice of Discount Rate Applicable to Government Resource Use: Theory and Limitations

DTIC Science & Technology

1987-12-01

print money , which necessarily makes government securities less risky to the individuals purchasing them than private securities are. This leads to a...the case of allocating a fixed initial sum of money over a T-period horizon. Let M denote the amount of money available for investment at time t - 0...amount of money available for government investment at 36 time t - 0 under a one-shot investment plan, and let r" denote the opportunity cost rate of

Sensitivity Analysis of Methane Hydrate Reservoirs: Effects of Reservoir Parameters on Gas Productivity and Economics

NASA Astrophysics Data System (ADS)

Anderson, B. J.; Gaddipati, M.; Nyayapathi, L.

2008-12-01

This paper presents a parametric study on production rates of natural gas from gas hydrates by the method of depressurization, using CMG STARS. Seven factors/parameters were considered as perturbations from a base-case hydrate reservoir description based on Problem 7 of the International Methane Hydrate Reservoir Simulator Code Comparison Study led by the Department of Energy and the USGS. This reservoir is modeled after the inferred properties of the hydrate deposit at the Prudhoe Bay L-106 site. The included sensitivity variables were hydrate saturation, pressure (depth), temperature, bottom-hole pressure of the production well, free water saturation, intrinsic rock permeability, and porosity. A two-level (L=2) Plackett-Burman experimental design was used to study the relative effects of these factors. The measured variable was the discounted cumulative gas production. The discount rate chosen was 15%, resulting in the gas contribution to the net present value of a reservoir. Eight different designs were developed for conducting sensitivity analysis and the effects of the parameters on the real and discounted production rates will be discussed. The breakeven price in various cases and the dependence of the breakeven price on the production parameters is given in the paper. As expected, initial reservoir temperature has the strongest positive effect on the productivity of a hydrate deposit and the bottom-hole pressure in the production well has the strongest negative dependence. Also resulting in a positive correlation is the intrinsic permeability and the initial free water of the formation. Negative effects were found for initial hydrate saturation (at saturations greater than 50% of the pore space) and the reservoir porosity. These negative effects are related to the available sensible heat of the reservoir, with decreasing productivity due to decreasing available sensible heat. Finally, we conclude that for the base case reservoir, the break-even price (BEP) for natural gas is approximately 7/mcf and for warmer and deeper reservoirs the BEP can approach 5.33/mcf.

Immediate effects of the initial FDA notification on the use of surgical mesh for pelvic organ prolapse surgery in medicare beneficiaries.

PubMed

Reynolds, W Stuart; Gold, Karen P; Ni, Shenghua; Kaufman, Melissa R; Dmochowski, Roger R; Penson, David F

2013-04-01

Prompted by increased reports of complications with the use of mesh for pelvic organ prolapse (POP) surgery, the FDA issued an initial public health notification (PHN) in 2008. We proposed to determine if the numbers of POP cases augmented with surgical mesh performed in U.S. Medicare beneficiaries changed relative to this PHN. Using administrative healthcare claims for beneficiaries enrolled in the U.S. Medicare program from 2008 to 2009, we identified women who underwent POP surgery with and without surgical mesh by procedural and diagnosis coding. In addition to comparing cases with and without mesh, we also calculated rates (number of cases per 100,000 female beneficiaries) and compared these relative to the timing of the PHN. We identified 104,185 POP procedures, of which 27,839 (26.7%) included mesh material and 76,346 (73.3%) did not. Between the last three quarters of 2008 and the first three of 2009, the rates of mesh cases increased (40.3-42.1, P < 0.001) and those without mesh decreased (115.5-111.4, P < 0.001). Inpatient procedures decreased and outpatient procedures increased for both those with and without mesh augmentation. For inpatient procedures, the relative use of biologic graft and synthetic mesh material did not vary over the study period. A substantial number of Medicare beneficiaries underwent mesh POP procedures in 2008-2009. However, despite the PHN cautioning about potential mesh complications, the numbers of mesh cases continued to rise in the immediate period after the PHN. Copyright © 2012 Wiley Periodicals, Inc.

Measles, mumps, and rubella antibody status and response to immunization in children after therapy for acute lymphoblastic leukemia.

PubMed

Aytac, Selin; Yalcin, S Songul; Cetin, Mualla; Yetgin, Sevgi; Gumruk, Fatma; Tuncer, Murat; Yurdakok, Kadriye; Gurgey, Aytemiz

2010-08-01

Seventy-seven patients with acute lymphoblastic leukemia (ALL) who were in complete remission and whose therapies had been stopped for at least 6 months before enrollment in this study were retrospectively analyzed regarding their antibody status for measles, mumps, and rubella, with the aim to demonstrate the seropositivity rate after treatment in the authors' group. Each patient's serum samples were analyzed by enzyme-linked immunosorbent assay (ELISA) method to determine the antibody titers before and after immunization. Measles serology was available in 77 children; 45 (58%) were seronegative. Initial ages of measle-seronegative patients were statistically lower than those of seropositive cases (median 3.29 versus 4.91 years, respectively). Mumps serology was available in 76 children; 36 (47%) were seronegative. Mumps-seropositive cases tended to have more frequent previous history of infection than seronegative cases (55.0% versus 28.6%, respectively, P = .05). Rubella serology was available in 76 children, and 20 (26.3%) were seronegative. It was determined that initial ages of rubella-seronegative patients were statistically lower than those of seropositive cases (median 3.03 versus 4.32 years, respectively). The authors concluded based on the results of their study that at a median of 3.31 years after completion of chemotherapy for ALL, the majority of cases had antibody levels lower than protective values for measles (58.4%); however, these values were 47.3% for mumps and 26.3% for rubella. Seroconversion rates after measles (55%) and mumps vaccination (57.1%) were still low. However, in the available cases, relatively adequate response to rubella vaccination (92.3%) was observed.

Isothermal and non-isothermal infiltration and deuterium transport: a case study on undisturbed soil column from headwater catchment

NASA Astrophysics Data System (ADS)

Sobotkova, Martina; Snehota, Michal; Tesar, Miroslav

2017-04-01

Isothermal and non-isothermal infiltration experiments with tracer breakthrough were carried out in the laboratory on intact column of sandy loam soil taken from Roklan site (Sumava Mountains, Czech Republic). In the case of isothermal experiment, the temperature of infiltrating water was almost equal to the initial temperature of the sample. For the non-isothermal case the infiltration was performed using water approximately 10 °C colder than was the initial temperature of soil sample. The experiments were otherwise conducted under the same initial and boundary conditions. Pressure heads and temperatures in two depths (8.8 and 15.3 cm) inside the soil were monitored as well as the temperature of water entering and leaving the sample. Water drained freely through the perforated plate at the bottom of the sample by gravity and outflow was measured using tipping bucket flowmeter. Permeability of the sample calculated for steady state stages of the experiment showed that significant difference between water flow rates recorded during two experiment could not be justified only by temperature induced changes of water viscosity and density. Results of deuterium breakthrough were nearly identical for isothermal and non-isothermal conditions.

Cost-effective hydrocele ablation.

PubMed

Fracchia, J A; Armenakas, N A; Kohan, A D

1998-03-01

The surgical repair of hydroceles can be relatively expensive in some cases in terms of costs and initial limitation of activity. We ascertain whether aspiration and sclerotherapy of hydroceles is a safe, efficient, cost-effective treatment modality in select patients. In 47 patients 51 hydroceles were treated in the office with aspiration and instillation of a sclerosing solution based on a sodium tetradecyl sulfate preparation. One treatment was done in 14 cases and 2 in the remainder. Medicare data for 1995 were used for charge analysis. The overall success rate was 61% (34 of 51 cases) with success defined as no perceptible ipsilateral scrotal fluid reaccumulation on palpation by a physician and complete patient satisfaction. The failure rate was 39% (17 cases) with failure defined as perceptible ipsilateral scrotal fluid reaccumulation on palpation by a physician and/or patient dissatisfaction. The charge differential of surgery versus aspiration and sclerotherapy was greater than 9:1. The aspiration and sclerotherapy technique that we used appears to be an efficacious, safe, cost-effective treatment modality in select patients with idiopathic hydroceles.

FOLFOXIRI Plus Bevacizumab as Conversion Therapy for Patients With Initially Unresectable Metastatic Colorectal Cancer: A Systematic Review and Pooled Analysis.

PubMed

Tomasello, Gianluca; Petrelli, Fausto; Ghidini, Michele; Russo, Alessandro; Passalacqua, Rodolfo; Barni, Sandro

2017-07-13

The combination of fluorouracil, oxaliplatin, and irinotecan plus bevacizumab (FOLFOXIRI-Bev) is an established and effective first-line chemotherapy regimen for metastatic colorectal cancer. However, resection rates of metastases and overall survival with this schedule have never been systematically evaluated in published studies including, but not limited to, the TRIBE (TRIplet plus BEvacizumab) trial. To assess the clinical efficacy of FOLFOXIRI-Bev, including outcomes and rates of surgical conversions. A systematic review was conducted in October 2016 in concordance with the PRISMA guidelines of PubMed, the Cochrane Central Register of Controlled Trials, SCOPUS, Web of Science, Google Scholar, CINAHL, Ovid, and EMBASE using the terms FOLFOXIRI and bevacizumab and (colorectal cancer). Clinical trials, retrospective case series, and prospective case series that used FOLFOXIRI-Bev for the treatment of initially unresectable metastatic colorectal cancer in humans were included. Individual case reports and retrospective case series with fewer than 10 patients were excluded. Data were extracted independently by 2 reviewers on a predesigned, standardized form. Ultimately, data were aggregated to obtain the pooled effect size of efficacy, according to the random-effects model and weighted for the number of patients included in each trial. Median overall survival and progression-free survival, overall response rates, and rates of R0 surgical conversions and overall surgical conversions. Eleven FOLFOXIRI-Bev studies published between 2010 and 2016 met the inclusion criteria and were pooled for analysis. The studies included 889 patients, with 877 patients clinically evaluable for overall response rates. The objective response rate to FOLFOXIRI-Bev was 69% (95% CI, 65%-72%; I2 = 25%). The rate of overall surgical conversions was 39.1% (95% CI, 26.9%-52.8%), and the rate of R0 surgical conversions was 28.1% (95% CI, 18.1%-40.8%). Median pooled overall survival was 30.2 months (95% CI, 26.5-33.7 months) in 6 trials with data available, and progression-free survival was 12.4 months (95% CI, 10.0-14.3 months) in 9 trials with data available. In meta-regression analysis, variables significantly associated with conversion surgery were disease limited to the liver and a higher median number of cycles (close to 12). For patients with surgically unresectable metastatic colorectal cancer, FOLFOXIRI-Bev is associated with a significant overall response rate. Such an effective regimen leads to a probability of surgical conversion of distant metastases approaching 40%, with more than one-fourth of patients having an R0 resection.

Vascularised free fibular flap in bone resection and reconstruction.

PubMed

Belt, P J; Dickinson, I C; Theile, D R B

2005-06-01

This paper compares allograft alone and in combination with vascularised free fibular flaps (FFF) to reconstruct long bone defects after tumour excision. We present 33 cases, 21 of these patients had reconstruction with an allograft alone as the initial procedure. Nine patients underwent reconstruction with FFF plus allograft plus iliac crest bone graft (ICG), two patients underwent reconstruction with a FFF and ICG and one patient underwent reconstruction with an allograft, a pedicled fibular flap and a FFF. The allograft was obtained from the Queensland Bone Bank and had been irradiated to 25 000Gy. In our experience (N=21) the complication rates with allograft alone were: delayed union 3, nonunion 7, fractured allograft 6, infection requiring resection of the allograft 3, other infections 2. The revision rate was 48% (10 cases of which five required a free fibular flap) and an average of 1.8 revision procedures were required. In the lower limb cases, the mean time to full weightbearing was 20 months and 40% were full weightbearing at 18 months. We felt that the high complication rate compared with other series may have been related to the irradiation of the graft. FFFs were used in 18 cases, 12 cases were primary reconstructions and six were revision reconstructions. The mean fibular length was 19.4 cm (range 10-29 cm). There were no flap losses and the FFF united at both ends of 11 of 12 primary reconstruction cases. One case had nonunion at one end, giving a union rate of 96% (23 of 24 junctions). When a FFF was used in combination with an allograft as a primary reconstruction, the allograft nonunion rate was 50% (five of 10 cases). The mean time to full weightbearing in the lower limb cases was 7.5 months and 100% were full weightbearing at 18 months. The FFF hastens time to full weightbearing but does not appear to affect the complication rates of allograft. The number of revision procedures required is reduced in the presence of a FFF and is the latter is a useful technique for the salvage of refractory cases.

A behaviourally anchored rating scale for evaluating the use of the WHO surgical safety checklist: development and initial evaluation of the WHOBARS.

PubMed

Devcich, Daniel A; Weller, Jennifer; Mitchell, Simon J; McLaughlin, Scott; Barker, Lauren; Rudolph, Jenny W; Raemer, Daniel B; Zammert, Martin; Singer, Sara J; Torrie, Jane; Frampton, Chris Ma; Merry, Alan F

2016-10-01

Realising the full potential of the WHO Surgical Safety Checklist (SSC) to reduce perioperative harm requires the constructive engagement of all operating room (OR) team members during its administration. To facilitate research on SSC implementation, a valid and reliable instrument is needed for measuring OR team behaviours during its administration. We developed a behaviourally anchored rating scale (BARS) for this purpose. We used a modified Delphi process, involving 16 subject matter experts, to compile a BARS with behavioural domains applicable to all three phases of the SSC. We evaluated the instrument in 80 adult OR cases and 30 simulated cases using two medical student raters and seven expert raters, respectively. Intraclass correlation coefficients were calculated to assess inter-rater reliability. Internal consistency and instrument discrimination were explored. Sample size estimates for potential study designs using the instrument were calculated. The Delphi process resulted in a BARS instrument (the WHOBARS) with five behavioural domains. Intraclass correlation coefficients calculated from the OR cases exceeded 0.80 for 80% of the instrument's domains across the SSC phases. The WHOBARS showed high internal consistency across the three phases of the SSC and ability to discriminate among surgical cases in both clinical and simulated settings. Fewer than 20 cases per group would be required to show a difference of 1 point between groups in studies of the SSC, where α=0.05 and β=0.8. We have developed a generic instrument for comprehensively rating the administration of the SSC and informing initiatives to realise its full potential. We have provided data supporting its capacity for discrimination, internal consistency and inter-rater reliability. Further psychometric evaluation is warranted. 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/

Transradial Approach for Hepatic Radioembolization: Initial Results and Technique.

PubMed

Bishay, Vivian L; Biederman, Derek M; Ward, Thomas J; van der Bom, Imramsjah Martijn J; Patel, Rahul S; Kim, Edward; Nowakowski, Francis S; Lookstein, Robert A; Fischman, Aaron M

2016-11-01

The transradial approach (TRA) has been shown to reduce the morbidity and mortality associated with arterial coronary interventions. Selective internal radiation therapy (SIRT) performed via the TRA can enhance patient comfort, compared with the traditional transfemoral approach (TFA), by allowing immediate ambulation and precluding potential complications associated with the TFA, such as closure device injury or retroperitoneal hematoma. We report our initial experience with and technique for using the TRA for SIRT. Between May 1, 2012, and April 30, 2015, a total of 574 procedures, including planning angiograms (n = 329) and infusions of 90 Y (n = 245), were performed for 318 patients (mean age, 64.5 years). Of the 245 patients who received 90 Y infusions, 52 had SIRT performed with the use of a permanent single-use implant of 90 Y resin microspheres and 193 had SIRT performed with the use of millions of small glass microspheres containing radioactive 90 Y. Procedural details, technical success, the radial artery (RA) occlusion rate noted at 30 days (as assessed via pulse examination), and the major and minor adverse events noted at 30 days were evaluated. Technical success was achieved in 561 of 574 cases (97.7%). The reasons for crossover to use of the TFA included an RA loop (n = 2), RA occlusion (n = 9), and type D response as determined by use of a Barbeau test (n = 2). Patients had undergone between zero and six previous TRA procedures. The mortality rate at 30 days was 0%. Superficial bruising occurred in 13 of 574 cases (2.3%). A grade 2 hematoma that required a second nonocclusive hemostasis cuff occurred in one case. Transient forearm numbness or pain occurred in two of 574 cases. One patient had a transient convulsive event occur after receiving intraarterial infusion of verapamil. RA occlusion occurred in nine of 574 cases (1.6%). Use of the TRA for SIRT is safe, feasible, and well tolerated and is associated with high rates of technical success and rare complications.

On the anisotropic advection-diffusion equation with time dependent coefficients

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

Hernandez-Coronado, Hector; Coronado, Manuel; Del-Castillo-Negrete, Diego B.

The advection-diffusion equation with time dependent velocity and anisotropic time dependent diffusion tensor is examined in regard to its non-classical transport features and to the use of a non-orthogonal coordinate system. Although this equation appears in diverse physical problems, particularly in particle transport in stochastic velocity fields and in underground porous media, a detailed analysis of its solutions is lacking. In order to study the effects of the time-dependent coefficients and the anisotropic diffusion on transport, we solve analytically the equation for an initial Dirac delta pulse. Here, we discuss the solutions to three cases: one based on power-law correlationmore » functions where the pulse diffuses faster than the classical rate ~t, a second case specically designed to display slower rate of diffusion than the classical one, and a third case to describe hydrodynamic dispersion in porous media« less

Ebola Virus Disease, Democratic Republic of the Congo, 2014.

PubMed

Nanclares, Carolina; Kapetshi, Jimmy; Lionetto, Fanshen; de la Rosa, Olimpia; Tamfun, Jean-Jacques Muyembe; Alia, Miriam; Kobinger, Gary; Bernasconi, Andrea

2016-09-01

During July-November 2014, the Democratic Republic of the Congo underwent its seventh Ebola virus disease (EVD) outbreak. The etiologic agent was Zaire Ebola virus; 66 cases were reported (overall case-fatality rate 74.2%). Through a retrospective observational study of confirmed EVD in 25 patients admitted to either of 2 Ebola treatment centers, we described clinical features and investigated correlates associated with death. Clinical features were mainly generic. At admission, 76% of patients had >1 gastrointestinal symptom and 28% >1 hemorrhagic symptom. The case-fatality rate in this group was 48% and was higher for female patients (67%). Cox regression analysis correlated death with initial low cycle threshold, indicating high viral load. Cycle threshold was a robust predictor of death, as were fever, hiccups, diarrhea, dyspnea, dehydration, disorientation, hematemesis, bloody feces during hospitalization, and anorexia in recent medical history. Differences from other outbreaks could suggest guidance for optimizing clinical management and disease control.

On the anisotropic advection-diffusion equation with time dependent coefficients

DOE PAGES

Hernandez-Coronado, Hector; Coronado, Manuel; Del-Castillo-Negrete, Diego B.

2017-02-01

The advection-diffusion equation with time dependent velocity and anisotropic time dependent diffusion tensor is examined in regard to its non-classical transport features and to the use of a non-orthogonal coordinate system. Although this equation appears in diverse physical problems, particularly in particle transport in stochastic velocity fields and in underground porous media, a detailed analysis of its solutions is lacking. In order to study the effects of the time-dependent coefficients and the anisotropic diffusion on transport, we solve analytically the equation for an initial Dirac delta pulse. Here, we discuss the solutions to three cases: one based on power-law correlationmore » functions where the pulse diffuses faster than the classical rate ~t, a second case specically designed to display slower rate of diffusion than the classical one, and a third case to describe hydrodynamic dispersion in porous media« less

Direct simulation of a self-similar plane wake

NASA Technical Reports Server (NTRS)

Moser, Robert D.; Rogers, Michael M.

1994-01-01

Direct simulations of two time-developing turbulent wakes have been performed. Initial conditions for the simulations were obtained from two realizations of a direct simulation of a turbulent boundary layer at momentum thickness Reynolds number 670. In addition, extra two dimensional disturbances were added in one of the cases to mimic two dimensional forcing. The unforced wake is allowed to evolve long enough to attain self similarity. The mass-flux Reynolds number (equivalent to the momentum thickness Reynolds number in spatially developing wakes) is 2000, which is high enough for a short k(exp -5/3) range to be evident in the streamwise one dimensional velocity spectrum. Several turbulence statistics have been computed by averaging in space and over the self-similar period in time. The growth rate in the unforced flow is low compared to experiments, but when this growth-rate difference is accounted for, the statistics of the unforced case are in reasonable agreement with experiments. However, the forced case is significantly different. The growth rate, turbulence Reynolds number, and turbulence intensities are as much as ten times larger in the forced case. In addition, the forced flow exhibits large-scale structures similar to those observed in transitional wakes, while the unforced flow does not.

Bacterial meningitis in children under 15 years of age in Nepal.

PubMed

Shrestha, Rajani Ghaju; Tandukar, Sarmila; Ansari, Shamshul; Subedi, Akriti; Shrestha, Anisha; Poudel, Rekha; Adhikari, Nabaraj; Basnyat, Shital Raj; Sherchand, Jeevan Bahadur

2015-08-19

Bacterial meningitis in children is a life-threatening problem resulting in severe morbidity and mortality. For the prompt initiation of antibacterial therapy, rapid and reliable diagnostic methods are of utmost importance. Therefore, this study was designed to find out the rate of bacterial pathogens of meningitis from suspected cases by performing conventional methods and latex agglutination. A descriptive type of study was carried out from May 2012 to April 2013. Cerebrospinal fluid (CSF) specimens from 252 suspected cases of meningitis were subjected for Gram staining, bacterial culture and latex agglutination test. The identification of growth of bacteria was done following standard microbiological methods recommended by American Society for Microbiology. Antibiotic sensitivity testing was done by modified Kirby-Bauer disk diffusion method. From the total 252 suspected cases, 7.2 % bacterial meningitis was revealed by Gram staining and culture methods whereas latex agglutination method detected 5.6 %. Gram-negative organisms contributed the majority of the cases (72.2 %) with Haemophilus influenzae as the leading pathogen for meningitis. Overall, 33.3 % mortality rate was found. In conclusion, a significant rate of bacterial meningitis was found in this study prompting concern for national wide surveillance.

Diversity of head shaking nystagmus in peripheral vestibular disease.

PubMed

Kim, Min-Beom; Huh, Se Hyung; Ban, Jae Ho

2012-06-01

To evaluate the characteristics of head shaking nystagmus in various peripheral vestibular diseases. Retrospective case series. Tertiary referral center. Data of 235 patients with peripheral vestibular diseases including vestibular neuritis, Ménière's disease, and benign paroxysmal positional vertigo, were retrospectively analyzed. All subjects presented between August 2009 and July 2010. Patients were tested for vestibular function including head shaking nystagmus and caloric information. Regarding vestibular neuritis, all tests were again performed during the 1-month follow-up. Head shaking nystagmus was classified as monophasic or biphasic and, according to the affected ear, was divided as ipsilesional or contralesional. Of the 235 patients, 87 patients revealed positive head shaking nystagmus. According to each disease, positive rates of head shaking nystagmus were as follows: 35 (100%) of 35 cases of vestibular neuritis, 11 (68.8%) of 16 cases of Ménière's disease, and 41 (22.2%) of 184 cases of benign paroxysmal positional vertigo. All cases of vestibular neuritis initially presented as a monophasic, contralesional beating, head shaking nystagmus. However, 1 month after first visit, the direction of nystagmus was changed to biphasic (contralesional first then ipsilesional beating) in 25 cases (72.5%) but not in 10 cases (27.5%). There was a significant correlation between the degree of initial caloric weakness and the biphasic conversion of head shaking nystagmus (p = 0.02). In 72.5% of vestibular neuritis cases, head shaking nystagmus was converted to biphasic during the subacute period. The larger the initial canal paresis was present, the more frequent the biphasic conversion of head shaking nystagmus occurred. However, Ménière's disease and benign paroxysmal positional vertigo did not have specific patterns of head shaking nystagmus.

Value of Specialist Pathology Review in a Single Statewide Gynecologic Cancer Service.

PubMed

Melon, Jerome; Leung, Yee; Salfinger, Stuart G; Tan, Jason; Mohan, Ganendra; Cohen, Paul A

2017-01-01

A case review by specialist diagnostic pathologists as part of a Gynecologic Oncology Multi-disciplinary Tumor group has the potential to influence the management of patients with cancer. The primary aim of this study was to determine the frequency of diagnostic discrepancies between the initial (nonspecialist) and final pathological diagnoses in cases referred to the Gynecologic Oncology Tumor Conference (TC) in Western Australia and the impact of such revised diagnosis on clinical management. A secondary aim was to assess the evolving workload encountered by the TC during a 5-year interval. The records of the weekly TC for the 2 calendar years 2008 and 2013 were examined, and histological and cytological specimens that had been initially assessed by "outside" (nonspecialist) pathology departments, and subsequently reviewed by specialist pathologists, were assessed. The initial and final diagnoses were compared, and where the pathological findings were amended upon review, it was determined whether the change affected clinical management. Diagnostic discrepancies that resulted in a change in patient management were classified as major, whereas discrepancies that did not affect patient management were classified as minor. A total of 481 outside cases were included among 2387 cases presented for histological review at the TC during the 2 years. For outside cases alone, the incidence of major diagnostic discrepancies was 3.4% in 2008, 5.5% in 2013 (no significant difference, P = 0.3787), and 4.6% for the 2 years combined. A recommendation for surgery was the most common change in clinical management as a result of major discrepancy. The minor discrepancy rate was 4.4% of outside cases for both years combined. Pathological discrepancies (major and minor) of the uterine corpus and cervix were most frequent, followed by those of the vulva and ovary. There was a 48.4% increase in total case discussions at the TC during the interval period with a significant rise in nonmalignant cases, 29.8% of the total cases in 2008 compared with 36.8% in 2013 (P = 0.0004). Nonspecialist pathology departments maintained a high level of reporting accuracy during the interval period, with the major discrepancy rate not changing significantly between 2008 and 2013. Specimens from the uterine corpus and cervix in particular may prove diagnostically challenging on occasion. A pathology review of outside cases by a tertiary-based laboratory in conjunction with a TC can identify a small but clinically significant number of cases that lead to a change in clinical management. It is uncertain whether this affects patient outcomes.

Initial home health outcomes under prospective payment.

PubMed

Schlenker, Robert E; Powell, Martha C; Goodrich, Glenn K

2005-02-01

To assess initial changes in home health patient outcomes under Medicare's home health Prospective Payment System (PPS), implemented by the Centers for Medicare and Medicaid Services (CMS) in October 2000. Pre-PPS and early PPS data were obtained from CMS Outcome and Assessment Information Set (OASIS) and Medicare claims files. Regression analysis was applied to national random samples (n=164,810) to estimate pre-PPS/PPS outcome and visit-per-episode changes. Outcome episodes were constructed from OASIS data and linked with Medicare claims data on visits. Outcome changes (risk adjusted) were mixed and generally modest. Favorable changes included higher improvement rates under PPS for functioning and dyspnea, higher community discharge rates, and lower hospitalization and emergent care rates. Most stabilization (nonworsening) outcome rates also increased. However, improvement rates were lower under PPS for wounds, incontinence, and cognitive and emotional/behavioral outcomes. Total visits per episode (case-mix adjusted) declined 16.6 percent although therapy visits increased by 8.4 percent. The outcome and visit results suggest improved system efficiency under PPS (fewer visits, similar outcomes). However, declines in several improvement rates merit ongoing monitoring, as do subsequent (posthome health) hospitalization and emergent care use. Since only the early PPS period was examined, longer-term analyses are needed.

Eighteen-year follow-up report of the surveillance and prevention of an HIV/AIDS outbreak amongst plasma donors in Hebei Province, China.

PubMed

Chen, Suliang; Zhao, Hongru; Zhao, Cuiying; Zhang, Yuqi; Li, Baojun; Bai, Guangyi; Liang, Liang; Lu, Xinli

2015-08-06

There has been a clear increase in HIV-1 infection cases in recent years in Hebei Province, China, and transmission via blood is one of the risk factors in the early. This article aimed to investigate the HIV infection rate and control efficiency among the paid blood donor population over a period of 18 years. From 1995-2013, HIV/AIDS cases among former blood donors in Hebei Province were registered and closely monitored to collect data of all-cause mortality, intervention measures to prevent family transmission, disease transmission between couples as well as between mothers and infants, and HAART therapy outcomes. A total of 326 cases were identified as directly infected with HIV/AIDS during plasma donation in Hebei Province. Of these, 146 cases (44.8%) were identified in the same year as infection; 180 cases (55.2%) were identified 1-18 years after infection because they did not participate in the 1995 screening. The final case was identified in February 2012. By 2013, the mortality rate and survival rate of plasma donor-related HIV/AIDS was 54.9% and 45.1%, respectively. The identified transmission rate between couples was 11.3% (8/71); this rate during the same year as infection was 3.3% (1/30), and the rate 4-17 years after HIV infection was 17.1% (7/41). Approximately 91.2% (145/159) of married women of childbearing age did not have children after being informed of HIV infection. Only 8.8% (14/159) of these women had children after being informed of HIV infection. The mother-to-infant transmission rate was 38.5% (5/13). The HAART coverage rate has increased from 10.1% (16/159) in 2003 to 83.6% (127/152) in 2013. Since 1999, the HIV mortality rate has trended up; by 2013, the cumulative mortality rate reached 54.9% (179/326). After HAART was initiated in China, the death rate decreased to some extent. Second generation transmission (via couple or mother-to-infant transmission) among blood donor-related HIV cases accounted for approximately 4.0% (13/326). All first- or second-generation cases were infected with HIV-1 subtype B. In this accident of HIV-infection among plasma donors in Hebei Province, a total of 339 direct and second-generation cases have been identified over 18 years of monitoring. Favorable clinical results have been achieved using intervention measurements and antiviral therapy.

Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province.

PubMed Central

May, P A; Brooke, L; Gossage, J P; Croxford, J; Adnams, C; Jones, K L; Robinson, L; Viljoen, D

2000-01-01

OBJECTIVES: This study determined the characteristics of fetal alcohol syndrome in a South African community, and methodology was designed for the multidisciplinary study of fetal alcohol syndrome in developing societies. METHODS: An active case ascertainment, 2-tier methodology was used among 992 first-grade pupils. A case-control design, using measures of growth, development, dysmorphology, and maternal risk, delineated characteristics of children with fetal alcohol syndrome. RESULTS: A high rate of fetal alcohol syndrome was found in the schools--40.5 to 46.4 per 1000 children aged 5 to 9 years--and age-specific community rates (ages 6-7) were 39.2 to 42.9. These rates are 18 to 141 times greater than in the United States. Rural residents had significantly more fetal alcohol syndrome. After control for ethnic variation, children with fetal alcohol syndrome had traits similar to those elsewhere: poor growth and development, congruent dysmorphology, and lower intellectual functioning. CONCLUSIONS: This study documented the highest fetal alcohol syndrome rate to date in an overall community population. Fetal alcohol syndrome initiatives that incorporate innovative sampling and active case ascertainment methods can be used to obtain timely and accurate data among developing populations. PMID:11111264

Linear Stability of Binary Alloy Solidification for Unsteady Growth Rates

NASA Technical Reports Server (NTRS)

Mazuruk, K.; Volz, M. P.

2010-01-01

An extension of the Mullins and Sekerka (MS) linear stability analysis to the unsteady growth rate case is considered for dilute binary alloys. In particular, the stability of the planar interface during the initial solidification transient is studied in detail numerically. The rapid solidification case, when the system is traversing through the unstable region defined by the MS criterion, has also been treated. It has been observed that the onset of instability is quite accurately defined by the "quasi-stationary MS criterion", when the growth rate and other process parameters are taken as constants at a particular time of the growth process. A singular behavior of the governing equations for the perturbed quantities at the constitutional supercooling demarcation line has been observed. However, when the solidification process, during its transient, crosses this demarcation line, a planar interface is stable according to the linear analysis performed.

Meningococcal disease. Secondary attack rate and chemoprophylaxis in the United States, 1974.

PubMed

1976-01-19

Three hundred twenty-six reported cases of meningococcal disease in the United States from November 1973 through March 1974 were investigated. Three household members became ill with meningococcal disease following onset of the initial case in their household. The secondary attack rate was approximately 3/1,000 household members. In 60% of the households, members were given an antimicrobial drug as chemoprophylaxis for meningococcal disease, but only 35% received minocycline hydrochloride or rifampin, the two drugs now available for the eradication of sulfonamide-resistant meningococci from the nasopharynx. Only 26% given chemoprophylaxis received the drug within 24 hours after the patient's hospital admission. Survey results indicate that the secondary attack rate of meningococcal disease may justify the use of chemoprophylaxis, but that frequently in the United States, the drugs given are likely to be ineffective, give too late, or administered to persons who are not at high risk to meningococcal disease.

Sudden spreading of infections in an epidemic model with a finite seed fraction

NASA Astrophysics Data System (ADS)

Hasegawa, Takehisa; Nemoto, Koji

2018-03-01

We study a simple case of the susceptible-weakened-infected-removed model in regular random graphs in a situation where an epidemic starts from a finite fraction of initially infected nodes (seeds). Previous studies have shown that, assuming a single seed, this model exhibits a kind of discontinuous transition at a certain value of infection rate. Performing Monte Carlo simulations and evaluating approximate master equations, we find that the present model has two critical infection rates for the case with a finite seed fraction. At the first critical rate the system shows a percolation transition of clusters composed of removed nodes, and at the second critical rate, which is larger than the first one, a giant cluster suddenly grows and the order parameter jumps even though it has been already rising. Numerical evaluation of the master equations shows that such sudden epidemic spreading does occur if the degree of the underlying network is large and the seed fraction is small.

Disease Course of Patients with Unilateral Pigmentary Retinopathy

PubMed Central

Potsidis, Emorfily; Berson, Eliot L.

2011-01-01

Purpose. To evaluate the change in ocular function by eye in patients with unilateral pigmentary retinopathy. Methods. Longitudinal regression was used to estimate mean exponential rates of change in Goldmann visual field area (V4e white test light) and in full-field electroretinogram (ERG) amplitudes to 0.5- and 30-Hz white flashes in 15 patients with unilateral pigmentary retinopathy. Snellen visual acuity was assessed case by case. Results. Mean annual rates of change for the affected eyes were −4.9% for visual field area, −4.7% for ERG amplitude to 0.5-Hz flashes, and −4.6% for ERG amplitude to 30-Hz flashes. All three rates were faster than the corresponding age-related rates of change for the fellow normal eyes (P = 0.0006, P = 0.003, P = 0.03, respectively). An initial cone ERG implicit time to 30-Hz flashes in affected eyes ≥40 ms predicted a faster mean rate of decline of visual field area and of ERG amplitude to 0.5- and 30-Hz flashes (P < 0.0001 for all three measures). The visual acuity of affected eyes was more likely to decrease in patients presenting at >35 years of age than in patients presenting at a younger age (P = 0.0004). Conclusions. The affected eye in unilateral pigmentary retinopathy shows a progressive loss of peripheral retinal function that cannot be attributed to aging alone and that is faster in eyes with a more prolonged initial cone ERG implicit time. Patients presenting at >35 years of age are at greater risk for losing visual acuity. PMID:21989720

Disease course of patients with unilateral pigmentary retinopathy.

PubMed

Potsidis, Emorfily; Berson, Eliot L; Sandberg, Michael A

2011-11-29

To evaluate the change in ocular function by eye in patients with unilateral pigmentary retinopathy. Longitudinal regression was used to estimate mean exponential rates of change in Goldmann visual field area (V4e white test light) and in full-field electroretinogram (ERG) amplitudes to 0.5- and 30-Hz white flashes in 15 patients with unilateral pigmentary retinopathy. Snellen visual acuity was assessed case by case. Mean annual rates of change for the affected eyes were -4.9% for visual field area, -4.7% for ERG amplitude to 0.5-Hz flashes, and -4.6% for ERG amplitude to 30-Hz flashes. All three rates were faster than the corresponding age-related rates of change for the fellow normal eyes (P = 0.0006, P = 0.003, P = 0.03, respectively). An initial cone ERG implicit time to 30-Hz flashes in affected eyes ≥ 40 ms predicted a faster mean rate of decline of visual field area and of ERG amplitude to 0.5- and 30-Hz flashes (P < 0.0001 for all three measures). The visual acuity of affected eyes was more likely to decrease in patients presenting at >35 years of age than in patients presenting at a younger age (P = 0.0004). The affected eye in unilateral pigmentary retinopathy shows a progressive loss of peripheral retinal function that cannot be attributed to aging alone and that is faster in eyes with a more prolonged initial cone ERG implicit time. Patients presenting at >35 years of age are at greater risk for losing visual acuity.

Clinical, pathological, and molecular data on desmoplastic/nodular medulloblastoma: case studies and a review of the literature.

PubMed

Siegfried, Aurore; Bertozzi, Anne Isabelle; Bourdeaut, Franck; Sevely, Annick; Loukh, Najat; Grison, Camille; Miquel, Catherine; Lafon, Delphine; Sevenet, Nicolas; Pietsch, Torsten; Dufour, Christelle; Delisle, Marie-Bernadette

2016-01-01

The aim of this study was to better define the clinical and biopathological features of patients with desmoplastic/nodular medulloblastoma (DNMB) and to further characterize this subgroup. 17 children aged < 5 years, with initial DNMB treated according to the HIT-SKK protocol, were evaluated. A retrospective central radiological review, a pathological and immunohistochemical study, and array-CGH and sequencing of germline SUFU and PTCH1 genes were performed. 15 histologically reviewed cases were confirmed as DNMB including three cases of medulloblastoma with extensive nodularity. Median age at diagnosis was 26 months. Radiology showed five cases with a vermis location and one with T2 hyperintensity. All cases showed a SHH immunoprofile. A 9q deletion was found in 6 cases, a MYCN-MYCL amplification in 1 case, and a SUFU germline mutation in 1 case (/9). The presence of SUFU and PTCH1 germline mutations agreed with previous reports. At 3 years, progression-free survival and overallsurvival rates were 72 ± 15% and 85 ± 10%, respectively. The rate of recurrence was relatively high (4 patients). This may have been because chemotherapy was delayed in two cases. Age > 3 years, and residual tumor may also have been an explanation for recurrence.

Clinical, pathological, and molecular data on desmoplastic/nodular medulloblastoma: case studies and a review of the literature

PubMed Central

Siegfried, Aurore; Bertozzi, Anne Isabelle; Bourdeaut, Franck; Sevely, Annick; Loukh, Najat; Grison, Camille; Miquel, Catherine; Lafon, Delphine; Sevenet, Nicolas; Pietsch, Torsten; Dufour, Christelle; Delisle, Marie-Bernadette

2016-01-01

The aim of this study was to better define the clinical and biopathological features of patients with desmoplastic/nodular medulloblastoma (DNMB) and to further characterize this subgroup. 17 children aged < 5 years, with initial DNMB treated according to the HIT-SKK protocol, were evaluated. A retrospective central radiological review, a pathological and immunohistochemical study, and array-CGH and sequencing of germline SUFU and PTCH1 genes were performed. 15 histologically reviewed cases were confirmed as DNMB including three cases of medulloblastoma with extensive nodularity. Median age at diagnosis was 26 months. Radiology showed five cases with a vermis location and one with T2 hyperintensity. All cases showed a SHH immuno-profile. A 9q deletion was found in 6 cases, a MYCN–MYCL amplification in 1 case, and a SUFU germline mutation in 1 case (/9). The presence of SUFU and PTCH1 germline mutations agreed with previous reports. At 3 years, progression-free survival and overall-survival rates were 72 ± 15% and 85 ± 10%, respectively. The rate of recurrence was relatively high (4 patients). This may have been because chemotherapy was delayed in two cases. Age > 3 years, and residual tumor may also have been an explanation for recurrence. PMID:26857864

Effect of fluid penetration on tensile failure during fracturing of an open-hole wellbore

NASA Astrophysics Data System (ADS)

Zeng, Fanhui; Cheng, Xiaozhao; Guo, Jianchun; Chen, Zhangxin; Tao, Liang; Liu, Xiaohua; Jiang, Qifeng; Xiang, Jianhua

2018-06-01

It is widely accepted that a fracture can be induced at a wellbore surface when the fluid pressure overcomes the rock tensile strength. However, few models of this phenomenon account for the fluid penetration effect. A rock is a typical permeable, porous medium, and the transmission of pressure from a wellbore to the surrounding rock temporally and spatially perturbs the effective stresses. In addition, these induced stresses influence the fracture initiation pressure. To gain a better understanding of the penetration effect on the initiation pressure of a permeable formation, a comprehensive formula is presented to study the effects of the in situ stresses, rock mechanical properties, injection rate, rock permeability, fluid viscosity, fluid compressibility and wellbore size on the magnitude of the initiation pressure during fracturing of an open-hole wellbore. In this context, the penetration effect is treated as a consequence of the interaction among these parameters by using Darcy’s law of radial flow. A fully coupled analytical procedure is developed to show how the fracturing fluid infiltrates the rock around the wellbore and considerably reduces the magnitude of the initiation pressure. Moreover, the calculation results are validated by hydraulic fracturing experiments in hydrostone. An exhaustive sensitivity study is performed, indicating that the local fluid pressure induced from a seepage effect strongly influences the fracture evolution. For permeable reservoirs, a low injection rate and a low viscosity of the injected fluid have a significant impact on the fracture initiation pressure. In this case, the Hubbert and Haimson equations to predict the fracture initiation pressure are not valid. The open-hole fracture initiation pressure increases with the fracturing fluid viscosity and fluid compressibility, while it decreases as the rock permeability, injection rate and wellbore size increase.

Eight years' experience with an IVF surrogate gestational pregnancy programme.

PubMed

Raziel, Arieh; Schachter, Morey; Strassburger, Deborah; Komarovsky, Dafna; Ron-El, Raphael; Friedler, Shevach

2005-08-01

The aim of this study was to retrospectively audit eight years' experience of an IVF surrogate gestational programme and to compare the outcome of surrogacy due to absence of the uterus with surrogacy indicated for repeated IVF failure and recurrent abortions. A total of 60 cycles of IVF surrogate pregnancy were initiated in 19 treated couples. Absence of the uterus was the indication for surrogacy in 10 cases: Rokitansky syndrome (eight cases) and post-hysterectomy (two cases) designated as group A. The indications in the remaining nine patients (group B) were: IVF implantation failure (three cases), habitual abortions (four cases) and deteriorating maternal diseases (two cases). IVF performance and subsequent pregnancy outcome of groups A and B were compared. There was no difference in ovarian stimulation parameters and in IVF performance between the groups A and B. The overall pregnancy rate per transfer was 10/60 (17%). The pregnancy rates per patient and per transfer were 7/10 (70%) and 7/35 (20%) in group A compared with 3/9 (33%) and 3/25 (12%) in group B. A median number of three treatment cycles were needed to achieve pregnancy. In conclusion, the existence or absence of the uterus in the commissioning mothers is irrelevant for their IVF performance and conception rates. In patients who conceived after more than three IVF cycles, an additional 'oocyte factor' might be present.

Lessons Learned: How Early College High Schools Offer a Pathway for High School Reform

ERIC Educational Resources Information Center

Kaniuka, Theodore Stefan; Vickers, Melinda

2010-01-01

In 2002, Early College High Schools Initiative became a reality across the United States for students and educators looking for ways to improve student graduation rates, college attendance, and overall student achievement. This mixed method case study found that (a) the early college high school environment supported the academic success of…

Mapping deforestation and forest degradation using Landsat time series: a case of Sumatra—Indonesia

Treesearch

Belinda Arunarwati Margono

2013-01-01

Indonesia experiences the second highest rate of deforestation among tropical countries (FAO 2005, 2010). Consequently, timely and accurate forest data are required to combat deforestation and forest degradation in support of climate change mitigation and biodiversity conservation policy initiatives. Remote sensing is considered as a significant data source for forest...

A Case Study of Perceptions and Experiences among African-American Males Regarding College Dropout Rates in a Community College

ERIC Educational Resources Information Center

Branch, James

2017-01-01

Community colleges enroll nearly half of the students in public undergraduate programs and a disproportionate number of first-generation, low-income, underprepared, and minority students. The new national completion agenda initiated by President Barack Obama had brought both visibility and pressure to community colleges, which had completion rates…

Lung cancer incidence trends in Uruguay 1990-2014: An age-period-cohort analysis.

PubMed

Alonso, Rafael; Piñeros, Marion; Laversanne, Mathieu; Musetti, Carina; Garau, Mariela; Barrios, Enrique; Bray, Freddie

2018-05-11

Uruguay, a country with one of the highest lung cancer rates worldwide, initiated a series of comprehensive anti-smoking measures in 2005. We assess the tobacco control policies in the context of cohort-driven lung cancer incidence trends over a 25-year period, providing baseline predictions to 2035. Using data from the National Cancer Registry of Uruguay, an age-period-cohort analysis of trends 1990-2014 was performed. The NORDPRED package was used to predict the annual number of new cases of lung cancer and incidence rates up to 2035. In men, age-standardised (world) rates declined from a peak of 165.6 in 1995 to 103.1 by 2014, translating to a 70% reduction in the risk of lung cancer in men born in 1970 relative to the early-1940s. In females, rates increased steadily from 18.3 in 1991 to 30.0 by 2014, with successive increases in risk among generations of women born 1940-1960. There is however evidence of a decline in observed rates in women born recently. Extrapolations of the trends indicate an 8% reduction in the mean number of new lung cancer cases in men by 2035, but a 69% increase in women. Despite observed and predicted reductions in lung cancer incidence in Uruguayan men, rates among women are set to continue to increase, with a large rise in the annual number of female lung cancer diagnoses expected before 2035. There are signals of a diminishing risk among recent generations of women born after 1960. The current analysis provides important baseline information in assessing the future impact of the recent tobacco control initiatives in Uruguay. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Feasibility and relevance of an operating room safety checklist for developing countries: Study in a French hospital in Djibouti].

PubMed

Becret, A; Clapson, P; Andro, C; Chapelier, X; Gauthier, J; Kaiser, E

2013-01-01

The use of the World Health Organization surgical safety checklist, mandatory in operating rooms (OR) in France, significantly reduces morbidity and mortality. Our objective was to evaluate the use of this checklist in the OR of a French military hospital in Djibouti (Horn of Africa). The study was performed in three stages: a retrospective evaluation of the checklist use over the previous two months, to assess the utilization and completeness rates; provision of information to the OR staff; and thereafter, prospective evaluation for a one-month period of checklist use, the reasons for non-compliance, and the cases in which the checklist identified errors and thus prevented serious adverse events. The initial utilization rate was 49%, with only 24% complete. After staff training and during the study these rates reached 100% and 99%. The staff encountered language difficulties in 53% of cases, and an interpreter was available for 81% of them. The capacity of the surgical safety checklist to detect serious adverse events was highlighted. The utilization and completeness rates were initially worse than those observed in metropolitan French ORs, but a simple staff information program was rapidly effective. Language difficulties are frequent but an interpreter is often available, unlike in developed countries where language problems are uncommon and the availability of interpreters difficult. Moreover, this study illustrates the ability of the checklist to detect and therefore prevent potentially serious adverse events.

How to quench a galaxy

NASA Astrophysics Data System (ADS)

Pontzen, Andrew; Tremmel, Michael; Roth, Nina; Peiris, Hiranya V.; Saintonge, Amélie; Volonteri, Marta; Quinn, Tom; Governato, Fabio

2017-02-01

We show how the interplay between active galactic nuclei (AGNs) and merger history determines whether a galaxy quenches star formation (SF) at high redshift. We first simulate, in a full cosmological context, a galaxy of total dynamical mass Mvir = 1012 M⊙ at z = 2. Then we systematically alter the accretion history of the galaxy by minimally changing the linear overdensity in the initial conditions. This `genetic modification' approach allows the generation of three sets of Λ CDM initial conditions leading to maximum merger ratios of 1:10, 1:5 and 2:3, respectively. The changes leave the final halo mass, large-scale structure and local environment unchanged, providing a controlled numerical experiment. Interaction between the AGN physics and mergers in the three cases leads, respectively, to a star-forming, temporarily quenched and permanently quenched galaxy. However, the differences do not primarily lie in the black hole accretion rates, but in the kinetic effects of the merger: the galaxy is resilient against AGN feedback unless its gaseous disc is first disrupted. Typical accretion rates are comparable in the three cases, falling below 0.1 M⊙ yr-1, equivalent to around 2 per cent of the Eddington rate or 10-3 times the pre-quenching star formation rate, in agreement with observations. This low level of black hole accretion can be sustained even when there is insufficient dense cold gas for SF. Conversely, supernova feedback is too distributed to generate outflows in high-mass systems, and cannot maintain quenching over periods longer than the halo gas cooling time.

Suppression and enhancement of decoherence in an atomic Josephson junction

NASA Astrophysics Data System (ADS)

Japha, Yonathan; Zhou, Shuyu; Keil, Mark; Folman, Ron; Henkel, Carsten; Vardi, Amichay

2016-05-01

We investigate the role of interatomic interactions when a Bose gas, in a double-well potential with a finite tunneling probability (a ‘Bose-Josephson junction’), is exposed to external noise. We examine the rate of decoherence of a system initially in its ground state with equal probability amplitudes in both sites. The noise may induce two kinds of effects: firstly, random shifts in the relative phase or number difference between the two wells and secondly, loss of atoms from the trap. The effects of induced phase fluctuations are mitigated by atom-atom interactions and tunneling, such that the dephasing rate may be suppressed by half its single-atom value. Random fluctuations may also be induced in the population difference between the wells, in which case atom-atom interactions considerably enhance the decoherence rate. A similar scenario is predicted for the case of atom loss, even if the loss rates from the two sites are equal. We find that if the initial state is number-squeezed due to interactions, then the loss process induces population fluctuations that reduce the coherence across the junction. We examine the parameters relevant for these effects in a typical atom chip device, using a simple model of the trapping potential, experimental data, and the theory of magnetic field fluctuations near metallic conductors. These results provide a framework for mapping the dynamical range of barriers engineered for specific applications and set the stage for more complex atom circuits (‘atomtronics’).

A probabilistic fatigue analysis of multiple site damage

NASA Technical Reports Server (NTRS)

Rohrbaugh, S. M.; Ruff, D.; Hillberry, B. M.; Mccabe, G.; Grandt, A. F., Jr.

1994-01-01

The variability in initial crack size and fatigue crack growth is incorporated in a probabilistic model that is used to predict the fatigue lives for unstiffened aluminum alloy panels containing multiple site damage (MSD). The uncertainty of the damage in the MSD panel is represented by a distribution of fatigue crack lengths that are analytically derived from equivalent initial flaw sizes. The variability in fatigue crack growth rate is characterized by stochastic descriptions of crack growth parameters for a modified Paris crack growth law. A Monte-Carlo simulation explicitly describes the MSD panel by randomly selecting values from the stochastic variables and then grows the MSD cracks with a deterministic fatigue model until the panel fails. Different simulations investigate the influences of the fatigue variability on the distributions of remaining fatigue lives. Six cases that consider fixed and variable conditions of initial crack size and fatigue crack growth rate are examined. The crack size distribution exhibited a dominant effect on the remaining fatigue life distribution, and the variable crack growth rate exhibited a lesser effect on the distribution. In addition, the probabilistic model predicted that only a small percentage of the life remains after a lead crack develops in the MSD panel.

Capture of shrinking targets with realistic shrink patterns.

PubMed

Hoffmann, Errol R; Chan, Alan H S; Dizmen, Coskun

2013-01-01

Previous research [Hoffmann, E. R. 2011. "Capture of Shrinking Targets." Ergonomics 54 (6): 519-530] reported experiments for capture of shrinking targets where the target decreased in size at a uniform rate. This work extended this research for targets having a shrink-size versus time pattern that of an aircraft receding from an observer. In Experiment 1, the time to capture the target in this case was well correlated in terms of Fitts' index of difficulty, measured at the time of capture of the target, a result that is in agreement with the 'balanced' model of Johnson and Hart [Johnson, W. W., and Hart, S. G. 1987. "Step Tracking Shrinking Targets." Proceedings of the human factors society 31st annual meeting, New York City, October 1987, 248-252]. Experiment 2 measured the probability of target capture for varying initial target sizes and target shrink rates constant, defined as the time for the target to shrink to half its initial size. Data of shrink time constant for 50% probability of capture were related to initial target size but did not greatly affect target capture as the rate of target shrinking decreased rapidly with time.

Novel Method to Detect and Characterize 18F-FDG Infiltration at the Injection Site: A Single-Institution Experience.

PubMed

Muzaffar, Razi; Frye, Sarah A; McMunn, Anna; Ryan, Kelley; Lattanze, Ron; Osman, Medhat M

2017-12-01

A novel quality control and quality assurance device provides time-activity curves that can identify and characterize PET/CT radiotracer infiltration at the injection site during the uptake phase. The purpose of this study was to compare rates of infiltration detected by the device with rates detected by physicians. We also assessed the value of using the device to improve injection results in our center. Methods: 109 subjects consented to the study. All had passive device sensors applied to their skin near the injection site and mirrored on the contralateral arm during the entire uptake period. Nuclear medicine physicians reviewed standard images for the presence of dose infiltration. Sensor-generated time-activity curves were independently examined and then compared with the physician reports. Injection data captured by the software were analyzed, and the results were provided to the technologists. Improvement measures were implemented, and rates were remeasured. Results: Physician review of the initial 40 head-to-toe field-of-view images identified 15 cases (38%) of dose infiltration (9 minor, 5 moderate, and 1 significant). Sensor time-activity curves on these 40 cases independently identified 22 cases (55%) of dose infiltration (16 minor, 5 moderate, and 1 significant). After the time-activity curve results and the contributing factor analysis were shared with technologists, injection techniques were modified and an additional 69 cases were studied. Of these, physician review identified 17 cases (25%) of infiltration (13 minor, 3 moderate, and 1 significant), a 34% decline. Sensor time-activity curves identified 4 cases (6%) of infiltration (2 minor and 2 moderate), an 89% decline. Conclusion: The device provides valuable quality control information for each subject. Time-activity curves can further characterize visible infiltration. Even when the injection site was out of the field of view, the time-activity curves could still detect and characterize infiltration. Our initial experience showed that the quality assurance information obtained from the device helped reduce the rate and severity of infiltration. The device revealed site-specific contributing factors that helped nuclear medicine physicians and technologists customize their quality improvement efforts to these site-specific issues. Reducing infiltration can improve image quality and SUV quantification, as well as the ability to minimize variability in a site's PET/CT results. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

[Clinical outcome and prognosis of neonatal bacterial meningitis].

PubMed

Ben Hamouda, H; Ben Haj Khalifa, A; Hamza, M A; Ayadi, A; Soua, H; Khedher, M; Sfar, M T

2013-09-01

To study the epidemiological, clinical, and bacteriological aspects as well as the outcome of neonatal bacterial meningitis and analyze the factors of poor prognosis of this condition. We report a retrospective analysis of 44 cases of neonatal bacterial meningitis hospitalized in the pediatric unit of Tahar Sfar Hospital in Mahdia, Tunisia, between January 1996 and December 2010. Inclusion criteria were infants less than 29 days of age who were hospitalized for bacterial meningitis diagnosed on either the presence of bacteria in cerebrospinal fluid or with more than 50 cells/mm(3), predominance of neutrophils, and the protein level greater than 1.2g/l. Clinical data were obtained through the analysis of patient files. Statistical analysis was based on the Chi(2) test, and P-values less than 0.05 were considered statistically significant. The incidence of neonatal bacterial meningitis was 0.49 per 1000 live births. The patients were premature in 20.4 % and low birth weight in 13.6 % of cases. The clinical presentation was not specific for most cases. The main signs at admission were hyperthermia (43.2 %), refusal to nurse (20.4 %), seizures (18.2 %), and respiratory distress (13.6 %). The cerebrospinal fluid culture was positive in 36.4 % of cases. The group B streptococcus was the most frequently isolated (62.5 %) followed by Escherichia coli (12.5 %). The association of cefotaxime-ampicillin-gentamicin was used as the first treatment in all cases. Ofloxacin was associated with initial antibiotic therapy during the first 5 days in 20.4 % of cases. The mortality rate was 15.9 % and the rate of neurological sequelae in survivors was 21.6 %. Prematurity, low birth weight, shock, respiratory distress, and pleocytosis of less than 500 cells/mm(3) were the main factors of a poor prognosis. The addition of ofloxacin to the initial antibiotic therapy was associated with a decreased rate of neurological sequelae in survivors (11 % vs. 25 %, P=0.042). This study emphasizes the severity of neonatal bacterial meningitis with high rates of mortality and neurological sequelae, especially in premature and low birth weight infants. An early diagnosis and effective antibiotic therapy is needed to improve the prognosis. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Non-equilibrium Phase Transitions: Activated Random Walks at Criticality

NASA Astrophysics Data System (ADS)

Cabezas, M.; Rolla, L. T.; Sidoravicius, V.

2014-06-01

In this paper we present rigorous results on the critical behavior of the Activated Random Walk model. We conjecture that on a general class of graphs, including , and under general initial conditions, the system at the critical point does not reach an absorbing state. We prove this for the case where the sleep rate is infinite. Moreover, for the one-dimensional asymmetric system, we identify the scaling limit of the flow through the origin at criticality. The case remains largely open, with the exception of the one-dimensional totally-asymmetric case, for which it is known that there is no fixation at criticality.

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

Casini, R.; Manso Sainz, R.

We present the frequency redistribution function for a polarized three-term atom of the Λ-type in the collisionless regime, and we specialize it to the case where both the initial and final terms of the three-state transition are metastable (i.e., with infinitely sharp levels). This redistribution function represents a generalization of the well-known R {sub II} function to the case where the lower terms of the transition can be polarized and carry atomic coherence, and it can be applied to the investigation of polarized line formation in tenuous plasmas, where collisional rates may be low enough that anisotropy-induced atomic polarization survivesmore » even in the case of metastable levels.« less

The mass function and dynamical mass of young star clusters: why their initial crossing-time matters crucially

NASA Astrophysics Data System (ADS)

Parmentier, Geneviève; Baumgardt, Holger

2012-12-01

We highlight the impact of cluster-mass-dependent evolutionary rates upon the evolution of the cluster mass function during violent relaxation, that is, while clusters dynamically respond to the expulsion of their residual star-forming gas. Mass-dependent evolutionary rates arise when the mean volume density of cluster-forming regions is mass-dependent. In that case, even if the initial conditions are such that the cluster mass function at the end of violent relaxation has the same shape as the embedded-cluster mass function (i.e. infant weight-loss is mass-independent), the shape of the cluster mass function does change transiently during violent relaxation. In contrast, for cluster-forming regions of constant mean volume density, the cluster mass function shape is preserved all through violent relaxation since all clusters then evolve at the same mass-independent rate. On the scale of individual clusters, we model the evolution of the ratio of the dynamical mass to luminous mass of a cluster after gas expulsion. Specifically, we map the radial dependence of the time-scale for a star cluster to return to equilibrium. We stress that fields of view a few pc in size only, typical of compact clusters with rapid evolutionary rates, are likely to reveal cluster regions which have returned to equilibrium even if the cluster experienced a major gas expulsion episode a few Myr earlier. We provide models with the aperture and time expressed in units of the initial half-mass radius and initial crossing-time, respectively, so that our results can be applied to clusters with initial densities, sizes, and apertures different from ours.

Effective school actions for mitigating seasonal influenza outbreaks in Niigata, Japan.

PubMed

Sugisaki, Koshu; Seki, Nao; Tanabe, Naohito; Saito, Reiko; Sasaki, Asami; Sasaki, Satoshi; Suzuki, Hiroshi

2013-01-01

Japan has implemented various school actions during seasonal influenza outbreaks since the 1950's under the School Health Law. However, the effective duration, extent, and timing of closures remain unresolved. We conducted a retrospective study on the relationship between elementary class closures and influenza outbreak control during four consecutive influenza seasons from the 2004-2005 to 2007-2008 school years in Joetsu, Niigata, Japan. Among a total of 1,061 classes of 72 schools, 624 cases of influenza outbreaks were documented among 61 schools. Class closures were carried out in a total of 62 cases in response to influenza outbreak, which was defined as a student absentee rate of greater than 10% due to influenza or influenza-like illness. Of these cases, two-day class closures were conducted the day after reaching a 10% student absentee rate in 28 cases and other types of closures were initiated in 34 cases. A markedly higher number of outbreak cases ended within one week for two-day class closures compared to the other types of closures (82.1% vs. 20.6%, respectively). The significant association between two-day class closures and interruption of an outbreak within one week was confirmed using a multivariable model adjusted for the season, grade, day of the week of an outbreak start, and absentee rate on the day of an outbreak start (OR, 3.18; 95% CI, 1.12-9.07; p = 0.030). Our results suggest that a two-day class closure carried out the day after reaching a 10% absentee rate is an effective approach for mitigating influenza outbreaks in elementary schools.

An intervention of active TB case finding among smokers attending routine primary care facilities in China: an exploratory study.

PubMed

Wei, Xiaolin; Zou, Guangyan; Chong, Marc Kc; Xu, Lin

2015-09-01

Smoking is an important risk factor of TB. However, no studies have been conducted to identify TB cases from smokers. We assessed the process and initial impact of active case finding among smokers at primary care facilities in a setting with high smoking rates and TB burden. A prospective quasi-experimental study was conducted in para-urban communities in Yunnan China between September 2013 and June 2014. Smokers attending primary care facilities in the intervention group were prescribed chest X-rays if they had diabetes or TB symptoms, or were elders or close contacts of TB patients. Those with X-rays suggestive of TB were referred to TB dispensaries for diagnosis. Passive case finding was practiced in the control group. In the intervention group, we screened 471 smokers with high risks of TB, of whom 73% took chest X-ray examinations. Eight TB cases were diagnosed, reflecting a 1.7% yield rate of all screened smokers. Smokers with diabetes (OR 6.003, 95% CI 1.057-34.075) were more likely to have TB compared with those without. In total, the intervention group reported significantly higher TB notification rate compared with the control group (38.6 vs 22.9 per 100 000, p=0.016). Active case finding among smokers with high risks of TB was feasible and contributed to improved notification rates. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effect of the Ethanol Injection Moment During Compression Stroke on the Combustion of Ethanol - Diesel Dual Direct Injection Engine

NASA Astrophysics Data System (ADS)

Liang, Yu; Zhou, Liying; Huang, Haomin; Xu, Mingfei; Guo, Mei; Chen, Xin

2018-01-01

A set of GDI system is installed on a F188 single-cylinder, air-cooled and direct injection diesel engine, which is used for ethanol injection, with the injection time controlled by the crank angle signal collected by AVL angle encoder. The injection of ethanol amounts to half of the thermal equivalent of an original diesel fuel. A 3D combustion model is established for the ethanol - diesel dual direct injection engine. Diesel was injected from the original fuel injection system, with a fuel supply advance angle of 20°CA. The ethanol was injected into the cylinder during compression process. Diesel injection began after the completion of ethanol injection. Ethanol injection starting point of 240°CA, 260°CA, 280°CA, 300°CA and 319.4°CA were simulated and analyzed. Due to the different timing of ethanol injection, the ignition of the ethanol mixture when diesel fires, results in non-uniform ignition distribution and flame propagation rate, since the distribution and concentration gradients of the ethanol mixture in the cylinder are different, thus affecting the combustion process. The results show that, when ethanol is injected at 319.4°CA, the combustion heat release rate and the pressure rise rate during the initial stage are the highest. Also, the maximum combustion pressure, with a relatively advance phase, is the highest. In case of later initial ethanol injection, the average temperature in the cylinder during the initial combustion period will have a faster rise. In case of initial injection at 319.4°CA, the average temperature in the cylinder is the highest, followed by 240°CA ethanol injection. In the post-combustion stage, the earlier ethanol injection will result in higher average temperature in the cylinder and more complete fuel combustion. The injection of ethanol at 319.4°CA produces earlier and highest NOX emissions.

Evolution of relative drifts and temperature anisotropies in expanding collisionless plasmas—1.5D vs. 2.5D hybrid simulations

NASA Astrophysics Data System (ADS)

Maneva, Y. G.; Poedts, S.; Araneda, J. A.

2016-02-01

We compare the results from 1.5D and 2.5D hybrid simulations (with fluid electrons, and kinetic/particle-in-cell protons and α particles) to investigate the effect of the solar wind expansion on the evolution of ion relative drifts in collisionless fast wind streams. We initialize the system with initial relative drifts and follow its evolution in time within and without the expanding box model, which takes into account the gradual solar wind expansion in the interplanetary medium. The decay of the differential streaming follows similar pattern in the 1.5D and 2.5D non-expanding cases. For the 1.5D studies we find no difference in the evolution of the initial relative drift speed with and without expansion, whereas in the two-dimensional case the differential streaming is further suppressed once the solar wind expansion is taken into account. This implies that a stronger acceleration source is required to compensate for the effect of the expansion and produce the observed solar wind acceleration rate. The 1.5D case shows stronger oscillations in all plasma properties with higher temperature anisotropies for the minor ions in the first few hundred gyro-periods of the simulations. Yet the preferential perpendicular heating for the minor ions is stronger in the 2.5D case with higher temperature anisotropies at the final stage.

A trap for the unwary: jury decision making in cases involving the entrapment defense.

PubMed

Peters, Christopher S; Lampinen, James Michael; Malesky, L Alvin

2013-02-01

This article examines the opinions of jury-eligible participants regarding entrapment-related issues in online sex offender sting operations. Participants provided lower guilt ratings when the undercover officer initiated the online sexual solicitation than when the defendant initiated the online sexual solicitation. This effect was mediated by the causal attributions (situational vs. dispositional) made by mock jurors for the defendant's actions. The results also suggested that the entrapment defense was less successful for participants with a crime control orientation than for participants with a due process orientation. Based on the results, it is implied that law enforcement should exercise caution when performing these types of sting operations. Furthermore, defense and prosecuting attorneys should take into account the originators of the sexual solicitation when deciding whether to plea bargain or take a case to trial.

Black hole genesis of dark matter

NASA Astrophysics Data System (ADS)

Lennon, Olivier; March-Russell, John; Petrossian-Byrne, Rudin; Tillim, Hannah

2018-04-01

We present a purely gravitational infra-red-calculable production mechanism for dark matter (DM) . The source of both the DM relic abundance and the hot Standard Model (SM) plasma is a primordial density of micro black holes (BHs), which evaporate via Hawking emission into both the dark and SM sectors. The mechanism has four qualitatively different regimes depending upon whether the BH evaporation is 'fast' or 'slow' relative to the initial Hubble rate, and whether the mass of the DM particle is 'light' or 'heavy' compared to the initial BH temperature. For each of these regimes we calculate the DM yield, Y, as a function of the initial state and DM mass and spin. In the 'slow' regime Y depends on only the initial BH mass over a wide range of initial conditions, including scenarios where the BHs are a small fraction of the initial energy density. The DM is produced with a highly non-thermal energy spectrum, leading in the 'light' DM mass regime (~260 eV and above depending on DM spin) to a strong constraint from free-streaming, but also possible observational signatures in structure formation in the spin 3/2 and 2 cases. The 'heavy' regime (~1.2 × 108 GeV to MPl depending on spin) is free of these constraints and provides new possibilities for DM detection. In all cases there is a dark radiation component predicted.

Disease spread across multiple scales in a spatial hierarchy: effect of host spatial structure and of inoculum quantity and distribution.

PubMed

Gosme, Marie; Lucas, Philippe

2009-07-01

Spatial patterns of both the host and the disease influence disease spread and crop losses. Therefore, the manipulation of these patterns might help improve control strategies. Considering disease spread across multiple scales in a spatial hierarchy allows one to capture important features of epidemics developing in space without using explicitly spatialized variables. Thus, if the system under study is composed of roots, plants, and planting hills, the effect of host spatial pattern can be studied by varying the number of plants per planting hill. A simulation model based on hierarchy theory was used to simulate the effects of large versus small planting hills, low versus high level of initial infections, and aggregated versus uniform distribution of initial infections. The results showed that aggregating the initially infected plants always resulted in slower epidemics than spreading out the initial infections uniformly. Simulation results also showed that, in most cases, disease epidemics were slower in the case of large host aggregates (100 plants/hill) than with smaller aggregates (25 plants/hill), except when the initially infected plants were both numerous and spread out uniformly. The optimal strategy for disease control depends on several factors, including initial conditions. More importantly, the model offers a framework to account for the interplay between the spatial characteristics of the system, rates of infection, and aggregation of the disease.

The Wisconsin Early Childhood Obesity Prevention Initiative: An Example of Statewide Collective Impact.

PubMed

Meinen, Amy; Hilgendorf, Amy; Korth, Amy L; Christens, Brian D; Breuer, Catherine; Joyner, Hilary; Polzin, Molle; Adams, Alexandra; Wolfe, Daithi; Braun, Abbe; Hoiting, Jill; Paulson, Jeanette; Cullen, Bridget; Stader, Kelli

2016-11-01

The Wisconsin Early Childhood Obesity Prevention Initiative (Initiative), established in 2007, seeks to address and prevent obesity in the early care and education system through nutrition and physical activity environmental and policy changes. The collaborative includes professionals from 3 state of Wisconsin Departments, the University of Wisconsin-Extension, the University of Wisconsin-Madison, and public health and early care and education organizations. This paper explores the efforts of the Initiative to advance our understanding of collective impact in practice and its value to health promotion efforts. Evaluators conducted a mixed methods case study to evaluate the application of collective impact principles by the Initiative. This included a survey of Initiative partners, review of archival documents, and qualitative interviews with Initiative leaders. Initiative partners noted progress in establishing the conditions for collective impact. Archival documents and interviews describe both formal and informal practices that helped set a common agenda, align and coordinate partner activities, and promote communication among Initiative leaders. Results also detail the important current and potential roles of “backbone” staff from healthTIDE to support the Initiative. Additionally, results suggest particularly challenging aspects of the Initiative’s impact model related to shared measurement and broader stakeholder communication. While the Initiative is still setting in place the conditions for collective impact, it has achieved significant policy, systems, and environment changes since its formation. Inclusion of nutrition and physical activity criteria in the state’s quality rating improvement system for child care centers is one of its outcomes. This case study offers several important insights about the application of collective impact in health promotion efforts, particularly in relation to the transition from previous collaborative activities, the value of establishing a clear common agenda among partners, the roles of backbone staff, and time and partner relationships in collective impact.

Risk factors for fatal outcome from rocky mountain spotted Fever in a highly endemic area-Arizona, 2002-2011.

PubMed

Regan, Joanna J; Traeger, Marc S; Humpherys, Dwight; Mahoney, Dianna L; Martinez, Michelle; Emerson, Ginny L; Tack, Danielle M; Geissler, Aimee; Yasmin, Seema; Lawson, Regina; Williams, Velda; Hamilton, Charlene; Levy, Craig; Komatsu, Ken; Yost, David A; McQuiston, Jennifer H

2015-06-01

Rocky Mountain spotted fever (RMSF) is a disease that now causes significant morbidity and mortality on several American Indian reservations in Arizona. Although the disease is treatable, reported RMSF case fatality rates from this region are high (7%) compared to the rest of the nation (<1%), suggesting a need to identify clinical points for intervention. The first 205 cases from this region were reviewed and fatal RMSF cases were compared to nonfatal cases to determine clinical risk factors for fatal outcome. Doxycycline was initiated significantly later in fatal cases (median, day 7) than nonfatal cases (median, day 3), although both groups of case patients presented for care early (median, day 2). Multiple factors increased the risk of doxycycline delay and fatal outcome, such as early symptoms of nausea and diarrhea, history of alcoholism or chronic lung disease, and abnormal laboratory results such as elevated liver aminotransferases. Rash, history of tick bite, thrombocytopenia, and hyponatremia were often absent at initial presentation. Earlier treatment with doxycycline can decrease morbidity and mortality from RMSF in this region. Recognition of risk factors associated with doxycycline delay and fatal outcome, such as early gastrointestinal symptoms and a history of alcoholism or chronic lung disease, may be useful in guiding early treatment decisions. Healthcare providers should have a low threshold for initiating doxycycline whenever treating febrile or potentially septic patients from tribal lands in Arizona, even if an alternative diagnosis seems more likely and classic findings of RMSF are absent. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Numerical study of Tallinn storm-water system flooding conditions using CFD simulations of multi-phase flow in a large-scale inverted siphon

NASA Astrophysics Data System (ADS)

Kaur, K.; Laanearu, J.; Annus, I.

2017-10-01

The numerical experiments are carried out for qualitative and quantitative interpretation of a multi-phase flow processes associated with malfunctioning of the Tallinn storm-water system during rain storms. The investigations are focused on the single-line inverted siphon, which is used as under-road connection of pipes of the storm-water system under interest. A multi-phase flow solver of Computational Fluid Dynamics software OpenFOAM is used for simulating the three-phase flow dynamics in the hydraulic system. The CFD simulations are performed with different inflow rates under same initial conditions. The computational results are compared essentially in two cases 1) design flow rate and 2) larger flow rate, for emptying the initially filled inverted siphon from a slurry-fluid. The larger flow-rate situations are under particular interest to detected possible flooding. In this regard, it is anticipated that the CFD solutions provide an important insight to functioning of inverted siphon under a restricted water-flow conditions at simultaneous presence of air and slurry-fluid.

Fatigue-Life Prediction Methodology Using Small-Crack Theory

NASA Technical Reports Server (NTRS)

Newmann, James C., Jr.; Phillips, Edward P.; Swain, M. H.

1997-01-01

This paper reviews the capabilities of a plasticity-induced crack-closure model to predict fatigue lives of metallic materials using 'small-crack theory' for various materials and loading conditions. Crack-tip constraint factors, to account for three-dimensional state-of-stress effects, were selected to correlate large-crack growth rate data as a function of the effective-stress-intensity factor range (delta K(eff)) under constant-amplitude loading. Some modifications to the delta k(eff)-rate relations were needed in the near-threshold regime to fit measured small-crack growth rate behavior and fatigue endurance limits. The model was then used to calculate small- and large-crack growth rates, and to predict total fatigue lives, for notched and un-notched specimens made of two aluminum alloys and a steel under constant-amplitude and spectrum loading. Fatigue lives were calculated using the crack-growth relations and microstructural features like those that initiated cracks for the aluminum alloys and steel for edge-notched specimens. An equivalent-initial-flaw-size concept was used to calculate fatigue lives in other cases. Results from the tests and analyses agreed well.

Sample substitution can be an acceptable data-collection strategy: the case of the Belgian Health Interview Survey.

PubMed

Demarest, Stefaan; Molenberghs, Geert; Van der Heyden, Johan; Gisle, Lydia; Van Oyen, Herman; de Waleffe, Sandrine; Van Hal, Guido

2017-11-01

Substitution of non-participating households is used in the Belgian Health Interview Survey (BHIS) as a method to obtain the predefined net sample size. Yet, possible effects of applying substitution on response rates and health estimates remain uncertain. In this article, the process of substitution with its impact on response rates and health estimates is assessed. The response rates (RR)-both at household and individual level-according to the sampling criteria were calculated for each stage of the substitution process, together with the individual accrual rate (AR). Unweighted and weighted health estimates were calculated before and after applying substitution. Of the 10,468 members of 4878 initial households, 5904 members (RRind: 56.4%) of 2707 households (RRhh: 55.5%) participated. For the three successive (matched) substitutes, the RR dropped to 45%. The composition of the net sample resembles the one of the initial samples. Applying substitution did not produce any important distorting effects on the estimates. Applying substitution leads to an increase in non-participation, but does not impact the estimations.

Combined interventions for mitigation of an influenza A (H1N1) 2009 outbreak in a physical training camp in Beijing, China.

PubMed

Chu, Chen-Yi; de Silva, U Chandimal; Guo, Jin-Peng; Wang, Yong; Wen, Liang; Lee, Vernon J; Li, Shen-Long; Huang, Liu-Yu

2017-07-01

Many studies have suggested the effectiveness of single control measures in the containment and mitigation of pandemic influenza A (H1N1) 2009. The effects of combined interventions by multiple control measures in reducing the impact of an influenza A (H1N1) 2009 outbreak in a closed physical training camp in Beijing, China were evaluated. Oseltamivir was prescribed for the treatment of confirmed cases and possible cases and as prophylaxis for all other participants in this training camp. Public health control measures were applied simultaneously, including the isolation of patients and possible cases, personal protection and hygiene, and social distancing measures. Symptom surveillance of all participants was initiated, and the actual attack rate was calculated. For comparison, the theoretical attack rate for this outbreak was projected using the Newton-Raphson numerical method. A total of 3256 persons were present at the physical training camp. During the outbreak, 405 (68.3%) possible cases and 26 (4.4%) confirmed cases were reported before the intervention and completed oseltamivir treatment; 162 (27.3%) possible cases were reported after the intervention and received part treatment and part prophylaxis. The other 2663 participants completed oseltamivir prophylaxis. Of the possible cases, 181 with fever ≥38.5°C were isolated. The actual attack rate for this outbreak of pandemic influenza A (H1N1) 2009 was 18.2%, which is much lower than the theoretical attack rate of 80% projected. Combined interventions of large-scale antiviral ring prophylaxis and treatment and public health control measures could be applied to reduce the magnitude of influenza A (H1N1) 2009 outbreaks in closed settings. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Differences in child versus parent reports of the child's health-related quality of life in children with epilepsy and healthy siblings.

PubMed

Baca, Christine Bower; Vickrey, Barbara G; Hays, Ron D; Vassar, Stefanie D; Berg, Anne T

2010-01-01

Self versus proxy perspectives may produce different results that are important for clinical decision-making and for assessing outcomes in research studies. We examined differences in child versus parent report of the child's health-related quality of life (HRQOL) in a large prospective, community-based study of newly diagnosed childhood epilepsy that included children with epilepsy (case) and sibling controls. HRQOL was assessed 8 to 9 years after initial diagnosis of epilepsy in a subset of 143 case-control matched pairs using the Child Health Questionnaire (CHQ), a generic HRQOL measure with child (CHQ-CF87), and parent (CHQ-PF50) versions. There were no significant differences between self-reported case and sibling control HRQOL scores on 9 of 11 scales or 2 global items. Nevertheless, parent ratings were significantly better (higher HRQOL) for sibling controls compared with epilepsy cases on 10 of 12 scales, global behavior and general health items, and the physical and psychosocial summary scores (P≤0.05). Parent-child agreement was low for cases and controls (kappa 0.27-0.33) for three single-item questions with the same wording on parent and child versions. Parent ratings of the case's HRQOL were often significantly associated with 5-year remission status and current antiepileptic drug use, but the case's self-reported HRQOL scores were not. In contrast, current pharmacoresistance was often associated with the child and parent ratings of the child's HRQOL. Children with epilepsy report HRQOL that is comparable to that of sibling controls, while parents rate children with epilepsy as having lower HRQOL than sibling controls. Measuring outcomes in studies of this population should incorporate both perspectives. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Evaluation of decontamination process of heart valve and artery tissues in European Homograft Bank (EHB): a retrospective study of 1,055 cases.

PubMed

Fan, Ye-Dong; Van Hoeck, Beatrice; Holovska, Vanda; Jashari, Ramadan

2012-06-01

To evaluate the efficiency of decontamination practice in European Homograft Bank (EHB), the data of the cardiovascular tissues received during recent 2 years were retrospectively analysed in this study. After initial assessment, the tissues were incubated in a 3-antibiotics' cocktail at 4°C for 20-48 h. The states of contamination were evaluated before and after incubation with the focus on the differences in donor type, tissue type, germ type and incubation time. Amongst 1,055 eligible tissues, 77.2% were hearts and 22.8% were arteries. 82.2% of the tissues were retrieved from the multi-organ donors (MOD), 15.4% from the recipients of heart transplantation (RHT) and 2.4% from the non-heart beating donors (NHBD). The initial contamination rate was 27.4% with a significantly higher incidence in arteries. The RHT tissues had the lowest contamination rate comparing to that of MOD and NHBD. Staphylococcus species was the major source of contamination. After antibiotic incubation, 76.8% of the contaminated tissues were disinfected, which was significantly higher for the hearts than the arteries. The RHT tissues had the highest decontamination rate than that of MOD and NHBD tissues. Propionibacterium acnes was detected in 48.1% of the remaining contaminated cases. The average incubation time of the Propionibacterium-positive tissues was significantly shorter than that of decontaminated tissues. In conclusion, the current decontamination protocol of EHB is sufficient for most of the initially contaminated bacteria, whereas it is inadequate for Propionibacterium acnes. This may be related to the slow-growing nature of this bacterium and thereby the relative shorter antibiotic incubation time.

The Neurological Compromised Spine Due to Ewing Sarcoma. What First: Surgery or Chemotherapy? Therapy, Survival, and Neurological Outcome of 15 Cases With Primary Ewing Sarcoma of the Vertebral Column.

PubMed

Mirzaei, Lida; Kaal, Suzanne E J; Schreuder, Hendrik W B; Bartels, Ronald H M A

2015-11-01

The vertebral column is an infrequent site of primary involvement in Ewing sarcoma. Yet when Ewing sarcoma is found in the spine, the urge for decompression is high because of the often symptomatic compression of neural structures. It is unclear in alleviating a neurological deficit whether chemotherapy is preferred over decompressive laminectomy. To underline, in this case series, the efficiency of initial chemotherapy before upfront surgery in the setting of high-grade spinal cord or cauda equina compression of primary Ewing sarcoma. Fifteen patients with Ewing sarcoma primarily located in the spine were treated at our institution between 1983 and 2015. Localization, neurological deficit expressed as Frankel grade, and outcome expressed as Rankin scale before and after initial chemotherapy, the recurrence rate, and overall survival were evaluated. The multidisciplinary approach of 1 case will be discussed in detail. Nine patients (60%) were female. The age at presentation was 15.0 ± 5.5 years (range: 0.9-22.8 years). Ten patients (67%) were initially treated with chemotherapy, and 1 patient (7%) was treated primarily with radiotherapy followed by chemotherapy. The remaining 4 patients (27%) were initially treated with decompressive surgery. All patients treated primarily nonsurgically improved neurologically at follow-up, showing the importance of chemotherapy as an effective initial treatment option. Adequate and quick decompression of neural structures with similar results can be achieved by chemotherapy and radiotherapy, avoiding the local spill of malignant cells.

Impact of TRMM and SSM/I Rainfall Assimilation on Global Analysis and QPF

NASA Technical Reports Server (NTRS)

Hou, Arthur; Zhang, Sara; Reale, Oreste

2002-01-01

Evaluation of QPF skills requires quantitatively accurate precipitation analyses. We show that assimilation of surface rain rates derived from the Tropical Rainfall Measuring Mission (TRMM) Microwave Imager and Special Sensor Microwave/Imager (SSM/I) improves quantitative precipitation estimates (QPE) and many aspects of global analyses. Short-range forecasts initialized with analyses with satellite rainfall data generally yield significantly higher QPF threat scores and better storm track predictions. These results were obtained using a variational procedure that minimizes the difference between the observed and model rain rates by correcting the moist physics tendency of the forecast model over a 6h assimilation window. In two case studies of Hurricanes Bonnie and Floyd, synoptic analysis shows that this procedure produces initial conditions with better-defined tropical storm features and stronger precipitation intensity associated with the storm.

Estimation of the incidence of severe fever with thrombocytopenia syndrome in high endemic areas in China: an inpatient-based retrospective study.

PubMed

Huang, Xiaoxia; Wang, Shiwen; Wang, Xianjun; Lyu, Yong; Jiang, Mei; Chen, Deying; Li, Kaichun; Liu, Jingyu; Xie, Shaoyu; Lyu, Tao; Sun, Jie; Xu, Pengpeng; Cao, Minghua; Liang, Mifang; Li, Dexin

2018-02-05

Severe fever with thrombocytopenia syndrome (SFTS) is a severe viral disease caused by SFTSV. It is important to estimate the rate of missed SFTS diagnosis and to further understand the actual incidence in high endemic areas in China. This study was conducted in two high SFTS endemic provinces in 2015. Patients hospitalized in 2014 or within 1 year before investigation were selected after considering their clinical manifestations, specifically, fever, platelet, and white blood cell. During retrospective investigation, sera were collected to detect SFTSV antibodies to assess SFTSV infection. To further understand SFTSV infection, acute phase sera were detected; SFTSV infection rate among a healthy population was also investigated to determine the basic infection level. In total, 246 hospitalized cases were included, including 83 cases (33.7%) with fever, thrombocytopenia and leukopenia, 38 cases (15.4%) with fever and thrombocytopenia but without leukopenia, and 125 cases (50.8%) without fever but with thrombocytopenia and leukopenia. In total, 13 patients (5.3%) were SFTSV IgM antibody-positive, 48 (19.5%) were IgG-positive. Of the 13 IgM-positive cases, 11 (84.6%) were IgG-positive (9 with titres ≥1:400). Seropositive rates of antibodies were high (8.4% for IgM and 30.1% for IgG) in patients with fever, thrombocytopenia and leukopenia. Furthermore, among IgG-positive cases in this group, 76% (19/25) of patients' IgG antibody titres were ≥1:400. Additionally, 28 of 246 cases were initially diagnosed with suspected SFTS and were then excluded, and 218 patients were never diagnosed with SFTS; the seropositive rates of IgM and IgG in these two groups were 25% and 67.9% and 2.8% and 13.3%, respectively. These rates were 64.3% and 21.4% in 14 sera collected during acute phase of the 28 cases mentioned above. Seropositive rate of SFTSV IgG was only 1.3% in the patient-matched healthy group, and no IgM antibody was detected. A preliminary estimate of 8.3% of SFTS cases were missed in SFTS high endemic provinces. The actual SFTS incidence was underestimated. Effective measures such as adding a new SFTS case category - "SFTS clinical diagnosis cases" or using serological detection methods during acute phase should be considered to avoid missed diagnoses.

Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: Review of consecutive 34 cases.

PubMed

Kocur, Damian; Zbroszczyk, Miłosz; Przybyłko, Nikodem; Hofman, Mariusz; Jamróz, Tomasz; Baron, Jan; Bażowski, Piotr; Kwiek, Stanisław

We report our experience with stent-assisted coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes, retreatment rate and periprocedural complications. The analysis included 34 consecutive ruptured and unruptured wide-neck aneurysms. The aneurysm size ranged from 2 to 18mm (mean 5.47). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of 6 months. Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 32 (94%) and 2 (6%) cases, respectively. Imaging follow-up, performed in 28 (82%) patients, showed no change in the degree of occlusion in 25 (89%) cases and coil compaction in 3 (11%) patients. Of these, one (3.6%) patient underwent a second coil embolization. The periprocedural severe complication rate was 2.9% (1/35) and was associated with prolonged attempt of retrieval of migrated coil resulting in anterior cerebral artery infarct with serious clinical consequences. In another 3 patients periprocedural adverse events without delayed clinical consequences were noticed. The clinical follow-up evaluation achieved in 33 (97%) patients showed no change in 30 (91%) cases, one patient (3%) with clinical improvement and two (6%) cases of neurological deterioration. The use of stent is feasible and effective for coil embolization of wide-necked anterior communicating artery aneurysms. Although periprocedural complications resulting in severe morbidity are rare, they should be noted, since in terms of thromboembolic events some of them presumably have a potential to be avoidable. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Bubble collisions and measures of the multiverse

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

Salem, Michael P., E-mail: salem@cosmos.phy.tufts.edu

2012-01-01

To compute the spectrum of bubble collisions seen by an observer in an eternally-inflating multiverse, one must choose a measure over the diverging spacetime volume, including choosing an ''initial'' hypersurface below which there are no bubble nucleations. Previous calculations focused on the case where the initial hypersurface is pushed arbitrarily deep into the past. Interestingly, the observed spectrum depends on the orientation of the initial hypersurface, however one's ability observe the effect rapidly decreases with the ratio of inflationary Hubble rates inside and outside one's bubble. We investigate whether this conclusion might be avoided under more general circumstances, including placingmore » the observer's bubble near the initial hypersurface. We find that it is not. As a point of reference, a substantial appendix reviews relevant aspects of the measure problem of eternal inflation.« less

Long-term outcomes after hepatic resection combined with radiofrequency ablation for initially unresectable multiple and bilobar liver malignancies.

PubMed

Qiu, Jianguo; Chen, Shuting; Wu, Hong

2014-05-01

Hepatic resection (HRE) combined with radiofrequency ablation (RFA) offers a surgical option to a group of patients with multiple and bilobar liver malignancies who are traditionally unresectable for inadequate functional hepatic reserve. The aims of the present study were to assess the perioperative outcomes, recurrence, and long-term survival rates for patients treated with HRE plus RFA in the management of primary hepatocellular carcinoma (HCC) and metastatic liver cancer (MLC). Data from all consecutive patients with primary and secondary hepatic malignancies who were treated with HRE combined with RFA between 2007 and 2013 were prospectively collected and retrospectively reviewed. A total of 112 patients, with 368 hepatic tumors underwent HRE combined with ultrasound-guided RFA, were included in the present study. There were 40 cases of HCC with 117 tumors and 72 cases of MLC with 251 metastases. Most cases of liver metastases originated from the gastrointestinal tract (44, 61.1%). Other uncommon lesions included breast cancer (5, 6.9%), pancreatic cancer (3, 4.2%), lung cancer (4, 5.6%), cholangiocarcinoma (4, 5.6%), and so on. The ablation success rates were 93.3% for HCC and 96.7% for MLC. The 1-, 2-, 3-, 4-, and 5-y overall recurrence rates were 52.5%, 59.5%, 72.3%, 75%, and 80% for the HCC group and 44.4%, 52.7%, 56.1%, 69.4%, and 77.8% for the MLC group, respectively. The 1-, 2-, 3-, 4-, and 5-y overall survival rates for the HCC patients were 67.5%, 50%, 32.5%, 22.5%, and 12.5% and for the MLC patients were 66.5%, 55.5%, 50%, 30.5%, and 19.4%, respectively. The corresponding recurrence-free survival rates for the HCC patients were 52.5%, 35%, 22.5%, 15%, and 10% and for the MLC patients were 58.3%, 41.6%, 23.6%, 16.9%, and 12.5%, respectively. HRE combined with RFA provides an effective treatment approach for patients with primary and secondary liver malignancies who are initially unsuitable for radical resection, with high local tumor control rates and promising survival data. Copyright © 2014 Elsevier Inc. All rights reserved.

The Impact of Graduate First Project on Students with Disabilities: Perceptions of Key Personnel

ERIC Educational Resources Information Center

Foley, Tamera Garrett

2012-01-01

The Graduate First initiative was implemented to address the dropout crisis among students with disabilities in the state of Georgia, who continue to demonstrate a rate of attrition twice that of their non-disabled peers (Georgia Department of Education [GA DOE], 2010). This mixed method case study explored the perceptions and experiences of a…

Global existence and large time asymptotic behavior of strong solutions to the Cauchy problem of 2D density-dependent Navier–Stokes equations with vacuum

NASA Astrophysics Data System (ADS)

Lü, Boqiang; Shi, Xiaoding; Zhong, Xin

2018-06-01

We are concerned with the Cauchy problem of the two-dimensional (2D) nonhomogeneous incompressible Navier–Stokes equations with vacuum as far-field density. It is proved that if the initial density decays not too slow at infinity, the 2D Cauchy problem of the density-dependent Navier–Stokes equations on the whole space admits a unique global strong solution. Note that the initial data can be arbitrarily large and the initial density can contain vacuum states and even have compact support. Furthermore, we also obtain the large time decay rates of the spatial gradients of the velocity and the pressure, which are the same as those of the homogeneous case.

Genome-Scale Analysis of Translation Elongation with a Ribosome Flow Model

PubMed Central

Meilijson, Isaac; Kupiec, Martin; Ruppin, Eytan

2011-01-01

We describe the first large scale analysis of gene translation that is based on a model that takes into account the physical and dynamical nature of this process. The Ribosomal Flow Model (RFM) predicts fundamental features of the translation process, including translation rates, protein abundance levels, ribosomal densities and the relation between all these variables, better than alternative (‘non-physical’) approaches. In addition, we show that the RFM can be used for accurate inference of various other quantities including genes' initiation rates and translation costs. These quantities could not be inferred by previous predictors. We find that increasing the number of available ribosomes (or equivalently the initiation rate) increases the genomic translation rate and the mean ribosome density only up to a certain point, beyond which both saturate. Strikingly, assuming that the translation system is tuned to work at the pre-saturation point maximizes the predictive power of the model with respect to experimental data. This result suggests that in all organisms that were analyzed (from bacteria to Human), the global initiation rate is optimized to attain the pre-saturation point. The fact that similar results were not observed for heterologous genes indicates that this feature is under selection. Remarkably, the gap between the performance of the RFM and alternative predictors is strikingly large in the case of heterologous genes, testifying to the model's promising biotechnological value in predicting the abundance of heterologous proteins before expressing them in the desired host. PMID:21909250

Evaluation of the National Human Immunodeficiency Virus Surveillance System for the 2011 diagnosis year.

PubMed

Karch, Debra L; Chen, Mi; Tang, Tian

2014-01-01

In 2009, the Centers for Disease Control and Prevention completed migration of all 59 surveillance project areas (PAs) from the case-based HIV/AIDS Reporting System to the document-based Enhanced HIV/AIDS Reporting System. We conducted a PA-level assessment of Enhanced HIV/AIDS Reporting System process and outcome standards for HIV infection cases. Process standards were reported by PAs and outcome standards were calculated using standardized Centers for Disease Control and Prevention SAS code. A total of 59 PAs including 50 US states, the District of Columbia, 6 separately funded cities (Chicago, Houston, Los Angeles County, New York City, Philadelphia, and San Francisco), and 2 territories (Puerto Rico and the Virgin Islands). Cases diagnosed or reported to the PA surveillance system between January 1, 2011, and December 31, 2011, using data collected through December 2012. Process standards for death ascertainment and intra- and interstate case de-duplication; outcome standards for completeness and timeliness of case reporting, data quality, intrastate duplication rate, risk factor ascertainment, and completeness of initial CD4 and viral load reporting. Fifty-five of 59 PAs (93%) reported linking cases to state vital records death certificates during 2012, 76% to the Social Security Death Master File, and 59% to the National Death Index. Seventy percent completed monthly intrastate, and 63% completed semiannual interstate de-duplication. Eighty-three percent met the 85% or more case ascertainment standard, and 92% met the 66% or more timeliness standard; 75% met the 97% or more data quality standard; all PAs met the 5% or less intrastate duplication rate; 41% met the 85% or more risk factor ascertainment standard; 90% met the 50% or more standard for initial CD4; and 93% met the same standard for viral load reporting. Overall, 7% of PAs met all 11 process and outcome standards. Findings support the need for continued improvement in HIV surveillance activities and monitoring of system outcomes.

Knowledge of orthodontic tooth movement through the maxillary sinus: a systematic review.

PubMed

Sun, Wentian; Xia, Kai; Huang, Xinqi; Cen, Xiao; Liu, Qing; Liu, Jun

2018-05-23

To investigate the feasibility, safety and stability of current interventions for moving teeth through the maxillary sinus (MTTMS) by performing a systematic review of the literature. The electronic databases PubMed, Embase, CENTRAL, Web of Science, CBM, CNKI and SIGLE were searched without a language restriction. The primary outcomes were parameters related to orthodontic treatment, including orthodontic protocols, magnitude of forces, type of tooth movement, duration and rate of tooth movement, and remolding of alveolar bone and the maxillary sinus floor. The secondary outcomes were safety and stability, including root resorption, perforation of the sinus floor, loss of pulp vitality and periodontal health and relapse. Nine case reports with 25 teeth were included and systematically analyzed. Fifty to two hundred g of force was applied to move teeth through the maxillary sinus. Bodily movement was accomplished, but initial tipping was observed in 7 cases. The rate was 0.6-0.7 mm/month for molar intrusion and 0.16-1.17 and 0.05-0.16 mm/month for mesial-distal movement of premolars and molars, respectively. Bone formation and remolding of the sinus floor occurred in 7 cases. Root resorption within 6 to 30 months was observed in 3 cases, while no cases of perforation of the sinus floor, loss of pulp vitality, periodontal health impairment or relapse were reported. At the present stage, no evidence-based protocol could be recommended to guide MTTMS. The empirical application of constant and light to moderate forces (by TAD, segment and multibrackets) to slowly move teeth through or into the maxillary sinus in adults appears to be practical and secure. Bodily movement was accomplished, but teeth appear to be easily tipped initially, potentially resulting in root resorption. However, this conclusion should be interpreted with caution as the currently available evidence is based on only a few case reports or case series and longitudinal or controlled studies are lacking in this area.

New closed analytical solutions for geometrically thick fluid tori around black holes. Numerical evolution and the onset of the magneto-rotational instability

NASA Astrophysics Data System (ADS)

Witzany, V.; Jefremov, P.

2018-06-01

Context. When a black hole is accreting well below the Eddington rate, a geometrically thick, radiatively inefficient state of the accretion disk is established. There is a limited number of closed-form physical solutions for geometrically thick (nonselfgravitating) toroidal equilibria of perfect fluids orbiting a spinning black hole, and these are predominantly used as initial conditions for simulations of accretion in the aforementioned mode. However, different initial configurations might lead to different results and thus observational predictions drawn from such simulations. Aims: We aim to expand the known equilibria by a number of closed multiparametric solutions with various possibilities of rotation curves and geometric shapes. Then, we ask whether choosing these as initial conditions influences the onset of accretion and the asymptotic state of the disk. Methods: We have investigated a set of examples from the derived solutions in detail; we analytically estimate the growth of the magneto-rotational instability (MRI) from their rotation curves and evolve the analytically obtained tori using the 2D magneto-hydrodynamical code HARM. Properties of the evolutions are then studied through the mass, energy, and angular-momentum accretion rates. Results: The rotation curve has a decisive role in the numerical onset of accretion in accordance with our analytical MRI estimates: in the first few orbital periods, the average accretion rate is linearly proportional to the initial MRI rate in the toroids. The final state obtained from any initial condition within the studied class after an evolution of ten or more orbital periods is mostly qualitatively identical and the quantitative properties vary within a single order of magnitude. The average values of the energy of the accreted fluid have an irregular dependency on initial data, and in some cases fluid with energies many times its rest mass is systematically accreted.

Malpractice suits in chest radiology: an evaluation of the histories of 8265 radiologists.

PubMed

Baker, Stephen R; Patel, Ronak H; Yang, Lily; Lelkes, Valdis M; Castro, Alejandro

2013-11-01

The aim of this study was to present rates of claims, causes of error, percentage of cases resulting in a judgment, and average payments made by radiologists in chest-related malpractice cases in a survey of 8265 radiologists. The malpractice histories of 8265 radiologists were evaluated from the credentialing files of One-Call Medical Inc., a preferred provider organization for computed tomography/magnetic resonance imaging in workers' compensation cases. Of the 8265 radiologists, 2680 (32.4%) had at least 1 malpractice suit. Of those who were sued, the rate of claims was 55.1 per 1000 person years. The rate of thorax-related suits was 6.6 claims per 1000 radiology practice years (95% confidence interval, 6.0-7.2). There were 496 suits encompassing 48 different causes. Errors in diagnosis comprised 78.0% of the causes. Failure to diagnose lung cancer was by far the most frequent diagnostic error, representing 211 cases or 42.5%. Of the 496 cases, an outcome was known in 417. Sixty-one percent of these were settled in favor of the plaintiff, with a mean payment of $277,230 (95% confidence interval, 226,967-338,614). Errors in diagnosis, and among them failure to diagnose lung cancer, were by far the most common reasons for initiating a malpractice suit against radiologists related to the thorax and its contents.

Circulation of Endemic Type 2 Vaccine-Derived Poliovirus in Egypt from 1983 to 1993

PubMed Central

Yang, Chen-Fu; Naguib, Tary; Yang, Su-Ju; Nasr, Eman; Jorba, Jaume; Ahmed, Nahed; Campagnoli, Ray; van der Avoort, Harrie; Shimizu, Hiroyuki; Yoneyama, Tetsuo; Miyamura, Tatsuo; Pallansch, Mark; Kew, Olen

2003-01-01

From 1988 to 1993, 30 cases of poliomyelitis associated with poliovirus type 2 were found in seven governorates of Egypt. Because many of the cases were geographically and temporally clustered and because the case isolates differed antigenically from the vaccine strain, it was initially assumed that the cases signaled the continued circulation of wild type 2 poliovirus. However, comparison of sequences encoding the major capsid protein, VP1 (903 nucleotides), revealed that the isolates were related (93 to 97% nucleotide sequence identity) to the Sabin type 2 oral poliovirus vaccine (OPV) strain and unrelated (<82% nucleotide sequence identity) to the wild type 2 polioviruses previously indigenous to Egypt (last known isolate: 1979) or to any contemporary wild type 2 polioviruses found elsewhere. The rate and pattern of VP1 divergence among the circulating vaccine-derived poliovirus (cVDPV) isolates suggested that all lineages were derived from a single OPV infection that occurred around 1983 and that progeny from the initiating infection circulated for approximately a decade within Egypt along several independent chains of transmission. Complete genomic sequences of an early (1988) and a late (1993) cVDPV isolate revealed that their 5′ untranslated region (5′ UTR) and noncapsid- 3′ UTR sequences were derived from other species C enteroviruses. Circulation of type 2 cVDPVs occurred at a time of low OPV coverage in the affected communities and ceased when OPV coverage rates increased. The potential for cVDPVs to circulate in populations with low immunity to poliovirus has important implications for current and future strategies to eradicate polio worldwide. PMID:12857906

Circulation of endemic type 2 vaccine-derived poliovirus in Egypt from 1983 to 1993.

PubMed

Yang, Chen-Fu; Naguib, Tary; Yang, Su-Ju; Nasr, Eman; Jorba, Jaume; Ahmed, Nahed; Campagnoli, Ray; van der Avoort, Harrie; Shimizu, Hiroyuki; Yoneyama, Tetsuo; Miyamura, Tatsuo; Pallansch, Mark; Kew, Olen

2003-08-01

From 1988 to 1993, 30 cases of poliomyelitis associated with poliovirus type 2 were found in seven governorates of Egypt. Because many of the cases were geographically and temporally clustered and because the case isolates differed antigenically from the vaccine strain, it was initially assumed that the cases signaled the continued circulation of wild type 2 poliovirus. However, comparison of sequences encoding the major capsid protein, VP1 (903 nucleotides), revealed that the isolates were related (93 to 97% nucleotide sequence identity) to the Sabin type 2 oral poliovirus vaccine (OPV) strain and unrelated (<82% nucleotide sequence identity) to the wild type 2 polioviruses previously indigenous to Egypt (last known isolate: 1979) or to any contemporary wild type 2 polioviruses found elsewhere. The rate and pattern of VP1 divergence among the circulating vaccine-derived poliovirus (cVDPV) isolates suggested that all lineages were derived from a single OPV infection that occurred around 1983 and that progeny from the initiating infection circulated for approximately a decade within Egypt along several independent chains of transmission. Complete genomic sequences of an early (1988) and a late (1993) cVDPV isolate revealed that their 5' untranslated region (5' UTR) and noncapsid- 3' UTR sequences were derived from other species C enteroviruses. Circulation of type 2 cVDPVs occurred at a time of low OPV coverage in the affected communities and ceased when OPV coverage rates increased. The potential for cVDPVs to circulate in populations with low immunity to poliovirus has important implications for current and future strategies to eradicate polio worldwide.

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study

PubMed Central

Dunnigan, Matthew G; Pollock, Allyson M

2003-01-01

Objectives To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Design Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Main outcome measures Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. Results By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). Conclusion The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1. What is already known on this topicThe full business cases for the 15 first wave private finance initiative (PFI) hospitals in England and Scotland projected reductions in acute beds of about 30% in the five years before the opening of the new replacement hospitalsThe new PFI Royal Infirmary of Edinburgh, which will fully open in 2003, is the cornerstone of Lothian Health Board's healthcare plan for its acute hospitalsWhat this study addsCompared with other Scottish NHS hospitals, service delivery has been reduced across Lothian associated with PFI developmentThe planning targets and increase in clinical activity in acute specialties in Lothian hospitals had not been achieved by 2000-1There is evidence of an independent “PFI effect” on hospital downsizing and bed reductions, which in Lothian has resulted in severe capacity constraints across all acute specialties with a need for immediate expansion in acute and community provisionFurther hospital and community service downsizing may be required to meet the financial deficit, which is principally due to the high costs of PFI PMID:12714469

Influencing factors of functional result and bone union in tibiotalocalcaneal arthrodesis with intramedullary locking nail: a retrospective series of 30 cases.

PubMed

Gross, Jean-Baptiste; Belleville, Rémi; Nespola, Arnaud; Poircuitte, Jean-Manuel; Coudane, Henry; Mainard, Didier; Galois, Laurent

2014-05-01

Initially considered as an established salvage procedure for tibiotalocalcaneal arthrodesis (TTCA), intramedullary nailing indications have expanded as evidenced in recent literature. We have tried to identify factors influencing functional result and bone union. In a retrospective study, 30 patients were treated by a TTCA between January 2006 and November 2011. Indications, operative technique, bone fusion, X-rays and functional result [American Foot and Ankle Society (AOFAS) and short-form health survey (SF-36) scores] before and after surgery were registered and analyzed. Thirty cases of TTCA were included. The patient's average age was 52 (range 24-90). Union rate was 86% for the tibiotalar joint and 74% for the subtalar joint with an average follow-up of 25.4 months (8-67). The mean AOFAS' score significantly improved (from 37 to 59) as the SF-36' score. Global complication rate was about 56%. It has not been possible to identify factors significantly influencing bone fusion or functional results. All septic cases achieved fusion without any septic resurgence. Retrograde intramedullary nailing in TTCA is an effective technique, which allows good clinical results even in case of septic history of the patient. Fusion rate and functional results were not significantly influenced by any of the factors examined in this study.

Gastroenteritis outbreaks on cruise ships: contributing factors and thresholds for early outbreak detection.

PubMed

Mouchtouri, Varvara A; Verykouki, Eleni; Zamfir, Dumitru; Hadjipetris, Christos; Lewis, Hannah C; Hadjichristodoulou, Christos

2017-11-01

When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013 by five seagoing cruise ships were analysed to identify attack rate thresholds for early outbreak detection. The overall incidence rate of AG was 2.81 cases per 10,000 traveller-days (95% confidence interval (CI): 0.00-17.60), while the attack rate was 19.37 cases per 10,000 travellers (95% CI: 0.00-127.69). The probability of an outbreak occurring was 11% if 4 per 1,000 passengers reported symptoms within the first 2 days of the voyage, and this increased to 23 % if 5 per 1,000 passengers reported such within the first 3 days. The risk ratio (RR) for outbreak occurrence was 2.35, 5.66 and 8.63 for 1, 2 and 3 days' delay of symptoms reporting respectively, suggesting a dose-response relationship. Shipping companies' policies and health authorities' efforts may consider these thresholds for initiating outbreak response measures based on the number of cases according to day of cruise. Efforts should focus on ensuring travellers report symptoms immediately and comply with isolation measures.

The current status of syphilis prevention and control in Jiangsu province, China: A cross-sectional study

PubMed Central

Chen, Yuan-Fang; Ding, Jian-Ping; Yan, Hong-Jing; Lu, Jing; Ding, Ping; Chen, Guo-Hong; Li, Jian-Jun; Huan, Xi-Ping; Yang, Hai-Tao; Tang, Wei-Ming; Fu, Geng-Feng

2017-01-01

Objective To analyze the midterm evaluation data from the National Syphilis Prevention and Control Plan (2010–2020) and evaluate the current status of syphilis prevention and control in Jiangsu province, China. Methods We collected data via (1) field surveys conducted in 2015 and (2) data recorded in existing syphilis surveillance systems. We conducted descriptive statistical analysis to evaluate the current landscape of syphilis control initiatives and their potential effect in syphilis control. Results The incidence of all cases of syphilis decreased from 2010 (32.3 per 100,000) to 2015 (30.1 per 100,000), with an annual growth of -1.17% (x2trend = -7.52, P<0.001) in Jiangsu province. The incidence of primary and secondary syphilis and congenital syphilis both decreased significantly from 2010 to 2015. The average awareness rate of syphilis knowledge among professional personnel was 95.4% (3781/3963). Rural residents had the lowest awareness rate (83.5%, 1875/2245) and commercial sex workers had the highest awareness rate (92.1%, 7804/8474) in 2015. Only 47.8% (33908/70894) of patients received provider-initiated syphilis counseling and testing (PISTC) services in sexually transmitted disease (STD) clinics, but 94.5% (87927/93020) of all syphilis patients received free testing for syphilis. Overall, 97.2% (9378/9648) of syphilis reported cases of syphilis at medical institutions were confirmed to be accurate, and 92.2% (5850/6345) of patients diagnosed with syphilis at medical institutions received treatment with penicillin. Conclusion The syphilis incidence rate in Jiangsu has decreased in recent years, but remains at a high level. It is essential to promote PISTC services to improve knowledge of syphilis and rates of testing and treatment in Jiangsu province. PMID:28837587

The current status of syphilis prevention and control in Jiangsu province, China: A cross-sectional study.

PubMed

Chen, Yuan-Fang; Ding, Jian-Ping; Yan, Hong-Jing; Lu, Jing; Ding, Ping; Chen, Guo-Hong; Li, Jian-Jun; Huan, Xi-Ping; Yang, Hai-Tao; Tang, Wei-Ming; Fu, Geng-Feng

2017-01-01

To analyze the midterm evaluation data from the National Syphilis Prevention and Control Plan (2010-2020) and evaluate the current status of syphilis prevention and control in Jiangsu province, China. We collected data via (1) field surveys conducted in 2015 and (2) data recorded in existing syphilis surveillance systems. We conducted descriptive statistical analysis to evaluate the current landscape of syphilis control initiatives and their potential effect in syphilis control. The incidence of all cases of syphilis decreased from 2010 (32.3 per 100,000) to 2015 (30.1 per 100,000), with an annual growth of -1.17% (x2trend = -7.52, P<0.001) in Jiangsu province. The incidence of primary and secondary syphilis and congenital syphilis both decreased significantly from 2010 to 2015. The average awareness rate of syphilis knowledge among professional personnel was 95.4% (3781/3963). Rural residents had the lowest awareness rate (83.5%, 1875/2245) and commercial sex workers had the highest awareness rate (92.1%, 7804/8474) in 2015. Only 47.8% (33908/70894) of patients received provider-initiated syphilis counseling and testing (PISTC) services in sexually transmitted disease (STD) clinics, but 94.5% (87927/93020) of all syphilis patients received free testing for syphilis. Overall, 97.2% (9378/9648) of syphilis reported cases of syphilis at medical institutions were confirmed to be accurate, and 92.2% (5850/6345) of patients diagnosed with syphilis at medical institutions received treatment with penicillin. The syphilis incidence rate in Jiangsu has decreased in recent years, but remains at a high level. It is essential to promote PISTC services to improve knowledge of syphilis and rates of testing and treatment in Jiangsu province.

Per-oral Endoscopic Myotomy (POEM) After the Learning Curve: Durable Long-term Results With a Low Complication Rate.

PubMed

Hungness, Eric S; Sternbach, Joel M; Teitelbaum, Ezra N; Kahrilas, Peter J; Pandolfino, John E; Soper, Nathaniel J

2016-09-01

We aimed to report long-term outcomes for patients undergoing per-oral endoscopic myotomy (POEM) after our initial 15-case learning curve. POEM has become an established, natural-orifice surgical approach for treating esophageal motility disorders. To date, published outcomes and comparative-effectiveness studies have included patients from the early POEM experience. Consecutive patients undergoing POEM after our initial 15 cases, with a minimum of 1-year postoperative follow-up, were included. Treatment success was defined as an Eckardt score ≤3 without reintervention. Gastroesophageal reflux was defined by abnormal pH-testing or reflux esophagitis >Los Angeles grade A. Between January 2012 and March 2015, 115 patients underwent POEM at a single, high-volume center. Operative time was 101 ± 29 minutes, with 95% (109/115) of patients discharged on postoperative day 1. Clavien-Dindo grade III complications occurred in 2.7%, one of which required diagnostic laparoscopy to rule out Veress needle injury to the gall bladder. The rate of grade I complications was 15.2%. At an average of 2.4 years post-POEM (range 12-52 months), the overall success rate was 92%. Objective evidence of reflux was present in 40% for all patients and 33% for patients with a body mass index <35 kg/m and no hiatal hernia. POEM performed by experienced surgeons provided durable symptomatic relief in 94% of patients with nonspastic achalasia and 90% of patients with type 3 achalasia/spastic esophageal motility disorders, with a low rate of complications. The rate of gastroesophageal reflux was comparable with prior studies of both POEM and laparoscopic Heller myotomy.

Survival rate and prognostic factors of conventional osteosarcoma in Northern Thailand: A series from Chiang Mai University Hospital.

PubMed

Pruksakorn, Dumnoensun; Phanphaisarn, Areerak; Arpornchayanon, Olarn; Uttamo, Nantawat; Leerapun, Taninnit; Settakorn, Jongkolnee

2015-12-01

Osteosarcoma is a common and aggressive primary malignant bone tumor occurring in children and adolescents. It is one of the most aggressive human cancers and the most common cause of cancer-associated limb loss. As treatment in Thailand has produced a lower survival rate than in developed countries; therefore, this study identified survival rate and the poor prognostic factors of osteosarcoma in Northern Thailand. The retrospective cases of osteosarcoma, diagnosis between 1 January 1996 and 31 December 2013, were evaluated. Five and ten year overall survival rates were analyzed using time-to-event analysis. Potential prognostic factors were identified by multivariate regression analysis. There were 208 newly diagnosed osteosarcomas during that period, and 144 cases met the criteria for analysis. The majority of the osteosarcoma cases (78.5%) were aged 0-24 years. The overall 5- and 10-year survival rates were 37.9% and 33.6%, respectively. Presence of metastasis at initial examination, delayed and against treatment co-operation, and axial skeletal location were identified as independent prognostic factors for survival, with hazard ratios of 4.3, 2.5 and 3.8, and 3.1, respectively. This osteosarcoma cohort had a relatively poor overall survival rate. The prognostic factors identified would play a critical role in modifying survival rates of osteosarcoma patients; as rapid disease recognition, a better treatment counselling, as well as improving of chemotherapeutic regimens were found to be important in improving the overall survival rate in Thailand. Copyright © 2015 Elsevier Ltd. All rights reserved.

Autoignition of hydrogen in shear flows

NASA Astrophysics Data System (ADS)

Kalbhor, Abhijit; Chaudhuri, Swetaprovo; Chitilappilly, Lazar

2018-05-01

In this paper, we compare the autoignition characteristics of laminar, nitrogen-diluted hydrogen jets in two different oxidizer flow configurations: (a) co-flowing heated air and (b) wake of heated air, using two-dimensional numerical simulations coupled with detailed chemical kinetics. In both cases, autoignition is observed to initiate at locations with low scalar dissipation rates and high HO2 depletion rates. It is found that the induction stage prior to autoignition is primarily dominated by chemical kinetics and diffusion while the improved scalar mixing imparted by the large-scale flow structures controls the ignition progress in later stages. We further investigate the ignition transience and its connection with mixing by varying the initial wake conditions and fuel jet to oxidizer velocity ratios. These studies reveal that the autoignition delay times are independent of initial wake flow conditions. However, with increased jet velocity ratios, the later stages of ignition are accelerated, mainly due to enhanced mixing facilitated by the higher scalar dissipation rates. Furthermore, the sensitivity studies for the jet in wake configuration show a significant reduction in ignition delay even for about 0.14% (by volume) hydrogen dilution in the oxidizer. In addition, the detailed autoignition chemistry and the relative roles of certain radical species in the initiation of the autoignition process in these non-premixed jets are investigated by tracking the evolution of important chain reactions using a Lagrangian particle tracking approach. The reaction H2 + O2 ↔ HO2 + H is recognized to be the dominant chain initiation reaction that provides H radicals essential for the progress of subsequent elementary reactions during the pre-ignition stage.

Direct Numerical Simulation of a Temporally Evolving Incompressible Plane Wake: Effect of Initial Conditions on Evolution and Topology

NASA Technical Reports Server (NTRS)

Sondergaard, R.; Cantwell, B.; Mansour, N.

1997-01-01

Direct numerical simulations have been used to examine the effect of the initial disturbance field on the development of three-dimensionality and the transition to turbulence in the incompressible plane wake. The simulations were performed using a new numerical method for solving the time-dependent, three-dimensional, incompressible Navier-Stokes equations in flows with one infinite and two periodic directions. The method uses standard Fast Fourier Transforms and is applicable to cases where the vorticity field is compact in the infinite direction. Initial disturbances fields examined were combinations of two-dimensional waves and symmetric pairs of 60 deg oblique waves at the fundamental, subharmonic, and sub-subharmonic wavelengths. The results of these simulations indicate that the presence of 60 deg disturbances at the subharmonic streamwise wavelength results in the development of strong coherent three-dimensional structures. The resulting strong three-dimensional rate-of-strain triggers the growth of intense fine scale motions. Wakes initiated with 60 deg disturbances at the fundamental streamwise wavelength develop weak coherent streamwise structures, and do not develop significant fine scale motions, even at high Reynolds numbers. The wakes which develop strong three-dimensional structures exhibit growth rates on par with experimentally observed turbulent plane wakes. Wakes which develop only weak three-dimensional structures exhibit significantly lower late time growth rates. Preliminary studies of wakes initiated with an oblique fundamental and a two-dimensional subharmonic, which develop asymmetric coherent oblique structures at the subharmonic wavelength, indicate that significant fine scale motions only develop if the resulting oblique structures are above an angle of approximately 45 deg.

High rate science data handling on Space Station Freedom

NASA Technical Reports Server (NTRS)

Handley, Thomas H., Jr.; Masline, Richard C.

1990-01-01

A study by NASA's User Information System Working Group for Space Station Freedom (SSF) has determined that the proposed onboard Data Management System, as initially configured, will be incapable of handling the data-generation rates typical of numerous scientific sensor payloads; many of these generate data at rates in excess of 10 Mbps, and there are at least four cases of rates in excess of 300 Mbps. The SSF Working Group has accordingly suggested an alternative conceptual architecture based on technology expected to achieve space-qualified status by 1995. The architecture encompasses recorders with rapid data-ingest capabilities and massive storage capabilities, optical delay lines allowing the recording of only the phenomena of interest, and data flow-compressing image processors.

Comparison of enrofloxacin and ceftiofur sodium for the treatment of relapse of undifferentiated fever/bovine respiratory disease in feedlot cattle.

PubMed

Abutarbush, Sameeh M; Schunicht, Oliver C; Wildman, Brian K; Hannon, Sherry J; Jim, G Kee; Ward, Tracy I; Booker, Calvin W

2012-01-01

This commercial field trial compared the efficacy of enrofloxacin and ceftiofur sodium in beef cattle at high risk of developing undifferentiated fever (UF), also known as bovine respiratory disease (BRD) that received tilmicosin at feedlot arrival, were diagnosed and initially treated for UF with tilmicosin, and subsequently required a second UF treatment (first relapse). Feedlot cattle (n = 463) were randomly assigned to 2 experimental groups: ENRO or CEF. Second UF relapse, 3rd UF relapse, overall case fatality and BRD case fatality rates were lower in the ENRO group than in the CEF group (P < 0.05). There were no differences in average daily gain (allocation to re-implant date), chronicity, histophilosis case fatality or miscellaneous case fatality rates between the groups (P ≥ 0.05). A per-animal economic advantage of Can$57.08 was calculated for the ENRO group versus the CEF group. In feedlot cattle in western Canada at high risk of developing UF, it was more cost effective to administer enrofloxacin than ceftiofur sodium for treatment of UF relapse.

Comparison of enrofloxacin and ceftiofur sodium for the treatment of relapse of undifferentiated fever/bovine respiratory disease in feedlot cattle

PubMed Central

Abutarbush, Sameeh M.; Schunicht, Oliver C.; Wildman, Brian K.; Hannon, Sherry J.; Jim, G. Kee; Ward, Tracy I.; Booker, Calvin W.

2012-01-01

This commercial field trial compared the efficacy of enrofloxacin and ceftiofur sodium in beef cattle at high risk of developing undifferentiated fever (UF), also known as bovine respiratory disease (BRD) that received tilmicosin at feedlot arrival, were diagnosed and initially treated for UF with tilmicosin, and subsequently required a second UF treatment (first relapse). Feedlot cattle (n = 463) were randomly assigned to 2 experimental groups: ENRO or CEF. Second UF relapse, 3rd UF relapse, overall case fatality and BRD case fatality rates were lower in the ENRO group than in the CEF group (P < 0.05). There were no differences in average daily gain (allocation to re-implant date), chronicity, histophilosis case fatality or miscellaneous case fatality rates between the groups (P ≥ 0.05). A per-animal economic advantage of Can$57.08 was calculated for the ENRO group versus the CEF group. In feedlot cattle in western Canada at high risk of developing UF, it was more cost effective to administer enrofloxacin than ceftiofur sodium for treatment of UF relapse. PMID:22753964

Therapeutic effects of saireito (chai-ling-tang), a traditional Japanese herbal medicine, on lymphedema caused by radiotherapy: a case series study.

PubMed

Nagai, Aiko; Shibamoto, Yuta; Ogawa, Keiko

2013-01-01

Despite the development of radiotherapy machines and technologies, a proportion of patients suffer from radiation-induced lymphedema. Saireito (SRT) is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in conditions such as nephritic disease. This study investigated the effect of SRT on lymphedema caused by radiotherapy. Four patients were treated with SRT at a dose of 9 g/day. The severity of lymphedema was evaluated using the Common Terminology Criteria for Adverse Events version 4 and Numerical Rating Scale before and after SRT treatment. After the treatment with SRT, 2 of 4 patients (50%) showed apparent improvement in lymphedema. One of the cases had difficulty in wearing the custom-made thermoplastic cast, but after SRT administration, he could wear the mask easily. One case decided to stop taking SRT 3 days after initiation because cough and fever appeared. In conclusion, it is important to control the side effects of radiotherapy, which leads to improved tumor control rates. Prospective randomized studies are necessary to confirm the findings of this case series study.

An experimental study on fatigue performance of cryogenic metallic materials for IMO type B tank

NASA Astrophysics Data System (ADS)

Lee, Jin-Sung; You, Won-Hyo; Yoo, Chang-Hyuk; Kim, Kyung-Su; Kim, Yooil

2013-12-01

Three materials SUS304, 9% Ni steel and Al 5083-O alloy, which are considered possible candidate for International Maritime Organization (IMO) type B Cargo Containment System, were studied. Monotonic tensile, fatigue, fatigue crack growth rate and Crack Tip Opening Displacement tests were carried out at room, intermediate low (-100 °C) and cryogenic (-163 °C) temperatures. The initial yield and tensile strengths of all materials tended to increase with decreasing temperature, whereas the change in elastic modulus was not as remarkable. The largest and smallest improvement ratio of the initial yield strengths due to a temperature reduction were observed in the SUS304 and Al 5083- O alloy, respectively. The fatigue strengths of the three materials increased with decreasing temperature. The largest increase in fatigue strength was observed in the Al 5083-O alloy, whereas the 9% Ni steel sample showed the smallest increase. In the fatigue crack growth rate test, SUS304 and Al 5083-O alloy showed a decrease in the crack propagation rate, due to decrease in temperature, but no visible improvement in da/dN was observed in the case of 9% Ni steel. In the Crack Tip Opening Displacement (CTOD) test, CTOD values were converted to critical crack length for the comparison with different thickness specimens. The critical crack length tended to decrease in the case of SUS304 and increase for the Al 5083-O alloy with decreasing temperature. In case of 9% Ni steel, change of critical crack length was not observed due to temperature decrease. In addition, the changing material properties according to the temperature of the LNG tank were analyzed according to the international code for the construction and equipment of ships carrying liquefied gases in bulk (IGC code) and the rules of classifications.

Initiating statistical process control to improve quality outcomes in colorectal surgery.

PubMed

Keller, Deborah S; Stulberg, Jonah J; Lawrence, Justin K; Samia, Hoda; Delaney, Conor P

2015-12-01

Unexpected variations in postoperative length of stay (LOS) negatively impact resources and patient outcomes. Statistical process control (SPC) measures performance, evaluates productivity, and modifies processes for optimal performance. The goal of this study was to initiate SPC to identify LOS outliers and evaluate its feasibility to improve outcomes in colorectal surgery. Review of a prospective database identified colorectal procedures performed by a single surgeon. Patients were grouped into elective and emergent categories and then stratified by laparoscopic and open approaches. All followed a standardized enhanced recovery protocol. SPC was applied to identify outliers and evaluate causes within each group. A total of 1294 cases were analyzed--83% elective (n = 1074) and 17% emergent (n = 220). Emergent cases were 70.5% open and 29.5% laparoscopic; elective cases were 36.8% open and 63.2% laparoscopic. All groups had a wide range in LOS. LOS outliers ranged from 8.6% (elective laparoscopic) to 10.8% (emergent laparoscopic). Evaluation of outliers demonstrated patient characteristics of higher ASA scores, longer operating times, ICU requirement, and temporary nursing at discharge. Outliers had higher postoperative complication rates in elective open (57.1 vs. 20.0%) and elective lap groups (77.6 vs. 26.1%). Outliers also had higher readmission rates for emergent open (11.4 vs. 5.4%), emergent lap (14.3 vs. 9.2%), and elective lap (32.8 vs. 6.9%). Elective open outliers did not follow trends of longer LOS or higher reoperation rates. SPC is feasible and promising for improving colorectal surgery outcomes. SPC identified patient and process characteristics associated with increased LOS. SPC may allow real-time outlier identification, during quality improvement efforts, and reevaluation of outcomes after introducing process change. SPC has clinical implications for improving patient outcomes and resource utilization.

Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections.

PubMed

Matter-Parrat, V; Ronde-Oustau, C; Boéri, C; Gaudias, J; Jenny, J-Y

2017-04-01

Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience

PubMed Central

Schwartz, Bryan G.; Ludeman, Daniel J.; Mayeda, Guy S.; Kloner, Robert A.; Economides, Christina; Burstein, Steven

2012-01-01

Background Patients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patients with CS at our institution. Methods All cases involving PLVADs in patients with CS between between January 1, 2008 and June 30, 2010 at a private, tertiary referral hospital were reviewed retrospectively. Results All 76 cases were identified (50 IABP only, 7 Impella, 19 TandemHeart). Most Impella (5/7) and TandemHeart (10/19) patients were initially treated with an IABP before "upgrading" for increased hemodynamic support. All 76 devices (100%) were initiated successfully. Percutaneous revascularization was attempted in 63 patients with angiographic success in 57 (90%). The incidences of major complications were similar between groups, except bleeding occurred less frequently with the IABP. Mean ejection fraction on presentation was 30.4±16.5% and increased by a mean of 6.6±11.4% (P < 0.001). With the institutional approach of treating patients with CS initially with vasopressors and IABPs, then upgrading to an Impella or TandemHeart device for patients refractory to IABP therapy, the overall mortality rate was 40%. Conclusion The Impella and TandemHeart devices can be initiated successfully in patients with CS, are associated with high rates of angiographic success during high risk percutaneous interventions and may benefit the myocardium during myocardial infarction. Randomized trials are warranted investigating use of the Impella and TandemHeart devices in patients with CS and in patients refractory to conventional IABP therapy. PMID:28348673

Studies of the Wetting of Gaps in Weightlessness

NASA Astrophysics Data System (ADS)

Collicott, Steven H.; Chen, Yongkang

2010-10-01

The geometry of a thin sheet metal vane terminating near a wall in a surface tension propellant management device (PMD) is common in devices designed by various people. A research program into the capillary fluid physics of the common vane-wall gap began in 1998 with the arrival of the second author at the School of Aeronautics and Astronautics at Purdue University. Drop tower experiments, Surface Evolver computations, and analysis were combined to explore the details of the fluid behavior in the vane-wall gap geometry. Results of four vane-wall gap experiment topics: critical wetting, advance rates, sensitivity to vane orientation, and effect of imperfect initial conditions, are discussed here. This work led to a desire by Weislogel to incorporate this type of geometry into his "Capillary Fluids Experiment" (CFE) that operated flawlessly on the International Space Station in 2006 and 2007. It is found that the wetting of vane-wall gaps is predicted correctly through use of the critical wetting analysis of Concus and Finn. Furthermore, the dynamics of the wetting flows are found to have scaling of flow rates versus time similar to those known for capillary advances in solid corners. In some cases, a seemingly misaligned vane is found to have more rapid capillary advance than for the same vane and gap but with the vane normal to the tank wall. An initial drop tower study of sensitivity to imperfect initial conditions shows that a critical wetting flow is largely immune to small tilts in the initial test orientation but that larger errors can be seen in cases that lack critical wetting and in the measurements of the time history of the meniscus minimum point.

Identifying Early Target Cells of Nipah Virus Infection in Syrian Hamsters.

PubMed

Baseler, Laura; Scott, Dana P; Saturday, Greg; Horne, Eva; Rosenke, Rebecca; Thomas, Tina; Meade-White, Kimberly; Haddock, Elaine; Feldmann, Heinz; de Wit, Emmie

2016-11-01

Nipah virus causes respiratory and neurologic disease with case fatality rates up to 100% in individual outbreaks. End stage lesions have been described in the respiratory and nervous systems, vasculature and often lymphoid organs in fatal human cases; however, the initial target organs of Nipah virus infection have not been identified. Here, we detected the initial target tissues and cells of Nipah virus and tracked virus dissemination during the early phase of infection in Syrian hamsters inoculated with a Nipah virus isolate from Malaysia (NiV-M) or Bangladesh (NiV-B). Syrian hamsters were euthanized between 4 and 48 hours post intranasal inoculation and tissues were collected and analyzed for the presence of viral RNA, viral antigen and infectious virus. Virus replication was first detected at 8 hours post inoculation (hpi). Nipah virus initially targeted type I pneumocytes, bronchiolar respiratory epithelium and alveolar macrophages in the lung and respiratory and olfactory epithelium lining the nasal turbinates. By 16 hpi, virus disseminated to epithelial cells lining the larynx and trachea. Although the pattern of viral dissemination was similar for both virus isolates, the rate of spread was slower for NiV-B. Infectious virus was not detected in the nervous system or blood and widespread vascular infection and lesions within lymphoid organs were not observed, even at 48 hpi. Nipah virus initially targets the respiratory system. Virus replication in the brain and infection of blood vessels in non-respiratory tissues does not occur during the early phase of infection. However, virus replicates early in olfactory epithelium and may serve as the first step towards nervous system dissemination, suggesting that development of vaccines that block virus dissemination or treatments that can access the brain and spinal cord and directly inhibit virus replication may be necessary for preventing central nervous system pathology.

Reconnection and interchange instability in the near magnetotail

DOE PAGES

Birn, Joachim; Liu, Yi -Hsin; Daughton, William; ...

2015-07-16

This paper provides insights into the possible coupling between reconnection and interchange/ballooning in the magnetotail related to substorms and flow bursts. The results presented are largely based on recent simulations of magnetotail dynamics, exploring onset and progression of reconnection. 2.5-dimensional particle-in-cell (PIC) simulations with different tail deformation demonstrate a clear boundary between stable and unstable cases depending on the amount of deformation, explored up to the real proton/electron mass ratio. The evolution prior to onset, as well as the evolution of stable cases, are governed by the conservation of integral flux tube entropy S as imposed in ideal MHD, maintainingmore » a monotonic increase with distance downtail. This suggests that ballooning instability in the tail should not be expected prior to the onset of tearing and reconnection. 3-D MHD simulations confirm this conclusion, showing no indication of ballooning prior to reconnection, if the initial state is ballooning stable. The simulation also shows that, after imposing resistivity necessary to initiate reconnection, the reconnection rate and energy release initially remain slow. However, when S becomes reduced from plasmoid ejection and lobe reconnection, forming a negative slope in S as a function of distance from Earth, the reconnection rate and energy release increase drastically. The latter condition has been shown to be necessary for ballooning/interchange instability, and the cross-tail structures that develop subsequently in the MHD simulation are consistent with such modes. The simulations support a concept in which tail activity is initiated by tearing instability but significantly enhanced by the interaction with ballooning/interchange enabled by plasmoid loss and lobe reconnection.« less

Harmonic plasma waves excitation and structure evolution of intense ion beams in background plasmas

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

Hu, Zhang-Hu, E-mail: zhanghu@dlut.edu.cn; Wang, You-Nian

2016-08-15

The long-term dynamic evolutions of intense ion beams in plasmas have been investigated with two-dimensional electromagnetic particle simulations, taking into account the effect of the two-stream instability between beam ions and plasma electrons. Depending on the initial beam radial density profile and velocity distribution, ring structures may be formed in the beam edge regions. At the later stage of beam-plasma interactions, the ion beams are strongly modulated by the two-stream instability and multiple density spikes are formed in the longitudinal direction. The formation of these density spikes is shown to result from the excitation of harmonic plasma waves when themore » instability gets saturated. Comparisons between the beam cases with initial flat-top and Gaussian radial density profiles are made, and a higher instability growth rate is observed for the flat-top profile case.« less

Modification of graphene oxide films by radiofrequency N2 plasma

NASA Astrophysics Data System (ADS)

Neustroev, E. P.; Burtseva, E. K.; Soloviev, B. D.; Prokopiev, A. R.; Popov, V. I.; Timofeev, V. B.

2018-04-01

The effect of treatment in nitrogen plasma on the properties of partially reduced graphene oxide (rGO) was studied. A comparison is made between two different sample locations in the reaction chamber. It is shown that in the case when rGO films were turned towards the inductor of the plasma system, the etching rate is much higher. Effective nitrogen functionalization of rGO was established in the second position, when the rGO films were turned in the opposite direction. In this case, the nitrogen content increases to 5 at% of the initial value. The change in the current-voltage characteristics is observed under illumination, which is independent of the wavelength. On and off daylight changes the resistance to 30% of the initial value. The magnitude of the photocurrent increases depending on the applied voltage. The effect is most noticeable for thin rGO films 10-15 nm in thickness.

Complications of Impulse Generator Exchange Surgery for Deep Brain Stimulation: A Single-Center, Retrospective Study.

PubMed

Helmers, Ann-Kristin; Lübbing, Isabel; Birkenfeld, Falk; Witt, Karsten; Synowitz, Michael; Mehdorn, Hubertus Maximilian; Falk, Daniela

2018-05-01

Nonrechargeable deep brain stimulation impulse generators (IGs) with low or empty battery status require surgical IG exchange several years after initial implantation. The aim of this study was to investigate complication rates after IG exchange surgery and identify risk factors. We retrospectively analyzed complications following IG exchange surgery from 2008 to 2015 in our department. Medical records of all patients who underwent IG exchange surgery were systematically reviewed. The shortest follow-up time was 19 months. From 2008 to 2015, 438 IGs were exchanged in 319 patients. Overall complication rate was 8.90%. Infection developed in 12 patients (2.74%). Six patients (1.37%) experienced local wound erosions. Hardware malfunctions were present in 11 patients (2.51%), and local hemorrhage was observed in 3 cases (0.68%). Repeated fixation of the IG was required in 2 patients (0.46%). Traction of the connecting cables necessitated surgical revision in 2 patients (0.46%). In 2 cases (0.46%), the IG was placed abdominally or exchanged for a smaller device owing to patient discomfort resulting from the initial positioning. One 80-year-old patient (0.23%) had severely worsening heart failure and died 4 days after IG exchange surgery. IG exchange surgery, although often considered a minor surgery, was associated with a complication rate of approximately 9% in our center. Patients and physicians should understand the complication rates associated with IG exchange surgery because this information might facilitate selection of a rechargeable IG. Copyright © 2018 Elsevier Inc. All rights reserved.

Incidence, in-hospital case-fatality rates, and management practices in Puerto Ricans hospitalized with acute myocardial infarction.

PubMed

Zevallos, Juan C; Yarzebski, Jorge; González, Juan A; Banchs, Héctor L; García-Palmieri, Mario; Mattei, Hernando; Ayala, José; González, Marijesmar; Torres, Vanessa; Ramos, Iris N; Pericchi, Luis R; Torres, David A; González, María C; Goldberg, Robert J

2013-09-01

There are extremely limited data on minority populations, especially Hispanics, describing the clinical epidemiology of acute coronary disease. The aim of this study is to examine the incidence rate of acute myocardial infarction (AMI), in-hospital case-fatality rate (CFR), and management practices among residents of greater San Juan (Puerto Rico) who were hospitalized with an initial AMI. Our trained study staff reviewed and independently validated the medical records of patients who had been hospitalized with possible AMI at any of the twelve hospitals located in greater San Juan during calendar year 2007. The incidence rate (# per 100,000 population) of 1,415 patients hospitalized with AMI increased with advancing age and were significantly higher for older patients for men (198) than they were for women (134). The average age of the study population was 64 years, and women comprised 45% of the study sample. Evidence-based cardiac therapies, e.g., aspirin, beta blockers, ACE inhibitors/angiotensin receptor blockers, and statins, were used with 60% of the hospitalized patients, and women were less likely than men to have received these therapies (59% vs. 65%) or to have undergone interventional cardiac procedures (47% vs. 59%) (p<0.05). The in-hospital CFR increased with advancing age and were higher for women (8.6%) than they were for men (6.0%) (p<0.05). Efforts are needed to reduce the magnitude of AMI, enhance the use of evidence-based cardiac therapies, reduce possible gender disparities, and improve the short-term prognoses of Puerto Rican patients hospitalized with an initial AMI.

Polymicrobial Gardnerella biofilm resists repeated intravaginal antiseptic treatment in a subset of women with bacterial vaginosis: a preliminary report.

PubMed

Swidsinski, Alexander; Loening-Baucke, Vera; Swidsinski, Sonja; Verstraelen, Hans

2015-03-01

Bacterial vaginosis is a recalcitrant polymicrobial biofilm infection that often resists standard antibiotic treatment. We therefore considered repeated treatment with octenidine, a local antiseptic that has previously been shown to be highly effective in several biofilm-associated infections. Twenty-four patients with recurrent BV were treated with a 7-day course of octenidine (octenidine dihydrochloride spray application with the commercial product Octenisept). In case of treatment failure or relapse within 6 months, patients were re-treated with a 28-day course of octenidine. In case of recurrence within 6 months after the second treatment course, patients were treated again with a 28-day course followed by weekly applications for 2 months. Treatment effect was evaluated by assessment of the presence of the biofilm on voided vaginal epithelial cells through fluorescence in situ hybridisation. The initial cure rate following a 7-day course of octenidine was as high as 87.5%. The 6-month relapse rate was, however, as high as 66.6%. Repeated treatment for 28 days led to an overall cure rate of 75.0%; however, it was also associated with emergence of complete resistance to octenidine in a subset of women. The overall cure rate after three treatment courses with 1-year follow-up was 62.5 %, with 37.5 % of the patients showing complete resistance to octenidine. Our preliminary results showed that octenidine dihydrochloride was initially highly effective, but the efficacy of repeated and prolonged treatment dropped quickly as challenge with the antiseptic rapidly led to bacterial resistance in a considerable subset of women.

Maternal and congenital syphilis in Shanghai, China, 2002 to 2006.

PubMed

Zhu, Liping; Qin, Min; Du, Li; Xie, Ri-hua; Wong, Tom; Wen, Shi Wu

2010-09-01

To assess the trends and determinants of maternal and congenital syphilis in Shanghai, China. We conducted a prospective cohort study of maternal and congenital syphilis from 2002 to 2006 in Shanghai, China. We presented the trends of maternal syphilis and congenital syphilis rates and compared outcomes in infants born to mothers with complete versus incomplete treatment for maternal syphilis. We also assessed the determinants of compliance to treatment of maternal syphilis and examined the associations of initial maternal RPR antibody level and gestational age at initiation of treatment with occurrence of congenital syphilis. A total of 535 537 pregnant women were included in the analysis. During this period of time, 1471 maternal syphilis cases (298.7 per 100 000 live births) and 334 congenital syphilis cases (62.4 per 100 000 live births) were identified. Both maternal and congenital syphilis rates increased from 2002 until 2005, with a slight decrease in 2006. The rate of maternal syphilis was 156.2 per 100 000 live births in Shanghai residents and 371.7 per 100 000 live births in the migrating population (p<0.001). The compliance to treatment for maternal syphilis was poorer in women with a lower level of education. The rate of congenital syphilis in infants born to mothers with incomplete treatment (50.8%) was much higher than in infants born to mothers with complete treatment (12.5%). Rates of fetal death, neonatal death, and major birth defects were 30.4%, 11.0%, and 3.8%, respectively, in the incomplete treatment group; the corresponding figures were 5.5%, 0.56%, and 0.46%, respectively, in the complete treatment group. Infant outcome was also affected by initial maternal RPR antibody level and time of treatment, with much better outcomes in mothers with low antibody levels and earlier treatment. There has been a resurgence of congenital syphilis in Shanghai, China, especially in the migrating population and other populations with a lower socioeconomic status. Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Study of a measles outbreak in Granada with preventive measures applied by the courts, Spain, 2010 to 2011.

PubMed

Navarro, E; Mochón, M M; Galicia, M D; Marín, I; Laguna, J

2013-10-24

Measles had practically been eliminated in Granada since the systematic vaccination of children with two doses introduced in 1984. However, in 2009 the disease returned in the form of small outbreaks. This study describes the measles outbreak that occurred in Granada from October 2010 to August 2011 and the measures imposed to control it. Information was sourced from the records of the Andalusian epidemiological surveillance system. A total of 308 cases were recorded, representing an incidence rate of 33.6 cases per 100,000 inhabitants. The first wave of the epidemic took place in Granada city, with the majority of cases occurring among families who lived in the Albaycín neighbourhood and were opposed to vaccination for ideological and/or religious reasons. The initial cases were in unvaccinated children aged 1 to 13 years. The outbreak later spread throughout the province. To control the outbreak, the vaccination schedule for the exposed children was brought up to date. The Regional Ministry of Health decided to take legal action in order to ensure vaccination of those in the initial nucleus of the outbreak.

Case file audit of Lidcombe program outcomes in a student-led stuttering clinic.

PubMed

McCulloch, Julia; Swift, Michelle C; Wagnitz, Bianca

2017-04-01

The current study aimed to benchmark clinical outcomes for preschool-aged clients (2;0-5;11 years old) that attended a student-led clinic and undertook the Lidcombe Program. A case file audit was undertaken for all preschool clients who attended the clinic between February 2008 and February 2013 and commenced the Lidcombe Program. Clients were grouped according to Stage 1 completion. A mixed ANOVA was used to test for differences between the groups in initial and final percentage syllables stuttered (%SS). Associations between case variable factors and treatment duration were investigated using Pearson correlations. Clients who completed Stage 1 had final %SS and severity rating (SR) scores comparable to the literature; however, the median Stage 1 duration was greater. Over half of the clients (57%) withdrew prior to completing Stage 1. These clients had a significantly higher %SS at final treatment session than their completing peers. Initial %SS and SR scores were the only case variables associated with treatment duration. Students can achieve the same short-term treatment outcomes for children who stutter using the Lidcombe Program as the current published literature; however, treatment duration is greater and may impact completion. Implications of this for clinical education are discussed.

A clinical analysis of 32 brainstem haemorrhages; with special reference to surviving but severely disabled cases.

PubMed

Komiyama, M; Boo, Y E; Yagura, H; Yasui, T; Baba, M; Hakuba, A; Nishimura, S

1989-01-01

Thirty-two patients with CT-documented primary brainstem haemorrhage were reviewed retrospectively to obtain a clearer overall clinical picture, especially of the severely disabled survivors. They were divided into 3 groups according to outcome: eleven cases (Group 1) died within 1 month following haemorrhage, 11 cases (Group 2) survived but became bedridden, necessitating full living support, and 10 cases (Group 3) showed minimal neurological deficits and resumed normal activities. Owing to CT and improved critical care, the survival rate was 66% for the whole series. Group 2 comprised 34% of all cases. These patients were mostly alert, quadruplegic, and communicated only with great difficulty. The most common initial symptoms and CT finding in each group were as follows; Group 1: unconsciousness, respiratory disturbance, negative light reflex, tachycardia, and haematoma greater than 3.0 cm; Group 2: disturbance of consciousness, respiratory disturbance, positive light reflex, normal heart rate, and 2.0 greater than haematoma less than 3.5 cm; and Group 3: alertness or only slight disturbance of consciousness, normal respiration, positive light reflex, normal heart rate, haematoma less than 2.5 cm. Although there is an overlap among them, these findings will be useful to distinguish the three groups from each other. Patients with disturbance of consciousness, respiratory disturbance, positive light reflex, normal heart rate, and 2.0 greater than haematoma less than 3.5 cm, have a chance to survive, but in severely disabled condition, if they were treated with vigorous intensive care in the acute stage.

An analysis of energy-drink toxicity in the National Poison Data System.

PubMed

Seifert, Sara M; Seifert, Steven A; Schaechter, Judy L; Bronstein, Alvin C; Benson, Blaine E; Hershorin, Eugene R; Arheart, Kristopher L; Franco, Vivian I; Lipshultz, Steven E

2013-08-01

Small studies have associated energy drinks-beverages that typically contain high concentrations of caffeine and other stimulants-with serious adverse health events. To assess the incidence and outcomes of toxic exposures to caffeine-containing energy drinks, including caffeinated alcoholic energy drinks, and to evaluate the effect of regulatory actions and educational initiatives on the rates of energy drink exposures. We analyzed all unique cases of energy drink exposures reported to the US National Poison Data System (NPDS) between October 1, 2010 and September 30, 2011. We analyzed only exposures to caffeine-containing energy drinks consumed as a single product ingestion and categorized them as caffeine-containing non-alcoholic, alcoholic, or "unknown" for those with unknown formulations. Non-alcoholic energy drinks were further classified as those containing caffeine from a single source and those containing multiple stimulant additives, such as guarana or yerba mate. The data were analyzed for the demographics and outcomes of exposures (unknown data were not included in the denominator for percentages). The rates of change of energy drink-related calls to poison centers were analyzed before and after major regulatory events. Of 2.3 million calls to the NPDS, 4854 (0.2%) were energy drink-related. The 3192 (65.8%) cases involving energy drinks with unknown additives were excluded. Of 1480 non-alcoholic energy drink cases, 50.7% were children < 6 years old; 76.7% were unintentional; and 60.8% were males. The incidence of moderate to major adverse effects of energy drink-related toxicity was 15.2% and 39.3% for non-alcoholic and alcoholic energy drinks, respectively. Major adverse effects consisted of three cases of seizure, two of non-ventricular dysrhythmia, one ventricular dysrhythmia, and one tachypnea. Of the 182 caffeinated alcoholic energy drink cases, 68.2% were < 20 years old; 76.7% were referred to a health care facility. Educational and legislative initiatives to enhance understanding of the health consequences of energy drink consumption were significantly associated with a decreased rate of energy drink-related cases (p = 0.036). About half the cases of energy drink-related toxicity involved unintentional exposures by children < 6 years old. Educational campaigns and legal restrictions on the sale of energy drinks were associated with decreasing calls to poison centers for energy drink toxicity and are encouraged.

Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India.

PubMed

Raizada, Neeraj; Khaparde, Sunil D; Salhotra, Virender Singh; Rao, Raghuram; Kalra, Aakshi; Swaminathan, Soumya; Khanna, Ashwani; Chopra, Kamal Kishore; Hanif, M; Singh, Varinder; Umadevi, K R; Nair, Sreenivas Achuthan; Huddart, Sophie; Prakash, C H Surya; Mall, Shalini; Singh, Pooja; Saha, B K; Denkinger, Claudia M; Boehme, Catharina; Sarin, Sanjay

2018-01-01

Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care. A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all pediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities. The current project enrolled 42,238 pediatric presumptive TB cases from April, 2014 to June, 2016. A total of 3,340 (7.91%, CI 7.65-8.17) bacteriologically confirmed TB cases were detected, of which 295 (8.83%, CI 7.9-9.86) were rifampicin-resistant. The level of rifampicin resistance in the project cohort was high. Overall Xpert yielded a high proportion of valid results and TB detection rates were more than three-fold higher than smear microscopy. The project provided same-day testing and early availability of results led to rapid treatment initiation and success rates and very low rates of treatment failure and loss to follow-up. The current project demonstrated the feasibility of rolling out rapid and upfront Xpert testing for pediatric presumptive TB cases through a single Xpert lab per city in an efficient manner. Rapid turnaround testing time facilitated prompt and appropriate treatment initiation. These results suggest that the upfront Xpert assay is a promising solution to address TB diagnosis in children. The high levels of rifampicin resistance detected in presumptive pediatric TB patients tested under the project are a major cause of concern from a public health perspective which underscores the need to further prioritize upfront Xpert access to this vulnerable population.

Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India

PubMed Central

Raizada, Neeraj; Khaparde, Sunil D.; Salhotra, Virender Singh; Rao, Raghuram; Kalra, Aakshi; Swaminathan, Soumya; Khanna, Ashwani; Chopra, Kamal Kishore; Hanif, M.; Singh, Varinder; Umadevi, K. R.; Nair, Sreenivas Achuthan; Huddart, Sophie; Prakash, C. H. Surya; Mall, Shalini; Singh, Pooja; Saha, B. K.; Denkinger, Claudia M.; Boehme, Catharina

2018-01-01

Background Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care. Methods A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all pediatric (0–14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities. Results The current project enrolled 42,238 pediatric presumptive TB cases from April, 2014 to June, 2016. A total of 3,340 (7.91%, CI 7.65–8.17) bacteriologically confirmed TB cases were detected, of which 295 (8.83%, CI 7.9–9.86) were rifampicin-resistant. The level of rifampicin resistance in the project cohort was high. Overall Xpert yielded a high proportion of valid results and TB detection rates were more than three-fold higher than smear microscopy. The project provided same-day testing and early availability of results led to rapid treatment initiation and success rates and very low rates of treatment failure and loss to follow-up. Conclusion The current project demonstrated the feasibility of rolling out rapid and upfront Xpert testing for pediatric presumptive TB cases through a single Xpert lab per city in an efficient manner. Rapid turnaround testing time facilitated prompt and appropriate treatment initiation. These results suggest that the upfront Xpert assay is a promising solution to address TB diagnosis in children. The high levels of rifampicin resistance detected in presumptive pediatric TB patients tested under the project are a major cause of concern from a public health perspective which underscores the need to further prioritize upfront Xpert access to this vulnerable population. PMID:29489887

Eosinophilic Gastroenteritis: Case Report and Review in Search for Diagnostic Key Points

PubMed Central

López-Medina, Guillermo; Gallo, Manuel; Prado, Alejandro; Vicuña-Honorato, Iliana; Castillo Díaz de León, Roxana

2015-01-01

Eosinophilic gastroenteritis is considered an uncommon disease with a low incidence rate that remains as a diagnostic challenge for the clinician, in spite of the fact that seventy years have passed since its original description. Hereby we present the case of a 29-year-old male without history of allergies who was evaluated for unspecific gastrointestinal symptoms, without relevant findings on physical examination and presenting an initial complete blood count (CBC) with severe eosinophilia. The patient was evaluated and the diagnosis of eosinophilic gastroenteritis was confirmed by histopathological findings. The relevance of the case resides in highlighting the lack of guidelines or consensus for histological diagnosis being virtually the only one available. To a similar extent, treatment evidence is based on case series with a reasonable number of patients and case reports. PMID:26075112

Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection.

PubMed

Shea, Katherine M; Hobbs, Athena L V; Jaso, Theresa C; Bissett, Jack D; Cruz, Christopher M; Douglass, Elizabeth T; Garey, Kevin W

2017-06-01

Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including Clostridium difficile infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD = 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD = 6.4) DOT/1,000 PD and 4.8 (SD = 3.6) DOT/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT/1,000 PD per month decrease; P = 0.023) and restriction (24.5 DOT/1,000 PD per month decrease; P < 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly ( P = 0.044) from preintervention using education (3.43 cases/10,000 PD) and restriction (2.2 cases/10,000 PD). Mean monthly CDI cases/10,000 PD decreased from 4.0 (SD = 2.1) preintervention to 2.2 (SD = 1.35) postrestriction. A significant increase in appropriate respiratory fluoroquinolone use occurred postrestriction versus preintervention in patients administered at least one dose (74/130 [57%] versus 74/232 [32%]; P < 0.001), as well as in those receiving two or more doses (47/65 [72%] versus 67/191 [35%]; P < 0.001). A significant reduction in the annual acquisition cost of moxifloxacin, the formulary respiratory fluoroquinolone, was observed postrestriction compared to preintervention within the health care system ($123,882 versus $12,273; P = 0.002). Implementation of a stewardship-initiated respiratory fluoroquinolone restriction program can increase appropriate use while reducing overall utilization, acquisition cost, and CDI rates within a health care system. Copyright © 2017 American Society for Microbiology.

Comparison of the quench and fault current limiting characteristics of the flux-coupling type SFCL with single and three-phase transformer

NASA Astrophysics Data System (ADS)

Jung, Byung Ik; Cho, Yong Sun; Park, Hyoung Min; Chung, Dong Chul; Choi, Hyo Sang

2013-01-01

The South Korean power grid has a network structure for the flexible operation of the system. The continuously increasing power demand necessitated the increase of power facilities, which decreased the impedance in the power system. As a result, the size of the fault current in the event of a system fault increased. As this increased fault current size is threatening the breaking capacity of the circuit breaker, the main protective device, a solution to this problem is needed. The superconducting fault current limiter (SFCL) has been designed to address this problem. SFCL supports the stable operation of the circuit breaker through its excellent fault-current-limiting operation [1-5]. In this paper, the quench and fault current limiting characteristics of the flux-coupling-type SFCL with one three-phase transformer were compared with those of the same SFCL type but with three single-phase transformers. In the case of the three-phase transformers, both the superconducting elements of the fault and sound phases were quenched, whereas in the case of the single-phase transformer, only that of the fault phase was quenched. For the fault current limiting rate, both cases showed similar rates for the single line-to-ground fault, but for the three-wire earth fault, the fault current limiting rate of the single-phase transformer was over 90% whereas that of the three-phase transformer was about 60%. It appears that when the three-phase transformer was used, the limiting rate decreased because the fluxes by the fault current of each phase were linked in one core. When the power loads of the superconducting elements were compared by fault type, the initial (half-cycle) load was great when the single-phase transformer was applied, whereas for the three-phase transformer, its power load was slightly lower at the initial stage but became greater after the half fault cycle.

Long-term outcomes after stenting as a “bridge to surgery” for the management of acute obstruction secondary to colorectal cancer

PubMed Central

Suárez, Javier; Jimenez-Pérez, Javier

2016-01-01

Obstructive symptoms are present in 8% of cases at the time of initial diagnosis in cases of colorectal cancer. Emergency surgery has been classically considered the treatment of choice in these patients. However, in the majority of studies, emergency colorectal surgery is burdened with higher morbidity and mortality rates than elective surgery, and many patients require temporal colostomy which deteriorates their quality of life and becomes permanent in 10%-40% of cases. The aim of stenting by-pass to surgery is to transform emergency surgery into elective surgery in order to improve surgical results, obtain an accurate tumoral staging and detection of synchronous lesions, stabilization of comorbidities and performance of laparoscopic surgery. Immediate results were more favourable in patients who were stented concerning primary anastomosis, permanent stoma, wound infection and overall morbidity, having the higher surgical risk patients the greater benefit. However, some findings laid out the possible implication of stenting in long-term results of oncologic treatment. Perforation after stenting is related to tumoral recurrence. In studies with perforation rates above 8%, higher recurrences rates in young patients and lower disease free survival have been shown. On the other hand, after stenting the number of removed lymph nodes in the surgical specimen is larger, patients can receive adjuvant chemotherapy earlier and in a greater percentage and the number of patients who can be surgically treated with laparoscopic surgery is larger. Finally, there are no consistent studies able to demonstrate that one strategy is superior to the other in terms of oncologic benefits. At present, it would seem wise to assume a higher initial complication rate in young patients without relevant comorbidities and to accept the risk of local recurrence in old patients (> 70 years) or with high surgical risk (ASA III/IV). PMID:26798441

The relationship of California's Medicaid reimbursement system to nurse staffing levels.

PubMed

Mukamel, Dana B; Kang, Taewoon; Collier, Eric; Harrington, Charlene

2012-10-01

Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics. A total of 927 California free-standing nursing homes in 2006. The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over. Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate. The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.

Medical Monitoring During Firefighter Incident Scene Rehabilitation.

PubMed

Barr, David A; Haigh, Craig A; Haller, Jeannie M; Smith, Denise L

2016-01-01

The objective of this study was to retrospectively investigate aspects of medical monitoring, including medical complaints, vital signs at entry, and vital sign recovery, in firefighters during rehabilitation following operational firefighting duties. Incident scene rehabilitation logs obtained over a 5-year span that included 53 incidents, approximately 40 fire departments, and more than 530 firefighters were reviewed. Only 13 of 694 cases involved a firefighter reporting a medical complaint. In most cases, vital signs were similar between firefighters who registered a complaint and those who did not. On average, heart rate was 104 ± 23 beats·min(-1), systolic blood pressure was 132 ± 17 mmHg, diastolic blood pressure was 81 ± 12 mmHg, and respiratory rate was 19 ± 3 breaths·min(-1) upon entry into rehabilitation. At least two measurements of heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate were obtained for 365, 383, 376, and 160 cases, respectively. Heart rate, systolic and diastolic blood pressures, and respiratory rate decreased significantly (p < 0.001) during rehabilitation. Initial vital signs and changes in vital signs during recovery were highly variable. Data from this study indicated that most firefighters recovered from the physiological stress of firefighting without any medical complaint or symptoms. Furthermore, vital signs were within fire service suggested guidelines for release within 10 or 20 minutes of rehabilitation. The data suggested that vital signs of firefighters with medical symptoms were not significantly different from vital signs of firefighters who had an unremarkable recovery.

Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2015-11-05

This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

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

Guardia, A. de, E-mail: amaury.de-guardia@cemagref.f; Universite Europeenne de Bretagne, F-35000 Rennes; Mallard, P.

This paper aimed to compare household waste, separated pig solids, food waste, pig slaughterhouse sludge and green algae regarding processes ruling nitrogen dynamic during composting. For each waste, three composting simulations were performed in parallel in three similar reactors (300 L), each one under a constant aeration rate. The aeration flows applied were comprised between 100 and 1100 L/h. The initial waste and the compost were characterized through the measurements of their contents in dry matter, total carbon, Kjeldahl and total ammoniacal nitrogen, nitrite and nitrate. Kjeldahl and total ammoniacal nitrogen and nitrite and nitrate were measured in leachates andmore » in condensates too. Ammonia and nitrous oxide emissions were monitored in continue. The cumulated emissions in ammonia and in nitrous oxide were given for each waste and at each aeration rate. The paper focused on process of ammonification and on transformations and transfer of total ammoniacal nitrogen. The parameters of nitrous oxide emissions were not investigated. The removal rate of total Kjeldahl nitrogen was shown being closely tied to the ammonification rate. Ammonification was modelled thanks to the calculation of the ratio of biodegradable carbon to organic nitrogen content of the biodegradable fraction. The wastes were shown to differ significantly regarding their ammonification ability. Nitrogen balances were calculated by subtracting nitrogen losses from nitrogen removed from material. Defaults in nitrogen balances were assumed to correspond to conversion of nitrate even nitrite into molecular nitrogen and then to the previous conversion by nitrification of total ammoniacal nitrogen. The pool of total ammoniacal nitrogen, i.e. total ammoniacal nitrogen initially contained in waste plus total ammoniacal nitrogen released by ammonification, was calculated for each experiment. Then, this pool was used as the referring amount in the calculation of the rates of accumulation, stripping and nitrification of total ammoniacal nitrogen. Separated pig solids were characterised by a high ability to accumulate total ammoniacal nitrogen. Whatever the waste, the striping rate depended mostly on the aeration rate and on the pool concentration in biofilm. The nitrification rate was observed as all the higher as the concentration in total ammoniacal nitrogen in the initial waste was low. Thus, household waste and green algae exhibited the highest nitrification rates. This result could mean that in case of low concentrations in total ammoniacal nitrogen, a nitrifying biomass was already developed and that this biomass consumed it. In contrast, in case of high concentrations, this could traduce some difficulties for nitrifying microorganisms to develop.« less

Treatment changes and long-term recurrence rates after hexaminolevulinate (HAL) fluorescence cystoscopy: does it really make a difference in patients with non-muscle-invasive bladder cancer (NMIBC)?

PubMed

Geavlete, Bogdan; Multescu, Razvan; Georgescu, Dragos; Jecu, Marian; Stanescu, Florin; Geavlete, Petrisor

2012-02-01

•  To evaluate in a prospective, randomized study the impact of hexaminolevulinate blue-light cystoscopy (HAL-BLC) on the diagnostic accuracy and treatment changes in cases of non-muscle invasive bladder cancer (NMIBC) compared with standard white-light cystoscopy (WLC). •  To compare the long-term recurrence rates in the two study arms. •  In all, 362 patients suspected of NMIBC were included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumours and underwent transurethral resection of bladder tumours. •  A single postoperative mytomicin-C instillation was performed in all cases, intravesical chemotherapy for intermediate-risk patients and BCG instillations for high-risk cases. •  The follow-up protocol consisted of urinary cytology and WLC every 3 months for 2 years. •  Only first-time recurrences after the initial diagnosis were considered. •  In the 142 patients with NMIBC in the HAL-BLC series, tumour detection rates significantly improved for carcinoma in situ, pTa andoverall cases. •  In 35.2% of the cases, additional malignant lesions were found by HAL-BLC and consequently, the recurrence- and progression-risk categories of patients and subsequent treatment improved in 19% of the cases due to fluorescence cystoscopy. •  In all, 125 patients in the HAL-BLC group and 114 of the WLC group completed the follow-up. •  The recurrence rate at 3 months was lower in the HAL-BLC series (7.2% vs 15.8%) due to fewer 'other site' recurrences when compared with the WLC series (0.8% vs 6.1%). •  The 1 and 2 years recurrence rates were significantly decreased in the HAL-BLC group compared with the WLC group (21.6% vs 32.5% and 31.2% vs 45.6%, respectively). •  HAL-BLC was better than WLC for detecting NMIBC cases and improved tumour detection rates. •  HAL-BLC significantly modified the postoperative treatment of cases. •  The 3 months, 1 and 2 years recurrence rates were significantly improved in the HAL-BLC arm. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Effects of irregular cerebrospinal fluid production rate in human brain ventricular system

NASA Astrophysics Data System (ADS)

Hadzri, Edi Azali; Shamsudin, Amir Hamzah; Osman, Kahar; Abdul Kadir, Mohammed Rafiq; Aziz, Azian Abd

2012-06-01

Hydrocephalus is an abnormal accumulation of fluid in the ventricles and cavities in the brain. It occurs when the cerebrospinal fluid (CSF) flow or absorption is blocked or when excessive CSF is secreted. The excessive accumulation of CSF results in an abnormal widening of the ventricles. This widening creates potentially harmful pressure on the tissues of the brain. In this study, flow analysis of CSF was conducted on a three-dimensional model of the third ventricle and aqueduct of Sylvius, derived from MRI scans. CSF was modeled as Newtonian Fluid and its flow through the region of interest (ROI) was done using EFD. Lab software. Different steady flow rates through the Foramen of Monro, classified by normal and hydrocephalus cases, were modeled to investigate its effects. The results show that, for normal and hydrocephalus cases, the pressure drop of CSF flow across the third ventricle was observed to be linearly proportionally to the production rate increment. In conclusion, flow rates that cause pressure drop of 5 Pa was found to be the threshold for the initial sign of hydrocephalus.

[Non-Hodgkin's malignant lymphoma with cervicofacial expression. Modulation of the radiotherapy-chemotherapy combination according to the cytological class].

PubMed

Bolla, M; Sotto, J J; Sotto, M F; Junien Lavillauroy, C; Bryon, J P; Vrousos, C; Holland, D

1984-01-01

An analysis was conducted in March 1983, after a mean follow up of 40 months, of cases of cervicofacial stages I and II non-Hodgkins malignant lymphoma in 3 children and 41 adults (mean age: 51 years, range: 6-90 years) treated between 1969 and March 1981. According to the Working Formulation malignancy was low in 4 cases, intermediate in 24 and high in 13; 3 cases could not ne classified retrospectively. Cytologic classification showed 13 of class 1 of low malignancy, 7 of class 2 of high malignancy with leukemic potential, and 16 of class 3 of high malignancy with a course leading to tumor formation. The cavum was involved in 10 cases, the tonsils in 9, the parotids in 1, the uvula in 1, isolated cervical adenopathies in 14, multiple unilateral adenopathies in 3 and bilateral cervical adenopathies in 5 cases. Therapy varied according to the series: in the first series (1969-1975) the 23 cases were treated by radiotherapy alone (40-55 Gy). In the second series (1976-1981) of 21 cases, chemotherapy was given as a function of the cytologic class: prophylactic chemotherapy for 6 months after radiation for classes 1 and 2, initial chemotherapy for 6 weeks, cerebral radiation and methotrexate intrathecally, and maintenance chemotherapy for 3 months in class 3. The failure rate for radiated zones was identical in the 2 series (less than 10%). Adjusted 5-year survival rate was 60% for series 1 against 70% for series 2 (p = 0.9), and adjusted remission rate was 43% against 64% (p = 0.8).

Testing the limits of optimality: the effect of base rates in the Monty Hall dilemma.

PubMed

Herbranson, Walter T; Wang, Shanglun

2014-03-01

The Monty Hall dilemma is a probability puzzle in which a player tries to guess which of three doors conceals a desirable prize. After an initial selection, one of the nonchosen doors is opened, revealing that it is not a winner, and the player is given the choice of staying with the initial selection or switching to the other remaining door. Pigeons and humans were tested on two variants of the Monty Hall dilemma, in which one of the three doors had either a higher or a lower chance of containing the prize than did the other two options. The optimal strategy in both cases was to initially choose the lowest-probability door available and then switch away from it. Whereas pigeons learned to approximate the optimal strategy, humans failed to do so on both accounts: They did not show a preference for low-probability options, and they did not consistently switch. An analysis of performance over the course of training indicated that pigeons learned to perform a sequence of responses on each trial, and that sequence was one that yielded the highest possible rate of reinforcement. Humans, in contrast, continued to vary their responses throughout the experiment, possibly in search of a more complex strategy that would exceed the maximum possible win rate.

Ozone reaction with clothing and its initiated VOC emissions in an environmental chamber.

PubMed

Rai, A C; Guo, B; Lin, C-H; Zhang, J; Pei, J; Chen, Q

2014-02-01

Human health is adversely affected by ozone and the volatile organic compounds (VOCs) produced from its reactions in the indoor environment. Hence, it is important to characterize the ozone-initiated reactive chemistry under indoor conditions and study the influence of different factors on these reactions. This investigation studied the ozone reactions with clothing through a series of experiments conducted in an environmental chamber under various conditions. The study found that the ozone reactions with a soiled (human-worn) T-shirt consumed ozone and generated VOCs. The ozone removal rate and deposition velocity for the T-shirt increased with the increasing soiling level and air change rate, decreased at high ozone concentrations, and were relatively unaffected by the humidity. The deposition velocity for the soiled T-shirt ranged from 0.15 to 0.29 cm/s. The ozone-initiated VOC emissions included C6-C10 straight-chain saturated aldehydes, acetone, and 4-OPA (4-oxopentanal). The VOC emissions were generally higher at higher ozone, humidity, soiling of T-shirt, and air change rate. The total molar yield was approximately 0.5 in most cases, which means that for every two moles of ozone removed by the T-shirt surface, one mole of VOCs was produced. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effect of Assumed Damage and Location on the Delamination Onset Predictions for Skin-Stiffener Debonding

NASA Technical Reports Server (NTRS)

Paris, Isabelle L.; Krueger, Ronald; OBrien, T. Kevin

2004-01-01

The difference in delamination onset predictions based on the type and location of the assumed initial damage are compared in a specimen consisting of a tapered flange laminate bonded to a skin laminate. From previous experimental work, the damage was identified to consist of a matrix crack in the top skin layer followed by a delamination between the top and second skin layer (+45 deg./-45 deg. interface). Two-dimensional finite elements analyses were performed for three different assumed flaws and the results show a considerable reduction in critical load if an initial delamination is assumed to be present, both under tension and bending loads. For a crack length corresponding to the peak in the strain energy release rate, the delamination onset load for an assumed initial flaw in the bondline is slightly higher than the critical load for delamination onset from an assumed skin matrix crack, both under tension and bending loads. As a result, assuming an initial flaw in the bondline is simpler while providing a critical load relatively close to the real case. For the configuration studied, a small delamination might form at a lower tension load than the critical load calculated for a 12.7 mm (0.5") delamination, but it would grow in a stable manner. For the bending case, assuming an initial flaw of 12.7 mm (0.5") is conservative, the crack would grow unstably.

Dynamic Rupture and Energy Partition in Models of Earthquake Faults

NASA Astrophysics Data System (ADS)

Shi, Z.; Needleman, A.; Ben-Zion, Y.

2006-12-01

We study properties of dynamic rupture and the partition of energy between radiation and dissipative mechanisms using 2D finite element calculations. The goal is to improve the understanding of these processes on faults at different evolutionary stages associated with different levels of geometrical complexity and possible presence of contrasting elastic properties across the fault. The initial calculations employ homogeneous media and a planar internal interface governed by a general rate- and state-dependent friction law that accounts for the gradual response of shear stress to abrupt changes of normal stress. Ruptures are initiated by gradually increasing the shear traction in a limited nucleation zone near the origin. By changing the rate dependency of the friction law and the size of the nucleation zone, we obtain four rupture modes: (i) supershear crack-like rupture; (ii) subshear crack-like rupture; (iii) subshear single pulse; and (iv) supershear train of pulses. Increasing the initial shear stress produces a transition from a subshear crack to a supershear crack, while increasing the rate dependency of the friction produces self-healing and the transition from a crack-like to a pulse mode of rupture. Properties of the nucleation process can strongly affect the rupture mode. In the cases examined, the total release of strain energy (over the same propagation distance) decreases following the order: supershear crack, subshear crack, train of pulses and single pulse. The ratio of the radiated kinetic energy to the energy dissipated in friction is about 5% for the supershear crack case and about 2% for the other three cases. Future work will involve similar calculations accounting for the generation of plastic strain in the bulk, the material contrast across the fault, and the addition of cohesive surfaces in the bulk to allow for the generation of new surfaces. The study may provide fundamental information on rupture processes in geologically-relevant circumstances and improve the understanding of physical limits on extreme ground motion. The results may be used to check assumptions made in observational works and may help to guide new observational research.

Diminished Social Motivation Negatively Impacts Reputation Management: Autism Spectrum Disorders as a Case in Point

PubMed Central

Chevallier, Coralie; Molesworth, Catherine; Happé, Francesca

2012-01-01

Human beings are endowed with a unique motivation to be included in social interactions. This natural social motivation, in turn, is thought to encourage behaviours such as flattery or self-deprecation aimed to ease interaction and to enhance the reputation of the individual who produces them. If this is the case, diminished social interest should affect reputation management. Here, we use Autism Spectrum Disorders (ASDs) –primarily characterised by pervasive social disinterest– as a model to investigate the effect of social motivation on reputation management. Children first rated a set of pictures and were then given the opportunity to inflate their initial ratings in front of an experimenter who declared that she had drawn the picture. Contrary to the controls, children with ASD did not enhance their ratings in the drawer's presence. Moreover, participants' flattery behaviour correlated with self-reports of social enjoyment. Our findings point to a link between diminished social interest and reputation management. PMID:22303483

Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center.

PubMed

Elander, Johanna; Nekludov, Michael; Larsson, Agneta; Nordlander, Britt; Eksborg, Staffan; Hydman, Jonas

2016-12-01

To provide retrospective, descriptive information on patients with cervical necrotizing fasciitis treated at a single center during the years 1998-2014, and to evaluate the outcome of a newly introduced treatment strategy. Retrospective analysis of clinical data obtained from medical records. Mortality, pre-morbidity, severity of illness, primary site of infection, type of bacteria, time parameters. The observed 3-month mortality was 6/59 (10 %). The most common initial foci of the infection were pharyngeal, dental or hypopharyngeal. The most common pathogen was Streptococcus milleri bacteria within the Streptococcus anginosus group (66 % of the cases). Using a combined treatment with early surgical debridement combined with hyperbaric oxygen treatment, it is possible to reduce the mortality rate among patients suffering from cervical necrotizing fasciitis, compared to the expected mortality rate and to previous historical reports. Data indicated that early onset of hyperbaric oxygen treatment may have a positive impact on survival rate, but no identifiable factor was found to prognosticate outcome.

Anomalous effects on radiation detectors and capacitance measurements inside a modified Faraday cage

NASA Astrophysics Data System (ADS)

Milián-Sánchez, V.; Mocholí-Salcedo, A.; Milián, C.; Kolombet, V. A.; Verdú, G.

2016-08-01

We present experimental results showing certain anomalies in the measurements performed inside a modified Faraday cage of decay rates of Ra-226, Tl-204 and Sr-90/I-90, of the gamma spectrum of a Cs-137 preparation, and of the capacitance of both a class-I multilayer ceramic capacitor and of the interconnection cable between the radiation detector and the scaler. Decay rates fluctuate significantly up to 5% around the initial value and differently depending on the type of nuclide, and the spectrum photopeak increases in 4.4%. In the case of the capacitor, direct capacitance measurements at 100 Hz, 10 kHz and 100 kHz show variations up to 0.7%, the most significant taking place at 100 Hz. In the case of the interconnection cable, the capacitance varies up to 1%. Dispersion also tends to increase inside the enclosure. However, the measured capacitance variations do not explain the variations observed in decay rates.

Recurrence of “cured” dural arteriovenous fistulas after Onyx embolization

PubMed Central

Adamczyk, Peter; Amar, Arun Paul; Mack, William J.; Larsen, Donald W.

2012-01-01

Endovascular embolization with Onyx has been increasingly used to treat intracranial and spinal dural arteriovenous fistulas (DAVFs). Several case series have been published in recent years reporting high DAVF cure rates with this technique. Although it is seldom reported, DAVF recurrence may occur despite initial “cure.” The authors present 3 separate cases of a recurrent DAVF after successful transarterial Onyx embolization. Despite adequate Onyx penetration into the fistula and draining vein, these cases demonstrate that DAVF recanalization may reappear with filling from previous or newly recruited arterial feeders. Other published reports of DAVF recurrence are examined, and potential contributory factors are discussed. These cases highlight the need for awareness of this possible phenomenon and suggest that follow-up angiography should be considered in patients treated with catheter embolization. PMID:22537121

The effect of sample storage on the performance and reproducibility of the galactomannan EIA test.

PubMed

Kimpton, George; White, P Lewis; Barnes, Rosemary A

2014-08-01

Galactomannan enzyme immune assay (GM EIA) is a nonculture test for detecting invasive aspergillosis (IA) forming a key part of diagnosis and management. Recent reports have questioned the reproducibility of indices after sample storage. To investigate this, 198 serum samples (72 from cases and 126 from controls) and 61 plasma samples (24 from cases and 37 from controls), initially tested between 2010 and 2013, were retested to determine any change in index. Data were also collected on circulatory protein levels for false-positive serum samples. Serum indices significantly declined on retesting (median: initial, 0.50, retest, 0.23; P < 0.0001). This was shown to be diagnosis dependent as the decline was apparent on retesting of control samples (median: initial 0.50, retest 0.12; P < 0.0001), but was not evident with case samples (median: initial, 0.80, retest, 0.80; P = 0.724). Plasma samples showed little change on reanalysis after long-term storage at 4°C. Retesting after freezing showed a decrease in index values for controls (median: initial 0.40, retest 0.26; P = 0.0505), but no significant change in cases. Circulatory proteins showed a correlation between serum albumin concentration and difference in index value on retesting. Overall, this study suggests that a lack of reproducibility in GM EIA positivity is only significant when disease is absent. Retesting after freezing helps to differentiate false-positive GM EIA results and, with consecutive positivity, could help to improve accuracy in predicting disease status. The freezing of samples prior to testing could potentially reduce false-positivity rates and the need to retest. © The Author 2014. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Incidence and Predictors of Immune Reconstitution Inflammatory Syndrome in a Rural Area of Mozambique

PubMed Central

Letang, Emilio; Miró, José M.; Nhampossa, Tacilta; Ayala, Edgar; Gascon, Joaquim; Menéndez, Clara; Alonso, Pedro L.; Naniche, Denise

2011-01-01

Background There is limited data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective observational cohort study was conducted to assess the incidence, clinical characteristics, outcome and predictors of IRIS in rural Mozambique. Methods One hundred and thirty-six consecutive antiretroviral treatment (ART)-naïve HIV-1-infected patients initiating ART at the Manhiça district hospital were prospectively followed for development of IRIS over 16 months. Survival analysis by Cox regression was performed to identify pre-ART predictors of IRIS development. Results Thirty-six patients developed IRIS [26.5%, incidence rate 3.1 cases/100 persons-month of ART (95% CI 2.2–4.3)]. Median time to IRIS onset was 62 days from ART initiation (IQR 35.5–93.5). Twenty-five cases (69.4%) were “unmasking”, 10 (27.8%) were “paradoxical”, and 1 (2.8%) developed a paradoxical worsening followed by the unmasking of another condition. Systemic OI (OI-IRIS) accounted for 47% (17/36) of IRIS cases, predominantly of KS (8 cases) and TB (6 cases) IRIS. Mucocutaneous IRIS manifestations (MC-IRIS) accounted for 53% (19/36) of IRIS events, mostly tinea (9 cases) and herpes simplex infection (3 cases). Multivariate analysis identified two independent predictors of IRIS development: pre-ART CD4 count <50 cells/µl (HR 2.3, 95% CI 1.19–4.44, p = 0.01) and body mass index (BMI) <18.5 (HR 2.15, 95% CI 1.07–4.3, p = 0.03). The pre-cART proportion of activated T-cells, as well as the immunologic and virologic response to ART were not associated with IRIS development. All patients continued on ART, 7 (19.4%) required hospitalization and there were 3 deaths (8.3%) attributable to IRIS. Conclusions IRIS is common in patients initiating ART in rural Mozambique. Pre-ART CD4 counts and BMI can easily be assessed at ART initiation in rural sub-Saharan Africa to identify patients at high risk of IRIS, for whom close supervision is warranted. PMID:21386993

Comparison of turnaround time and total cost of HIV testing before and after implementation of the 2014 CDC/APHL Laboratory Testing Algorithm for diagnosis of HIV infection.

PubMed

Chen, Derrick J; Yao, Joseph D

2017-06-01

Updated recommendations for HIV diagnostic laboratory testing published by the Centers for Disease Control and Prevention and the Association of Public Health Laboratories incorporate 4th generation HIV immunoassays, which are capable of identifying HIV infection prior to seroconversion. The purpose of this study was to compare turnaround time and cost between 3rd and 4th generation HIV immunoassay-based testing algorithms for initially reactive results. The clinical microbiology laboratory database at Mayo Clinic, Rochester, MN was queried for 3rd generation (from November 2012 to May 2014) and 4th generation (from May 2014 to November 2015) HIV immunoassay results. All results from downstream supplemental testing were recorded. Turnaround time (defined as the time of initial sample receipt in the laboratory to the time the final supplemental test in the algorithm was resulted) and cost (based on 2016 Medicare reimbursement rates) were assessed. A total of 76,454 and 78,998 initial tests were performed during the study period using the 3rd generation and 4th generation HIV immunoassays, respectively. There were 516 (0.7%) and 581 (0.7%) total initially reactive results, respectively. Of these, 304 (58.9%) and 457 (78.7%) were positive by supplemental testing. There were 10 (0.01%) cases of acute HIV infection identified with the 4th generation algorithm. The most frequent tests performed to confirm an HIV-positive case using the 3rd generation algorithm, which were reactive initial immunoassay and positive HIV-1 Western blot, took a median time of 1.1 days to complete at a cost of $45.00. In contrast, the most frequent tests performed to confirm an HIV-positive case using the 4th generation algorithm, which included a reactive initial immunoassay and positive HIV-1/-2 antibody differentiation immunoassay for HIV-1, took a median time of 0.4 days and cost $63.25. Overall median turnaround time was 2.2 and 1.5 days, and overall median cost was $63.90 and $72.50 for 3rd and 4th generation algorithms, respectively. Both 3rd and 4th generation HIV immunoassays had similar total numbers of tests performed and positivity rates during the study period. A greater proportion of reactive 4th generation immunoassays were confirmed to be positive, and the 4th generation algorithm identified several cases of acute HIV infection that would have been missed by the 3rd generation algorithm. The 4th generation algorithm had a more rapid turnaround time but higher cost for confirmed positive HIV infections and overall, compared to the 3rd generation algorithm. Copyright © 2017 Elsevier B.V. All rights reserved.

Adsorption of dissolved Reactive red dye from aqueous phase onto activated carbon prepared from agricultural waste.

PubMed

Senthilkumaar, S; Kalaamani, P; Porkodi, K; Varadarajan, P R; Subburaam, C V

2006-09-01

The adsorption of Reactive red dye (RR) onto Coconut tree flower carbon (CFC) and Jute fibre carbon (JFC) from aqueous solution was investigated. Adsorption studies were carried out at different initial dye concentrations, initial solution pH and adsorbent doses. The kinetic studies were also conducted; the adsorption of Reactive red onto CFC and JFC followed pseudosecond-order rate equation. The effective diffusion coefficient was evaluated to establish the film diffusion mechanism. Quantitative removal of Reactive red dye was achieved at strongly acidic conditions for both the carbons studied. The adsorption isotherm data were fitted well to Langmuir isotherm and the adsorption capacity were found to be 181.9 and 200 mg/g for CFC and JFC, respectively. The overall rate of dye adsorption appeared to be controlled by chemisorption, in this case in accordance with poor desorption studies.

Ab-Initio-Based Kinetic Modeling to Understand RAFT Exchange: The Case of 2-Cyano-2-Propyl Dodecyl Trithiocarbonate and Styrene.

PubMed

Desmet, Gilles B; De Rybel, Nils; Van Steenberge, Paul H M; D'hooge, Dagmar R; Reyniers, Marie-Françoise; Marin, Guy B

2018-01-01

Ab-initio-calculated rate coefficients for addition and fragmentation in reversible-addition fragmentation chain transfer (RAFT) polymerization of styrene with 2-cyano-2-propyl dodecyl trithiocarbonate initiated by azobisisobutyronitrile allow the reliable simulation of the experimentally observed conversion, number average chain length, and dispersity. The rate coefficient for addition of a macroradical R i to the macroRAFT agent R i X at 333 K (6.8 10 4 L mol -1 s -1 ) is significantly lower than to the initial RAFT agent R 0 X (3.2 10 6 L mol -1 s -1 ), mainly due to a difference in activation energy (15.4 vs 3.0 kJ mol -1 ), which causes the dispersity to spike in the beginning of the polymerization. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Calculations of the skyshine gamma-ray dose rates from independent spent fuel storage installations (ISFSI) under worst case accident conditions

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

Pace, J.V. III; Cramer, S.N.; Knight, J.R.

1980-09-01

Calculations of the skyshine gamma-ray dose rates from three spent fuel storage pools under worst case accident conditions have been made using the discrete ordinates code DOT-IV and the Monte Carlo code MORSE and have been compared to those of two previous methods. The DNA 37N-21G group cross-section library was utilized in the calculations, together with the Claiborne-Trubey gamma-ray dose factors taken from the same library. Plots of all results are presented. It was found that the dose was a strong function of the iron thickness over the fuel assemblies, the initial angular distribution of the emitted radiation, and themore » photon source near the top of the assemblies. 16 refs., 11 figs., 7 tabs.« less

Turbulent breakage of ductile aggregates.

PubMed

Marchioli, Cristian; Soldati, Alfredo

2015-05-01

In this paper we study breakage rate statistics of small colloidal aggregates in nonhomogeneous anisotropic turbulence. We use pseudospectral direct numerical simulation of turbulent channel flow and Lagrangian tracking to follow the motion of the aggregates, modeled as sub-Kolmogorov massless particles. We focus specifically on the effects produced by ductile rupture: This rupture is initially activated when fluctuating hydrodynamic stresses exceed a critical value, σ>σ(cr), and is brought to completion when the energy absorbed by the aggregate meets the critical breakage value. We show that ductile rupture breakage rates are significantly reduced with respect to the case of instantaneous brittle rupture (i.e., breakage occurs as soon as σ>σ(cr)). These discrepancies are due to the different energy values at play as well as to the statistical features of energy distribution in the anisotropic turbulence case examined.

A study of pump cavitation damage

NASA Astrophysics Data System (ADS)

Brophy, M. C.; Stinebring, D. R.; Billet, M. L.

1983-11-01

The cavitation assessment for the space shuttle main engine high pressure oxidizer turbopump is documented. A model of the flow through the pump was developed. Initially, a computational procedure was used to analyze the flow through the inlet casing including the prediction of wakes downstream of the casing vanes. From these flow calculations, cavitation patterns on the inducer blades were approximated and the damage rate estimated. The model correlates the heavy damage on the housing and over the inducer with unsteady blade surface cavitation. The unsteady blade surface cavitation is due to the large incidence changes caused by the wakes of the upstream vanes. Very high cavitation damage rates are associated with this type of cavitation. Design recommendations for reducing the unsteady cavitation include removing the set of vanes closest to the inducer and modifying the remaining vanes.

Accreting white dwarf models for type 1 supernovae. 1: Presupernova evolution and triggering mechanisms

NASA Technical Reports Server (NTRS)

Nomoto, K.

1981-01-01

As a plausible explosion model for a Type I supernova, the evolution of carbon-oxygen white dwarfs accreting helium in binary systems was investigated from the onset of accretion up to the point at which a thermonuclear explosion occurs. The relationship between the conditions in the binary system and the triggering mechanism for the supernova explosion is discussed, especially for the cases with relatively slow accretion rate. It is found that the growth of a helium zone on the carbon-oxygen core leads to a supernova explosion which is triggered either by the off-center helium detonation for slow and intermediate accretion rates or by the carbon deflagration for slow and rapid accretion rates. Both helium detonation and carbon deflagration are possible for the case of slow accretion, since in this case the initial mass of the white dwarf is an important parameter for determining the mode of ignition. Finally, various modes of building up the helium zone on the white dwarf, namely, direct transfer of helium from the companion star and the various types and strength of the hydrogen shell flashes are discussed in some detail.

Sterilization failures in Singapore: an examination of ligation techniques and failure rates.

PubMed

Cheng, M C; Wong, Y M; Rochat, R W; Ratnam, S S

1977-04-01

The University Department of Obstetrics and Gynecology, Kandang Kerbau Hospital in Singapore, initiated a study in early 1974 of failure rates for various methods of sterilization and the factors responsible for the failures. During the period January 1974 to March 1976, 51 cases of first pregnancy following ligation were discovered. Cumulative failure rates at 24 months were 0.34 per 100 women for abdominal sterilization, 1.67 for culdoscopic, 3.12 for vaginal, and 4.49 for laparoscopic procedures. Findings for 35 patients who underwent religation showed that recanalization and the establishment of a fistulous opening caused the majority of failures. Clearly, more effective methods of tubal occlusion in sterilization are needed.

Comparison of Complications Rates in Endoscopic Surgery Performed by a Clinical Assistant vs. An Experienced Endoscopic Surgeon

PubMed Central

Singhi, Aditi

2009-01-01

Study Objectives: (a) To find out the actual incidence of complications during endoscopic surgeries. (b) Comparison of complication rate between an experienced laparoscopic surgeon (> 10 years of experience in endoscopic surgery) and a clinical assistant (> 3 years of experience in endoscopic surgery). (c) How to manage complications in endoscopic surgery. (d) Concrete suggestions to reduce the complication rate. Design: Retrospective study (Canadian Task Force classification ii-2). Setting: Tertiary gynecologic endoscopic unit. Patients: A total of 3204 cases of gynecologic endoscopic surgery out of which 2001 were laparoscopic and 1203 were hysteroscopic surgeries. Interventions: Laparoscopic and hysteroscopic gynecologic surgeries in indicated cases. Measurements and Main Results: The study was carried out between April 2003 and October 2007 at a referral center for endoscopic surgery. A total of 3204 cases of gynecologic endoscopic surgery were studied. There were five significant complications in laparoscopic surgeries and four significant complications in hysteroscopic surgeries seen in four years and six months. All the complications could be managed with no mortality. Conversion to laparotomy was needed in eight cases of laparoscopic surgeries and none in hysteroscopic surgeries. Conclusion: The risk of complication reduces with the experience in endoscopic surgery. However, the proper grooming of a novice in experienced hands, for a sufficient period of time, can minimize the complication rate in the initial learning phase. The complication may be utilized as a stepping-stone to overcome any given situation without panic, but with adequate safety. PMID:22442510

Research participation experiences of informants of suicide and control cases: taken from a case-control psychological autopsy study of people who died by suicide.

PubMed

Wong, Paul W C; Chan, Wincy S C; Beh, Philip S L; Yau, Fiona W S; Yip, Paul S F; Hawton, Keith

2010-01-01

Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. (1) To investigate whether informants of suicide cases recruited by two approaches (coroners' court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. The acceptance rate for our original psychological autopsy study was modest. The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Cost-effectiveness of active case-finding of household contacts of pulmonary tuberculosis patients in a low HIV, tuberculosis-endemic urban area of Lima, Peru.

PubMed

Shah, L; Rojas, M; Mori, O; Zamudio, C; Kaufman, J S; Otero, L; Gotuzzo, E; Seas, C; Brewer, T F

2017-04-01

We compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.

Mode of delivery, but not questionnaire length, affected response in an epidemiological study of eating-disordered behavior.

PubMed

Mond, J M; Rodgers, B; Hay, P J; Owen, C; Beumont, P J V

2004-11-01

The effects of questionnaire length and mode of delivery on response rates were examined in an epidemiological study of eating-disordered behavior. Short (8 pages) and long (14 pages) questionnaires were posted or hand-delivered to a community sample of 802 women. Nonrespondents who received the first questionnaire by hand delivery received a reminder letter and replacement questionnaire by post; those who received the initial questionnaire by post were further randomized to receive the first reminder by hand delivery or by post, in short or long form. A second reminder letter and questionnaire (in short or long form) were posted to all remaining nonrespondents. The overall response rate was 52.9%. This is a conservative estimate of true response, because in a substantial proportion of cases (12.2%) individuals were no longer resident at the listed address. There was a significant effect of mode of delivery on response, favoring hand delivery, at both the initial mailout and first reminder. There was no effect of questionnaire length on response to the initial mailout, although overall response was significantly higher for the longer form. It was estimated that an overall response of 58.0% would have been achieved had first reminders been hand-delivered to all nonrespondents who received the initial mailout by post. Delivery of questionnaires by hand may be an effective way to increase response rates in epidemiological research, but little is to be gained by reducing questionnaire length.

Solar Spectral Radiative Forcing During the Southern African Regional Science Initiative

NASA Technical Reports Server (NTRS)

Pilewskie, P.; Pommier, J.; Bergstrom, R.; Gore, W.; Howard, S.; Rabbette, M.; Schmid, B.; Hobbs, P. V.; Tsay, S. C.

2003-01-01

During the dry season component of the Southern African Regional Science Initiative (SAFARI) in late winter 2000, the net solar spectral irradiance was measured at flight levels throughout biomass burning haze layers. From these measurements, the flux divergence, fractional absorption, instantaneous heating rate, and absorption efficiency were derived. Two cases are examined: on 24 August 2000 off the coast of Mozambique in the vicinity of Inhaca Island and on 6 September 2000 in a very thick continental haze layer over Mongu, Zambia. The measured absolute absorption was substantially higher for the case over Mongu where the measured midvisible optical depth exceeded unity. Instantaneous heating from aerosol absorption was 4 K d(sup -1) over Mongu, Zambia and 1.5 K d(sup -1) near Inhaca Island, Mozambique. However, the spectral absorption efficiency was nearly identical for both cases. Although the observations over Inhaca Island preceded the river of smoke from the southern African continent by nearly 2 weeks, the evidence here suggests a continental influence in the lower tropospheric aerosol far from source regions of burning.

Reach a nonlinear consensus for MAS via doubly stochastic quadratic operators

NASA Astrophysics Data System (ADS)

Abdulghafor, Rawad; Turaev, Sherzod; Zeki, Akram; Al-Shaikhli, Imad

2018-06-01

This technical note addresses the new nonlinear protocol class of doubly stochastic quadratic operators (DSQOs) for coordination of consensus problem in multi-agent systems (MAS). We derive the conditions for ensuring that every agent reaches consensus on a desired rate of the group's decision where the group decision value in its agent's initial statuses varies. Besides that, we investigate a nonlinear protocol sub-class of extreme DSQO (EDSQO) to reach a consensus for MAS to a common value with nonlinear low-complexity rules and fast time convergence if the interactions for each agent are not selfish. In addition, to extend the results to reach a consensus and to avoid the selfish case we specify a general class of DSQO for reaching a consensus under any given case of initial states. The case that MAS reach a consensus by DSQO is if each member of the agent group has positive interactions of DSQO (PDSQO) with the others. The convergence of both EDSQO and PDSQO classes is found to be directed towards the centre point. Finally, experimental simulations are given to support the analysis from theoretical aspect.

Evaluation of American Board of Orthodontics certification protocols in postgraduate orthodontic programs in the United States and Canada.

PubMed

Park, Jae Hyun; Putrus, Raphael R; Pruzansky, Dawn P; Grubb, John

2017-03-01

The objective of this study was to identify the board certification protocols that hospital and university-based postgraduate orthodontic programs have in place to prepare residents for the American Board of Orthodontics (ABO) certification examination. An electronic survey was sent to the program directors of each of the 72 postgraduate orthodontic programs in the United States and Canada. The survey consisted of 49 questions about demographics, resident case assignment protocols, and ABO examination preparation methods. The response rate was 81%. Most programs were 30 to 36 months in length (72.7%). Many residents had a case load of 51 to 75 during their first year (50.9%), with an average maximum case load of 70 to 109. There was a positive correlation with both the number of cases that first-year residents start and the length of the program (Spearman correlation coefficient = 0.379; P <0.01) when compared with maximum case load. Approximately 72% of the programs do not offer a written mock board examination; however, 72% reported offering a clinical mock board examination. ABO cases are identified within the first 6 months of most programs. About 88% of respondents believe that residents take advantage of the banking system, and that over the past 5 years ABO Initial Certification Examination applications have increased. Most program directors (89.1%) believe that their program length is sufficient for board preparation. Subjects tested in the written examination are integrated into the didactic curriculum and strengthened with ongoing literature reviews, with a passing rate over 90%. Clinical examination preparation varies, with most programs requiring a mock board examination for graduation. Total participation in both the Initial Certification Examination and banking has increased since 2010; better follow-up protocols are needed to track residents after graduation. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

The impact of use of an intraoperative margin assessment device on re-excision rates.

PubMed

Sebastian, Molly; Akbari, Stephanie; Anglin, Beth; Lin, Erin H; Police, Alice M

2015-01-01

Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. An intraoperative margin assessment tool (MarginProbe) has been approved for use in the US since 2013. This study is the first compilation of data from routine use of the device, to assess the impact of device utilization on re-excision rates. We present a retrospective, observational, review from groups of consecutive patients, before and after the implementation of intraoperative use of the device during lumpectomy procedures. Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also, when feasible, imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. For each surgeon, historical re-excision rates were established based on a consecutive set of patients from a time period proximal to initiation of use of the device. From March 2013 to April 2014 the device was routinely used by 4 surgeons in 3 centers. In total, 165 cases lumpectomy cases were performed. Positive margins resulted in additional re-excision procedures in 9.7% (16/165) of the cases. The corresponding historical set from 2012 and 2013 consisted of 186 Lumpectomy cases, in which additional re-excision procedures were performed in 25.8% (48/186) of the cases. The reduction in the rate of re-excision procedures was significant 62% (P < 0.0001). Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.

Robot-assisted radical prostatectomy: a case series of the first 100 patients -constitutional introduction and implementation on the basis of comprehensive department of minimal invasive surgery center-

PubMed Central

2013-01-01

Background Although a very small number of Japanese hospitals had been performing robotic surgery before 2011, the number now using it is increasing rapidly due to the application of health insurance to robotic surgery for prostate cancer (PCa) since April, 2012. We report our initial experience of treating 100 patients by robot-assisted radical prostatectomy (RARP) with a focus on constitutional introduction and implementation based on minimal invasive surgery center (MISC) and patient outcomes. Methods The MISC involved all of the hospital sections related to robotic surgery including four surgery departments, anesthesiology, operating room nurses, medical engineers. The data were prospectively collected from the first 100 consecutive patients who underwent RARP under supervision of MISC for localized PCa from October 2010 to December 2012. Results During the period of our initial 100 cases of RARP, the gynecology, respiratory and digestive surgery departments performed initial cases of 20, 33 and 23 robotic surgeries under control of MISC. Peri-operative complications in RARP appeared to be minimal with no cases of intra-operative open conversion. The positive surgical margin rate was 19% for the entire series. At the median follow-up time of 11.9 months, 91% of patients had undetectable PSA levels, and 76% of patients were not using pads. Sequential urinary functional data indicated a significant beneficial effect on lower urinary tract symptoms beyond cancer control over a period of several months. Although the pre-operative potent patient number was small, the transitions of constant potency recovery at precise time points were shown according to different nerve sparing procedures. Conclusions This is the first report of an initial 100 RARP cases that were implemented using the constitutional framework of an academic institution. The MISC is providing immeasurable benefits from the aspects of patient safety and education for the robotic surgical team. RARP is a safe and efficient method for achieving PCa control together with functional preservation, even during the initial trial for this procedure. PMID:24171923

Robot-assisted radical prostatectomy: a case series of the first 100 patients--constitutional introduction and implementation on the basis of comprehensive department of minimal invasive surgery center.

PubMed

Sejima, Takehiro; Masago, Toshihiko; Morizane, Shuichi; Hikita, Katsuya; Kobayashi, Naoto; Yao, Akihisa; Muraoka, Kuniyasu; Honda, Masashi; Kitano, Hiroya; Takenaka, Atsushi

2013-10-30

Although a very small number of Japanese hospitals had been performing robotic surgery before 2011, the number now using it is increasing rapidly due to the application of health insurance to robotic surgery for prostate cancer (PCa) since April, 2012. We report our initial experience of treating 100 patients by robot-assisted radical prostatectomy (RARP) with a focus on constitutional introduction and implementation based on minimal invasive surgery center (MISC) and patient outcomes. The MISC involved all of the hospital sections related to robotic surgery including four surgery departments, anesthesiology, operating room nurses, medical engineers. The data were prospectively collected from the first 100 consecutive patients who underwent RARP under supervision of MISC for localized PCa from October 2010 to December 2012. During the period of our initial 100 cases of RARP, the gynecology, respiratory and digestive surgery departments performed initial cases of 20, 33 and 23 robotic surgeries under control of MISC. Peri-operative complications in RARP appeared to be minimal with no cases of intra-operative open conversion. The positive surgical margin rate was 19% for the entire series. At the median follow-up time of 11.9 months, 91% of patients had undetectable PSA levels, and 76% of patients were not using pads. Sequential urinary functional data indicated a significant beneficial effect on lower urinary tract symptoms beyond cancer control over a period of several months. Although the pre-operative potent patient number was small, the transitions of constant potency recovery at precise time points were shown according to different nerve sparing procedures. This is the first report of an initial 100 RARP cases that were implemented using the constitutional framework of an academic institution. The MISC is providing immeasurable benefits from the aspects of patient safety and education for the robotic surgical team. RARP is a safe and efficient method for achieving PCa control together with functional preservation, even during the initial trial for this procedure.

Reoperations after tricuspid valve repair: re-repair versus replacement

PubMed Central

Hwang, Ho Young; Kim, Kyung-Hwan; Kim, Ki-Bong

2016-01-01

Background Data demonstrating results of reoperation after initial tricuspid valve repair are scarce. We evaluated outcomes of tricuspid reoperations after tricuspid valve repair and compared the results of tricuspid re-repair with those of tricuspid valve replacement (TVR). Methods From 1994 to 2012, 53 patients (56±15 years, male:female =14:39) underwent tricuspid reoperations due to recurrent tricuspid regurgitation (TR) after initial repair. Twenty-two patients underwent tricuspid re-repair (TAP group) and 31 patients underwent TVR (TVR group). Results Early mortality occurred in 6 patients (11%). Early mortality and incidence of postoperative complications were similar between the 2 groups. There were 14 cases of late mortality including 9 cardiac deaths. Five- and 10-year free from cardiac death rates were 82% and 67%, respectively, without any intergroup difference. Recurrent TR (> moderate) developed in 6 TAP group patients and structural valve deterioration occurred in 1 TVR group patient (P=0.002). Isolated tricuspid valve surgery (P=0.044) and presence of atrial fibrillation during the follow-up (P=0.051) were associated with recurrent TR after re-repair. However, the overall tricuspid valve-related event rates were similar between the 2 groups with 5- and 10-year rates of 61% and 41%, respectively. Conclusions Tricuspid valve reoperation after initial repair resulted in high rates of operative mortality and complications. Long-term event-free rate was similar regardless of the type of surgery. However, great care might be needed when performing re-repair in patients with atrial fibrillation and those who had isolated tricuspid valve disease due to high recurrence of TR after re-repair. PMID:26904221

Impact of microbial activity on the hydraulic properties of fractured chalk.

PubMed

Arnon, Shai; Adar, Eilon; Ronen, Zeev; Yakirevich, Alexander; Nativ, Ronit

2005-02-01

The impact of microbial activity on fractured chalk transmissivity was investigated on a laboratory scale. Long-term experiments were conducted on six fractured chalk cores (20 cm diameter, 23-44 cm long) containing a single natural fracture embedded in a porous matrix. Biodegradation experiments were conducted under various conditions, including several substrate and oxygen concentrations and flow rates. 2,4,6-Tribromophenol (TBP) was used as a model contaminant (substrate). TBP biodegradation efficiency depended mainly on the amount of oxygen. However, under constant oxygen concentration at the core inlet, elevating the flow rates increased the removal rate of TBP. Transmissivity reduction was clearly related to TBP removal rate, following an initial slow decline and a further sharp decrease with time. The fracture's transmissivity was reduced by as much as 97% relative to the initial value, with no leveling off of the clogging process. For the most extreme cases, reductions of 262 and 157 microm in the equivalent hydraulic apertures were recorded for fractures with initial apertures of 495 and 207 microm, respectively. The reductions in fracture transmissivity occurred primarily because of clogging by bacterial cells and extracellular polymeric substances (EPS) produced by the bacteria. Most of the biodegradation activity was concentrated near the fracture inlet, where the most suitable biodegradation conditions (nutrients and oxygen) prevailed, suggesting that the clogging had occurred in that vicinity. The clogging must have changed the structure of the fracture void, thereby reducing the active volume participating in flow and transport processes. This phenomenon caused accelerated transport of non-reactive tracers and doubled the fracture's dispersivity under constant flow rates.

On rate-state and Coulomb failure models

USGS Publications Warehouse

Gomberg, J.; Beeler, N.; Blanpied, M.

2000-01-01

We examine the predictions of Coulomb failure stress and rate-state frictional models. We study the change in failure time (clock advance) Δt due to stress step perturbations (i.e., coseismic static stress increases) added to "background" stressing at a constant rate (i.e., tectonic loading) at time t0. The predictability of Δt implies a predictable change in seismicity rate r(t)/r0, testable using earthquake catalogs, where r0 is the constant rate resulting from tectonic stressing. Models of r(t)/r0, consistent with general properties of aftershock sequences, must predict an Omori law seismicity decay rate, a sequence duration that is less than a few percent of the mainshock cycle time and a return directly to the background rate. A Coulomb model requires that a fault remains locked during loading, that failure occur instantaneously, and that Δt is independent of t0. These characteristics imply an instantaneous infinite seismicity rate increase of zero duration. Numerical calculations of r(t)/r0 for different state evolution laws show that aftershocks occur on faults extremely close to failure at the mainshock origin time, that these faults must be "Coulomb-like," and that the slip evolution law can be precluded. Real aftershock population characteristics also may constrain rate-state constitutive parameters; a may be lower than laboratory values, the stiffness may be high, and/or normal stress may be lower than lithostatic. We also compare Coulomb and rate-state models theoretically. Rate-state model fault behavior becomes more Coulomb-like as constitutive parameter a decreases relative to parameter b. This is because the slip initially decelerates, representing an initial healing of fault contacts. The deceleration is more pronounced for smaller a, more closely simulating a locked fault. Even when the rate-state Δt has Coulomb characteristics, its magnitude may differ by some constant dependent on b. In this case, a rate-state model behaves like a modified Coulomb failure model in which the failure stress threshold is lowered due to weakening, increasing the clock advance. The deviation from a non-Coulomb response also depends on the loading rate, elastic stiffness, initial conditions, and assumptions about how state evolves.

Comparison of phenylephrine administration and exercise versus phenylephrine administration and a rolling procedure for the correction of nephrosplenic entrapment of the large colon in horses: 88 cases (2004-2010).

PubMed

Fultz, Lisa E; Peloso, John G; Giguère, Steeve; Adams, Aric R

2013-04-15

To compare the outcome of horses with nephrosplenic entrapment of the large colon (NSELC) that were treated nonsurgically by IV administration of phenylephrine and exercise with that of horses treated by IV administration of phenylephrine and a rolling procedure under general anesthesia. Retrospective case series. 88 horses with NSELC. Horses examined between 2004 and 2010 because of acute abdominal pain that had NSELC on the basis of findings on abdominal palpation per rectum, abdominal ultrasonography, or both were included. Medical records were reviewed to obtain information on treatment (IV administration of phenylephrine and exercise vs IV administration of phenylephrine and a rolling procedure) and outcome. Overall, 85% (75/88) of horses with NSELC responded to exercise or rolling under general anesthesia. The success rate of rolling under general anesthesia (42/50 [84%]) was significantly higher than the success rate of exercise after IV administration of phenylephrine (24/38 [63.2%]). Resolution of NSELC was achieved by rolling under general anesthesia in 8 of 14 horses that initially failed to resolve with exercise. A rolling procedure performed under general anesthesia had a higher success rate than exercise after IV phenylephrine administration for resolution of NSELC in horses, suggesting that rolling could be considered as the initial medical treatment. The rolling procedure may be labor intensive and should only be attempted in a surgical facility in the event that exploratory laparotomy is required.

Accretion rates of protoplanets 2: Gaussian distribution of planestesimal velocities

NASA Technical Reports Server (NTRS)

Greenzweig, Yuval; Lissauer, Jack J.

1991-01-01

The growth rate of a protoplanet embedded in a uniform surface density disk of planetesimals having a triaxial Gaussian velocity distribution was calculated. The longitudes of the aspses and nodes of the planetesimals are uniformly distributed, and the protoplanet is on a circular orbit. The accretion rate in the two body approximation is enhanced by a factor of approximately 3, compared to the case where all planetesimals have eccentricity and inclination equal to the root mean square (RMS) values of those variables in the Gaussian distribution disk. Numerical three body integrations show comparable enhancements, except when the RMS initial planetesimal eccentricities are extremely small. This enhancement in accretion rate should be incorporated by all models, analytical or numerical, which assume a single random velocity for all planetesimals, in lieu of a Gaussian distribution.

Organized Chronic Subdural Hematomas Treated by Large Craniotomy with Extended Membranectomy as the Initial Treatment

PubMed Central

Balevi, Mustafa

2017-01-01

Objective: The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH). Materials and Methods: We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance – mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24–72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH). Results: Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients (n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%. Conclusion: Large craniotomy and extended membrane excision for OSDH still carry a high rate of mortality and morbidity in elderly patients. TP, RSH, and postoperative seizures are frequently seen complications in elderly patients. PMID:29114271

Organized Chronic Subdural Hematomas Treated by Large Craniotomy with Extended Membranectomy as the Initial Treatment.

PubMed

Balevi, Mustafa

2017-01-01

The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH). We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance - mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24-72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH). Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients ( n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%. Large craniotomy and extended membrane excision for OSDH still carry a high rate of mortality and morbidity in elderly patients. TP, RSH, and postoperative seizures are frequently seen complications in elderly patients.

Vanishing Act: Experiments on Fission Track Annealing in Monazite

NASA Astrophysics Data System (ADS)

Shipley, N. K.; Fayon, A. K.

2006-12-01

To determine the viability of monazite as a low temperature thermochronometer, we conducted fission track annealing experiments under isothermal conditions. These experiments evaluated the effects of uranium concentration and zoning on annealing rates. Fission track annealing rates in monazite were also compared to those in Durango apatite. Preliminary results indicate that monazite grains with higher initial track densities anneal at faster rates than those with low initial densities and that fission tracks in monazite anneal at a faster rate than those in apatite. Monazite sand grains were selected from a placer sand deposit, mounted in teflon, and polished. Grains were imaged with electron backscattering to characterize zoning patterns and variations in uranium concentration. Monazite grain mounts were etched in boiling 37% HCl for 50 minutes and fission track densities were determined using standard fission track counting techniques. Durango apatite was etched in 5N HNO3 at room temperature for 20 seconds. After the initial track densities were determined, mounts in one group were annealed at 150 ° C for 1to 6 h. The mounts in a second group were annealed at 200 ° C for 2 hour periods along with mounts of Durango apatite grains. All grains were re-polished prior to each anneal. Upon completion of the experiment, backscatter images were taken of grains from which fission track counts were obtained to verify continuance of concentric zoning. Results of these experiments indicate that annealing rates of fission tracks in monazite vary as a function of uranium concentration. Uranium concentration was constrained on the basis of zoning patterns obtained from electron backscatter images. Fission track densities in grains with initial track densities of approximately 2.4 × 106 tracks/cm2 were reduced at average rate of 16% every two hours. In contrast, track densities in grains with initial track densities of approximately 1.6 × 106 tracks/cm2 average 4.6% density reduction every two hours. In both cases, track density reduction in monazite was faster than the rate of 0.1 % every two hours obtained for apatite. This would indicate that fission track annealing occurs at a lower temperature in monazite than in apatite. Thus monazite would be useful as a low temperature chronometer for determining cooling histories in recently exhumed rocks.

Identical bacterial populations colonize premature infant gut, skin, and oral microbiomes and exhibit different in situ growth rates

PubMed Central

Olm, Matthew R.; Brown, Christopher T.; Brooks, Brandon; Firek, Brian; Baker, Robyn; Burstein, David; Soenjoyo, Karina; Thomas, Brian C.; Morowitz, Michael; Banfield, Jillian F.

2017-01-01

The initial microbiome impacts the health and future development of premature infants. Methodological limitations have led to gaps in our understanding of the habitat range and subpopulation complexity of founding strains, as well as how different body sites support microbial growth. Here, we used metagenomics to reconstruct genomes of strains that colonized the skin, mouth, and gut of two hospitalized premature infants during the first month of life. Seven bacterial populations, considered to be identical given whole-genome average nucleotide identity of >99.9%, colonized multiple body sites, yet none were shared between infants. Gut-associated Citrobacter koseri genomes harbored 47 polymorphic sites that we used to define 10 subpopulations, one of which appeared in the gut after 1 wk but did not spread to other body sites. Differential genome coverage was used to measure bacterial population replication rates in situ. In all cases where the same bacterial population was detected in multiple body sites, replication rates were faster in mouth and skin compared to the gut. The ability of identical strains to colonize multiple body sites underscores the habit flexibility of initial colonists, whereas differences in microbial replication rates between body sites suggest differences in host control and/or resource availability. Population genomic analyses revealed microdiversity within bacterial populations, implying initial inoculation by multiple individual cells with distinct genotypes. Overall, however, the overlap of strains across body sites implies that the premature infant microbiome can exhibit very low microbial diversity. PMID:28073918

Delayed surgical repair of posttraumatic posterior urethral distraction defects in children and adolescents: long-term results.

PubMed

Podesta, Miguel; Podesta, Miguel

2015-04-01

Various surgical techniques have been proposed to treat pelvic fracture urethral distraction defects (PFUDDs) in children (Figure): primary alignment of the acute transected urethra, substitution procedures and delayed anastomosis urethroplasties (DAU) by perineal, elaborated perineal, transpubic or perineo-abdominal/partial transpubic access. However, long-term follow-up of surgical correction for PFUDDS with DAU is infrequently reported in the literature. Long-term efficacy of DAU in children and adolescents with PFUDDs was evaluated. Other surgical methods used to accomplish tension-free DAU were also described. We reviewed records of 49 male children aged 3.5-17.5 years (median 9.6) with PFUDDS who underwent DAU from 1980 to 2006. Median PFUDDs length was 3 cm (range 2-6). Six patients had prior failed treatments: anastomotic urethroplasties (5) and internal urethrotomy (1). Surgical access was transperineal in 28 cases and perineal/partial pubectomy in 21. Urethral rerouting was performed in 8 cases. Median follow-up was 6.5 years (range 5-22). On review median PFUDDS length in patients treated with primary cystostomy was 3 cm compared to those initially managed with urethral alignment (4 cm). Five patients treated with perineal DAU developed recurrent strictures at the anastomosis site, successfully managed with additional perineal/partial pubectomy anastomosis (4 cases) and internal urethrotomy (1). Primary and overall success rate was 89, 7% and 100%, respectively. Urinary incontinence occurred in 9 cases. Two had overflow incontinence and performed self-catheterization; 1 developed sphincter incontinence and required AUS placement, while 4 of 6 cases with mild stress incontinence achieved dryness at pubertal age. Retrospectively, associated bladder neck lesions at trauma time were noted in 5 patients. Three patients with erectile dysfunction before DAU remained impotent. In children, several factors make management of PFUDDs more difficult than in adults: 1) restricted surgical access to reach a high lying proximal urethral end, 2) long distraction defects, 3) simultaneous bladder neck and membranous urethral lesions and 4) small urethral caliber. In our experience and that of others (Turner Warwick, 1989 and Ranjan, 2012), radiographic and endoscopic findings provide information on stricture features; however, the final choice of surgical exposure to restore urethral continuity is made at operative time based on PFUDD complexity. Perineal exposure usually allows performing DAU in 2 cm long PFUDDs. Ten percent of our patients treated with perineal DAU developed recurrent strictures attributed to inappropriate access selection or unrecognized PFUDD complexity. Failures were treated endoscopically (1) and by perineal/partial pubectomy anastomotic urethroplasty (4) with 100% final success. We used perineal/partial pubectomy DAU in 43% of the cases to excise pelvic scarring and bridge long urethral gaps, with urethral rerouting in 8 cases. Success rate of initial perineal and perineal/partial pubectomy anastomotic procedures was 82% and 100%, respectively. Koraitim (1997), Orabi (2008) and Ranjan (2012) reported excellent outcomes in children with either transperineal or transpubic anastomotic repair, as opposed to poor results in those undergoing substitution urethroplaties. Most reports rarely evaluate urinary incontinence after successful DAU. At the end of follow-up only 2 of our 9 initial incontinent cases remain with acceptable stress incontinence. Retrospectively, in 5 cases the original trauma comprised the bladder neck and the membranous sphincter mechanism. In our series erectile dysfunction after trauma did not change after DAU except in 1 patient who regained potency 1 year after repair. All patients were referred after initial treatment was done elsewhere, thus they may represent the most severe PFUDDs cases. Additionally, erection dysfunction was not investigated in the kind of detail required due to patients' age. DAU has durable success rate for PFUDDs treatment in children with a healthy bulbar urethra. In childhood, additional surgical steps are frequently needed to achieve direct anastomotic repair. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Developmental dysplasia of the hip: impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints-a single center retrospective comparative cohort study based on Graf's method of hip ultrasonography.

PubMed

Tschauner, Christian; Fürntrath, Frank; Saba, Yasaman; Berghold, Andrea; Radl, Roman

2011-12-01

PURPOSE/BACKGROUND/INTRODUCTION: The aim of this study was to retrospectively evaluate the impact of neonatal sonographic hip screening using Graf's method for the management and outcome of orthopaedic treatment of decentered hip joints with developmental dysplasia of the hip (DDH), using three decades (1978-2007) of clinical information compiled in a medical database. Three representative cohorts of consecutive cases of decentered hip joints were selected according to different search criteria and inclusion and exclusion parameters: (1) cohort 1 (1978-1982; n = 80), without sonographic screening; (2) cohort 2.1 (1994-1996; n = 91), with nationwide established general sonographic screening according to the Graf-method; (3) cohort 2.2 (2003-2005; n = 91), with sonographic screening including referred cases for open reduction from non-screened populations. These three cohorts were compared for the following parameters: age at initial treatment, successful closed reduction, necessary overhead traction, necessary adductor-tenotomy, rate of open reduction, rate of avascular necrosis (AVN) and rate of secondary acetabuloplasty. The age at initial treatment was reduced from 5.5 months in the first cohort to 2 months in the two subsequent two cohorts and the rate of successful closed reduction increased from 88.7 to 98.9 and 95.6%, respectively. There was a statistically significant improvement in six out of seven parameters with sonographic hip screening; only the rate of secondary acetabuloplasty did not improve significantly. Compared to the era before the institution of a sonographic hip screening programme according to the Graf-method in Austria in 1992, ultrasound screening based-treatment of decentered hip joints has become safer, shorter and simpler: "safer" means lower rate of AVN, "shorter" means less treatment time due to earlier onset and "simpler" means that the devices are now less invasive and highly standardized.

Experience of treatment of patients with granulomatous lobular mastitis.

PubMed

Hur, Sung Mo; Cho, Dong Hui; Lee, Se Kyung; Choi, Min-Young; Bae, Soo Youn; Koo, Min Young; Kim, Sangmin; Choe, Jun-Ho; Kim, Jung-Han; Kim, Jee Soo; Nam, Seok-Jin; Yang, Jung-Hyun; Lee, Jeong Eon

2013-07-01

To present the author's experience with various treatment methods of granulomatous lobular mastitis (GLM) and to determine effective treatment methods of GLM. Fifty patients who were diagnosed with GLM were classified into five groups based on the initial treatment methods they underwent, which included observation (n = 8), antibiotics (n = 3), steroid (n = 13), drainage (n = 14), and surgical excision (n = 12). The treatment processes in each group were examined and their clinical characteristics, treatment processes, and results were analyzed respectively. Success rates with each initial treatment were observation, 87.5%; antibiotics, 33.3%; steroids, 30.8%; drainage, 28.6%; and surgical excision, 91.7%. In most cases of observation, the lesions were small and the symptoms were mild. A total of 23 patients underwent surgical excision during treatment. Surgical excision showed particularly fast recovery, high success rate (90.3%) and low recurrence rate (8.7%). The clinical course of GLM is complex and the outcome of each treatment type are variable. Surgery may play an important role when a lesion is determined to be mass-forming or appears localized as an abscess pocket during breast examination or imaging study.

Gonorrhea in homosexual men.

PubMed Central

Austin, T. W.; Lent, B.; Pattison, F. L.

1978-01-01

Extragenital gonorrhea was seen in 65% of 54 cases of gonorrhea in 43 homosexual men attending a venereal diseases clinic between 1974 and 1977; in 21 cases the infection was extragenital only. This type of gonorrhea was often asymptomatic and was associated with a high rate of failure of initial treatment in 6 of the 50 cases in which the patient returned for follow-up assessment, and in 5 of the 6 the persistent infection was extragenital. Syphillis was seen concomitantly or had previously occurred in 6 of the 54 cases. Fifteen of 28 cases of primary, secondary or early latent syphilis seen in men during the same study period had occurred in homosexuals. Appropriate testing for extragenital gonorrhea and for syphilis is important in homosexual men who present for examination, and homosexuality with the possibility of extragenital gonorrhea should be considered in a man with syphilis of recent onset. PMID:709473

Gonorrhea in homosexual men.

PubMed

Austin, T W; Lent, B; Pattison, F L

1978-10-07

Extragenital gonorrhea was seen in 65% of 54 cases of gonorrhea in 43 homosexual men attending a venereal diseases clinic between 1974 and 1977; in 21 cases the infection was extragenital only. This type of gonorrhea was often asymptomatic and was associated with a high rate of failure of initial treatment in 6 of the 50 cases in which the patient returned for follow-up assessment, and in 5 of the 6 the persistent infection was extragenital. Syphillis was seen concomitantly or had previously occurred in 6 of the 54 cases. Fifteen of 28 cases of primary, secondary or early latent syphilis seen in men during the same study period had occurred in homosexuals. Appropriate testing for extragenital gonorrhea and for syphilis is important in homosexual men who present for examination, and homosexuality with the possibility of extragenital gonorrhea should be considered in a man with syphilis of recent onset.

The emergence of coherence over the course of decision making.

PubMed

Simon, D; Pham, L B; Le, Q A; Holyoak, K J

2001-09-01

Previous research has indicated that decision making is accompanied by an increase in the coherence of assessments of the factors related to the decision alternatives. In the present study, the authors investigated whether this coherence shift is obtained before people commit to a decision, and whether it is obtained in the course of a number of other processing tasks. College students were presented with a complex legal case involving multiple conflicting arguments. Participants rated agreement with the individual arguments in isolation before seeing the case and after processing it under various initial sets, including playing the role of a judge assigned to decide the case. Coherence shifts were observed when participants were instructed to delay making the decision (Experiment 1), to memorize the case (Experiment 2), and to comprehend the case (Experiment 3). The findings support the hypothesis that a coherence-generating mechanism operates in a variety of processing tasks, including decision making.

Nucleosynthesis in the neighborhood of a black hole

NASA Technical Reports Server (NTRS)

Chakrabarti, Sandip K.

1986-01-01

The preliminary results from simulations of nucleosynthesis inside a thick accretion disk around a black hole are discussed as a function of the accretion rate, the viscosity parameter, and the mass of the black hole. Results for the Bondi accretion case are also presented. Taking the case of a 10-solar mass and a 10 to the 6th-solar mass central Schwarzschild hole, detailed evolution of a representative element of matter as it accretes into the hole is presented in the case when the initial abundance (at the outer edge of the disk) is the same as the solar abundance. It is suggested that such studies may eventually shed light on the composition of the outgoing jets observed in the active galaxies and SS433.

76 FR 25328 - New Mexico Green Initiatives, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-04

... Mexico Green Initiatives, LLC's application for market-based rate authority, with an accompanying rate... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. ER11-3431-000] New Mexico Green Initiatives, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes Request for...

[Clinical characteristics of patients with workplace-associated mood disorder --comparison with non-workplace-associated group].

PubMed

Okazaki, Tsubasa; Kato, Satoshi

2011-01-01

The purpose of this study was to describe the clinical characteristics of patients with workplace-associated mood disorder. We conducted a clinical survey involving 84 clinical cases (regular employees suffering from mood disorder) who were hospitalized in the Psychiatry Department of Jichi Medical University Hospital, for a period over 8 years and 4 months between April 1st, 2000 and July 31st, 2008. The size of the workplace-associated group as a percentage of those patients in whom the onset of the symptom was occasioned by an evident issue at their workplace was 65%. This rate accounted for 74% of the total patients if clinical cases in which an evident issue at the workplace served as a significant trigger for the symptom were added to these patients in the case of an initial episode in the "non-workplace associated group". In the workplace-associated group, cases in which the premorbid character was a "depression-related personality" comprised only 42%, and was noticeably characterized by a perfection-oriented habit, enthusiastic character, conformity with other people, etc. Furthermore, the percentage of patients who were diagnosed with a "depression-related personality" comprised only 59% of the "overworked group", in which a heavy workload was evident in the workplace-associated group. In the workplace-associated group, the percentage of cases involving managerial workers was significantly high; their rate as initial cases was significantly high, as well the proportion of favorable outcomes. In the workplace-associated group, the percentage of patients who showed unambiguous depression at the initial stage was significantly low. Likewise, a similar result was obtained in the overworked group. Workplace-associated mood disorder today tends to have a stress-related aspect, or aspect of adjustment disorder. There was a period in many cases during which the main symptoms were insomnia, headache, panic attack, etc., prior to the onset of unambiguous depression in the workplace-associated mood disorder group. In depression associated with workplace-associated mood disorder, there are two pathological stages. The stage of adjustment disorder is the period in which such conditions are the main symptoms, and a serious or moderate stage of major depressive disorder is the period after full-scale depression develops in the wake of the former stage. What contributes to protection against depression are a proper diagnosis of depression whose pathological condition is at an early adjustment disorder stage and appropriate therapeutic measures.

Trend of application of World Health Organization control strategy of tuberculosis in Egypt.

PubMed

Saad-Hussein, Amal; Mohammed, Asmaa M

2014-09-01

World Health Organization (WHO) control policy for tuberculosis (TB) includes Bacillus Calmette-Guérin (BCG) vaccine at birth, case detection, and treatment of cases with directly observed therapy short-course (DOTS). This policy has been applied through the Ministry of Health and Population in Egypt for more than 30years. The controversies about the efficacy of the BCG vaccination against TB in adults initiate some suggestions for its discontinuation from compulsory vaccinations in countries with low incidence of TB. The present work aimed to study the trend of applying the WHO control policy for TB in Egypt among the Egyptian population throughout the last 20years (1992-2011). The documented database of the country, bibliographic review on MEDLINE, published studies and reports, WHO and EMRO databases that covered the period from 1992 to 2011 were used in this study. The incidence rate of all forms of TB (pulmonary and extrapulmonary) dropped by 50% from 34 cases to 17 cases per 100,000 population, as well as the prevalence rate declined by 60.6% from 71 cases per 100,000 population throughout the last 20years. Case detection and treatment success rates have increased throughout the studied period while it flat-lined over the past 6years which may need attention. The results of this study introduce an evidence-based recommendation for continuation of the WHO TB control policy in Egypt towards elimination of the disease. Copyright © 2014 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

The genetic landscape of high-risk neuroblastoma | Office of Cancer Genomics

Cancer.gov

Abstract: Neuroblastoma is a malignancy of the developing sympathetic nervous system that often presents with widespread metastatic disease, resulting in survival rates of less than 50%. To determine the spectrum of somatic mutation in high-risk neuroblastoma, we studied 240 affected individuals (cases) using a combination of whole-exome, genome and transcriptome sequencing as part of the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) initiative.

The Human Dimension of Systemic Department-Level Change: A Change Agent's Retrospective on a Case of Reform

ERIC Educational Resources Information Center

Vanasupa, Linda

2011-01-01

This paper represents a narrative of the process of department-level reform through the eyes of the initiating agent of change. Over the course of reform, our program has grown by 40%, primarily through retaining students. We exhibit a 10% net important rate of engineering students in the first two years of the curriculum relative to the college's…

TID and SEE Response of an Advanced Samsung 4G NAND Flash Memory

NASA Technical Reports Server (NTRS)

Oldham, Timothy R.; Friendlich, M.; Howard, J. W.; Berg, M. D.; Kim, H. S.; Irwin, T. L.; LaBel, K. A.

2007-01-01

Initial total ionizing dose (TID) and single event heavy ion test results are presented for an unhardened commercial flash memory, fabricated with 63 nm technology. Results are that the parts survive to a TID of nearly 200 krad (SiO2), with a tractable soft error rate of about 10(exp -l2) errors/bit-day, for the Adams Ten Percent Worst Case Environment.

Methods and Measures Used for Follow-up at 15 Years of the English and Romanian Adoptee (ERA) Study

ERIC Educational Resources Information Center

Monographs of the Society for Research in Child Development, 2010

2010-01-01

This chapter covers the methods and measures used in the ERA study, with a special focus on age 15 outcomes. First, the authors outline the sample participation rate for the 15-year follow-up--the percentages in all cases referring to the numbers at the time of initial sample contact. They then describe the measures used in this monograph,…

Uncertainty and sensitivity analysis of the basic reproduction number of diphtheria: a case study of a Rohingya refugee camp in Bangladesh, November–December 2017

PubMed Central

Matsuyama, Ryota; Lee, Hyojung; Yamaguchi, Takayuki; Tsuzuki, Shinya

2018-01-01

Background A Rohingya refugee camp in Cox’s Bazar, Bangladesh experienced a large-scale diphtheria epidemic in 2017. The background information of previously immune fraction among refugees cannot be explicitly estimated, and thus we conducted an uncertainty analysis of the basic reproduction number, R0. Methods A renewal process model was devised to estimate the R0 and ascertainment rate of cases, and loss of susceptible individuals was modeled as one minus the sum of initially immune fraction and the fraction naturally infected during the epidemic. To account for the uncertainty of initially immune fraction, we employed a Latin Hypercube sampling (LHS) method. Results R0 ranged from 4.7 to 14.8 with the median estimate at 7.2. R0 was positively correlated with ascertainment rates. Sensitivity analysis indicated that R0 would become smaller with greater variance of the generation time. Discussion Estimated R0 was broadly consistent with published estimate from endemic data, indicating that the vaccination coverage of 86% has to be satisfied to prevent the epidemic by means of mass vaccination. LHS was particularly useful in the setting of a refugee camp in which the background health status is poorly quantified. PMID:29629244

Uncertainty and sensitivity analysis of the basic reproduction number of diphtheria: a case study of a Rohingya refugee camp in Bangladesh, November-December 2017.

PubMed

Matsuyama, Ryota; Akhmetzhanov, Andrei R; Endo, Akira; Lee, Hyojung; Yamaguchi, Takayuki; Tsuzuki, Shinya; Nishiura, Hiroshi

2018-01-01

A Rohingya refugee camp in Cox's Bazar, Bangladesh experienced a large-scale diphtheria epidemic in 2017. The background information of previously immune fraction among refugees cannot be explicitly estimated, and thus we conducted an uncertainty analysis of the basic reproduction number, R 0 . A renewal process model was devised to estimate the R 0 and ascertainment rate of cases, and loss of susceptible individuals was modeled as one minus the sum of initially immune fraction and the fraction naturally infected during the epidemic. To account for the uncertainty of initially immune fraction, we employed a Latin Hypercube sampling (LHS) method. R 0 ranged from 4.7 to 14.8 with the median estimate at 7.2. R 0 was positively correlated with ascertainment rates. Sensitivity analysis indicated that R 0 would become smaller with greater variance of the generation time. Estimated R 0 was broadly consistent with published estimate from endemic data, indicating that the vaccination coverage of 86% has to be satisfied to prevent the epidemic by means of mass vaccination. LHS was particularly useful in the setting of a refugee camp in which the background health status is poorly quantified.

Correlates of human papillomavirus vaccination rates in low-income, minority adolescents: a multicenter study.

PubMed

Perkins, Rebecca B; Brogly, Susan B; Adams, William G; Freund, Karen M

2012-08-01

Low rates of human papillomavirus (HPV) vaccination in low-income, minority adolescents may exacerbate racial disparities in cervical cancer incidence. Using electronic medical record data and chart abstraction, we examined correlates of HPV vaccine series initiation and completion among 7702 low-income and minority adolescents aged 11-21 receiving primary care at one of seven medical centers between May 1, 2007, and June 30, 2009. Our population included 61% African Americans, 13% Caucasians, 15% Latinas, and 11% other races; 90% receive public insurance (e.g., Medicaid). We used logistic regression to estimate the associations between vaccine initiation and completion and age, race/ethnicity, number of contacts with the healthcare system, provider documentation, and clinical site of care. Of the 41% of adolescent girls who initiated HPV vaccination, 20% completed the series. A higher proportion of girls aged 11-<13 (46%) and 13-<18 (47%) initiated vaccination than those aged 18-21 (28%). In adjusted analyses, receipt of other recommended adolescent vaccines was associated with vaccine initiation, and increased contact with the medical system was associated with both initiation and completion of the series. Conversely, provider failure to document risky health behaviors predicted nonvaccination. Manual review of a subset of unvaccinated patients' charts revealed no documentation of vaccine discussions in 67% of cases. Fewer than half of low-income and minority adolescents receiving health maintenance services initiated HPV vaccination, and only 20% completed the series. Provider failure to discuss vaccination with their patients appears to be an important contributor to nonvaccination. Future research should focus on improving both initiation and completion of HPV vaccination in high-risk adolescents.

Under Pressure: Financial Effect of the Hospital-Acquired Conditions Initiative-A Statewide Analysis of Pressure Ulcer Development and Payment.

PubMed

Meddings, Jennifer; Reichert, Heidi; Rogers, Mary A M; Hofer, Timothy P; McMahon, Laurence F; Grazier, Kyle L

2015-07-01

To assess the financial effect of the 2008 Hospital-Acquired Conditions Initiative (HACI) pressure ulcer payment changes on Medicare, other payers, and hospitals. Retrospective before-and-after study of all-payer statewide administrative data for more than 2.4 million annual adult discharges in 2007 and 2009 using the Healthcare Cost and Utilization Project State Inpatient Datasets for California. How often and by how much the 2008 payment changes for pressure ulcers affected hospital payment was assessed. Nonfederal acute care California hospitals (N = 311). Adults discharged from acute-care hospitals. Pressure ulcer rates and hospital payment changes. Hospital-acquired pressure ulcer rates were low in 2007 (0.28%) and 2009 (0.27%); present-on-admission pressure ulcer rates increased from 2.3% in 2007 to 3.0% in 2009. According to clinical stage of pressure ulcer (available in 2009), hospital-acquired Stage III and IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for Stage III and IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges, for a statewide payment decrease of $310,444 (0.001%) for all payers and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers), reducing statewide payment by $62,538,586 (0.21%) for all payers and $47,237,984 (0.32%) for Medicare. The total financial effect of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than Stages III and IV. The removal of payment for hospital-acquired Stage III and IV ulcers by implementation of the HACI policy was 1/200th that of the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital-Acquired Conditions Initiative. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Posttransplant Lymphoproliferative Disorder After Clinical Islet Transplantation: Report of the First Two Cases.

PubMed

Peters, A; Olateju, T; Deschenes, J; Shankarnarayan, S H; Chua, N; Shapiro, A M J; Senior, P

2017-09-01

We report the first two cases of posttransplant lymphoproliferative disorder (PTLD) in recipients of islet transplants worldwide. First, a 44-year-old recipient of three islet infusions developed PTLD 80 months after his initial transplantation, presenting with abdominal pain and diffuse terminal ileum thickening on imaging. He was treated with surgical excision, reduction of immunosuppression, and rituximab. Seven months later, he developed central nervous system PTLD, presenting with vertigo and diplopia; immunosuppression was discontinued, resulting in graft loss, and he was given high-dose methotrexate and underwent consolidative autologous stem cell transplantation. He remains in remission 37 months after the initial diagnosis. Second, a 58-year-old female recipient of two islet infusions developed PTLD 24 months after initial islet infusion, presenting with pancytopenia secondary to extensive bone marrow involvement. Immunosuppression was discontinued, resulting in graft loss, and she received rituximab and chemotherapy, achieving complete remission. Both patients were monomorphic B cell PTLD subtype by histology and negative for Epstein-Barr virus in tissue or blood. These cases document the first occurrences of this rare complication in islet transplantation, likely secondary to prolonged, intensive immunosuppression, and highlight the varying clinical manifestations of PTLD. Further studies are needed to determine incidence rate and risk factors in islet transplantation. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Ebola Holding Units at government hospitals in Sierra Leone: evidence for a flexible and effective model for safe isolation, early treatment initiation, hospital safety and health system functioning

PubMed Central

Johnson, Oliver; Youkee, Daniel; Brown, Colin S; Lado, Marta; Wurie, Alie; Bash-Taqi, Donald; Hall, Andy; Hanciles, Eva; Kamara, Isata; Kamara, Cecilia; Kamboz, Amardeep; Seedat, Ahmed; Thomas, Suzanne; Kamara, T B; Leather, Andrew J M; Kargbo, Brima

2016-01-01

The 2014-2015 West African outbreak of Ebola Virus Disease (EVD) claimed the lives of more than 11,000 people and infected over 27,000 across seven countries. Traditional approaches to containing EVD proved inadequate and new approaches for controlling the outbreak were required. The Ministry of Health & Sanitation and King’s Sierra Leone Partnership developed a model for Ebola Holding Units (EHUs) at Government Hospitals in the capital city Freetown. The EHUs isolated screened or referred suspect patients, provided initial clinical care, undertook laboratory testing to confirm EVD status, referred onward positive cases to an Ebola Treatment Centre or negative cases to the general wards, and safely stored corpses pending collection by burial teams. Between 29th May 2014 and 19th January 2015, our five units had isolated approximately 37% (1159) of the 3097 confirmed cases within Western Urban and Rural district. Nosocomial transmission of EVD within the units appears lower than previously documented at other facilities and staff infection rates were also low. We found that EHUs are a flexible and effective model of rapid diagnosis, safe isolation and early initial treatment. We also demonstrated that it is possible for international partners and government facilities to collaborate closely during a humanitarian crisis. PMID:28588922

Recurrence of Phaeochromocytoma and Abdominal Paraganglioma After Initial Surgical Intervention.

PubMed

Johnston, Philip C; Mullan, Karen R; Atkinson, A Brew; Eatock, Fiona C; Wallace, Helen; Gray, Moyra; Hunter, Steven J

2015-05-01

Clinical and biochemical follow up after surgery for phaeochromocytoma is essential with long term studies demonstrating recurrence frequencies between 6% and 23%. To examine the characteristics and frequency of tumour recurrence in a regional endocrine referral centre, in patients with surgical resection of phaeochromocytoma (P) and abdominal paraganglioma (AP). We identified a cohort of 52 consecutive patients who attended our Regional Endocrinology & Diabetes Centre and retrospectively reviewed their clinical, biochemical and radiological data (between 2002 and 2013). After confirmation of early post-operative remission by negative biochemical testing, tumour recurrence was defined by demonstration of catecholamine excess with confirmatory imaging. Phaeochromocytoma was confirmed histologically in all cases (43:P, 9:AP, mean-age:53 years). Open adrenalectomy was performed in 20 cases and laparoscopically in 32. Hereditary phaeochromocytoma was confirmed by genetic analysis in 12 (23%) patients. Median follow up time from initial surgery was 47 months, (range: 12 - 296 months), 49 patients had no evidence of tumour recurrence at latest follow-up. Three patients (6%) demonstrated tumour development, one in a patient with VHL which occurred in a contralateral adrenal gland, one sporadic case had local recurrence, and an adrenal tumour occurred in a patient with a SDHB gene mutation who had a previous bladder tumour. After initial surgery, the tumours occurred at 8.6, 12.0 and 17.7 years respectively. In this study tumour development occurred in 6% of patients. Although tumour rates were low, careful and sustained clinical and biochemical follow up is advocated, as new tumour development or recurrence may occur long after the initial surgery is performed.

Increased suicide risk and clinical correlates of suicide among patients with Parkinson's disease.

PubMed

Lee, Taeyeop; Lee, Hochang Benjamin; Ahn, Myung Hee; Kim, Juyeon; Kim, Mi Sun; Chung, Sun Ju; Hong, Jin Pyo

2016-11-01

Parkinson's disease (PD) is a debilitating, neurodegenerative condition frequently complicated by psychiatric symptoms. Patients with PD may be at higher risk for suicide than the general population, but previous estimates are limited and conflicting. The aim of this study is to estimate the suicide rate based on the clinical case registry and to identify risk factors for suicide among patients diagnosed with PD. The target sample consisted of 4362 patients diagnosed with PD who were evaluated at a general hospital in Seoul, South Korea, from 1996 to 2012. The standardized mortality ratio for suicide among PD patients was estimated. In order to identify the clinical correlates of suicide, case-control study was conducted based on retrospective chart review. The 29 suicide cases (age: 62.3 ± 13.7 years; females: 34.5%) were matched with 116 non-suicide controls (age: 63.5 ± 9.2 years; females 56.9%) by the year of initial PD evaluation. The SMR for suicide in PD patients was 1.99 (95% CI 1.33-2.85). Mean duration from time of initial diagnosis to suicide among cases was 6.1 ± 3.5 years. Case-control analysis revealed that male, initial extremity of motor symptom onset, history of depressive disorder, delusion, any psychiatric disorder, and higher L-dopa dosage were significantly associated with suicide among PD patients. Other PD-related variables such as UPDRS motor score were not significantly associated with death by suicide. Suicide risk in PD patients is approximately 2 times higher than that in the general population. Psychiatric disorders, and also L-dopa medication need further attention with respect to suicide. Copyright © 2016 Elsevier Ltd. All rights reserved.

Visual memory effects on intraoperator study design: determining a minimum time gap between case reviews to reduce recall bias.

PubMed

Campbell, W Scott; Talmon, Geoffrey A; Foster, Kirk W; Baker, John J; Smith, Lynette M; Hinrichs, Steven H

2015-03-01

The objective of this research was to determine test intervals between intraoperator case reviews to minimize the impact of recall. Three pathologists were presented with a group of 120 slides and subsequently challenged with a study set of 120 slides after 2-week and 4-week intervals. The challenge set consisted of 60 slides seen during the initial review and 60 slides previously unseen within the study. Pathologists rendered a diagnosis for each slide and indicated whether they recalled seeing the slide previously (yes/no). Two weeks after having been shown 60 cases from a challenge set of 120 cases, the pathologists correctly remembered 26, 22, and 24 cases or 40% overall. After 4 weeks, the pathologists correctly recalled 31% of cases previously seen. Pathologists were capable of recalling from memory cases seen previously at 2 and 4 weeks. Recall rates may be sufficiently high to affect intraobserver study design. Copyright© by the American Society for Clinical Pathology.

Gastroenteritis outbreaks on cruise ships: contributing factors and thresholds for early outbreak detection

PubMed Central

Mouchtouri, Varvara A; Verykouki, Eleni; Zamfir, Dumitru; Hadjipetris, Christos; Lewis, Hannah C; Hadjichristodoulou, Christos

2017-01-01

When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013 by five seagoing cruise ships were analysed to identify attack rate thresholds for early outbreak detection. The overall incidence rate of AG was 2.81 cases per 10,000 traveller-days (95% confidence interval (CI): 0.00–17.60), while the attack rate was 19.37 cases per 10,000 travellers (95% CI: 0.00–127.69). The probability of an outbreak occurring was 11% if 4 per 1,000 passengers reported symptoms within the first 2 days of the voyage, and this increased to 23 % if 5 per 1,000 passengers reported such within the first 3 days. The risk ratio (RR) for outbreak occurrence was 2.35, 5.66 and 8.63 for 1, 2 and 3 days’ delay of symptoms reporting respectively, suggesting a dose–response relationship. Shipping companies’ policies and health authorities’ efforts may consider these thresholds for initiating outbreak response measures based on the number of cases according to day of cruise. Efforts should focus on ensuring travellers report symptoms immediately and comply with isolation measures. PMID:29162205

Vital signs: melanoma incidence and mortality trends and projections - United States, 1982-2030.

PubMed

Guy, Gery P; Thomas, Cheryll C; Thompson, Trevor; Watson, Meg; Massetti, Greta M; Richardson, Lisa C

2015-06-05

Melanoma incidence rates have continued to increase in the United States, and risk behaviors remain high. Melanoma is responsible for the most skin cancer deaths, with about 9,000 persons dying from it each year. CDC analyzed current (2011) melanoma incidence and mortality data, and projected melanoma incidence, mortality, and the cost of treating newly diagnosed melanomas through 2030. Finally, CDC estimated the potential melanoma cases and costs averted through 2030 if a comprehensive skin cancer prevention program was implemented in the United States. In 2011, the melanoma incidence rate was 19.7 per 100,000, and the death rate was 2.7 per 100,000. Incidence rates are projected to increase for white males and females through 2019. Death rates are projected to remain stable. The annual cost of treating newly diagnosed melanomas was estimated to increase from $457 million in 2011 to $1.6 billion in 2030. Implementation of a comprehensive skin cancer prevention program was estimated to avert 230,000 melanoma cases and $2.7 billion in initial year treatment costs from 2020 through 2030. If additional prevention efforts are not undertaken, the number of melanoma cases is projected to increase over the next 15 years, with accompanying increases in health care costs. Much of this morbidity, mortality, and health care cost can be prevented. Substantial reductions in melanoma incidence, mortality, and cost can be achieved if evidence-based comprehensive interventions that reduce ultraviolet (UV) radiation exposure and increase sun protection are fully implemented and sustained.

Da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies.

PubMed

Zorn, Kevin C; Gofrit, Ofer N; Orvieto, Marcelo A; Mikhail, Albert A; Galocy, R Matthew; Shalhav, Arieh L; Zagaja, Gregory P

2007-11-01

Previous reports have suggested that a 2% to 5% device failure rate (FR) be quoted when counseling patients about robot-assisted laparoscopic radical prostatectomy (RLRP). We sought to evaluate our FR on the da Vinci system. Since February 2003, more than 800 RLRPs have been performed at our institution using a single three-armed robotic unit. A prospective database was analyzed to determine the device FR and whether it resulted in case abortion or open conversion. Intuitive Surgical Systems provided data concerning the system's performance, including its fault rate. Error messages were classified as recoverable and non-recoverable faults. Between February 2003 and November 2006, 725 RLRP cases were available for evaluation. There were no intraoperative device failures that resulted in a case conversion. Technical errors resulting in surgeon handicap occurred in 3 cases (0.4%). Four patients (0.5%) had their procedures aborted secondary to system failure at initial set-up prior to patient entrance to the operating room. Data analysis retrieved from the da Vinci console reported on a total of 807 procedures since 2003. Only 4 cases (0.4%) were reported from the Intuitive Surgical database to result in either an aborted or a converted case, which compares favorably with our results. Since the last computer system upgrade (September 2005), the mean recoverable and non-recoverable fault rates per procedure were 0.21 and 0.05, respectively. For all the advanced features the da Vinci system offers, it is surprisingly reliable. Throughout our RLRP experience, device failure resulted in case conversion, procedure abortion, and surgeon handicap in 0, 0.5%, and 0.4% of procedures, respectively. As such, a lowered device FR of 0.5% should be used when counseling patients undergoing RLRP. To avoid futile general anesthesia, a policy should be enforced to ensure that the da Vinci system is completely set up before the patient enters the operating room.

The recent outbreaks and reemergence of poliovirus in war and conflict-affected areas.

PubMed

Akil, Luma; Ahmad, H Anwar

2016-08-01

Poliomyelitis is a highly infectious disease caused by poliovirus, which becomes difficult to manage/eradicate in politically unstable areas. The objectives of this study were to determine the movement and management of such polio outbreaks in endemic countries and countries with reoccurring cases of polio and to determine the effect of political instability on polio eradication. In this study, the extent of polio outbreaks was examined and modeled using statistical methodologies and mapped with GIS software. Data on polio cases and immunization were collected for countries with polio cases for the period 2011 to 2014. Weekly data from the Global Polio Eradication Initiative were collected for selected countries. The recent virus origin and current movement was mapped using GIS. Correlations between immunization rates, the Global Peace Index (GPI), and other indicators of a country's political stability with polio outbreaks were determined. Data were analyzed using SAS 9.4 and ArcGIS 10. For several reasons, Pakistan remains highly vulnerable to new incidences of polio (306 cases in 2014). Overall immunization rates showed a steady decline over time in selected countries. Countries with polio cases were shown to have high rates of infant mortality, and their GPI ranked between 2.0 and 3.3; displaced populations, level of violent crime rating, and political instability also were ranked high for several countries. Polio was shown to be high in areas with increased conflict and instability. Displaced populations living in hard-to-reach areas may lack access to proper vaccination and health care. Wars and conflict have also resulted in the reemergence of polio in otherwise polio-free countries. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Factors Affecting the Designation of Cerebrovascular Diseases as Work-Related in Administrative Litigation

PubMed Central

Kim, Hyeongsu; Rim, Hwayoung; Chang, Sounghoon; Lee, Kunsei

2008-01-01

The purpose of this study was to identify factors that could be used as standardized criteria for evaluating occupational diseases in initial assessments or requests for examination. Using 100 administrative litigation cases on the work-relatedness of cerebrovascular diseases (CVDs) by the Seoul Branch of the Korea Labor Welfare Corporation (KLWC) from 1997 to 2002, we estimated the relationship between the investigated variables and designation of the work-relatedness of the CVD. As for the age, the odds ratio of the acceptance rate of a case as work-related in subjects over 60 yr of age was 0.08 (95% CI, 0.01-0.75), which was compared to subjects under 30 yr of age. Regarding working hours, the odds ratio of the acceptance rate of a case as work-related in CVDs in those over 56 hr was 9.50 (95% CI, 1.92-47.10) when compared to those less than 56 hr. As for the benefit type, the odds ratio of the acceptance rate of a case as work-related in medical benefits was 5.74 (95% CI, 1.29-25.54), compared to survivor benefits. As for the criteria for defining situations as work overload, the odds ratio of the acceptance rate of a case as work-related in injured workers was 12.06 (95% CI, 3.12-46.62), compared to that in non-injured workers. Our findings show that the criteria for defining situations of work overload played an important role in assessing the work-relatedness of CVDs in administrative litigation, and it is necessary to make the scientific evidence on judgement of work-relatedness on overwork. PMID:18437006

Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals.

PubMed

Talsma, A K; Reedijk, A M J; Damhuis, R A M; Westenend, P J; Vles, W J

2011-04-01

Re-resection rate after breast-conserving surgery (BCS) has been introduced as an indicator of quality of surgical treatment in international literature. The present study aims to develop a case-mix model for re-resection rates and to evaluate its performance in comparing results between hospitals. Electronic records of eligible patients diagnosed with in-situ and invasive breast cancer in 2006 and 2007 were derived from 16 hospitals in the Rotterdam Cancer Registry (RCR) (n = 961). A model was built in which prognostic factors for re-resections after BCS were identified and expected re-resection rate could be assessed for hospitals based on their case mix. To illustrate the opportunities of monitoring re-resections over time, after risk adjustment for patient profile, a VLAD chart was drawn for patients in one hospital. In general three out of every ten women had re-surgery; in about 50% this meant an additive mastectomy. Independent prognostic factors of re-resection after multivariate analysis were histological type, sublocalisation, tumour size, lymph node involvement and multifocal disease. After correction for case mix, one hospital was performing significantly less re-resections compared to the reference hospital. On the other hand, two were performing significantly more re-resections than was expected based on their patient mix. Our population-based study confirms earlier reports that re-resection is frequently required after an initial breast-conserving operation. Case-mix models such as the one we constructed can be used to correct for variation between hospitals performances. VLAD charts are valuable tools to monitor quality of care within individual hospitals. Copyright © 2011 Elsevier Ltd. All rights reserved.

A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility.

PubMed

Cassir, Nadim; Delarozière, Jean-Christophe; Dubourg, Gregory; Delord, Marion; Lagier, Jean-Christophe; Brouqui, Phillipe; Fenollar, Florence; Raoult, Didier; Fournier, Pierre Edouard

2016-11-01

OBJECTIVE To describe and analyze a large outbreak of Clostridium difficile 027 (CD-027) infections. METHODS Confirmed CD-027 cases were defined as CD infection plus real-time polymerase chain reaction assay (PCR) positive for CD-027. Clinical and microbiological data on patients with CD-027 infection were collected from January 2013 to December 2015 in the Provence-Alpes-Côte-d'Azur region (southeastern France). RESULTS In total, 19 healthcare facilities reported 144 CD-027 infections (112 confirmed and 32 probable CD-027 infections) during a 22-month period outbreak. Although the incidence rate per 10,000 bed days was lower in long-term care facilities (LTCFs) than in acute care facilities (0.05 vs 0.14; P<.001), cases occurred mainly in LTCFs, one of which was the probable source of this outbreak. After centralization of CD testing, the rate of confirmed CD-027 cases from LTCFs or residential-care homes increased significantly (69% vs 92%; P<.001). Regarding confirmed CD-027 patients, the sex ratio and the median age were 0.53 and 84.2 years, respectively. The 30-day crude mortality rate was 31%. Most patients (96%) had received antibiotics within 3 months prior to the CD colitis diagnosis. During the study period, the rate of patients with CD-027 (compared with all patients tested in the point-of-care laboratories) decreased significantly (P=.03). CONCLUSIONS A large CD-027 outbreak occurred in southeastern France as a consequence of an initial cluster of cases in a single LTCF. Successful interventions included rapid isolation and testing of residents with potentially infectious diarrhea and cohorting of case patients in a specialized infectious diseases ward to optimize management. Infect Control Hosp Epidemiol 2016;1-5.

The recent outbreaks and reemergence of poliovirus in war and conflict-affected areas

PubMed Central

Akil, Luma; Ahmad, H. Anwar

2016-01-01

SUMMARY Background Poliomyelitis is a highly infectious disease caused by poliovirus, which becomes difficult to manage/eradicate in politically unstable areas. The objectives of this study were to determine the movement and management of such polio outbreaks in endemic countries and countries with reoccurring cases of polio and to determine the effect of political instability on polio eradication. Methods In this study, the extent of polio outbreaks was examined and modeled using statistical methodologies and mapped with GIS software. Data on polio cases and immunization were collected for countries with polio cases for the period 2011 to 2014. Weekly data from the Global Polio Eradication Initiative were collected for selected countries. The recent virus origin and current movement was mapped using GIS. Correlations between immunization rates, the Global Peace Index (GPI), and other indicators of a country’s political stability with polio outbreaks were determined. Data were analyzed using SAS 9.4 and ArcGIS 10. Results For several reasons, Pakistan remains highly vulnerable to new incidences of polio (306 cases in 2014). Overall immunization rates showed a steady decline over time in selected countries. Countries with polio cases were shown to have high rates of infant mortality, and their GPI ranked between 2.0 and 3.3; displaced populations, level of violent crime rating, and political instability also were ranked high for several countries. Conclusion Polio was shown to be high in areas with increased conflict and instability. Displaced populations living in hard-to-reach areas may lack access to proper vaccination and health care. Wars and conflict have also resulted in the reemergence of polio in otherwise polio-free countries. PMID:27237735

Bayesian inference in an extended SEIR model with nonparametric disease transmission rate: an application to the Ebola epidemic in Sierra Leone.

PubMed

Frasso, Gianluca; Lambert, Philippe

2016-10-01

SummaryThe 2014 Ebola outbreak in Sierra Leone is analyzed using a susceptible-exposed-infectious-removed (SEIR) epidemic compartmental model. The discrete time-stochastic model for the epidemic evolution is coupled to a set of ordinary differential equations describing the dynamics of the expected proportions of subjects in each epidemic state. The unknown parameters are estimated in a Bayesian framework by combining data on the number of new (laboratory confirmed) Ebola cases reported by the Ministry of Health and prior distributions for the transition rates elicited using information collected by the WHO during the follow-up of specific Ebola cases. The time-varying disease transmission rate is modeled in a flexible way using penalized B-splines. Our framework represents a valuable stochastic tool for the study of an epidemic dynamic even when only irregularly observed and possibly aggregated data are available. Simulations and the analysis of the 2014 Sierra Leone Ebola data highlight the merits of the proposed methodology. In particular, the flexible modeling of the disease transmission rate makes the estimation of the effective reproduction number robust to the misspecification of the initial epidemic states and to underreporting of the infectious cases. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

AN EVALUATION OF PRIMARY DATA-COLLECTION MODES IN AN ADDRESS-BASED SAMPLING DESIGN.

PubMed

Amaya, Ashley; Leclere, Felicia; Carris, Kari; Liao, Youlian

2015-01-01

As address-based sampling becomes increasingly popular for multimode surveys, researchers continue to refine data-collection best practices. While much work has been conducted to improve efficiency within a given mode, additional research is needed on how multimode designs can be optimized across modes. Previous research has not evaluated the consequences of mode sequencing on multimode mail and phone surveys, nor has significant research been conducted to evaluate mode sequencing on a variety of indicators beyond response rates. We conducted an experiment within the Racial and Ethnic Approaches to Community Health across the U.S. Risk Factor Survey (REACH U.S.) to evaluate two multimode case-flow designs: (1) phone followed by mail (phone-first) and (2) mail followed by phone (mail-first). We compared response rates, cost, timeliness, and data quality to identify differences across case-flow design. Because surveys often differ on the rarity of the target population, we also examined whether changes in the eligibility rate altered the choice of optimal case flow. Our results suggested that, on most metrics, the mail-first design was superior to the phone-first design. Compared with phone-first, mail-first achieved a higher yield rate at a lower cost with equivalent data quality. While the phone-first design initially achieved more interviews compared to the mail-first design, over time the mail-first design surpassed it and obtained the greatest number of interviews.

Incident rate and risk factors for tuberculosis among patients with type 2 diabetes: retrospective cohort study in Shanghai, China.

PubMed

Qiu, Hanbo; Shi, Yan; Li, Yanyun; Shen, Xin; Li, Rui; Yang, Qundi; Pan, Qichao; Yan, Fei

2017-07-01

To examine the incident rate of tuberculosis (TB) and its associates among adults with type 2 diabetes in Shanghai, China. We conducted a retrospective cohort study among 170 399 patients with type 2 diabetes aged ≥18 years who were registered in Shanghai community-based diabetes management system between 2004 and 2009. Their TB status was tracked until 31 December 2014. Cox regression was performed to identify the risk factors for TB. We documented 785 new TB cases during 654 977 person-years of follow-up. The incident rate of TB was 224.20 (206.69, 243.16) per 100 000 person-years among men and 51.34 (44.75, 58.92) per 100 000 person-years among women. A 1-unit increase of BMI was associated with a risk reduction in 16% (P < 0.01) for men and a 14% (P < 0.01) reduction for women. TB cases were more likely to be insulin-dependent [men: hazard ratio = 2.13 (1.29, 3.53); women: 3.28 (1.28, 8.39)] and had a poor glucose level initially [men: 1.21 (1.15, 1.27); women: 1.27 (1.18, 1.37)]. The risk factor for TB specific to men was a young age at diagnosis of diabetes, and the protective factor specific to women was actively engaging in physical activity. TB incident rate among patients with type 2 diabetes was substantially higher among men than among women. The risk of TB was reversely associated with initial BMI. The severity of poor glucose control among patients with diabetes was also linearly associated with the risk of TB. © 2017 John Wiley & Sons Ltd.

Current CD4 cell count and the short-term risk of AIDS and death before the availability of effective antiretroviral therapy in HIV-infected children and adults.

PubMed

Dunn, David; Woodburn, Patrick; Duong, Trinh; Peto, Julian; Phillips, Andrew; Gibb, Di; Porter, Kholoud

2008-02-01

Currently, there are no comparable estimates of the short-term risk of disease progression in the absence of effective antiretroviral therapy for human immunodeficiency virus (HIV)-infected adults and children. A joint analysis of 2 large studies of children with vertically acquired HIV infection (the HIV Paediatric Prognostic Markers Collaborative Study) and adults with seroconversion (the CASCADE [Concerted Action on Sero-Conversion to AIDS and Death in Europe] collaboration) was conducted. Follow-up was censored at the end of 1995, before the introduction of combination antiretroviral therapy. The incidence rates of death and AIDS or death (AIDS/death) were estimated on the basis of age and current CD4 cell count. A total of 1260 deaths (over 20,500 person-years of follow-up) and 1894 initial AIDS events (over 17,200 person-years of follow-up) were observed among 6741 patients (3244 children [i.e., patients < or =15 years of age] and 3497 adults). Young children (age, <5 years) experienced high morbidity and mortality rates. After adjustment for the CD4 cell count, the effect of age on disease progression was not significant among older children, whereas the risk increased markedly in association with increasing age among adults. Death rates were similar among older children and adults aged approximately 20 years, as were the rates of progression to AIDS/death when cases of serious recurrent bacterial infection, which has a more restrictive case definition in adults, were excluded. Similar CD4 cell count criteria for initiation of antiretroviral therapy can be applied to adults and children > or = 5 years of age.

Diagnosis of Metastasis to the Thyroid Gland: Comparison of Core-Needle Biopsy and Fine-Needle Aspiration.

PubMed

Choi, Sang Hyun; Baek, Jung Hwan; Ha, Eun Ju; Choi, Young Jun; Song, Dong Eun; Kim, Jae Kyun; Chung, Ki-Wook; Kim, Tae Yong; Lee, Jeong Hyun

2016-04-01

Early detection and diagnosis of metastasis to the thyroid gland is important. This study aims to evaluate the clinical value of core-needle biopsy (CNB) by comparing the results of CNB and fine-needle aspiration (FNA) in patients with clinically suspected metastasis to the thyroid gland. Case series with chart review. Tertiary referral practice. Fifty-two thyroid nodules from 52 patients with clinically suspected metastasis to the thyroid gland (mean age, 62.8 years). Of these 52 patients, FNA was initially used in 41 patients and CNB in 20 patients (11 patients as the initial approach and 9 patients after inconclusive FNA results). Ultrasound features of metastasis to the thyroid gland were evaluated. The diagnostic performance, repeated diagnostic examination rate, and diagnostic surgery rate were evaluated for FNA and CNB. Among these 52 patients, 46 were diagnosed with thyroid metastases and 6 were diagnosed with primary thyroid cancer. Common ultrasound features were an ovoid to round shape (58.7%), ill-defined margin (56.5%), hypoechogenicity (65.2%), and no calcifications (87.0%). Core-needle biopsy achieved a significantly higher sensitivity than FNA (100.0% vs 58.6%, P = .008) without any false-negative results. Both the repeated diagnostic examination rate and the diagnostic surgery rate were significantly lower in CNB than in FNA (5.0% vs 46.3%, P = .001, and 5.0% vs 34.1%, P = .013, respectively). In cases of known rare primary malignancy, nontypical ultrasound features of primary thyroid malignancy, and need for an additional immunohistochemical analysis, CNB may be primarily considered. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Consensus review of discordant findings maximizes cancer detection rate in double-reader screening mammography: Irish National Breast Screening Program experience.

PubMed

Shaw, Colette M; Flanagan, Fidema L; Fenlon, Helen M; McNicholas, Michelle M

2009-02-01

To assesses consensus review of discordant screening mammography findings in terms of its sensitivity, safety, and effect on overall performance in the first 6 years of operation of the Irish National Breast Screening Program (NBSP). Women who participated in the Irish NBSP gave written informed consent for use of their data for auditing purposes. Local ethics committee approval was obtained. The study population consisted of women who participated in the Irish NBSP and underwent initial screening mammography at one of the two screening centers serving the eastern part of Ireland between 2000 and 2005. Independent double reading of mammograms was performed. When the readers disagreed regarding referral, the case was reviewed by a consensus panel. Of the 128 569 screenings performed, 1335 (1%) were discussed by consensus. Of the 1335 cases discussed by consensus, 606 (45.39%) were recalled for further assessment. This resulted in an overall recall rate of 4.41%. In those recalled to assessment, 71 cases of malignant disease were diagnosed (ductal carcinoma in situ, n = 24; invasive cancer, n = 47). The remaining 729 patients were returned to biennial screening. Of these 729 patients, seven had false-negative findings that were identified in the subsequent screening round. Use of the highest reader recall method, in which a patient is recalled if her findings are deemed abnormal by either reader, could potentially increase the cancer detection rate by 0.6 per 1000 women screened but would increase the recall rate by 12.69% and the number of false-positive findings by 15.37%. The consensus panel identified 71 (7.33%) of 968 cancers diagnosed. Consensus review substantially reduced the number of cases recalled and was associated with a low false-negative rate.

Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women.

PubMed

Gultekin, Murat; Zayifoglu Karaca, Mujdegul; Kucukyildiz, Irem; Dundar, Selin; Boztas, Guledal; Semra Turan, Hatice; Hacikamiloglu, Ezgi; Murtuza, Kamil; Keskinkilic, Bekir; Sencan, Irfan

2018-05-01

To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 1 million screened women. Women over age 30 were invited for population based screening via HPV DNA and conventional cytology. Samples were collected by family physicians and the evaluations and reports had been performed in the National Central HPV laboratories. The acceptance rate for HPV based cervical cancer screening after first invitation was nearly 36.5%. Since HPV DNA tests have been implemented, cervical cancer screening rates have shown 4-5-fold increase in primary level. Through the evaluation of all, HPV positivity was seen in 3.5%. The commonest HPV genotypes were 16, followed by 51, 31, 52 and 18. Among the 37.515 HPV positive cases, cytological abnormality rate was 19.1%. Among HPV positive cases, 16.962 cases had HPV 16 or 18 or other oncogenic HPV types with abnormal cytology (>ASC-US). These patients were referred to colposcopy. The colposcopy referral rate was 1.6%. Among these, final clinico-pathological data of 3.499 patients were normal in 1.985 patients, CIN1 in 708, CIN2 in 285, CIN3 in 436 and cancer in 85 patients and only pap-smear program could miss 45.9% of ≥CIN3 cases. The results of 1 million women including the evaluation of 13 HPV genotypes with respect to prevalence, geographic distribution and abnormal cytology results shows that HPV DNA can be used in primary level settings to have a high coverage rated screening program and is very effective compared to conventional pap-smear. © 2017 The Authors International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women

PubMed Central

Zayifoglu Karaca, Mujdegul; Kucukyildiz, Irem; Dundar, Selin; Boztas, Guledal; Semra Turan, Hatice; Hacikamiloglu, Ezgi; Murtuza, Kamil; Keskinkilic, Bekir; Sencan, Irfan

2017-01-01

To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 1 million screened women. Women over age 30 were invited for population based screening via HPV DNA and conventional cytology. Samples were collected by family physicians and the evaluations and reports had been performed in the National Central HPV laboratories. The acceptance rate for HPV based cervical cancer screening after first invitation was nearly 36.5%. Since HPV DNA tests have been implemented, cervical cancer screening rates have shown 4–5‐fold increase in primary level. Through the evaluation of all, HPV positivity was seen in 3.5%. The commonest HPV genotypes were 16, followed by 51, 31, 52 and 18. Among the 37.515 HPV positive cases, cytological abnormality rate was 19.1%. Among HPV positive cases, 16.962 cases had HPV 16 or 18 or other oncogenic HPV types with abnormal cytology (>ASC‐US). These patients were referred to colposcopy. The colposcopy referral rate was 1.6%. Among these, final clinico‐pathological data of 3.499 patients were normal in 1.985 patients, CIN1 in 708, CIN2 in 285, CIN3 in 436 and cancer in 85 patients and only pap‐smear program could miss 45.9% of ≥CIN3 cases. The results of 1 million women including the evaluation of 13 HPV genotypes with respect to prevalence, geographic distribution and abnormal cytology results shows that HPV DNA can be used in primary level settings to have a high coverage rated screening program and is very effective compared to conventional pap‐smear. PMID:29235108

The scaling of contact rates with population density for the infectious disease models.

PubMed

Hu, Hao; Nigmatulina, Karima; Eckhoff, Philip

2013-08-01

Contact rates and patterns among individuals in a geographic area drive transmission of directly-transmitted pathogens, making it essential to understand and estimate contacts for simulation of disease dynamics. Under the uniform mixing assumption, one of two mechanisms is typically used to describe the relation between contact rate and population density: density-dependent or frequency-dependent. Based on existing evidence of population threshold and human mobility patterns, we formulated a spatial contact model to describe the appropriate form of transmission with initial growth at low density and saturation at higher density. We show that the two mechanisms are extreme cases that do not capture real population movement across all scales. Empirical data of human and wildlife diseases indicate that a nonlinear function may work better when looking at the full spectrum of densities. This estimation can be applied to large areas with population mixing in general activities. For crowds with unusually large densities (e.g., transportation terminals, stadiums, or mass gatherings), the lack of organized social contact structure deviates the physical contacts towards a special case of the spatial contact model - the dynamics of kinetic gas molecule collision. In this case, an ideal gas model with van der Waals correction fits well; existing movement observation data and the contact rate between individuals is estimated using kinetic theory. A complete picture of contact rate scaling with population density may help clarify the definition of transmission rates in heterogeneous, large-scale spatial systems. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Muscle vibration sustains motor unit firing rate during submaximal isometric fatigue in humans

PubMed Central

Griffin, L; Garland, S J; Ivanova, T; Gossen, E R

2001-01-01

In keeping with the ‘muscular wisdom hypothesis’, many studies have documented that the firing rate of the majority of motor units decreased during fatiguing isometric contractions. The present study investigated whether the application of periodic muscle vibration, which strongly activates muscle spindles, would alter the modulation of motor unit firing rate during submaximal fatiguing isometric contractions. Thirty-three motor units from the lateral head of the triceps brachii muscle were recorded from 10 subjects during a sustained isometric 20 % maximal voluntary contraction (MVC) of the elbow extensors. Vibration was interposed on the contraction for 2 s every 10 s. Twenty-two motor units were recorded from the beginning of the fatigue task. The discharge rate of the majority of motor units remained constant (12/22) or increased (4/22) with fatigue. Six motor units demonstrated a reduction in discharge rate that later returned toward initial values; these motor units had higher initial discharge rates than the other 16 motor units. In a second series of experiments, four subjects held a sustained isometric 20 % MVC for 2 min and then vibration was applied as above for the remainder of the contraction. In this case, motor units initially demonstrated a decrease in firing rate that increased after the vibration was applied. Thus muscle spindle disfacilitation of the motoneurone pool may be associated with the decline of motor unit discharge rate observed during the first 2 min of the contraction. In a third set of experiments, seven subjects performed the main experiment on one occasion and repeated the fatigue task without vibration on a second occasion. Neither the endurance time of the fatiguing contraction nor the MVC torque following fatigue was affected by the application of vibration. This finding calls into question the applicability of the muscular wisdom hypothesis to submaximal contractions. PMID:11559785

Muscle vibration sustains motor unit firing rate during submaximal isometric fatigue in humans.

PubMed

Griffin, L; Garland, S J; Ivanova, T; Gossen, E R

2001-09-15

1. In keeping with the 'muscular wisdom hypothesis', many studies have documented that the firing rate of the majority of motor units decreased during fatiguing isometric contractions. The present study investigated whether the application of periodic muscle vibration, which strongly activates muscle spindles, would alter the modulation of motor unit firing rate during submaximal fatiguing isometric contractions. 2. Thirty-three motor units from the lateral head of the triceps brachii muscle were recorded from 10 subjects during a sustained isometric 20 % maximal voluntary contraction (MVC) of the elbow extensors. Vibration was interposed on the contraction for 2 s every 10 s. Twenty-two motor units were recorded from the beginning of the fatigue task. The discharge rate of the majority of motor units remained constant (12/22) or increased (4/22) with fatigue. Six motor units demonstrated a reduction in discharge rate that later returned toward initial values; these motor units had higher initial discharge rates than the other 16 motor units. 3. In a second series of experiments, four subjects held a sustained isometric 20 % MVC for 2 min and then vibration was applied as above for the remainder of the contraction. In this case, motor units initially demonstrated a decrease in firing rate that increased after the vibration was applied. Thus muscle spindle disfacilitation of the motoneurone pool may be associated with the decline of motor unit discharge rate observed during the first 2 min of the contraction. 4. In a third set of experiments, seven subjects performed the main experiment on one occasion and repeated the fatigue task without vibration on a second occasion. Neither the endurance time of the fatiguing contraction nor the MVC torque following fatigue was affected by the application of vibration. This finding calls into question the applicability of the muscular wisdom hypothesis to submaximal contractions.

SHIMMER (1.0): a novel mathematical model for microbial and biogeochemical dynamics in glacier forefield ecosystems

NASA Astrophysics Data System (ADS)

Bradley, J. A.; Anesio, A. M.; Singarayer, J. S.; Heath, M. R.; Arndt, S.

2015-10-01

SHIMMER (Soil biogeocHemIcal Model for Microbial Ecosystem Response) is a new numerical modelling framework designed to simulate microbial dynamics and biogeochemical cycling during initial ecosystem development in glacier forefield soils. However, it is also transferable to other extreme ecosystem types (such as desert soils or the surface of glaciers). The rationale for model development arises from decades of empirical observations in glacier forefields, and enables a quantitative and process focussed approach. Here, we provide a detailed description of SHIMMER, test its performance in two case study forefields: the Damma Glacier (Switzerland) and the Athabasca Glacier (Canada) and analyse sensitivity to identify the most sensitive and unconstrained model parameters. Results show that the accumulation of microbial biomass is highly dependent on variation in microbial growth and death rate constants, Q10 values, the active fraction of microbial biomass and the reactivity of organic matter. The model correctly predicts the rapid accumulation of microbial biomass observed during the initial stages of succession in the forefields of both the case study systems. Primary production is responsible for the initial build-up of labile substrate that subsequently supports heterotrophic growth. However, allochthonous contributions of organic matter, and nitrogen fixation, are important in sustaining this productivity. The development and application of SHIMMER also highlights aspects of these systems that require further empirical research: quantifying nutrient budgets and biogeochemical rates, exploring seasonality and microbial growth and cell death. This will lead to increased understanding of how glacier forefields contribute to global biogeochemical cycling and climate under future ice retreat.

Modeling potential responses to smallpox as a bioterrorist weapon.

PubMed

Meltzer, M I; Damon, I; LeDuc, J W; Millar, J D

2001-01-01

We constructed a mathematical model to describe the spread of smallpox after a deliberate release of the virus. Assuming 100 persons initially infected and 3 persons infected per infectious person, quarantine alone could stop disease transmission but would require a minimum daily removal rate of 50% of those with overt symptoms. Vaccination would stop the outbreak within 365 days after release only if disease transmission were reduced to <0.85 persons infected per infectious person. A combined vaccination and quarantine campaign could stop an outbreak if a daily quarantine rate of 25% were achieved and vaccination reduced smallpox transmission by > or = 33%. In such a scenario, approximately 4,200 cases would occur and 365 days would be needed to stop the outbreak. Historical data indicate that a median of 2,155 smallpox vaccine doses per case were given to stop outbreaks, implying that a stockpile of 40 million doses should be adequate.

An analysis of pump cavitation damage. [Space Shuttle main engine high pressure oxidizer turbopump

NASA Technical Reports Server (NTRS)

Brophy, M. C.; Stinebring, D. R.; Billet, M. L.

1985-01-01

The cavitation assessment for the space shuttle main engine high pressure oxidizer turbopump is documented. A model of the flow through the pump was developed. Initially, a computational procedure was used to analyze the flow through the inlet casing including the prediction of wakes downstream of the casing vanes. From these flow calculations, cavitation patterns on the inducer blades were approximated and the damage rate estimated. The model correlates the heavy damage on the housing and over the inducer with unsteady blade surface cavitation. The unsteady blade surface cavitation is due to the large incidence changes caused by the wakes of the upstream vanes. Very high cavitation damage rates are associated with this type of cavitation. Design recommendations for reducing the unsteady cavitation include removing the set of vanes closest to the inducer and modifying the remaining vanes.

A study of pump cavitation damage. [space shuttle main engine high pressure oxidizer turbopump

NASA Technical Reports Server (NTRS)

Brophy, M. C.; Stinebring, D. R.; Billet, M. L.

1983-01-01

The cavitation assessment for the space shuttle main engine high pressure oxidizer turbopump is documented. A model of the flow through the pump was developed. Initially, a computational procedure was used to analyze the flow through the inlet casing including the prediction of wakes downstream of the casing vanes. From these flow calculations, cavitation patterns on the inducer blades were approximated and the damage rate estimated. The model correlates the heavy damage on the housing and over the inducer with unsteady blade surface cavitation. The unsteady blade surface cavitation is due to the large incidence changes caused by the wakes of the upstream vanes. Very high cavitation damage rates are associated with this type of cavitation. Design recommendations for reducing the unsteady cavitation include removing the set of vanes closest to the inducer and modifying the remaining vanes.

Assessing Hepatitis C Burden and Treatment Effectiveness through the British Columbia Hepatitis Testers Cohort (BC-HTC): Design and Characteristics of Linked and Unlinked Participants

PubMed Central

Janjua, Naveed Zafar; Kuo, Margot; Chong, Mei; Yu, Amanda; Alvarez, Maria; Cook, Darrel; Armour, Rosemary; Aiken, Ciaran; Li, Karen; Mussavi Rizi, Seyed Ali; Woods, Ryan; Godfrey, David; Wong, Jason; Gilbert, Mark; Tyndall, Mark W.; Krajden, Mel

2016-01-01

Background The British Columbia (BC) Hepatitis Testers Cohort (BC-HTC) was established to assess and monitor hepatitis C (HCV) epidemiology, cost of illness and treatment effectiveness in BC, Canada. In this paper, we describe the cohort construction, data linkage process, linkage yields, and comparison of the characteristics of linked and unlinked individuals. Methods The BC-HTC includes all individuals tested for HCV and/or HIV or reported as a case of HCV, hepatitis B (HBV), HIV or active tuberculosis (TB) in BC linked with the provincial health insurance client roster, medical visits, hospitalizations, drug prescriptions, the cancer registry and mortality data using unique personal health numbers. The cohort includes data since inception (1990/1992) of each database until 2012/2013 with plans for annual updates. We computed linkage rates by year and compared the characteristics of linked and unlinked individuals. Results Of 2,656,323 unique individuals available in the laboratory and surveillance data, 1,427,917(54%) were included in the final linked cohort, including about 1.15 million tested for HCV and about 1.02 million tested for HIV. The linkage rate was 86% for HCV tests, 89% for HCV cases, 95% for active TB cases, 48% for HIV tests and 36% for HIV cases. Linkage rates increased from 40% for HCV negatives and 70% for HCV positives in 1992 to ~90% after 2005. Linkage rates were lower for males, younger age at testing, and those with unknown residence location. Linkage rates for HCV testers co-infected with HIV, HBV or TB were very high (90–100%). Conclusion Linkage rates increased over time related to improvements in completeness of identifiers in laboratory, surveillance, and registry databases. Linkage rates were higher for HCV than HIV testers, those testing positive, older individuals, and females. Data from the cohort provide essential information to support the development of prevention, care and treatment initiatives for those infected with HCV. PMID:26954020

Assessing Hepatitis C Burden and Treatment Effectiveness through the British Columbia Hepatitis Testers Cohort (BC-HTC): Design and Characteristics of Linked and Unlinked Participants.

PubMed

Janjua, Naveed Zafar; Kuo, Margot; Chong, Mei; Yu, Amanda; Alvarez, Maria; Cook, Darrel; Armour, Rosemary; Aiken, Ciaran; Li, Karen; Mussavi Rizi, Seyed Ali; Woods, Ryan; Godfrey, David; Wong, Jason; Gilbert, Mark; Tyndall, Mark W; Krajden, Mel

2016-01-01

The British Columbia (BC) Hepatitis Testers Cohort (BC-HTC) was established to assess and monitor hepatitis C (HCV) epidemiology, cost of illness and treatment effectiveness in BC, Canada. In this paper, we describe the cohort construction, data linkage process, linkage yields, and comparison of the characteristics of linked and unlinked individuals. The BC-HTC includes all individuals tested for HCV and/or HIV or reported as a case of HCV, hepatitis B (HBV), HIV or active tuberculosis (TB) in BC linked with the provincial health insurance client roster, medical visits, hospitalizations, drug prescriptions, the cancer registry and mortality data using unique personal health numbers. The cohort includes data since inception (1990/1992) of each database until 2012/2013 with plans for annual updates. We computed linkage rates by year and compared the characteristics of linked and unlinked individuals. Of 2,656,323 unique individuals available in the laboratory and surveillance data, 1,427,917(54%) were included in the final linked cohort, including about 1.15 million tested for HCV and about 1.02 million tested for HIV. The linkage rate was 86% for HCV tests, 89% for HCV cases, 95% for active TB cases, 48% for HIV tests and 36% for HIV cases. Linkage rates increased from 40% for HCV negatives and 70% for HCV positives in 1992 to ~90% after 2005. Linkage rates were lower for males, younger age at testing, and those with unknown residence location. Linkage rates for HCV testers co-infected with HIV, HBV or TB were very high (90-100%). Linkage rates increased over time related to improvements in completeness of identifiers in laboratory, surveillance, and registry databases. Linkage rates were higher for HCV than HIV testers, those testing positive, older individuals, and females. Data from the cohort provide essential information to support the development of prevention, care and treatment initiatives for those infected with HCV.

Rates of breastfeeding initiation among newborns.

PubMed

Maimburg, Rikke Damkjær

2017-06-01

Rates of breastfeeding initiation in hospitals with a tertiary neonatal intensive care unit are limited. A follow-up study with prospectively collected data in a Danish university hospital with approximately 5000 annual births was conducted. Between 1 February 2015 and 30 June 2015, 1939 newborns were enrolled in the study. Rates of frequencies for initiation of breastfeeding were calculated. High initiations rates for breastfeeding were found among term-born infants. Newborns of multiparous women had the highest initiation rate of 91.7% and newborns delivered by cesarean section had the lowest initiation rate of 73.3%. Copyright © 2017 Elsevier B.V. All rights reserved.

Incidence and outcome of subtypes of ischaemic stroke: initial results from the north East melbourne stroke incidence study (NEMESIS).

PubMed

Dewey, Helen M; Sturm, Jonathan; Donnan, Geoffrey A; Macdonell, Richard A L; McNeil, John J; Thrift, Amanda G

2003-01-01

Information about the incidence and outcome of stroke subtypes is necessary to understand the likely impact of stroke prevention and treatment strategies. The purpose of this study was to determine the incidence and outcome of subtypes of cerebral infarction (CI). All strokes occurring in a population of 133816 in Melbourne, Australia, during a 12-month period of 1996 and 1997 were identified and cases of CI subtyped according to the Oxfordshire Community Stroke Project classification. 276 'first-ever-in-a-lifetime' stroke cases were registered. CI accounted for 72% of cases. Annual incidence rates per 100000 persons adjusted to the 'world' population were 11 (95% CI, 4-18) for TACI, 25 (95% CI, 15-35) for PACI, 17 (95% CI, 9-25) for POCI and 18 (95% CI, 10-26) for LACI. 28-day case fatality was highest for TACI (35%; 95% CI, 19-51%) and first year recurrence rate highest for PACI (17%; 95% CI, 8-26%). TACI had the poorest functional outcome at 3 and 12 months. These findings are similar to those of two previous studies conducted in the northern hemisphere. Copyright 2003 S. Karger AG, Basel

Transluminal Angioplasty of Peroneal Artery Branches in Diabetics: Initial Technical Experience

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

Graziani, Lanfroi, E-mail: langrazi@tin.it; Silvestro, Antonio; Monge, Luca

2008-01-15

The present study aimed to report the technical feasibility of percutaneous transluminal angioplasty (PTA) of obstructed or insufficient collateral branches (anterior and posterior perforating branches) from distal peroneal to foot arteries in diabetic patients with chronic critical limb ischemia (CLI) and chronic noncrossable occlusion of the anterior and posterior tibial arteries. Twenty-four diabetic CLI patients (age, 67 {+-} 8 years; 87% males) undergoing collateral PTA were included. Baseline clinical angiographic and follow-up data were retrospectively reviewed. Collateral PTA was associated with a concomitant PTA of other sites in 21 (83%) cases. In 15 cases the treated collateral linked the peronealmore » with the plantaris communis; in 9 cases, the peroneal with the dorsalis pedis. Angiographic results of collateral PTA were good in 13 cases (<30% residual stenosis), whereas the result was considered moderate (30%-49% residual stenosis) in the remaining cases. Neither perforation nor acute occlusion of the treated collaterals or other relevant complications were observed. Mean follow-up was 32 {+-} 17 months. Major amputation was necessary for two (8.3%) patients. Cumulative limb salvage rates at 2 and 4 years were 96% and 87%, respectively. In conclusion, this initial experience shows that PTA of the collateral branches from distal peroneal to foot arteries is a feasible technique. Future studies are required to define the clinical role of this novel approach.« less

A Single Institution Review of Initial Application of a 5-mm Stapler.

PubMed

Rogers, Andrew P; Zens, Tiffany J; Kohler, Jonathan E; Le, Hau D; Nichol, Peter F; Leys, Charles M

2016-08-01

Operating in small spaces presents physical constraints that can be even more challenging in minimally invasive operations. Recently, a 5-mm stapler was approved for use in general surgery and pediatric surgery. Here, we present our initial experience using the 5-mm stapler in pediatric general surgery. A retrospective chart review was conducted to identify cases using the 5-mm stapler at our institution. Demographic data included age (in months) and weight (in kilograms). Operative data included indication for use, number of loads used, complications related to 5-mm stapler use, and interventions to address complications. A second review focused on patients undergoing the same operations, but using a 10-mm stapler. A total of 60 staple loads were deployed in 32 procedures. There were four adverse outcomes, all recognized intraoperatively. One bleed resulted from application on irradiated tissue and another bleed from application to a small noninflamed mesoappendix. A bronchial staple line leak resulted from improper stapler loading, and a bowel anastomosis leak was oversewn with a single stitch. When compared with 32 matched cases using a 10-mm stapler, there was no difference in age (5-mm = 39.11 months, 10-mm = 50.21 months, P = .49) or weight (5-mm = 16.34 kg, 10-mm = 19.93 kg, P = .51). A total of 60 staple applications were used, with one bleed noted. There was no significant difference in overall complication rate (5-mm rate = 4/60, 10-mm rate = 1/60; P = .36). Our initial experience suggests that although there were more complications with the 5-mm stapler, there is no statistically significant difference in complication rates when compared with the 10-mm stapler. Furthermore, the 5-mm stapler complications can be corrected with device training and proper patient selection. In appropriately selected pediatric surgery cases with size limitations, the 5-mm stapler can be used to minimize the invasiveness of the operation.

Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest: Primary Results From the HeartRescue Project.

PubMed

van Diepen, Sean; Girotra, Saket; Abella, Benjamin S; Becker, Lance B; Bobrow, Bentley J; Chan, Paul S; Fahrenbruch, Carol; Granger, Christopher B; Jollis, James G; McNally, Bryan; White, Lindsay; Yannopoulos, Demetris; Rea, Thomas D

2017-09-22

The HeartRescue Project is a multistate public health initiative focused on establishing statewide out-of-hospital cardiac arrest (OHCA) systems of care to improve case capture and OHCA care in the community, by emergency medical services (EMS), and at hospital level. From 2011 to 2015 in the 5 original HeartRescue states, all adults with EMS-treated OHCA due to a presumed cardiac cause were included. In an adult population of 32.8 million, a total of 64 988 OHCAs-including 10 046 patients with a bystander-witnessed OHCA with a shockable rhythm-were treated by 330 EMS agencies. From 2011 to 2015, the case-capture rate for all-rhythm OHCA increased from an estimated 39.0% (n=6762) to 89.2% (n=16 103; P <0.001 for trend). Overall survival to hospital discharge was 11.4% for all rhythms and 34.0% in the subgroup with bystander-witnessed OHCA with a shockable rhythm. We observed modest temporal increases in bystander cardiopulmonary resuscitation (41.8-43.5%, P <0.001 for trend) and bystander automated external defibrillator application (3.2-5.6%, P <0.001 for trend) in the all-rhythm group, although there were no temporal changes in survival. There were marked all-rhythm survival differences across the 5 states (8.0-16.1%, P <0.001) and across participating EMS agencies (2.7-26.5%, P <0.001). In the initial 5 years, the HeartRescue Project developed a population-based OHCA registry and improved statewide case-capture rates and some processes of care, although there were no early temporal changes in survival. The observed survival variation across states and EMS systems presents a future challenge to elucidate the characteristics of high-performing systems with the goal of improving OHCA care and survival. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Acute and Late Toxicity After Dose Escalation to 82 GyE Using Conformal Proton Radiation for Localized Prostate Cancer: Initial Report of American College of Radiology Phase II Study 03-12

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

Coen, John J., E-mail: jcoen@partners.org; Bae, Kyounghwa; Zietman, Anthony L.

Purpose: Several randomized trials have shown a benefit of dose escalation to 78 to 79 Gy for men treated with external radiation for localized prostate cancer. Single-institution data suggest a benefit with even higher doses. American College of Radiology 03-12 is a Phase II trial testing the safety and efficacy of 82 GyE (Gray equivalent) delivered with conformal proton radiation. Methods and Materials: From 2003-2006, 85 men with localized prostate cancer were accrued to American College of Radiology 03-12. Eighty-four were eligible for analysis. They were treated with conformal proton radiation alone to a total dose of 82 GyE. Themore » study was designed to test whether the rate of 18-month Grade 3+ late toxicity was greater than 10%. Results: The median follow-up was 31.6 months. Regarding treatment-related acute toxicity, there were 39 Grade 1 cases (46%), 19 Grade 2 cases (23%) and 2 Grade 3 cases (2%). Regarding genitourinary/gastrointestinal toxicity, there were 42 Grade 1 cases (50%), 12 Grade 2 cases (14%) and 1 Grade 3 case (1%). Regarding late toxicity, there were 28 Grade 1 cases (33%), 22 Grade 2 cases (26%), 6 Grade 3 cases (7%), and 1 Grade 4 case (1%). The late genitourinary/gastrointestinal rates were the same. The estimated rate of Grade 3+ late toxicity at 18 months was 6.08%. Conclusions: Although not free of late toxicity, 82 GyE at 2 GyE per fraction delivered with conformal proton radiation did not exceed the late morbidity target tested in this trial. There was sufficient morbidity, however, that this may be the maximal dose that can be delivered safely with this technique and fractionation.« less

Defining Polio: Closing the Gap in Global Surveillance.

PubMed

Tajaldin, Bachir; Almilaji, Khaled; Langton, Paul; Sparrow, Annie

2015-01-01

By late 2012 the Global Polio Eradication Initiative (GPEI) had nearly eradicated this ancient infectious disease. Successful surveillance programs for acute flaccid paralysis however rely on broad governmental support for implementation. With the onset of conflict, public health breakdown has contributed to the resurgence of polio in a number of regions. The current laboratory based case definition may be a contributory factor in these regions. We sought to compare case definition rates using strict laboratory based criteria to rates obtained using the clinical criteria in modern day Syria. We also sought to examine this distribution of cases by sub-region. We examined the World Health Organization (WHO) reported figures for Syria from 2013-2014 using laboratory based criteria. We compared these with cases obtained when clinical criteria were applied. In addition we sought data from the opposition controlled Assistance Coordination Unit which operates in non-Government controlled areas where WHO data maybe incomplete. Cases were carefully examined for potential overlap to avoid double reporting. Whilst the WHO data clearly confirmed the polio outbreak in Syria, it did so with considerable delay and with under reporting of cases, particularly from non-government controlled areas. In addition, laboratory based case definition led to a substantial underestimate of polio (36 cases) compared with those found with the clinically compatible definition (an additional 46 cases). Rates of adequate diagnostic specimens from suspected cases are well below target, no doubt reflecting the effect of conflict in these areas. We have identified a gap in the surveillance of polio, a global threat. The current laboratory based definition, in the setting of conflict and insecurity, leads to under diagnosis of polio with potential delays and inadequacies in coordinating effective responses to contain outbreaks and eradicate polio. Breakdown in public health measures as a contributing factor is likely to result in a resurgence of previously controlled infectious diseases. The clinical definition should be reinstituted to supplement the lab-based definition. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

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.

Bundled payment initiatives for Medicare and non-Medicare total joint arthroplasty patients at a community hospital: bundles in the real world.

PubMed

Doran, James P; Zabinski, Stephen J

2015-03-01

In the setting of current United States healthcare reform, bundled payment initiatives and episode of care payment models for total joint arthroplasty (TJA) have become increasingly common. The following is a review of our results and experience in a community hospital with bundled payment initiatives for both non-Medicare and Medicare TJA patients since 2011. We have successfully decreased the cost of the TJA episode of care in comparison to our historical averages prior to 2011. This cost-reduction has primarily been achieved through decreased length of inpatient stay, increased discharge to home rather than to skilled nursing or inpatient rehabilitation facilities, reduction in implant cost, improvement in readmission rate and migration of cases to lower cost sites of service. Copyright © 2015 Elsevier Inc. All rights reserved.

Systematic ultrasound-guided saturation and template biopsy of the prostate: indications and advantages of extended sampling.

PubMed

Isbarn, Hendrik; Briganti, Alberto; De Visschere, Pieter J L; Fütterer, Jurgen J; Ghadjar, Pirus; Giannarini, Gianluca; Ost, Piet; Ploussard, Guillaume; Sooriakumaran, Prasanna; Surcel, Christian I; van Oort, Inge M; Yossepowitch, Ofer; van den Bergh, Roderick C N

2015-04-01

Prostate biopsy (PB) is the gold standard for the diagnosis of prostate cancer (PCa). However, the optimal number of biopsy cores remains debatable. We sought to compare contemporary standard (10-12 cores) vs. saturation (=18 cores) schemes on initial as well as repeat PB. A non-systematic review of the literature was performed from 2000 through 2013. Studies of highest evidence (randomized controlled trials, prospective non-randomized studies, and retrospective reports of high quality) comparing standard vs saturation schemes on initial and repeat PB were evaluated. Outcome measures were overall PCa detection rate, detection rate of insignificant PCa, and procedure-associated morbidity. On initial PB, there is growing evidence that a saturation scheme is associated with a higher PCa detection rate compared to a standard one in men with lower PSA levels (<10 ng/ml), larger prostates (>40 cc), or lower PSA density values (<0.25 ng/ml/cc). However, these cut-offs are not uniform and differ among studies. Detection rates of insignificant PCa do not differ in a significant fashion between standard and saturation biopsies. On repeat PB, PCa detection rate is likewise higher with saturation protocols. Estimates of insignificant PCa vary widely due to differing definitions of insignificant disease. However, the rates of insignificant PCa appear to be comparable for the schemes in patients with only one prior negative biopsy, while saturation biopsy seems to detect more cases of insignificant PCa compared to standard biopsy in men with two or more prior negative biopsies. Very extensive sampling is associated with a high rate of acute urinary retention, whereas other severe adverse events, such as sepsis, appear not to occur more frequently with saturation schemes. Current evidence suggests that saturation schemes are associated with a higher PCa detection rate compared to standard ones on initial PB in men with lower PSA levels or larger prostates, and on repeat PB. Since most data are derived from retrospective studies, other endpoints such as detection rate of insignificant disease - especially on repeat PB - show broad variations throughout the literature and must, thus, be interpreted with caution. Future prospective controlled trials should be conducted to compare extended templates with newer techniques, such as image-guided sampling, in order to optimize PCa diagnostic strategy.

Syringe Pump Performance Maintained with IV Filter Use During Low Flow Rate Delivery for Pediatric Patients.

PubMed

Chau, Destiny F; Vasilopoulos, Terrie; Schoepf, Miriam; Zhang, Christina; Fahy, Brenda G

2016-09-01

Complex surgical and critically ill pediatric patients rely on syringe infusion pumps for precise delivery of IV medications. Low flow rates and in-line IV filter use may affect drug delivery. To determine the effects of an in-line filter to remove air and/or contaminants on syringe pump performance at low flow rates, we compared the measured rates with the programmed flow rates with and without in-line IV filters. Standardized IV infusion assemblies with and without IV filters (filter and control groups) attached to a 10-mL syringe were primed and then loaded onto a syringe pump and connected to a 16-gauge, 16-cm single-lumen catheter. The catheter was suspended in a normal saline fluid column to simulate the back pressure from central venous circulation. The delivered infusate was measured by gravimetric methods at predetermined time intervals, and flow rate was calculated. Experimental trials for initial programmed rates of 1.0, 0.8, 0.6, and 0.4 mL/h were performed in control and filter groups. For each trial, the flow rate was changed to double the initial flow rate and was then returned to the initial flow rate to analyze pump performance for titration of rates often required during medication administration. These conditions (initial rate, doubling of initial rate, and return to initial rate) were analyzed separately for steady-state flow rate and time to steady state, whereas their average was used for percent deviation analysis. Differences between control and filter groups were assessed using Student t tests with adjustment for multiplicity (using n = 3 replications per group). Mean time from 0 to initial flow (startup delay) was <1 minute in both groups with no statistical difference between groups (P = 1.0). The average time to reach steady-state flow after infusion startup or rate changes was not statistically different between the groups (range, 0.8-5.5 minutes), for any flow rate or part of the trial (initial rate, doubling of initial rate, and return to initial rate), although the study was underpowered to detect small time differences. Overall, the mean steady-state flow rate for each trial was below the programmed flow rate with negative mean percent deviations for each trial. In the 1.0-mL/h initial rate trial, the steady-state flow rate attained was lower in the filter than the control group for the initial rate (P = 0.04) and doubling of initial rate (P = 0.04) with a trend during the return to initial rate (P = 0.06), although this same effect was not observed when doubling the initial rate trials of 0.8 or 0.6 mL/h or any other rate trials compared with the control group. With low flow rates used in complex surgical and pediatric critically ill patients, the addition of IV filters did not confer statistically significant changes in startup delay, flow variability, or time to reach steady-state flow of medications administered by syringe infusion pumps. The overall flow rate was lower than programmed flow rate with or without a filter.

Criminal Behavior and Repeat Violent Trauma: A Case-Control Study.

PubMed

Nanney, John T; Conrad, Erich J; McCloskey, Michael; Constans, Joseph I

2015-09-01

Repeat violent injury is common among young urban men and is increasingly a focus of trauma center-based injury prevention efforts. Though understanding risk factors for repeat violent injury may be critical in designing such interventions, this knowledge is limited. This study aims to determine which criminal behaviors, both before and after the initial trauma, predict repeat violent trauma. Gun, violent, and drug crimes are expected to increase risk of subsequent violent injury among victims of violence. A case-control design examined trauma registry and publicly available criminal data for all male patients aged <40 years presenting for violent trauma between April 2006 and December 2011 (N=1,142) to the sole Level 1 trauma center in a city with high rates of violence. Logistic regression was used to determine criminal behaviors predictive of repeat violent injury. Data were obtained and analyzed between January 2013 and June 2014. Regarding crimes committed before the first injury, only drug crime (OR=5.32) predicted repeat violent trauma. With respect to crimes committed after the initial injury, illegal gun possession (OR=2.70) predicted repeat victimization. Initiating gun (OR=3.53) or drug crime (OR=5.12) was associated with increased risk. Prior drug involvement may identify young male victims of violence as at high risk of repeat violent injury. Gun carrying and initiating drug involvement after the initial injury may increase risk of repeat injury and may be important targets for interventions aimed at preventing repeat violent trauma. Published by Elsevier Inc.

Transient chaos in the Lorenz-type map with periodic forcing.

PubMed

Maslennikov, Oleg V; Nekorkin, Vladimir I; Kurths, Jürgen

2018-03-01

We consider a case study of perturbing a system with a boundary crisis of a chaotic attractor by periodic forcing. In the static case, the system exhibits persistent chaos below the critical value of the control parameter but transient chaos above the critical value. We discuss what happens to the system and particularly to the transient chaotic dynamics if the control parameter periodically oscillates. We find a non-exponential decaying behavior of the survival probability function, study the impact of the forcing frequency and amplitude on the escape rate, analyze the phase-space image of the observed dynamics, and investigate the influence of initial conditions.

Transient chaos in the Lorenz-type map with periodic forcing

NASA Astrophysics Data System (ADS)

Maslennikov, Oleg V.; Nekorkin, Vladimir I.; Kurths, Jürgen

2018-03-01

We consider a case study of perturbing a system with a boundary crisis of a chaotic attractor by periodic forcing. In the static case, the system exhibits persistent chaos below the critical value of the control parameter but transient chaos above the critical value. We discuss what happens to the system and particularly to the transient chaotic dynamics if the control parameter periodically oscillates. We find a non-exponential decaying behavior of the survival probability function, study the impact of the forcing frequency and amplitude on the escape rate, analyze the phase-space image of the observed dynamics, and investigate the influence of initial conditions.

High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia.

PubMed

Doshi, Jalpa A; Li, Pengxiang; Huo, Hairong; Pettit, Amy R; Kumar, Rishab; Weiss, Brenda M; Huntington, Scott F

2016-03-01

Specialty drugs often offer medical advances but are frequently subject to high cost sharing. This is particularly true with Medicare Part D, where after meeting a deductible, patients without low-income subsidies (non-LIS) typically face 25% to 33% coinsurance (initial coverage phase with "specialty tier" cost sharing), followed by ~50% coinsurance (coverage gap phase), and then 5% coinsurance (catastrophic phase). Yet, no studies have examined the impact of such high cost sharing on specialty drug initiation under Part D. Oral tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), making it an apt case study. A retrospective claims-based analysis utilizing 2011 to 2013 100% Medicare claims. TKI initiation rates and time to initiation were compared between fee-for-service non-LIS Part D patients newly diagnosed with CML and their LIS counterparts who faced nominal cost sharing of ≤ $5. The first 30-day TKI fill "straddled" benefit phases, for a mean out-of-pocket cost of $2600 or more for non-LIS patients. Non-LIS patients were less likely than LIS patients to have a TKI claim within 6 months of diagnosis (45.3% vs 66.9%; P < .001) and those initiating a TKI took twice as long to fill it (mean = 50.9 vs 23.7 days; P < .001). Cox regressions controlling for sociodemographic, clinical, and plan characteristics confirmed descriptive findings (hazard ratio, 0.59; 95% CI, 0.45-0.76). Extensive sensitivity analyses confirmed the robustness of our findings. High cost sharing was associated with reduced and/or delayed initiation of TKIs. We discuss policy strategies to reduce current financial barriers that adversely impact access to critical therapies under Medicare Part D.

Infectious disease morbidity among young HIV-1-exposed but uninfected infants in Latin American and Caribbean countries: the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study.

PubMed

Mussi-Pinhata, Marisa M; Freimanis, Laura; Yamamoto, Aparecida Y; Korelitz, James; Pinto, Jorge A; Cruz, Maria L S; Losso, Marcelo H; Read, Jennifer S

2007-03-01

The goal was to describe the frequency, characteristics, and correlates of infectious disease morbidity during the first 6 months of life among HIV-1-exposed but uninfected infants. The study population consisted of infants enrolled in the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study who were HIV-1 uninfected and had follow-up data through the 6-month study visit. Definitive and presumed infections were recorded at study visits (birth, 6-12 weeks, and 6 months). Of 462 HIV-1-uninfected infants with 11,644 child-weeks of observation, 283 experienced > or = 1 infection. These 283 infants experienced 522 infections (1.8 infections per infant). The overall incidence rate of infections was 4.5 cases per 100 child-weeks of observation. Overall, the most common infections were skin or mucous membrane infections (1.9 cases per 100 child-weeks) and respiratory tract infections (1.7 cases per 100 child-weeks). Thirty-six percent of infants had > 1 respiratory tract infection (1.8 cases per 100 child-weeks). Incidence rates of upper and lower respiratory tract infections were similar (0.89 cases per 100 child-weeks and 0.9 cases per 100 child-weeks, respectively). Cutaneous and/or oral candidiasis occurred in 48 neonates (10.3%) and 92 older infants (19.3%). Early neonatal sepsis was diagnosed in 12 infants (26.0 cases per 1000 infants). Overall, 81 of 462 (17.5%) infants were hospitalized with an infection. Infants with lower respiratory tract infections were hospitalized frequently (40.7%). The occurrence of > or = 1 neonatal infection was associated with more-advanced maternal HIV-1 disease, tobacco use during pregnancy, infant anemia, and crowding. Lower maternal CD4+ cell counts, receipt of intrapartum antibiotic treatment, and country of residence were associated with postneonatal infections. Close monitoring of HIV-1-exposed infants, especially those who are anemic at birth or whose mothers have more-advanced HIV-1 disease or who smoked during pregnancy, remains important.

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis.

PubMed

Park, Yoonah; Yong, Yuen Geng; Yun, Seong Hyeon; Jung, Kyung Uk; Huh, Jung Wook; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

2015-05-01

This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC). This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes. Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%). The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase.

The wave equation in Friedmann-Robertson-Walker space-times and asymptotics of the intensity and distance relationship of a localised source

NASA Astrophysics Data System (ADS)

Starko, Darij; Craig, Walter

2018-04-01

Variations in redshift measurements of Type 1a supernovae and intensity observations from large sky surveys are an indicator of a component of acceleration in the rate of expansion of space-time. A key factor in the measurements is the intensity-distance relation for Maxwell's equations in Friedmann-Robertson-Walker (FRW) space-times. In view of future measurements of the decay of other fields on astronomical time and spatial scales, we determine the asymptotic behavior of the intensity-distance relationship for the solution of the wave equation in space-times with an FRW metric. This builds on previous work done on initial value problems for the wave equation in FRW space-time [Abbasi, B. and Craig, W., Proc. R. Soc. London, Ser. A 470, 20140361 (2014)]. In this paper, we focus on the precise intensity decay rates of the special cases for curvature k = 0 and k = -1, as well as giving a general derivation of the wave solution for -∞ < k < 0. We choose a Cauchy surface {(t, x) : t = t0 > 0} where t0 represents the time of an initial emission source, relative to the Big Bang singularity at t = 0. The initial data [g(x), h(x)] are assumed to be compactly supported; supp(g, h) ⊆ BR(0) and terms in the expression for the fundamental solution for the wave equation with the slowest decay rate are retained. The intensities calculated for coordinate time {t : t > 0} contain correction terms proportional to the ratio of t0 and the time differences ρ = t - t0. For the case of general curvature k, these expressions for the intensity reduce by scaling to the same form as for k = -1, from which we deduce the general formula. We note that for typical astronomical events such as Type 1a supernovae, the first order correction term for all curvatures -∞ < k < 0 is on the order of 10-4 smaller than the zeroth order term. These correction terms are small but may be significant in applications to alternative observations of cosmological space-time expansion rates.

Ceftaroline fosamil use in hospitalized patients with acute bacterial skin and skin structure infections: Budget impact analysis from a hospital perspective.

PubMed

Huang, Xingyue; Beresford, Eric; Lodise, Thomas; Friedland, H David

2013-06-15

The budgetary impact of adding ceftaroline fosamil to a hospital formulary for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) was evaluated. A three-year hospital budget impact model was constructed with three initial treatment options for ABSSSIs: ceftaroline fosamil, vancomycin plus aztreonam, and other vancomycin-containing regimens. The target population was hospitalized adult patients with an ABSSSI. Clinical cure rates with initial treatment were assumed to be similar to those from ceftaroline fosamil clinical trials. Patients who did not respond to initial treatment were assumed to be treated successfully with second-line antimicrobial therapy. Length of stay and cost per hospital day (by success or failure with initial treatment) were estimated based on a large database from more than 100 U.S. hospitals. Other model inputs included the annual number of ABSSSI admissions, projected annual case growth rate, proportion of ABSSSI target population receiving vancomycin-containing regimen, expected proportion of ABSSSI target population to be treated with ceftaroline fosamil, drug acquisition cost, cost of antibiotic administration, and cost of vancomycin monitoring. Sensitivity analysis using 95% confidence limits of clinical cure rates was also performed. The estimated total cost of care for treating a patient with an ABSSSI was $395 lower with ceftaroline fosamil ($15,087 versus $15,482) compared with vancomycin plus aztreonam and $72 lower ($15,087 versus $15,159) compared with other vancomycin-containing regimens. Model estimates indicated that adding ceftaroline fosamil to the hospital formulary would not have a negative effect on a hospital's budget for ABSSSI treatment.

Application of Appropriate Use Criteria for Initial Transthoracic Echocardiography in an Academic Outpatient Pediatric Cardiology Program.

PubMed

Safa, Raya; Aggarwal, Sanjeev; Misra, Amrit; Kobayashi, Daisuke

2017-08-01

Transthoracic echocardiography (TTE) is a non-invasive diagnostic modality for children with suspected heart disease. The American College of Cardiology published Appropriate Use Criteria (AUC) for an initial outpatient pediatric TTE in 2014 to promote effective care and improve resource utilization. The objective was to determine the appropriateness of TTE per the published AUC in a single academic pediatric cardiology clinic as a baseline performance quality measure. The echocardiography database was used to identify initial outpatient TTE in children during January-March 2014. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. The effect of AUC and age groups on yield of abnormal TTE findings was analyzed. Of the 2166 screened studies, our study cohort consisted of 247 TTEs. Indications rated A, M, and R were found in 129, 27, and 90, respectively, and 1 was unclassifiable. Majority of TTE (n = 183) were normal, although incidental findings were noted in 32 and abnormal findings in 32 cases. Abnormal findings were noted in 26/129 of A, 2/27 of M, and 4/90 of R. Indications rated A were significantly associated with yield of abnormal TTE findings, adjusted by age group. Infants and adolescents were more likely to have abnormal TTE findings compared to young children. Recently published AUC were validated for initial TTE in the outpatient pediatric cardiology clinic. Appropriateness rated by AUC was highly associated with yield of abnormal TTE findings and worked best in infants and adolescent.

Replication RCT of Early Universal Prevention Effects on Young Adult Substance Misuse

PubMed Central

Spoth, Richard; Trudeau, Linda; Redmond, Cleve; Shin, Chungyeol

2014-01-01

Objective For many substances, more frequent and problematic use occurs in young adulthood; these types of use are predicted by the timing of initiation during adolescence. We replicated and extended an earlier study examining whether delayed substance initiation during adolescence, resulting from universal preventive interventions implemented in middle school, reduces problematic use in young adulthood. Method Participants were middle school students from 36 Iowa schools randomly assigned to the Strengthening Families Program plus Life Skills Training (SFP 10–14 + LST), LST-only, or a control condition. Self-report questionnaires were collected at 11 time points, including four during young adulthood. The intercept (average level) and rate of change (slope) in young adult frequency measures (drunkenness, alcohol-related problems, cigarettes, and illicit drugs) across ages 19–22 were modeled as outcomes influenced by growth factors describing substance initiation during adolescence. Analyses entailed testing a two-step hierarchical latent growth curve model; models included the effects of baseline risk, intervention condition assignment, and their interaction. Results Analyses showed significant indirect intervention effects on the average levels of all young adult outcomes, through effects on adolescent substance initiation growth factors, along with intervention by risk interaction effects favoring the higher-risk subsample. Additional direct effects on young adult use were observed in some cases. Relative reduction rates were larger for the higher-risk subsample at age 22, ranging from 5.8% to 36.4% on outcomes showing significant intervention effects. Conclusions Universal preventive interventions implemented during early adolescence have the potential to decrease the rates of substance use and associated problems, into young adulthood. PMID:24821095

Under Pressure: Financial Impact of the Hospital-Acquired Conditions Initiative. A Statewide Analysis of Pressure Ulcer Development and Payment

PubMed Central

Meddings, Jennifer A.; Reichert, Heidi; Rogers, Mary A. M.; Hofer, Timothy P.; McMahon, Laurence F.; Grazier, Kyle L.

2017-01-01

OBJECTIVE To assess the financial impact of the 2008 Hospital-Acquired Conditions Initiative’s pressure ulcer payment changes on Medicare and other payors. DESIGN, SETTING AND PARTICIPANTS Retrospective before-and-after study of all-payor statewide administrative data for >2.4 million annual adult discharges from 311 nonfederal acute-care California hospitals in 2007 and 2009, using the Healthcare Cost and Utilization Project State Inpatient Datasets. We assessed how often and by how much the 2008 payment changes for pressure ulcers affected hospital payment. MEASUREMENTS Pressure ulcer rates and hospital payment changes RESULTS Hospital-acquired pressure ulcer rates were very low (0.28%) in 2007 and 2009; present-on-admission pressure ulcer rates increased from 2.35% in 2007 to 3.00% in 2009. By clinical stage of pressure ulcer (available in 2009), hospital-acquired stage III–IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for stage III–IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges for a statewide payment decrease of $310,444 (0.001%) for all payors and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers) reducing statewide payment by $62,538,586 (0.21%) for all payors and $47,237,984 (0.32%) for Medicare. CONCLUSION The total financial impact of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than stages III–IV. The removal of payment for hospital-acquired stage III–IV ulcers was more than 200 times less than the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital-Acquired Conditions Initiative. PMID:26140454

Reaction Rate of Ti0.18Zr0.84Cr1.0Fe0.7Mn0.3Cu0.057 to Use for the Heat Driven Type Compact Metal Hydride Refrigerator

NASA Astrophysics Data System (ADS)

Bae, Sang-Chul; Katsuta, Masafumi

Our final goal of this study is to develop the heat driven type compact metal hydride (MH) refrigeration system for the vending machine and the show case, and to attain a refrigeration temperature of 243 K by using a heat source of about 423K. The reaction rate of the MH to use for the heat source, MH used for heat source is studied firstly because the MH refrigeration system consists of two MHs, one is used for the heat source and the other is used for the cooling load extracting. As for the reaction rate in the hydriding process, initially, a rapid surface reaction, governed by the relation 1-(1-F )1/3=kht . After the MH surface has been covered by hydride, the reaction becomes diffusion controlled with the relation 1-3(1-F ' )2/3+2(1-F ' )=k'ht . The reaction rates, kh and k'h , are exponentially proportional to the pressure difference and increase with temperature. And, as for the dehydriding process, it is found out that the rate-controlling step is uniquely diffusion reaction. The dehydriding reaction rate is exponentially proportional to the pressure difference and the initial reacted fraction, and increases with temperature. Finally, on the basis of these experimental results, the brand new rate correlations are reasonably derived. The predicted results for this correlation are in successfully agreement with the experimental ones.

Review Article: Influenza Transmission on Aircraft: A Systematic Literature Review.

PubMed

Leitmeyer, Katrin; Adlhoch, Cornelia

2016-09-01

Air travel is associated with the spread of influenza through infected passengers and potentially through in-flight transmission. Contact tracing after exposure to influenza is not performed systematically. We performed a systematic literature review to evaluate the evidence for influenza transmission aboard aircraft. Using PubMed and EMBASE databases, we identified and critically appraised identified records to assess the evidence of such transmission to passengers seated in close proximity to the index cases. We also developed a bias assessment tool to evaluate the quality of evidence provided in the retrieved studies. We identified 14 peer-reviewed publications describing contact tracing of passengers after possible exposure to influenza virus aboard an aircraft. Contact tracing during the initial phase of the influenza A(H1N1)pdm09 pandemic was described in 11 publications. The studies describe the follow-up of 2,165 (51%) of 4,252 traceable passengers. Altogether, 163 secondary cases were identified resulting in an overall secondary attack rate among traced passengers of 7.5%. Of these secondary cases, 68 (42%) were seated within two rows of the index case. We found an overall moderate quality of evidence for transmission of influenza virus aboard an aircraft. The major limiting factor was the comparability of the studies. A majority of secondary cases was identified at a greater distance than two rows from the index case. A standardized approach for initiating, conducting, and reporting contact tracing could help to increase the evidence base for better assessing influenza transmission aboard aircraft.

Review Article: Influenza Transmission on Aircraft

PubMed Central

Adlhoch, Cornelia

2016-01-01

Background: Air travel is associated with the spread of influenza through infected passengers and potentially through in-flight transmission. Contact tracing after exposure to influenza is not performed systematically. We performed a systematic literature review to evaluate the evidence for influenza transmission aboard aircraft. Methods: Using PubMed and EMBASE databases, we identified and critically appraised identified records to assess the evidence of such transmission to passengers seated in close proximity to the index cases. We also developed a bias assessment tool to evaluate the quality of evidence provided in the retrieved studies. Results: We identified 14 peer-reviewed publications describing contact tracing of passengers after possible exposure to influenza virus aboard an aircraft. Contact tracing during the initial phase of the influenza A(H1N1)pdm09 pandemic was described in 11 publications. The studies describe the follow-up of 2,165 (51%) of 4,252 traceable passengers. Altogether, 163 secondary cases were identified resulting in an overall secondary attack rate among traced passengers of 7.5%. Of these secondary cases, 68 (42%) were seated within two rows of the index case. Conclusion: We found an overall moderate quality of evidence for transmission of influenza virus aboard an aircraft. The major limiting factor was the comparability of the studies. A majority of secondary cases was identified at a greater distance than two rows from the index case. A standardized approach for initiating, conducting, and reporting contact tracing could help to increase the evidence base for better assessing influenza transmission aboard aircraft. PMID:27253070

Different types of pausing modes during transcription initiation.

PubMed

Lerner, Eitan; Ingargiola, Antonino; Lee, Jookyung J; Borukhov, Sergei; Michalet, Xavier; Weiss, Shimon

2017-08-08

In many cases, initiation is rate limiting to transcription. This due in part to the multiple cycles of abortive transcription that delay promoter escape and the transition from initiation to elongation. Pausing of transcription in initiation can further delay promoter escape. The previously hypothesized pausing in initiation was confirmed by two recent studies from Duchi et al. 1 and from Lerner, Chung et al. 2 In both studies, pausing is attributed to a lack of forward translocation of the nascent transcript during initiation. However, the two works report on different pausing mechanisms. Duchi et al. report on pausing that occurs during initiation predominantly on-pathway of transcript synthesis. Lerner, Chung et al. report on pausing during initiation as a result of RNAP backtracking, which is off-pathway to transcript synthesis. Here, we discuss these studies, together with additional experimental results from single-molecule FRET focusing on a specific distance within the transcription bubble. We show that the results of these studies are complementary to each other and are consistent with a model involving two types of pauses in initiation: a short-lived pause that occurs in the translocation of a 6-mer nascent transcript and a long-lived pause that occurs as a result of 1-2 nucleotide backtracking of a 7-mer transcript.

Augmentin in acute exacerbations of chronic bronchitis.

PubMed

Aigner, K; Schindl, R; Mittermayer, H

1984-01-01

Forty-five patients with acute chronic bronchitis were treated with Augmentin, an amoxycillin combined with the beta-lactamase inhibitor clavulanic acid, initially by parenteral administration followed by oral treatment after 3 days lasting in the mean 7.1 days. The over-all clinical evaluation showed a cure rate of 93%. Side-effects were comparable to therapy with other amoxycillins. Bacteriological evaluation of the sputum samples demonstrated in 91% of cases an elimination of the initially isolated organism. Prior to therapy we found in 25% of the isolated strains beta-lactamase-producing and Augmentin-sensitive organisms. The parenteral formulation of Augmentin seems to be a valuable addition to the parenteral therapy of lower respiratory tract infections.

Low Rates of Major Complications for Radiofrequency Ablation of Atrial Fibrillation Maintained Over 14 Years: A Single Centre Experience of 2750 Consecutive Cases.

PubMed

Voskoboinik, Aleksandr; Sparks, Paul B; Morton, Joseph B; Lee, Geoffrey; Joseph, Stephen A; Hawson, Joshua J; Kistler, Peter M; Kalman, Jonathan M

2018-02-03

Despite technological advances, studies continue to report high complication rates for atrial fibrillation (AF) ablation. We sought to review complication rates for AF ablation at a high-volume centre over a 14-year period and identify predictors of complications. We reviewed prospectively collected data from 2750 consecutive AF ablation procedures at our institution using radiofrequency energy (RF) between January 2004 and May 2017. All cases were performed under general anaesthetic with transoesophageal echocardiography (TEE), 3D-mapping and an irrigated ablation catheter. Double transseptal puncture was performed under TEE guidance. All patients underwent wide antral circumferential isolation of the pulmonary veins (30W anteriorly, 25W posteriorly) with substrate modification at operator discretion. Of 2255 initial and 495 redo procedures, ablation strategies were: pulmonary vein isolation (PVI) only 2097 (76.3%), PVI+lines 368 (13.4%), PVI+posterior wall 191 (6.9%), PVI+cavotricuspid isthmus 277 (10.1%). There were 23 major (0.84%) and 20 minor (0.73%) complications. Cardiac tamponade (five cases - 0.18%) and phrenic nerve palsy (one case - 0.04%) rates were very low. Major vascular complications necessitating surgery or blood transfusion occurred in five patients (0.18%). There were no cases of death, permanent disability, atrio-oesophageal fistulae or symptomatic pulmonary vein (PV) stenosis, although there were five TEE probe-related complications (0.18%). Female gender (OR 2.14; 95% CI 1.07-4.26) but not age >70 (OR 1.01) was the only multivariate predictor of complications. Atrial fibrillation ablation performed at a high-volume centre using RF can be achieved with a low major complication rate in a representative AF population over a sustained period of time. Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos).

PubMed

Chandran, Sujievvan; Efthymiou, Marios; Kaffes, Arthur; Chen, John Wei; Kwan, Vu; Murray, Michael; Williams, David; Nguyen, Nam Quoc; Tam, William; Welch, Christine; Chong, Andre; Gupta, Saurabh; Devereaux, Ben; Tagkalidis, Peter; Parker, Frank; Vaughan, Rhys

2015-01-01

Recent medical literature on novel lumen-apposing stents for the treatment of pancreatic fluid collections (PFCs) is limited by small numbers, solo operators, and single-center experience. To evaluate a recently developed lumen-apposing, fully covered self-expandable metal stent (FCSEMS) in the management of PFCs. Retrospective case series. Thirteen tertiary and private health care centers across Australia. Forty-seven patients (median age 51 years) who underwent endoscopic management of PFCs. Insertion of FCSEMS after PFC puncture under EUS guidance. A subgroup of 9 patients underwent direct endoscopic necrosectomy. Technical and clinical success rate, adverse event rate. The technical success rate was 53 of 54 patients (98.1%), and the initial clinical success rate was 36 of 47 (76.6%), which was sustained for more than 6 months in 34 of 36 (94.4%). Early adverse events included 4 cases (7.4%) of stent migration during direct endoscopic necrosectomy, 4 cases (7.4%) of sepsis, 1 case (1.9%) of bleeding, and 1 case (1.9%) of stent migration into the fistula tract. Late adverse events were 6 (11.1%) spontaneous stent migrations, 3 (5.6%) recurrent stent occlusions, 3 (5.6%) tissue ingrowth/overgrowth, and 2 (3.7%) bleeding into PFC. The majority of stents inserted (48 of 54, 88.9%) and removed (31 of 35, 88.6%) in our study were described by the operator as superior to pigtail stents with regard to ease of use. Retrospective study. Although FCSEMSs are technically easier to insert and remove compared with traditional pigtail stents, there are significant limitations to the widespread use of FCSEMSs in the management of PFCs. These include cost, adverse events, and lower-than-expected resolution rates. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Halocarbons as Halon Replacements. Volume 1. Technology Review and Initiation

DTIC Science & Technology

1991-03-01

gases is usually accomplished by packed bed or plate-tower scrubbers . In some cases Venturi scrubbers are used for simultaneous removal of 95 TABLE 24...packed bed or plate-tower scrubbers to lower emissions to acceptable levels. When water is used as the scrubbing liquor, the blowdown stream is acidic...blowdown rates and makeup water. Because of these acidic conditions, the scrubber must be lined with an acid-resistant material. A highly basic

Characterizing the Epidemiology of the 2009 Influenza A/H1N1 Pandemic in Mexico

PubMed Central

Chowell, Gerardo; Echevarría-Zuno, Santiago; Viboud, Cécile; Simonsen, Lone; Tamerius, James; Miller, Mark A.; Borja-Aburto, Víctor H.

2011-01-01

Background Mexico's local and national authorities initiated an intense public health response during the early stages of the 2009 A/H1N1 pandemic. In this study we analyzed the epidemiological patterns of the pandemic during April–December 2009 in Mexico and evaluated the impact of nonmedical interventions, school cycles, and demographic factors on influenza transmission. Methods and Findings We used influenza surveillance data compiled by the Mexican Institute for Social Security, representing 40% of the population, to study patterns in influenza-like illness (ILIs) hospitalizations, deaths, and case-fatality rate by pandemic wave and geographical region. We also estimated the reproduction number (R) on the basis of the growth rate of daily cases, and used a transmission model to evaluate the effectiveness of mitigation strategies initiated during the spring pandemic wave. A total of 117,626 ILI cases were identified during April–December 2009, of which 30.6% were tested for influenza, and 23.3% were positive for the influenza A/H1N1 pandemic virus. A three-wave pandemic profile was identified, with an initial wave in April–May (Mexico City area), a second wave in June–July (southeastern states), and a geographically widespread third wave in August–December. The median age of laboratory confirmed ILI cases was ∼18 years overall and increased to ∼31 years during autumn (p<0.0001). The case-fatality ratio among ILI cases was 1.2% overall, and highest (5.5%) among people over 60 years. The regional R estimates were 1.8–2.1, 1.6–1.9, and 1.2–1.3 for the spring, summer, and fall waves, respectively. We estimate that the 18-day period of mandatory school closures and other social distancing measures implemented in the greater Mexico City area was associated with a 29%–37% reduction in influenza transmission in spring 2009. In addition, an increase in R was observed in late May and early June in the southeast states, after mandatory school suspension resumed and before summer vacation started. State-specific fall pandemic waves began 2–5 weeks after school reopened for the fall term, coinciding with an age shift in influenza cases. Conclusions We documented three spatially heterogeneous waves of the 2009 A/H1N1 pandemic virus in Mexico, which were characterized by a relatively young age distribution of cases. Our study highlights the importance of school cycles on the transmission dynamics of this pandemic influenza strain and suggests that school closure and other mitigation measures could be useful to mitigate future influenza pandemics. Please see later in the article for the Editors' Summary PMID:21629683

The LPM effect in sequential bremsstrahlung 2: factorization

DOE PAGES

Arnold, Peter; Chang, Han-Chih; Iqbal, Shahin

2016-09-13

The splitting processes of bremsstrahlung and pair production in a medium are coherent over large distances in the very high energy limit, which leads to a suppression known as the Landau-Pomeranchuk-Migdal (LPM) effect. In this paper, we continue analysis of the case when the coherence lengths of two consecutive splitting processes overlap (which is important for understanding corrections to standard treatments of the LPM effect in QCD), avoiding soft-gluon approximations. In particular, this paper analyzes the subtle problem of how to precisely separate overlapping double splitting (e.g. overlapping double bremsstrahlung) from the case of consecutive, independent bremsstrahlung (which is themore » case that would be implemented in a Monte Carlo simulation based solely on single splitting rates). As an example of the method, we consider the rate of real double gluon bremsstrahlung from an initial gluon with various simplifying assumptions (thick media; q approximation; large N c; and neglect for the moment of processes involving 4-gluon ver-tices) and explicitly compute the correction Δ dΓ/dx dy due to overlapping formation times.« less

Influence of carbon monoxide poisoning on the fetal heart monitor tracing: a report of 3 cases.

PubMed

Towers, Craig V; Corcoran, Vincent A

2009-03-01

The diagnosis of carbon monoxide poisoning in the third trimester of pregnancy requires an index of suspicion, and the appearance of the fetal heart monitor tracing may help in this regard. Three cases of third-trimester acute carbon monoxide poisoning occurred. In each pregnancy, the fetal heart monitor tracing on admission was correlated with the maternal carboxyhemoglobin level, and how the pattern changed following the institution of therapy was analyzed. In all 3 cases, the initial fetal heart rate pattern demonstrated decreased variability with an elevated baseline and an absence of accelerations and decelerations. Within 45-90 minutes of treatment onset, the baseline fetal heart rate dropped by 20-40 beats per minute, the variability became moderate, and accelerations occurred. Absent accelerations with minimal variability, if caused by uteroplacental insufficiency, are usually preceded by recurrent decelerations. Absent accelerations with minimal variability in the absence of recurrent decelerations may suggest another cause, of which carbon monoxide intoxication can be added to the differential, especially since this disorder often has nonspecific clinical symptoms.

Comprehensive all-sky search for periodic gravitational waves in the sixth science run LIGO data

NASA Astrophysics Data System (ADS)

Abbott, B. P.; Abbott, R.; Abbott, T. D.; Abernathy, M. R.; Acernese, F.; Ackley, K.; Adams, C.; Adams, T.; Addesso, P.; Adhikari, R. X.; Adya, V. B.; Affeldt, C.; Agathos, M.; Agatsuma, K.; Aggarwal, N.; Aguiar, O. D.; Aiello, L.; Ain, A.; Ajith, P.; Allen, B.; Allocca, A.; Altin, P. A.; Anderson, S. B.; Anderson, W. G.; Arai, K.; Araya, M. C.; Arceneaux, C. C.; Areeda, J. S.; Arnaud, N.; Arun, K. G.; Ascenzi, S.; Ashton, G.; Ast, M.; Aston, S. M.; Astone, P.; Aufmuth, P.; Aulbert, C.; Babak, S.; Bacon, P.; Bader, M. K. M.; Baker, P. T.; Baldaccini, F.; Ballardin, G.; Ballmer, S. W.; Barayoga, J. C.; Barclay, S. E.; Barish, B. C.; Barker, D.; Barone, F.; Barr, B.; Barsotti, L.; Barsuglia, M.; Barta, D.; Bartlett, J.; Bartos, I.; Bassiri, R.; Basti, A.; Batch, J. C.; Baune, C.; Bavigadda, V.; Bazzan, M.; Bejger, M.; Bell, A. S.; Berger, B. K.; Bergmann, G.; Berry, C. P. L.; Bersanetti, D.; Bertolini, A.; Betzwieser, J.; Bhagwat, S.; Bhandare, R.; Bilenko, I. A.; Billingsley, G.; Birch, J.; Birney, R.; Biscans, S.; Bisht, A.; Bitossi, M.; Biwer, C.; Bizouard, M. A.; Blackburn, J. K.; Blair, C. D.; Blair, D. G.; Blair, R. M.; Bloemen, S.; Bock, O.; Boer, M.; Bogaert, G.; Bogan, C.; Bohe, A.; Bond, C.; Bondu, F.; Bonnand, R.; Boom, B. A.; Bork, R.; Boschi, V.; Bose, S.; Bouffanais, Y.; Bozzi, A.; Bradaschia, C.; Brady, P. R.; Braginsky, V. B.; Branchesi, M.; Brau, J. E.; Briant, T.; Brillet, A.; Brinkmann, M.; Brisson, V.; Brockill, P.; Broida, J. E.; Brooks, A. F.; Brown, D. A.; Brown, D. D.; Brown, N. M.; Brunett, S.; Buchanan, C. C.; Buikema, A.; Bulik, T.; Bulten, H. J.; Buonanno, A.; Buskulic, D.; Buy, C.; Byer, R. L.; Cabero, M.; Cadonati, L.; Cagnoli, G.; Cahillane, C.; Calderón Bustillo, J.; Callister, T.; Calloni, E.; Camp, J. B.; Cannon, K. C.; Cao, J.; Capano, C. D.; Capocasa, E.; Carbognani, F.; Caride, S.; Casanueva Diaz, J.; Casentini, C.; Caudill, S.; Cavaglià, M.; Cavalier, F.; Cavalieri, R.; Cella, G.; Cepeda, C. B.; Cerboni Baiardi, L.; Cerretani, G.; Cesarini, E.; Chan, M.; Chao, S.; Charlton, P.; Chassande-Mottin, E.; Cheeseboro, B. D.; Chen, H. Y.; Chen, Y.; Cheng, C.; Chincarini, A.; Chiummo, A.; Cho, H. S.; Cho, M.; Chow, J. H.; Christensen, N.; Chu, Q.; Chua, S.; Chung, S.; Ciani, G.; Clara, F.; Clark, J. A.; Cleva, F.; Coccia, E.; Cohadon, P.-F.; Colla, A.; Collette, C. G.; Cominsky, L.; Constancio, M.; Conte, A.; Conti, L.; Cook, D.; Corbitt, T. R.; Cornish, N.; Corsi, A.; Cortese, S.; Costa, C. A.; Coughlin, M. W.; Coughlin, S. B.; Coulon, J.-P.; Countryman, S. T.; Couvares, P.; Cowan, E. E.; Coward, D. M.; Cowart, M. J.; Coyne, D. C.; Coyne, R.; Craig, K.; Creighton, J. D. E.; Creighton, T.; Cripe, J.; Crowder, S. G.; Cumming, A.; Cunningham, L.; Cuoco, E.; Dal Canton, T.; Danilishin, S. L.; D'Antonio, S.; Danzmann, K.; Darman, N. S.; Dasgupta, A.; Da Silva Costa, C. F.; Dattilo, V.; Dave, I.; Davier, M.; Davies, G. S.; Daw, E. J.; Day, R.; De, S.; DeBra, D.; Debreczeni, G.; Degallaix, J.; De Laurentis, M.; Deléglise, S.; Del Pozzo, W.; Denker, T.; Dent, T.; Dergachev, V.; De Rosa, R.; DeRosa, R. T.; DeSalvo, R.; Devine, R. C.; Dhurandhar, S.; Díaz, M. C.; Di Fiore, L.; Di Giovanni, M.; Di Girolamo, T.; Di Lieto, A.; Di Pace, S.; Di Palma, I.; Di Virgilio, A.; Dolique, V.; Donovan, F.; Dooley, K. L.; Doravari, S.; Douglas, R.; Downes, T. P.; Drago, M.; Drever, R. W. P.; Driggers, J. C.; Ducrot, M.; Dwyer, S. E.; Edo, T. B.; Edwards, M. C.; Effler, A.; Eggenstein, H.-B.; Ehrens, P.; Eichholz, J.; Eikenberry, S. S.; Engels, W.; Essick, R. C.; Etzel, T.; Evans, M.; Evans, T. M.; Everett, R.; Factourovich, M.; Fafone, V.; Fair, H.; Fairhurst, S.; Fan, X.; Fang, Q.; Farinon, S.; Farr, B.; Farr, W. M.; Favata, M.; Fays, M.; Fehrmann, H.; Fejer, M. M.; Fenyvesi, E.; Ferrante, I.; Ferreira, E. C.; Ferrini, F.; Fidecaro, F.; Fiori, I.; Fiorucci, D.; Fisher, R. P.; Flaminio, R.; Fletcher, M.; Fournier, J.-D.; Frasca, S.; Frasconi, F.; Frei, Z.; Freise, A.; Frey, R.; Frey, V.; Fritschel, P.; Frolov, V. V.; Fulda, P.; Fyffe, M.; Gabbard, H. A. G.; Gair, J. R.; Gammaitoni, L.; Gaonkar, S. G.; Garufi, F.; Gaur, G.; Gehrels, N.; Gemme, G.; Geng, P.; Genin, E.; Gennai, A.; George, J.; Gergely, L.; Germain, V.; Ghosh, Abhirup; Ghosh, Archisman; Ghosh, S.; Giaime, J. A.; Giardina, K. D.; Giazotto, A.; Gill, K.; Glaefke, A.; Goetz, E.; Goetz, R.; Gondan, L.; González, G.; Gonzalez Castro, J. M.; Gopakumar, A.; Gordon, N. A.; Gorodetsky, M. L.; Gossan, S. E.; Gosselin, M.; Gouaty, R.; Grado, A.; Graef, C.; Graff, P. B.; Granata, M.; Grant, A.; Gras, S.; Gray, C.; Greco, G.; Green, A. C.; Groot, P.; Grote, H.; Grunewald, S.; Guidi, G. M.; Guo, X.; Gupta, A.; Gupta, M. K.; Gushwa, K. E.; Gustafson, E. K.; Gustafson, R.; Hacker, J. J.; Hall, B. R.; Hall, E. D.; Hammond, G.; Haney, M.; Hanke, M. M.; Hanks, J.; Hanna, C.; Hannam, M. D.; Hanson, J.; Hardwick, T.; Harms, J.; Harry, G. M.; Harry, I. W.; Hart, M. J.; Hartman, M. T.; Haster, C.-J.; Haughian, K.; Heidmann, A.; Heintze, M. C.; Heitmann, H.; Hello, P.; Hemming, G.; Hendry, M.; Heng, I. S.; Hennig, J.; Henry, J.; Heptonstall, A. W.; Heurs, M.; Hild, S.; Hoak, D.; Hofman, D.; Holt, K.; Holz, D. E.; Hopkins, P.; Hough, J.; Houston, E. A.; Howell, E. J.; Hu, Y. M.; Huang, S.; Huerta, E. A.; Huet, D.; Hughey, B.; Husa, S.; Huttner, S. H.; Huynh-Dinh, T.; Indik, N.; Ingram, D. R.; Inta, R.; Isa, H. N.; Isac, J.-M.; Isi, M.; Isogai, T.; Iyer, B. R.; Izumi, K.; Jacqmin, T.; Jang, H.; Jani, K.; Jaranowski, P.; Jawahar, S.; Jian, L.; Jiménez-Forteza, F.; Johnson, W. W.; Jones, D. I.; Jones, R.; Jonker, R. J. G.; Ju, L.; Haris, K.; Kalaghatgi, C. V.; Kalogera, V.; Kandhasamy, S.; Kang, G.; Kanner, J. B.; Kapadia, S. J.; Karki, S.; Karvinen, K. S.; Kasprzack, M.; Katsavounidis, E.; Katzman, W.; Kaufer, S.; Kaur, T.; Kawabe, K.; Kéfélian, F.; Kehl, M. S.; Keitel, D.; Kelley, D. B.; Kells, W.; Kennedy, R.; Key, J. S.; Khalili, F. Y.; Khan, I.; Khan, S.; Khan, Z.; Khazanov, E. A.; Kijbunchoo, N.; Kim, Chi-Woong; Kim, Chunglee; Kim, J.; Kim, K.; Kim, N.; Kim, W.; Kim, Y.-M.; Kimbrell, S. J.; King, E. J.; King, P. J.; Kissel, J. S.; Klein, B.; Kleybolte, L.; Klimenko, S.; Koehlenbeck, S. M.; Koley, S.; Kondrashov, V.; Kontos, A.; Korobko, M.; Korth, W. Z.; Kowalska, I.; Kozak, D. B.; Kringel, V.; Krishnan, B.; Królak, A.; Krueger, C.; Kuehn, G.; Kumar, P.; Kumar, R.; Kuo, L.; Kutynia, A.; Lackey, B. D.; Landry, M.; Lange, J.; Lantz, B.; Lasky, P. D.; Laxen, M.; Lazzarini, A.; Lazzaro, C.; Leaci, P.; Leavey, S.; Lebigot, E. O.; Lee, C. H.; Lee, H. K.; Lee, H. M.; Lee, K.; Lenon, A.; Leonardi, M.; Leong, J. R.; Leroy, N.; Letendre, N.; Levin, Y.; Lewis, J. B.; Li, T. G. F.; Libson, A.; Littenberg, T. B.; Lockerbie, N. A.; Lombardi, A. L.; London, L. T.; Lord, J. E.; Lorenzini, M.; Loriette, V.; Lormand, M.; Losurdo, G.; Lough, J. D.; Lück, H.; Lundgren, A. P.; Lynch, R.; Ma, Y.; Machenschalk, B.; MacInnis, M.; Macleod, D. M.; Magaña-Sandoval, F.; Magaña Zertuche, L.; Magee, R. M.; Majorana, E.; Maksimovic, I.; Malvezzi, V.; Man, N.; Mandel, I.; Mandic, V.; Mangano, V.; Mansell, G. L.; Manske, M.; Mantovani, M.; Marchesoni, F.; Marion, F.; Márka, S.; Márka, Z.; Markosyan, A. S.; Maros, E.; Martelli, F.; Martellini, L.; Martin, I. W.; Martynov, D. V.; Marx, J. N.; Mason, K.; Masserot, A.; Massinger, T. J.; Masso-Reid, M.; Mastrogiovanni, S.; Matichard, F.; Matone, L.; Mavalvala, N.; Mazumder, N.; McCarthy, R.; McClelland, D. E.; McCormick, S.; McGuire, S. C.; McIntyre, G.; McIver, J.; McManus, D. J.; McRae, T.; McWilliams, S. T.; Meacher, D.; Meadors, G. D.; Meidam, J.; Melatos, A.; Mendell, G.; Mercer, R. A.; Merilh, E. L.; Merzougui, M.; Meshkov, S.; Messenger, C.; Messick, C.; Metzdorff, R.; Meyers, P. M.; Mezzani, F.; Miao, H.; Michel, C.; Middleton, H.; Mikhailov, E. E.; Milano, L.; Miller, A. L.; Miller, A.; Miller, B. B.; Miller, J.; Millhouse, M.; Minenkov, Y.; Ming, J.; Mirshekari, S.; Mishra, C.; Mitra, S.; Mitrofanov, V. P.; Mitselmakher, G.; Mittleman, R.; Moggi, A.; Mohan, M.; Mohapatra, S. R. P.; Montani, M.; Moore, B. C.; Moore, C. J.; Moraru, D.; Moreno, G.; Morriss, S. R.; Mossavi, K.; Mours, B.; Mow-Lowry, C. M.; Mueller, G.; Muir, A. W.; Mukherjee, Arunava; Mukherjee, D.; Mukherjee, S.; Mukund, N.; Mullavey, A.; Munch, J.; Murphy, D. J.; Murray, P. G.; Mytidis, A.; Nardecchia, I.; Naticchioni, L.; Nayak, R. K.; Nedkova, K.; Nelemans, G.; Nelson, T. J. N.; Neri, M.; Neunzert, A.; Newton, G.; Nguyen, T. T.; Nielsen, A. B.; Nissanke, S.; Nitz, A.; Nocera, F.; Nolting, D.; Normandin, M. E. N.; Nuttall, L. K.; Oberling, J.; Ochsner, E.; O'Dell, J.; Oelker, E.; Ogin, G. H.; Oh, J. J.; Oh, S. H.; Ohme, F.; Oliver, M.; Oppermann, P.; Oram, Richard J.; O'Reilly, B.; O'Shaughnessy, R.; Ottaway, D. J.; Overmier, H.; Owen, B. J.; Pai, A.; Pai, S. A.; Palamos, J. R.; Palashov, O.; Palomba, C.; Pal-Singh, A.; Pan, H.; Pankow, C.; Pannarale, F.; Pant, B. C.; Paoletti, F.; Paoli, A.; Papa, M. A.; Paris, H. R.; Parker, W.; Pascucci, D.; Pasqualetti, A.; Passaquieti, R.; Passuello, D.; Patricelli, B.; Patrick, Z.; Pearlstone, B. L.; Pedraza, M.; Pedurand, R.; Pekowsky, L.; Pele, A.; Penn, S.; Perreca, A.; Perri, L. M.; Phelps, M.; Piccinni, O. J.; Pichot, M.; Piergiovanni, F.; Pierro, V.; Pillant, G.; Pinard, L.; Pinto, I. M.; Pitkin, M.; Poe, M.; Poggiani, R.; Popolizio, P.; Post, A.; Powell, J.; Prasad, J.; Predoi, V.; Prestegard, T.; Price, L. R.; Prijatelj, M.; Principe, M.; Privitera, S.; Prix, R.; Prodi, G. A.; Prokhorov, L.; Puncken, O.; Punturo, M.; Puppo, P.; Pürrer, M.; Qi, H.; Qin, J.; Qiu, S.; Quetschke, V.; Quintero, E. A.; Quitzow-James, R.; Raab, F. J.; Rabeling, D. S.; Radkins, H.; Raffai, P.; Raja, S.; Rajan, C.; Rakhmanov, M.; Rapagnani, P.; Raymond, V.; Razzano, M.; Re, V.; Read, J.; Reed, C. M.; Regimbau, T.; Rei, L.; Reid, S.; Reitze, D. H.; Rew, H.; Reyes, S. D.; Ricci, F.; Riles, K.; Rizzo, M.; Robertson, N. A.; Robie, R.; Robinet, F.; Rocchi, A.; Rolland, L.; Rollins, J. G.; Roma, V. J.; Romano, J. D.; Romano, R.; Romanov, G.; Romie, J. H.; Rosińska, D.; Rowan, S.; Rüdiger, A.; Ruggi, P.; Ryan, K.; Sachdev, S.; Sadecki, T.; Sadeghian, L.; Sakellariadou, M.; Salconi, L.; Saleem, M.; Salemi, F.; Samajdar, A.; Sammut, L.; Sanchez, E. J.; Sandberg, V.; Sandeen, B.; Sanders, J. R.; Sassolas, B.; Sathyaprakash, B. S.; Saulson, P. R.; Sauter, O. E. S.; Savage, R. L.; Sawadsky, A.; Schale, P.; Schilling, R.; Schmidt, J.; Schmidt, P.; Schnabel, R.; Schofield, R. M. S.; Schönbeck, A.; Schreiber, E.; Schuette, D.; Schutz, B. F.; Scott, J.; Scott, S. M.; Sellers, D.; Sengupta, A. S.; Sentenac, D.; Sequino, V.; Sergeev, A.; Setyawati, Y.; Shaddock, D. A.; Shaffer, T.; Shahriar, M. S.; Shaltev, M.; Shapiro, B.; Shawhan, P.; Sheperd, A.; Shoemaker, D. H.; Shoemaker, D. M.; Siellez, K.; Siemens, X.; Sieniawska, M.; Sigg, D.; Silva, A. D.; Singer, A.; Singer, L. P.; Singh, A.; Singh, R.; Singhal, A.; Sintes, A. M.; Slagmolen, B. J. J.; Smith, J. R.; Smith, N. D.; Smith, R. J. E.; Son, E. J.; Sorazu, B.; Sorrentino, F.; Souradeep, T.; Srivastava, A. K.; Staley, A.; Steinke, M.; Steinlechner, J.; Steinlechner, S.; Steinmeyer, D.; Stephens, B. C.; Stone, R.; Strain, K. A.; Straniero, N.; Stratta, G.; Strauss, N. A.; Strigin, S.; Sturani, R.; Stuver, A. L.; Summerscales, T. Z.; Sun, L.; Sunil, S.; Sutton, P. J.; Swinkels, B. L.; Szczepańczyk, M. J.; Tacca, M.; Talukder, D.; Tanner, D. B.; Tápai, M.; Tarabrin, S. P.; Taracchini, A.; Taylor, R.; Theeg, T.; Thirugnanasambandam, M. P.; Thomas, E. G.; Thomas, M.; Thomas, P.; Thorne, K. A.; Thrane, E.; Tiwari, S.; Tiwari, V.; Tokmakov, K. V.; Toland, K.; Tomlinson, C.; Tonelli, M.; Tornasi, Z.; Torres, C. V.; Torrie, C. I.; Töyrä, D.; Travasso, F.; Traylor, G.; Trifirò, D.; Tringali, M. C.; Trozzo, L.; Tse, M.; Turconi, M.; Tuyenbayev, D.; Ugolini, D.; Unnikrishnan, C. S.; Urban, A. L.; Usman, S. A.; Vahlbruch, H.; Vajente, G.; Valdes, G.; van Bakel, N.; van Beuzekom, M.; van den Brand, J. F. J.; Van Den Broeck, C.; Vander-Hyde, D. C.; van der Schaaf, L.; van Heijningen, J. V.; van Veggel, A. A.; Vardaro, M.; Vass, S.; Vasúth, M.; Vaulin, R.; Vecchio, A.; Vedovato, G.; Veitch, J.; Veitch, P. J.; Venkateswara, K.; Verkindt, D.; Vetrano, F.; Viceré, A.; Vinciguerra, S.; Vine, D. J.; Vinet, J.-Y.; Vitale, S.; Vo, T.; Vocca, H.; Vorvick, C.; Voss, D. V.; Vousden, W. D.; Vyatchanin, S. P.; Wade, A. R.; Wade, L. E.; Wade, M.; Walker, M.; Wallace, L.; Walsh, S.; Wang, G.; Wang, H.; Wang, M.; Wang, X.; Wang, Y.; Ward, R. L.; Warner, J.; Was, M.; Weaver, B.; Wei, L.-W.; Weinert, M.; Weinstein, A. J.; Weiss, R.; Wen, L.; Weßels, P.; Westphal, T.; Wette, K.; Whelan, J. T.; Whiting, B. F.; Williams, R. D.; Williamson, A. R.; Willis, J. L.; Willke, B.; Wimmer, M. H.; Winkler, W.; Wipf, C. C.; Wittel, H.; Woan, G.; Woehler, J.; Worden, J.; Wright, J. L.; Wu, D. S.; Wu, G.; Yablon, J.; Yam, W.; Yamamoto, H.; Yancey, C. C.; Yu, H.; Yvert, M.; ZadroŻny, A.; Zangrando, L.; Zanolin, M.; Zendri, J.-P.; Zevin, M.; Zhang, L.; Zhang, M.; Zhang, Y.; Zhao, C.; Zhou, M.; Zhou, Z.; Zhu, X. J.; Zucker, M. E.; Zuraw, S. E.; Zweizig, J.; LIGO Scientific Collaboration; Virgo Collaboration

2016-08-01

We report on a comprehensive all-sky search for periodic gravitational waves in the frequency band 100-1500 Hz and with a frequency time derivative in the range of [-1.18 ,+1.00 ] ×1 0-8 Hz /s . Such a signal could be produced by a nearby spinning and slightly nonaxisymmetric isolated neutron star in our galaxy. This search uses the data from the initial LIGO sixth science run and covers a larger parameter space with respect to any past search. A Loosely Coherent detection pipeline was applied to follow up weak outliers in both Gaussian (95% recovery rate) and non-Gaussian (75% recovery rate) bands. No gravitational wave signals were observed, and upper limits were placed on their strength. Our smallest upper limit on worst-case (linearly polarized) strain amplitude h0 is 9.7 ×1 0-25 near 169 Hz, while at the high end of our frequency range we achieve a worst-case upper limit of 5.5 ×1 0-24 . Both cases refer to all sky locations and entire range of frequency derivative values.

The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

PubMed Central

Botelho, Renata Maria de Oliveira; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; de Góis, Aécio Flávio Teixeira; Batista, Ruth Ester Assayag

2016-01-01

ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. Results: ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112). Conclusion: the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC. PMID:27878221

Antibiotic resistance in severe odontogenic infections of the South Australian population: a 9-year retrospective audit.

PubMed

Liau, I; Han, J; Bayetto, K; May, B; Goss, A; Sambrook, P; Cheng, A

2018-06-01

The aims of this study were to evaluate the microbiological trends in severe odontogenic infections requiring hospital admission in the South Australian Oral and Maxillofacial Surgery Unit. Rates of antibiotic resistance to empirical antibiotic regimens were determined to quantify the clinical implications of antibiotic-resistant odontogenic infections. A retrospective case audit was performed on all odontogenic infections admitted to the Royal Adelaide Hospital over a 9-year period. Data was collected regarding demographics, microbiological culture and sensitivity results, and clinical outcome variables. Of a total of 672 patients, microbiology data was available for 447 cases. Penicillin-resistant organisms were identified in 10.8% of patients, who required a significantly longer length of hospital admission (mean, 9.93 days) and higher rates of non-response to initial surgical therapy (40%). There were moderate rates of antibiotic-resistant odontogenic infections within the South Australian population. Patients within this subgroup demonstrate markedly poorer clinical outcomes. Effective treatment of odontogenic infections involves early operative intervention, with adjunctive use of appropriate antibiotic therapy that involves close monitoring of response to removal of the cause and use of first-line antibiotic agents. Cases that fail to respond require urgent specialist review in order to reduce morbidity and mortality outcomes. © 2018 Australian Dental Association.

Games policy makers and providers play: introducing case-mix-based payment to hospital chronic care units in Japan.

PubMed

Ikegami, Naoki

2009-06-01

Case-mix-based payment was developed for hospital chronic care units in Japan to replace the flat per diem rate and encourage the admission of patients with higher medical acuity and was part of a policy initiative to make the tariff more evidence based. However, although the criteria for grouping patients were developed from a statistical analysis of resource use, the tariff was subsequently set below costs, particularly for the groups with the lowest medical acuity, both because of the prime minister's decision to decrease total health expenditures and because of the health ministry's decision to target the reductions on chronic care units. Providers quickly adapted to the new payment system mainly by reclassifying their patients to higher medical acuity groups. Some hospitals reported high prevalence rates of urinary tract infections and pressure ulcers. The government responded by issuing directives to providers to calculate the prevalence rates and document the care that has been mandated for the patients at risk. However, in order to monitor compliance and to evaluate whether the patient is being billed for the appropriate case-mix group, the government must invest in developing a comprehensive patient-level database and in training staff for making on-site inspections.

Radiologic Placement of Uncovered Stents for the Treatment of Malignant Colonic Obstruction Proximal to the Descending Colon

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

Yoon, Jehong; Kwon, Se Hwan, E-mail: Kwon98@khu.ac.kr; Lee, Chang-Kyun

PurposeTo evaluate the safety, feasibility, and patency rates of radiologic placement of uncovered stents for the treatment of malignant colonic obstruction proximal to the descending colon.Materials and MethodsThis was a retrospective, single-center study. From May 2003 to March 2015, 53 image-guided placements of uncovered stents (44 initial placements, 9 secondary placements) were attempted in 44 patients (male:female = 23:21; mean age, 71.8 years). The technical and clinical success, complication rates, and patency rates of the stents were also evaluated. Technical success was defined as the successful deployment of the stent under fluoroscopic guidance alone and clinical success was defined as the relief of obstructivemore » symptoms or signs within 48 h of stent deployment.ResultsIn total, 12 (27.3 %) patients underwent preoperative decompression, while 32 (72.7 %) underwent decompression with palliative intent. The technical success rate was 93.2 % (41/44) for initial placement and 88.9 % (8/9) for secondary placement. Secondary stent placement in the palliative group was required in nine patients after successful initial stent placement due to stent obstruction from tumor ingrowth (n = 7) and stent migration (n = 2). The symptoms of obstruction were relieved in all successful cases (100 %). In the palliative group, the patency rates were 94.4 % at 1 month, 84.0 % at 3 months, 64.8 % at 6 months, and 48.6 % at 12 months.ConclusionsThe radiologic placement of uncovered stents for the treatment of malignant obstruction proximal to the descending colon is feasible and safe, and provides acceptable clinical results.« less

Reducing preterm birth by a statewide multifaceted program: an implementation study.

PubMed

Newnham, John P; White, Scott W; Meharry, Suzanne; Lee, Han-Shin; Pedretti, Michelle K; Arrese, Catherine A; Keelan, Jeffrey A; Kemp, Matthew W; Dickinson, Jan E; Doherty, Dorota A

2017-05-01

A comprehensive preterm birth prevention program was introduced in the state of Western Australia encompassing new clinical guidelines, an outreach program for health care practitioners, a public health program for women and their families based on print and social media, and a new clinic at the state's sole tertiary level perinatal center for referral of those pregnant women at highest risk. The initiative had the single aim of safely lowering the rate of preterm birth. The objective of the study was to evaluate the outcomes of the initiative on the rates of preterm birth both statewide and in the single tertiary level perinatal referral center. This was a prospective population-based cohort study of perinatal outcomes before and after 1 full year of implementation of the preterm birth prevention program. In the state overall, the rate of singleton preterm birth was reduced by 7.6% and was lower than in any of the preceding 6 years. This reduction amounted to 196 cases relative to the year before the introduction of the initiative and the effect extended from the 28-31 week gestational age group onward. Within the tertiary level center, the rate of preterm birth in 2015 was also significantly lower than in the preceding years. A comprehensive and multifaceted preterm birth prevention program aimed at both health care practitioners and the general public, operating within the environment of a government-funded universal health care system can significantly lower the rate of early birth. Further research is now required to increase the effect and to determine the relative contributions of each of the interventions. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

Compulsion or chronobiology? A case of severe obsessive-compulsive disorder treated with cognitive-behavioral therapy augmented with chronotherapy.

PubMed

Coles, Meredith E; Sharkey, Katherine M

2011-06-15

Individuals with treatment-resistant obsessive compulsive disorder (OCD) have elevated rates of delayed sleep phase. This report describes a patient with severe OCD who had failed prior trials of pharmacotherapy and psychotherapy, and whose symptoms were associated with delayed bedtimes and delays in the time she initiated her nighttime compulsions. Case report. A 54 year-old woman with OCD kept sleep/symptom logs as an adjunct to traditional cognitive-behavioral therapy for OCD. At presentation, she reported habitual bedtime = 06:00, wake time = 13:00, sleep latency ' 5 min, and total sleep time = 6.5-7.5 h. Later time of initiating her compulsions was associated with longer time performing the compulsions (r = 0.86, p < 0.001). Cognitive-behavioral therapy with adjunctive chronotherapy was associated with substantial improvement. OCD patients with nighttime compulsions may receive light exposure that results in delayed sleep times/circadian phase. Chronotherapy may enhance outcomes for refractory OCD patients, particularly those who perform compulsions at night.

An aggressive primary orbital natural killer/T-cell lymphoma case: poor response to chemotherapy.

PubMed

Marchino, Tizana; Ibáñez, Núria; Prieto, Sebastián; Novelli, Silvana; Szafranska, Justyna; Mozos, Anna; Graell, Xavier; Buil, José A

2014-01-01

Natural killer/T-cell lymphoma (NKTCL) and its presentation with extranodal orbital involvement as a single lesion are extremely rare. The aim of this article was to describe the presentation, diagnosis, and systemic treatment of a primary orbital NKTCL. A 67-year-old Caucasian woman presented with left exophthalmos, pain, periorbital swelling, and limited extrinsic ocular motility. Orbital cellulitis was suspected, but finally orbital biopsy was performed due to no response to initial antibiotic and anti-inflammatory standard treatment. The pathologic diagnosis was NKTCL. Systemic evaluations were negative. CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy was initiated, but after 2 cycles of treatment, tumoral progression was observed. SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide) rescue chemotherapy was then administered. Lymphoma progression was inevitable. She died 10 months later. Although more nasal NKTCL cases have been described, the nonnasal primary orbital NKTCL is an uncommon neoplasm with high mortality rate, despite the recent use of more potent chemotherapy regimens.

Using Large-Eddy Simulation to Explore Microphysical Precursor Conditions for Precipitation Initiation in Marine Stratocumulus

NASA Astrophysics Data System (ADS)

Chandler, H.; Mechem, D. B.; Fridlind, A. M.; Ackerman, A. S.

2016-12-01

Although the classical model of how a population of cloud droplets grows to precipitation-sized drops through the condensation and coalescence processes is well accepted, it does not fully address the history of how nascent precipitation drops come about in warm clouds. Precipitation initiation is influenced by the properties of the cloud drop distribution and in bulk large-eddy simulation (LES) models is parameterized by autoconversion. Double-moment formulations of autoconversion rate generally weight cloud water content qc more than cloud drop concentration Nc (e.g., qc2.47Nc-1.79, Khairoutdinov and Kogan 2000) and precipitation rate scalings derived from field campaigns suggest a dominance of thermodynamic over aerosol factors. However, the mechanisms that drive precipitation initiation in any given cloud are still uncertain. From the perspective of autoconversion, do the regions where precipitation onset occurs experience large liquid water content values (large qc), or are they anomalously clean (small Nc)? Recent laboratory measurements suggest that fluctuations in the supersaturation field may also play a role in precipitation initiation. This study explores the nature of precursor conditions to precipitation onset within marine stratocumulus clouds. We apply an LES model with size-resolving microphysics to a case of marine stratocumulus over the eastern north Atlantic. Backward trajectories originating from regions of precipitation initiation are calculated from the time-evolving LES flow fields to examine the history of fluid parcels that ultimately contain embryonic precipitation.

Low accuracy of the national reporting system of acute hepatitis C infection in Taiwan, 1995-2004.

PubMed

Kee, Kwong-Ming; Hung, Chi-Ming; Wang, Jing-Houng; Hung, Chao-Hung; Chen, Pao-Fei; Lin, Kuo-Sin; Lu, Sheng-Nan

2010-07-01

This study attempted to clarify accuracy of acute hepatitis C (AHC) and its clinical characteristics. We reviewed 632 reported cases from national surveillance data of the Taiwan Center for Disease Control between 1995 and 2004, and reclassified diagnoses. A definite case was defined as alanine aminotransferase (ALT) > 10 x the upper limit of normal (ULN) with seroconversion of anti-hepatitis C virus antibody (anti-HCV). A probable case was defined as (i) seroconversion of anti-HCV and/or elevated ALT levels; or (ii) anti-HCV(+) but titers increased (from < 40 S/CO to >or= 40 S/CO) and ALT > 10 x the ULN. A suspected case was defined as initial anti-HCV(+) and ALT level > 10 x the ULN and/or jaundice. Excluded cases were defined as ALT levels less than 10 x ULN with initial positive anti-HCV Ab. A total of 310 (49%) cases were confirmed as AHC; these included 95 (15%) definite and 215 (34%) probable cases. Higher incidence rates and accuracy of AHC were demonstrated in the southern area significantly if compared with northern, eastern and central areas, respectively (all P < 0.05). On comparison between blood centers and hospitals, more AHC cases were found in Southern Taiwan than in other areas (157/73 vs 24/40, P < 0.001), younger mean age (33.3 +/- 11.1 vs 49.3 +/- 16.4, P < 0.001), lower ALT levels (263.1 +/- 200.9 vs 1264.2 +/- 706.8, P < 0.001) and male predominance (191/39 vs 46/18, P = 0.046). This study showed our reporting system over-estimated the AHC diagnosis, which is also a common issue worldwide. Greater efforts are needed to establish appropriate reporting systems, as well as more supplemental methods to distinguish between prevalent and incident cases.

Characteristic clinical features of Aspergillus appendicitis: Case report and literature review.

PubMed

Gjeorgjievski, Mihajlo; Amin, Mitual B; Cappell, Mitchell S

2015-11-28

This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new case. The currently reported case of pathologically-proven Aspergillus appendicitis was identified by computerized search of pathology database at William Beaumont Hospital, 1999-2014. Prior cases were identified by computerized literature search. Among 10980 pathology reports of pathologically-proven appendicitis, one case of Aspergillus appendicitis was identified (rate = 0.01%). A young boy with profound neutropenia, recent chemotherapy, and acute myelogenous leukemia presented with right lower quadrant pain, pyrexia, and generalized malaise. Abdominal computed tomography scan showed a thickened appendiceal wall and periappendiceal inflammation, suggesting appendicitis. Emergent laparotomy showed an inflamed, thickened appendix, which was resected. The patient did poorly postoperatively with low-grade-fevers while receiving antibacterial therapy, but rapidly improved after initiating amphotericin therapy. Microscopic examination of a silver stain of the appendectomy specimen revealed fungi with characteristic Aspergillus morphology, findings confirmed by immunohistochemistry. Primary Aspergillus appendicitis is exceptionally rare, with only 3 previously reported cases. All three cases presented with (1)-neutropenia, (2)-recent chemotherapy, (3)-acute leukemia, and (4)-suspected appendicitis; (5)-the two prior cases initially treated with antibacterial therapy, fared poorly before instituting anti-Aspergillus therapy. The current patient satisfied all these five criteria. Based on these four cases, a clinical pentad is proposed for Aspergillus appendicitis: clinically-suspected appendicitis, neutropenia, recent chemotherapy, acute leukemia, and poor clinical response if treated solely by antibacterial/anti-candidial therapy. Patients presenting with this proposed pentad may benefit from testing for Aspergillus infection by silver-stains/immunohistochemistry and considering empirical anti-Aspergillus therapy pending a tissue diagnosis.

Clinical and economic consequences of vancomycin and fidaxomicin for the treatment of Clostridium difficile infection in Canada.

PubMed

Wagner, Monika; Lavoie, Louis; Goetghebeur, Mireille

2014-03-01

Clostridium difficile infection (CDI) represents a public health problem with increasing incidence and severity. To evaluate the clinical and economic consequences of vancomycin compared with fidaxomicin in the treatment of CDI from the Canadian health care system perspective. A decision-tree model was developed to compare vancomycin and fidaxomicin for the treatment of severe CDI. The model assumed identical initial cure rates and included first recurrent episodes of CDI (base case). Treatment of patients presenting with recurrent CDI was examined as an alternative analysis. Costs included were for study medication, physician services and hospitalization. Cost effectiveness was measured as incremental cost per recurrence avoided. Sensitivity analyses of key input parameters were performed. In a cohort of 1000 patients with an initial episode of severe CDI, treatment with fidaxomicin led to 137 fewer recurrences at an incremental cost of $1.81 million, resulting in an incremental cost of $13,202 per recurrence avoided. Among 1000 patients with recurrent CDI, 113 second recurrences were avoided at an incremental cost of $18,190 per second recurrence avoided. Incremental costs per recurrence avoided increased with increasing proportion of cases caused by the NAP1/B1/027 strain. Results were sensitive to variations in recurrence rates and treatment duration but were robust to variations in other parameters. The use of fidaxomicin is associated with a cost increase for the Canadian health care system. Clinical benefits of fidaxomicin compared with vancomycin depend on the proportion of cases caused by the NAP1/B1/027 strain in patients with severe CDI.

[Economic impact of etanercept and adalimumab biosimilars on hospitals scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products].

PubMed

Berreur, B; Guerin, F; Christophe, B; Limido, G; Paubel, P

2018-01-01

To evaluate the economic impact of future prescriptions of etanercept and adalimumab biosimilars at the territorial scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products. Determination of the number and status of patients (naive or in continuation of treatment) from the National Database "Datamart de Consommation Inter-Régimes" of health insurance, concerned by a dispensation in a pharmacy of etanercept or adalimumab in 2015. Calculation of potential savings in case of biosimilar requirements according to 3 hypotheses: 63% (rate observed in a previous study) of initiations are treated with biosimiliaries and the others by princeps (H 1 ); all initiations under biosimilars and continuation therapy with the princeps (H 2 ) or all patients are treated with biosimilars (H 3 ). The annual savings are estimated at 237,000 € with the H 1 hypothesis. In the case of H 2 , the expected savings would be 376,200 € per year. In the case of H 3 , savings for the community could reach almost 1,282,800 € per year. The arrival of biosimilars allows significant savings for medicines market. According to the French recommendations in 2016, the expected savings are between the H 1 and H 2 hypothesis. The rate of penetration of biosimilars depends on many factors such as the involvement of health professionals, patient adherence, or health authority recommendations. Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative.

PubMed

Chang, Victor; Schwalb, Jason M; Nerenz, David R; Pietrantoni, Lisa; Jones, Sharon; Jankowski, Michelle; Oja-Tebbe, Nancy; Bartol, Stephen; Abdulhak, Muwaffak

2015-12-01

OBJECT Given the scrutiny of spine surgery by policy makers, spine surgeons are motivated to demonstrate and improve outcomes, by determining which patients will and will not benefit from surgery, and to reduce costs, often by reducing complications. Insurers are similarly motivated. In 2013, Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) established the Michigan Spine Surgery Improvement Collaborative (MSSIC) as a Collaborative Quality Initiative (CQI). MSSIC is one of the newest of 21 other CQIs that have significantly improved-and continue to improve-the quality of patient care throughout the state of Michigan. METHODS MSSIC focuses on lumbar and cervical spine surgery, specifically indications such as stenosis, disk herniation, and degenerative disease. Surgery for tumors, traumatic fractures, deformity, scoliosis, and acute spinal cord injury are currently not within the scope of MSSIC. Starting in 2014, MSSIC consisted of 7 hospitals and in 2015 included another 15 hospitals, for a total of 22 hospitals statewide. A standardized data set is obtained by data abstractors, who are funded by BCBSM/BCN. Variables of interest include indications for surgery, baseline patient-reported outcome measures, and medical history. These are obtained within 30 days of surgery. Outcome instruments used include the EQ-5D general health state score (0 being worst and 100 being the best health one can imagine) and EQ-5D-3 L. For patients undergoing lumbar surgery, a 0 to 10 numeric rating scale for leg and back pain and the Oswestry Disability Index for back pain are collected. For patients undergoing cervical surgery, a 0 to 10 numeric rating scale for arm and neck pain, Neck Disability Index, and the modified Japanese Orthopaedic Association score are collected. Surgical details, postoperative hospital course, and patient-reported outcome measures are collected at 90-day, 1-year, and 2-year intervals. RESULTS As of July 1, 2015, a total of 6397 cases have been entered into the registry. This number reflects 4824 eligible cases with confirmed surgery dates. Of these 4824 eligible cases, 3338 cases went beyond the 120-day window and were considered eligible for the extraction of surgical details, 90-day outcomes, and adverse events. Among these 3338 patients, there are a total of 2469 lumbar cases, 862 cervical cases, and 7 combined procedures that were entered into the registry. CONCLUSIONS In addition to functioning as a registry, MSSIC is also meant to be a platform for quality improvement with the potential for future initiatives and best practices to be implemented statewide in order to improve quality and lower costs. With its current rate of recruitment and expansion, MSSIC will provide a robust platform as a regional prospective registry. Its unique funding model, which is supported by BCBSM/BCN, will help ensure its longevity and viability, as has been observed in other CQIs that have been active for several years.

The value of initial cavitation to predict re-treatment with pulmonary tuberculosis.

PubMed

Huang, Qiusheng; Yin, Yongmei; Kuai, Shougang; Yan, Yan; Liu, Jun; Zhang, YingYing; Shan, Zhongbao; Gu, Lan; Pei, Hao; Wang, Jun

2016-05-06

Pulmonary cavitation is the classic hallmark of pulmonary tuberculosis (PTB) and is the site of very high mycobacterial burden associated with antimycobacterial drug resistance and treatment failure. The objective of this study was to investigate the relationship between re-treatment PTB and initial pulmonary cavitation coordinated with other clinical factors. We conducted a case-control study of 291 newly diagnosed cases of pulmonary TB in The Infectious Hospital of Wuxi from Dec 2009 to Dec 2011 with complete follow-up information until December 31st of 2014. 68 patients were followed-up with PTB re-treatment; the rest of the PTB patients (n = 223) had completed anti-TB treatment, and cured without re-treatment were selected as controls. The univariate analysis [hazard ratio (HR) 1.885, 95 % CI 1.170-3.035, P = 0.009] and the multivariable analysis (HR 2.242, 95 % CI 1.294-3.882, P = 0.004) demonstrated that the initial pulmonary cavitation was a prognostic predictor for TB re-treatment. Additionally, the re-treatment rates in PTB patients with cavitation and no-cavitation were 27.1 and 15.5 %, respectively, with significant difference (log-rank test; P = 0.010). Other factors, age of ≥60 and history of smoking, were also prognostic variables. Initial pulmonary cavitation of chest X-ray was a significant predictor for PTB re-treatment.

Condensation and dissociation rates for gas phase metal clusters from molecular dynamics trajectory calculations

DOE PAGES

Yang, Huan; Goudeli, Eirini; Hogan, Christopher J.

2018-04-24

In gas phase synthesis systems, clusters form and grow via condensation, in which a monomer binds to an existing cluster. While a hard sphere equation is frequently used to predict the condensation rate coefficient, this equation neglects the influences of potential interactions and cluster internal energy on the condensation process. Here, we present a collision rate theory-Molecular Dynamics simulation approach to calculate condensation probabilities and condensation rate coefficients; we use this approach to examine atomic condensation onto 6-56 atom Au and Mg clusters. The probability of condensation depends upon the initial relative velocity ( v) between atom and cluster andmore » the initial impact parameter ( b). In all cases there is a well-defined region of b-v space where condensation is highly probable, and outside of which the condensation probability drops to zero. For Au clusters with more than 10 atoms, we find that at gas temperatures in the 300-1200 K range, the condensation rate coefficient exceeds the hard sphere rate coefficient by a factor of 1.5-2.0. Conversely, for Au clusters with 10 or fewer atoms, and for 14 atom and 28 atom Mg clusters, as cluster equilibration temperature increases the condensation rate coefficient drops to values below the hard sphere rate coefficient. Calculations also yield the self-dissociation rate coefficient, which is found to vary considerably with gas temperature. Finally, calculations results reveal that grazing (high b) atom-cluster collisions at elevated velocity (> 1000 m s -1) can result in the colliding atom rebounding (bounce) from the cluster surface or binding while another atom dissociates (replacement). In conclusion, the presented method can be applied in developing rate equations to predict material formation and growth rates in vapor phase systems.« less

Condensation and dissociation rates for gas phase metal clusters from molecular dynamics trajectory calculations.

PubMed

Yang, Huan; Goudeli, Eirini; Hogan, Christopher J

2018-04-28

In gas phase synthesis systems, clusters form and grow via condensation, in which a monomer binds to an existing cluster. While a hard-sphere equation is frequently used to predict the condensation rate coefficient, this equation neglects the influences of potential interactions and cluster internal energy on the condensation process. Here, we present a collision rate theory-molecular dynamics simulation approach to calculate condensation probabilities and condensation rate coefficients. We use this approach to examine atomic condensation onto 6-56-atom Au and Mg clusters. The probability of condensation depends upon the initial relative velocity (v) between atom and cluster and the initial impact parameter (b). In all cases, there is a well-defined region of b-v space where condensation is highly probable, and outside of which the condensation probability drops to zero. For Au clusters with more than 10 atoms, we find that at gas temperatures in the 300-1200 K range, the condensation rate coefficient exceeds the hard-sphere rate coefficient by a factor of 1.5-2.0. Conversely, for Au clusters with 10 or fewer atoms and for 14- and 28-atom Mg clusters, as cluster equilibration temperature increases, the condensation rate coefficient drops to values below the hard-sphere rate coefficient. Calculations also yield the self-dissociation rate coefficient, which is found to vary considerably with gas temperature. Finally, calculations results reveal that grazing (high b) atom-cluster collisions at elevated velocity (>1000 m s -1 ) can result in the colliding atom rebounding (bounce) from the cluster surface or binding while another atom dissociates (replacement). The presented method can be applied in developing rate equations to predict material formation and growth rates in vapor phase systems.

Condensation and dissociation rates for gas phase metal clusters from molecular dynamics trajectory calculations

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

Yang, Huan; Goudeli, Eirini; Hogan, Christopher J.

In gas phase synthesis systems, clusters form and grow via condensation, in which a monomer binds to an existing cluster. While a hard sphere equation is frequently used to predict the condensation rate coefficient, this equation neglects the influences of potential interactions and cluster internal energy on the condensation process. Here, we present a collision rate theory-Molecular Dynamics simulation approach to calculate condensation probabilities and condensation rate coefficients; we use this approach to examine atomic condensation onto 6-56 atom Au and Mg clusters. The probability of condensation depends upon the initial relative velocity ( v) between atom and cluster andmore » the initial impact parameter ( b). In all cases there is a well-defined region of b-v space where condensation is highly probable, and outside of which the condensation probability drops to zero. For Au clusters with more than 10 atoms, we find that at gas temperatures in the 300-1200 K range, the condensation rate coefficient exceeds the hard sphere rate coefficient by a factor of 1.5-2.0. Conversely, for Au clusters with 10 or fewer atoms, and for 14 atom and 28 atom Mg clusters, as cluster equilibration temperature increases the condensation rate coefficient drops to values below the hard sphere rate coefficient. Calculations also yield the self-dissociation rate coefficient, which is found to vary considerably with gas temperature. Finally, calculations results reveal that grazing (high b) atom-cluster collisions at elevated velocity (> 1000 m s -1) can result in the colliding atom rebounding (bounce) from the cluster surface or binding while another atom dissociates (replacement). In conclusion, the presented method can be applied in developing rate equations to predict material formation and growth rates in vapor phase systems.« less

Condensation and dissociation rates for gas phase metal clusters from molecular dynamics trajectory calculations

NASA Astrophysics Data System (ADS)

Yang, Huan; Goudeli, Eirini; Hogan, Christopher J.

2018-04-01

In gas phase synthesis systems, clusters form and grow via condensation, in which a monomer binds to an existing cluster. While a hard-sphere equation is frequently used to predict the condensation rate coefficient, this equation neglects the influences of potential interactions and cluster internal energy on the condensation process. Here, we present a collision rate theory-molecular dynamics simulation approach to calculate condensation probabilities and condensation rate coefficients. We use this approach to examine atomic condensation onto 6-56-atom Au and Mg clusters. The probability of condensation depends upon the initial relative velocity (v) between atom and cluster and the initial impact parameter (b). In all cases, there is a well-defined region of b-v space where condensation is highly probable, and outside of which the condensation probability drops to zero. For Au clusters with more than 10 atoms, we find that at gas temperatures in the 300-1200 K range, the condensation rate coefficient exceeds the hard-sphere rate coefficient by a factor of 1.5-2.0. Conversely, for Au clusters with 10 or fewer atoms and for 14- and 28-atom Mg clusters, as cluster equilibration temperature increases, the condensation rate coefficient drops to values below the hard-sphere rate coefficient. Calculations also yield the self-dissociation rate coefficient, which is found to vary considerably with gas temperature. Finally, calculations results reveal that grazing (high b) atom-cluster collisions at elevated velocity (>1000 m s-1) can result in the colliding atom rebounding (bounce) from the cluster surface or binding while another atom dissociates (replacement). The presented method can be applied in developing rate equations to predict material formation and growth rates in vapor phase systems.

Epidemiological Patterns of Initial and Subsequent Injuries in Collegiate Football Athletes.

PubMed

Williams, Jacob Z; Singichetti, Bhavna; Li, Hongmei; Xiang, Henry; Klingele, Kevin E; Yang, Jingzhen

2017-04-01

A body of epidemiological studies has examined football injuries and associated risk factors among collegiate athletes. However, few existing studies specifically analyzed injury risk in terms of initial or subsequent injuries. To determine athlete-exposures (AEs) and rates of initial and subsequent injury among collegiate football athletes. Descriptive epidemiological study. Injury and exposure data collected from collegiate football players from two Division I universities (2007-2011) were analyzed. Rate of initial injury was calculated as the number of initial injuries divided by the total number of AEs for initial injuries, while the rate for subsequent injury was calculated as the number of subsequent injuries divided by the total number of AEs for subsequent injury. Poisson regression was used to determine injury rate ratio (subsequent vs initial injury), with adjustment for other covariates. The total AEs during the study period were 67,564, resulting in an overall injury rate of 35.2 per 10,000 AEs. Rates for initial and subsequent injuries were 31.7 and 45.3 per 10,000 AEs, respectively, with a rate ratio (RR) of 1.4 for rate of subsequent injury vs rate of initial injury (95% CI, 1.1-1.9). Rate of injury appeared to increase with each successive injury. RR during games was 1.8 (95% CI, 1.1-3.0). The rate of subsequent injuries to the head, neck, and face was 10.9 per 10,000 AEs, nearly double the rate of initial injuries to the same sites (RR = 2.0; 95% CI, 1.1-3.5). For wide receivers, the rate of subsequent injuries was 2.2 times the rate of initial injuries (95% CI, 1.3-3.8), and for defensive linemen, the rate of subsequent injuries was 2.1 times the rate of initial injuries (95% CI, 1.1-3.9). The method used in this study allows for a more accurate determination of injury risk among football players who have already been injured at least once. Further research is warranted to better identify which specific factors contribute to this increased risk for subsequent injury.

Incidence of narcolepsy before and after MF59-adjuvanted influenza A(H1N1)pdm09 vaccination in South Korean soldiers.

PubMed

Kim, Woo Jung; Lee, Sang Don; Lee, Eun; Namkoong, Kee; Choe, Kang-Won; Song, Joon Young; Cheong, Hee Jin; Jeong, Hye Won; Heo, Jung Yeon

2015-09-11

Previous reports mostly from Europe suggested an association between an occurrence of narcolepsy and an influenza A(H1N1)pdm09 vaccine adjuvanted with AS03 (Pandemrix(®)). During the 2009 H1N1 pandemic vaccination campaign, the Korean military performed a vaccination campaign with one type of influenza vaccine containing MF59-adjuvants. This study was conducted to investigate the background incidence rate of narcolepsy in South Korean soldiers and the association of the MF59-adjuvanted vaccine with the occurrence of narcolepsy in a young adult group. To assess the incidence of narcolepsy, we retrospectively reviewed medical records of suspicious cases of narcolepsy in 2007-2013 in the whole 20 military hospitals of the Korean military. The screened cases were classified according to the Brighton Collaboration case definition of narcolepsy. After obtaining the number of confirmed cases of narcolepsy per 3 months in 2007-2013, we compared the crude incidence rate of narcolepsy before and after the vaccination campaign. We included 218 narcolepsy suspicious cases in the initial review, which were screened by the diagnostic code on the computerized disease registry in 2007-2013. Forty-one cases were finally diagnosed with narcolepsy in 2007-2013 (male sex, 95%; median age, 21 years). The average background incidence rate of narcolepsy in Korean soldiers was 0.91 cases per 100,000 persons per year. During the 9 months before vaccination implementation (April to December 2009), 6 narcolepsy cases occurred, whereas during the next 9 months (January to September 2010) including the 3-month vaccination campaign, 5 cases occurred. The incidence of narcolepsy in South Korean soldiers was not increased after the pandemic vaccination campaign using the MF59-adjuvanted vaccine. Our results suggest that the MF59-adjuvanted H1N1 vaccine did not contribute to the occurrence of narcolepsy in this young adult group. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reynolds-number dependence of the dimensionless dissipation rate in homogeneous magnetohydrodynamic turbulence.

PubMed

Linkmann, Moritz; Berera, Arjun; Goldstraw, Erin E

2017-01-01

This paper examines the behavior of the dimensionless dissipation rate C_{ɛ} for stationary and nonstationary magnetohydrodynamic (MHD) turbulence in the presence of external forces. By combining with previous studies for freely decaying MHD turbulence, we obtain here both the most general model equation for C_{ɛ} applicable to homogeneous MHD turbulence and a comprehensive numerical study of the Reynolds number dependence of the dimensionless total energy dissipation rate at unity magnetic Prandtl number. We carry out a series of medium to high resolution direct numerical simulations of mechanically forced stationary MHD turbulence in order to verify the predictions of the model equation for the stationary case. Furthermore, questions of nonuniversality are discussed in terms of the effect of external forces as well as the level of cross- and magnetic helicity. The measured values of the asymptote C_{ɛ,∞} lie between 0.193≤C_{ɛ,∞}≤0.268 for free decay, where the value depends on the initial level of cross- and magnetic helicities. In the stationary case we measure C_{ɛ,∞}=0.223.

Life cycle, techno-economic and dynamic simulation assessment of bioelectrochemical systems: A case of formic acid synthesis.

PubMed

Shemfe, Mobolaji; Gadkari, Siddharth; Yu, Eileen; Rasul, Shahid; Scott, Keith; Head, Ian M; Gu, Sai; Sadhukhan, Jhuma

2018-05-01

A novel framework, integrating dynamic simulation (DS), life cycle assessment (LCA) and techno-economic assessment (TEA) of a bioelectrochemical system (BES), has been developed to study for the first time wastewater treatment by removal of chemical oxygen demand (COD) by oxidation in anode and thereby harvesting electron and proton for carbon dioxide reduction reaction or reuse to produce products in cathode. Increases in initial COD and applied potential increase COD removal and production (in this case formic acid) rates. DS correlations are used in LCA and TEA for holistic performance analyses. The cost of production of HCOOH is €0.015-0.005 g -1 for its production rate of 0.094-0.26 kg yr -1 and a COD removal rate of 0.038-0.106 kg yr -1 . The life cycle (LC) benefits by avoiding fossil-based formic acid production (93%) and electricity for wastewater treatment (12%) outweigh LC costs of operation and assemblage of BES (-5%), giving a net 61MJkg -1 HCOOH saving. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

29 CFR 101.17 - Initiation of representation cases and petitions for clarification and amendment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 2 2011-07-01 2011-07-01 false Initiation of representation cases and petitions for... BOARD STATEMENTS OF PROCEDURES Representation Cases Under Section 9(c) of the Act and Petitions for... Initiation of representation cases and petitions for clarification and amendment. The investigation of the...

29 CFR 101.17 - Initiation of representation cases and petitions for clarification and amendment.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 2 2014-07-01 2014-07-01 false Initiation of representation cases and petitions for... BOARD STATEMENTS OF PROCEDURES Representation Cases Under Section 9(c) of the Act and Petitions for... Initiation of representation cases and petitions for clarification and amendment. The investigation of the...

IS PAIN IN ONE KNEE ASSOCIATED WITH ISOMETRIC MUSCLE STRENGTH IN THE CONTRALATERAL LIMB? - DATA FROM THE OSTEOARTHRITIS INITIATIVE (OAI)

PubMed Central

Steidle, E.; Wirth, W.; Glass, N.; Ruhdorfer, A.; Cotofana, S.; Eckstein, F.; Segal, N. A.

2014-01-01

Objective Knee pain and muscle weakness confer risk for knee osteoarthritis incidence and progression. The purpose of this study was to determine whether unilateral knee pain influences contralateral thigh muscle strength. Design Of 4796 Osteoarthritis Initiative participants, 224 (mean±SD age 63.9±8.9 years) cases could be matched to a control. Cases were defined as having unilateral knee pain (numerical rating scale (NRS)≥4/10; ≥infrequent pain) and one pain-free knee (NRS 0–1; ≤infrequent pain; WOMAC≤1). Controls were defined as having bilaterally pain-free knees (NRS 0–1; ≤infrequent pain; WOMAC≤1). Maximal isometric muscle strength [N] was compared between limbs in participants with unilateral pain (cases), and between pain-free limbs of cases and controls. Results Knee extensor/flexor strength in pain-free limbs of cases was lower than in bilaterally pain-free controls (−5.5%/–8.4%; p=0.043/p=0.022). Within cases, maximum extensor/flexor strength was significantly lower in the painful than in the pain-free limb (−6.4%/4.1%; p<0.0001/p=0.015). Conclusions These results suggest that strength in limbs without knee pain is associated with the pain status of the contralateral knee. The strength difference between unilateral pain-free cases and matched bilateral pain-free controls was similar to that between limbs in persons with unilateral knee pain. Lower strength due to contralateral knee pain might be centrally mediated. PMID:25768069

Perforated peptic ulcer following gastric bypass for obesity.

PubMed

Macgregor, A M; Pickens, N E; Thoburn, E K

1999-03-01

Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

Direct simulation of high-speed mixing layers

NASA Technical Reports Server (NTRS)

Mukunda, H. S.; Sekar, B.; Carpenter, M. H.; Drummond, J. Philip; Kumar, Ajay

1992-01-01

A computational study of a nonreacting high-speed mixing layer is performed. A higher order algorithm with sufficient grid points is used to resolve all relevant scales. In all cases, a temporal free-stream disturbance is introduced. The resulting flow is time-sampled to generate a statistical cross section of the flow properties. The studies are conducted at two convective Mach numbers, three free-stream turbulence intensities, three Reynolds numbers, and two types of initial profiles-hyperbolic tangent (tanh) and boundary layer. The boundary-layer profile leads to more realistic predictions of the transition processes. The predicted transition Reynolds number of 0.18 x 10(exp 6) compares well with experimental data. Normalized vortex spacings for the boundary-layer case are about 3.5 and compare favorably with the 1.5 to 2.5 found in experimental measurements. The tanh profile produces spacings of about 10. The growth rate of the layer is shown to be moderately affected by the initial disturbance field, but comparison with experimental data shows moderate agreement. For the boundary-layer case, it is shown that noise at the Strouhal number of 0.007 is selectively amplified and shows little Reynolds number dependence.

Hemophagocytic syndrome as the initial manifestation of systemic lupus erythematosus.

PubMed

Egües Dubuc, César Antonio; Uriarte Ecenarro, Miren; Meneses Villalba, Carlos; Aldasoro Cáceres, Vicente; Hernando Rubio, Iñaki; Belzunegui Otano, Joaquín

2014-01-01

Hemophagocytic syndrome (HS) occurs in autoimmune diseases and belongs to the hemophagocytic lymphohistiocytosis group of diseases. This paper describes the features of 2 patients with systemic lupus erythematosus (SLE) who presented HS as the initial clinical manifestation. Both patients had prolonged fever not associated to an infectious process and did not respond to broad-spectrum antibiotics. The diagnosis of HS secondary to SLE is complicated, because it has some features in common, but HS is characterized by hyperferritinemia, hipofibrinogemia, hypertriglyceridemia and a decrease in the erythrocyte sedimentation rate, unlike SLE. HS treatment when associated to SLE is not well established, but steroids and/or immunoglobulins are effective as the initial treatment, and in refractory cases, cyclosporine or cyclophosphamide may be associated. HS can be the initial manifestation of SLE and should be suspected in patients with organ enlargement, cytopenias, clotting disorders, liver disorders and prolonged fever unresponsive to antibiotics. Anakinra may be a treatment option in adult HS associated to SLE. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Attitude determination of a high altitude balloon system. Part 2: Development of the parameter determination process

NASA Technical Reports Server (NTRS)

Nigro, N. J.; Elkouh, A. F.

1975-01-01

The attitude of the balloon system is determined as a function of time if: (a) a method for simulating the motion of the system is available, and (b) the initial state is known. The initial state is obtained by fitting the system motion (as measured by sensors) to the corresponding output predicted by the mathematical model. In the case of the LACATE experiment the sensors consisted of three orthogonally oriented rate gyros and a magnetometer all mounted on the research platform. The initial state was obtained by fitting the angular velocity components measured with the gyros to the corresponding values obtained from the solution of the math model. A block diagram illustrating the attitude determination process employed for the LACATE experiment is shown. The process consists of three essential parts; a process for simulating the balloon system, an instrumentation system for measuring the output, and a parameter estimation process for systematically and efficiently solving the initial state. Results are presented and discussed.

A Theory of the von Weimarn Rules Governing the Average Size of Crystals Precipitated from a Supersaturated Solution

NASA Technical Reports Server (NTRS)

Barlow, Douglas A.; Baird, James K.; Su, Ching-Hua

2003-01-01

More than 75 years ago, von Weimarn summarized his observations of the dependence of the average crystal size on the initial relative concentration supersaturation prevailing in a solution from which crystals were growing. Since then, his empirically derived rules have become part of the lore of crystal growth. The first of these rules asserts that the average crystal size measured at the end of a crystallization increases as the initial value of the relative supersaturation decreases. The second rule states that for a given crystallization time, the average crystal size passes through a maximum as a function of the initial relative supersaturation. Using a theory of nucleation and growth due to Buyevich and Mansurov, we calculate the average crystal size as a function of the initial relative supersaturation. We confirm the von Weimarn rules for the case where the nucleation rate is proportional to the third power or higher of the relative supersaturation.

Thermal desorption of hydrogen from Mg2Ni hydrogen storage materials.

PubMed

Hur, Tae Hong; Han, Jeong Seb; Kim, Jin Ho; Kim, Byung Kwan

2011-07-01

In order to investigate the influence of HCS on the hydrogen occupation site of Mg2Ni alloy, the thermal desorption technique has been applied to Mg2Ni hydride made by hydriding combustion synthesis (HCS). Mg2Ni was made under low temperature in a short time by the HCS compared to conventional melting process. At various initial hydride wt% from 0.91 to 3.52, the sample was heated to 623 K at a rate of 1.0 K/min. The starting temperature of the evolution of hydrogen goes higher as the initial hydride wt% increases. Only one peak is shown in the case of the small initial hydride wt%. But two peaks appeared with increasing initial hydride wt%. The activation energies obtained by the first and second peaks are 113.0 and 99.5 kJ/mol respectively. The two site occupation model by Darriet et al. was proved. The influence of HCS on the hydrogen occupation site of Mg2Ni alloy is nonexistent.

A protocol of early aggressive acceleration of tube feeding increases ileus without perceptible benefit in severely burned patients.

PubMed

Kesey, Jennifer; Dissanaike, Sharmila

2013-01-01

Optimal nutrition is essential to the recovery of burned patients. The authors evaluated the efficacy of an aggressive nutrition delivery protocol. The following protocol was implemented: initiation of tube feeds within 4 hours, acceleration to goal rate within 8 hours, and tolerance of gastric residual volumes of 400 ml. Patients on the protocol formed the study group whereas patients admitted immediately before implementation served as controls for a study period of 7 days after admission. Outcome variables included ileus, prokinetic medication use, intensive care unit and overall length of stay, ventilator days and mortality. Variables were compared using bivariate analysis. The 42 study subjects and 34 controls were similar at baseline. Time to initiation was similar (6.8 vs 9.4 hours; P = .226), however, goal rate was achieved much sooner in the study group (11.2 vs 20.9 hours; P < .001). Number of hours spent at goal was different on days 1 and 2 (6.62 vs 2.74, P = .003 and 17.24 vs 13.18, P = .032) with no difference thereafter. Residual volumes in the study group were higher from day 2 onward, and remained increased throughout the study period (401 vs 234 ml average; P = .449). Clinical ileus was much more common in the study group (8 cases vs 1, P = .037). There was no difference in length of stay or mortality. The protocol was successfully implemented and resulted in early achievement of goal tube feed rates. However, this resulted in tube feed intolerance as manifested by more cases of clinical ileus.

[Clinical characteristics and therapeutic effect of drug-resistant tuberculosis in children].

PubMed

Liao, Q; Tan, S; Zhu, Y; Wan, C M; Deng, S Y; Shu, M

2017-02-02

Objective: To explore the clinical characteristics of drug-resistant tuberculosis (TB) in children and to study the effectiveness of second-line anti-TB therapy for children and to examine the incidence of adverse drug reactions. Method: Retrospective research was conducted. The clinical records of children in West China Second Hospital diagnosed as drug-resistant TB from January 2010 to June 2014 were investigated.The clinical characteristics and risk factors were analyzed retrospectively. Treatment effect at discharge was examined as a short-term outcome indicator to evaluate the effectiveness of second-line anti-TB therapy and the incidence of adverse drug reactions. χ(2) test was used. Result: Forty-six patients were diagnosed as drug-resistant TB in 443 children infected with TB, with a 10.4% resistance rate. The 46 children included 26 male and 20 female patients, aged from one month and 28 days to 17 years and 5 months, with the average age (8.4±4.5) years, >7 to 14 years old patients as the biggest part(25 patients, 54.3%). Among the 46 children, 20 patients(43.5%)had close contact with TB patients, of whom 12 patients (60.0%) contacted with family members (including parents, brothers and sisters and grandparents living together) and 8 patients(40.0%) contacted with patients from outside family (such as relatives or neighbors). Moreover, 11 cases (23.9%) were under initial treatment and 35 cases (76.1%) were retreated.From 2010 to 2014, the number of cases of initial and retreated patients had no significant difference(0 and 1, 1 and 13, 4 and 7, 4 and 11, 2 and 3 cases, χ(2)=3.255, P =0.196). Among retreated patients, 31.4% (11/35) had irregular treatment before.Until discharge, the effective rate was 87.0% (40/46), while the incidence rate of adverse drug reaction was 10.9%(5/46). Conclusion: The therapy for drug-resistant TB is effective and the incidence of adverse drug reaction is relatively low.

Uveal Melanoma Regression after Brachytherapy: Relationship with Chromosome 3 Monosomy Status.

PubMed

Salvi, Sachin M; Aziz, Hassan A; Dar, Suhail; Singh, Nakul; Hayden-Loreck, Brandy; Singh, Arun D

2017-07-01

The objective was to evaluate the relationship between the regression rate of ciliary body melanoma and choroidal melanoma after brachytherapy and chromosome 3 monosomy status. We conducted a prospective and consecutive case series of patients who underwent biopsy and brachytherapy for ciliary/choroidal melanoma. Tumor biopsy performed at the time of radiation plaque placement was analyzed with fluorescence in situ hybridization to determine the percentage of tumor cells with chromosome 3 monosomy. The regression rate was calculated as the percent change in tumor height at months 3, 6, and 12. The relationship between regression rate and tumor location, initial tumor height, and chromosome 3 monosomy (percentage) was assessed by univariate linear regression (R version 3.1.0). Of the 75 patients included in the study, 8 had ciliary body melanoma, and 67 were choroidal melanomas. The mean tumor height at the time of diagnosis was 5.2 mm (range: 1.90-13.00). The percentage composition of chromosome 3 monosomy ranged from 0-20% (n = 35) to 81-100% (n = 40). The regression of tumor height at months 3, 6, and 12 did not statistically correlate with tumor location (ciliary or choroidal), initial tumor height, or chromosome 3 monosomy (percentage). The regression rate of choroidal melanoma following brachytherapy did not correlate with chromosome 3 monosomy status.

Time trend of reported cases and publications: hepatitis E in comparison to hepatitis A - D in Germany from 2001 to 2016.

PubMed

Wehmeyer, Malte H; Hartl, Johannes; von Wulffen, Moritz; Lohse, Ansgar W; Pischke, Sven

2018-01-01

The frequency of autochthonous hepatitis E virus (HEV) infections in Western countries has increased since the millennium, probably due to a higher awareness for HEV. The aim of this study was to analyze the epidemiological situation and regional distribution of HEV in comparison to hepatitis A - D in Germany. Data of the reported cases, patients' travel histories, and the regional distribution of hepatitis A - E virus infections from 2001 to 2017 were extracted from databases of the Robert Koch Institute. The number of publications per year on each hepatitis virus was used as a surrogate parameter for scientific awareness. The incidence of HEV infections increased from 31 reported cases in 2001 to 1991 cases in 2016 with a rate of autochthonous HEV infections of 44.4 % in 2001 and 83.9 % in 2016. In 2016, the HEV incidence was 4.4/100 000 in Eastern Germany and 2.0/100 000 in Western Germany. From 2001 to 2016, the numbers of hepatitis A and C virus infections decreased, while the number of hepatitis B virus infections initially decreased followed by an increase since 2014. The incidence of hepatitis D virus infections remained low. The incidence rates of hepatitis A - D virus infections were comparable between Eastern and Western Germany in 2016. There was a strong correlation between publications on HEV and reported HEV cases (Pearson r = 0.9803, p < 0.01). Especially in Eastern Germany, but also in Western Germany, the rate of reported HEV cases and the scientific awareness for this disease increased strongly since 2001. © Georg Thieme Verlag KG Stuttgart · New York.

Detecting paroxysmal coughing from pertussis cases using voice recognition technology.

PubMed

Parker, Danny; Picone, Joseph; Harati, Amir; Lu, Shuang; Jenkyns, Marion H; Polgreen, Philip M

2013-01-01

Pertussis is highly contagious; thus, prompt identification of cases is essential to control outbreaks. Clinicians experienced with the disease can easily identify classic cases, where patients have bursts of rapid coughing followed by gasps, and a characteristic whooping sound. However, many clinicians have never seen a case, and thus may miss initial cases during an outbreak. The purpose of this project was to use voice-recognition software to distinguish pertussis coughs from croup and other coughs. We collected a series of recordings representing pertussis, croup and miscellaneous coughing by children. We manually categorized coughs as either pertussis or non-pertussis, and extracted features for each category. We used Mel-frequency cepstral coefficients (MFCC), a sampling rate of 16 KHz, a frame Duration of 25 msec, and a frame rate of 10 msec. The coughs were filtered. Each cough was divided into 3 sections of proportion 3-4-3. The average of the 13 MFCCs for each section was computed and made into a 39-element feature vector used for the classification. We used the following machine learning algorithms: Neural Networks, K-Nearest Neighbor (KNN), and a 200 tree Random Forest (RF). Data were reserved for cross-validation of the KNN and RF. The Neural Network was trained 100 times, and the averaged results are presented. After categorization, we had 16 examples of non-pertussis coughs and 31 examples of pertussis coughs. Over 90% of all pertussis coughs were properly classified as pertussis. The error rates were: Type I errors of 7%, 12%, and 25% and Type II errors of 8%, 0%, and 0%, using the Neural Network, Random Forest, and KNN, respectively. Our results suggest that we can build a robust classifier to assist clinicians and the public to help identify pertussis cases in children presenting with typical symptoms.

Reconstruction of disease transmission rates: Applications to measles, dengue, and influenza.

PubMed

Lange, Alexander

2016-07-07

Transmission rates are key in understanding the spread of infectious diseases. Using the framework of compartmental models, we introduce a simple method to reconstruct time series of transmission rates directly from incidence or disease-related mortality data. The reconstruction employs differential equations, which model the time evolution of infective stages and strains. Being sensitive to initial values, the method produces asymptotically correct solutions. The computations are fast, with time complexity being quadratic. We apply the reconstruction to data of measles (England and Wales, 1948-1967), dengue (Thailand, 1982-1999), and influenza (U.S., 1910-1927). The Measles example offers comparison with earlier work. Here we re-investigate reporting corrections, include and exclude demographic information. The dengue example deals with the failure of vector-control measures in reducing dengue hemorrhagic fever (DHF) in Thailand. Two competing mechanisms have been held responsible: strain interaction and demographic transitions. Our reconstruction reveals that both explanations are possible, showing that the increase in DHF cases is consistent with decreasing transmission rates resulting from reduced vector counts. The flu example focuses on the 1918/1919 pandemic, examining the transmission rate evolution for an invading strain. Our analysis indicates that the pandemic strain could have circulated in the population for many months before the pandemic was initiated by an event of highly increased transmission. Copyright © 2016 Elsevier Ltd. All rights reserved.

Simulation of MAD Cow Disease Propagation

NASA Astrophysics Data System (ADS)

Magdoń-Maksymowicz, M. S.; Maksymowicz, A. Z.; Gołdasz, J.

Computer simulation of dynamic of BSE disease is presented. Both vertical (to baby) and horizontal (to neighbor) mechanisms of the disease spread are considered. The game takes place on a two-dimensional square lattice Nx×Ny = 1000×1000 with initial population randomly distributed on the net. The disease may be introduced either with the initial population or by a spontaneous development of BSE in an item, at a small frequency. Main results show a critical probability of the BSE transmission above which the disease is present in the population. This value is vulnerable to possible spatial clustering of the population and it also depends on the mechanism responsible for the disease onset, evolution and propagation. A threshold birth rate below which the population is extinct is seen. Above this threshold the population is disease free at equilibrium until another birth rate value is reached when the disease is present in population. For typical model parameters used for the simulation, which may correspond to the mad cow disease, we are close to the BSE-free case.

Deformation dependence of proton decay rates and angular distributions in a time-dependent approach

NASA Astrophysics Data System (ADS)

Carjan, N.; Talou, P.; Strottman, D.

1998-12-01

A new, time-dependent, approach to proton decay from axially symmetric deformed nuclei is presented. The two-dimensional time-dependent Schrödinger equation for the interaction between the emitted proton and the rest of the nucleus is solved numerically for well defined initial quasi-stationary proton states. Applied to the hypothetical proton emission from excited states in deformed nuclei of 208Pb, this approach shows that the problem cannot be reduced to one dimension. There are in general more than one directions of emission with wide distributions around them, determined mainly by the quantum numbers of the initial wave function rather than by the potential landscape. The distribution of the "residual" angular momentum and its variation in time play a major role in the determination of the decay rate. In a couple of cases, no exponential decay was found during the calculated time evolution (2×10-21 sec) although more than half of the wave function escaped during that time.

Alcoholic fermentation of raw cassava starch by Rhizopus koji without cooking

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

Fuijo, Y.; Suyanadona, P.; Attasampunna, P.

Using only wheat bran koji from the Rhizopus strain, raw cassava starch and cassava pellets converted reasonably well to alcohol (ethanol) without cooking at 35 degrees C and pH 4.5-5.0. When the initial broth contained 30 g raw cassava starch, 10 g Rhizopus species koji, and 100 mL tap water, 12.1 g of alcohol was recovered by final distillation from fermented broth. In this case, 12.1 g alcohol corresponds to an 85.5% conversion rate based on the theoretical value of the starch content. When the initial broth contained 40 g cassava starch, 14.1 g of alcohol was recovered, where 14.1more » g corresponds to a 74.5% conversion rate. The alcoholic fermentation process described in the present work is considered more effective and reasonable than the process using raw starch without cooking reported until now, since the new process makes it unnecessary to add yeast cells and glucoamylase preparation. (Refs. 15).« less

Alcoholic fermentation of raw cassava starch by Rhizopus koji without cooking

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

Fujio, Y.; Suyanadona, P.; Attasampunna, P.

Using only wheat bran koji from the Rhizopus strain, raw cassava starch and casava pellets converted reasonably well to alcohol (ethanol) without cooking at 35/sup 0/C and pH 4.5-5.0. When the initial broth contained 30 g raw cassava starch, 10 g Rhizopus sp. koji, and 100 mL tap water, 12.1 g of alcohol was recovered by final distillation from fermented broth. In this case, 12.1 g alcohol corresponds to an 85.5% conversion rate based on the theoretical value of the starch content. When the initial broth contained 40 g cassava starch, 14.1 g of alcohol was recovered, where 14.1 gmore » corresponds to a 74.5% conversion rate. The alcoholic fermentation process described in the present work is considered more effective and reasonable than the process using raw starch without cooking reported until now, since the new process makes it unnecessary to add yeast cells and glucoamylase preparation.« less

Studies with spike initiators - Linearization by noise allows continuous signal modulation in neural networks

NASA Technical Reports Server (NTRS)

Yu, Xiaolong; Lewis, Edwin R.

1989-01-01

It is shown that noise can be an important element in the translation of neuronal generator potentials (summed inputs) to neuronal spike trains (outputs), creating or expanding a range of amplitudes over which the spike rate is proportional to the generator potential amplitude. Noise converts the basically nonlinear operation of a spike initiator into a nearly linear modulation process. This linearization effect of noise is examined in a simple intuitive model of a static threshold and in a more realistic computer simulation of spike initiator based on the Hodgkin-Huxley (HH) model. The results are qualitatively similar; in each case larger noise amplitude results in a larger range of nearly linear modulation. The computer simulation of the HH model with noise shows linear and nonlinear features that were earlier observed in spike data obtained from the VIIIth nerve of the bullfrog. This suggests that these features can be explained in terms of spike initiator properties, and it also suggests that the HH model may be useful for representing basic spike initiator properties in vertebrates.

Identification of forty cases with alkaptonuria in one village in Jordan.

PubMed

Al-Sbou, Mohammed; Mwafi, Nesrin; Lubad, Mohammad Abu

2012-12-01

Alkaptonuria (AKU) is one of the four initially identified inborn errors of metabolism. The prevalence of AKU is unknown in Jordan. Therefore, a research project was started in April 2009 at the Faculty of Medicine/Mutah University in southern Jordan. The aims of the project were to identify people with AKU, to screen all family members with history of AKU, and to increase the awareness about the disease among health care professionals and the community in southern Jordan. Targeted family screening method was used to identify patients with AKU. In this paper, we present preliminary results of screening 17 families with history of AKU in a single village in southern region of Jordan. Forty cases with AKU were identified in this village (age range, 1-60 years). Early cases with AKU were diagnosed through out this study, two-third of patients (n = 28) were under the age of thirty. Interestingly, nine cases with AKU were identified in one family. Our experience suggests that for the identification of cases with AKU where consanguinity is common, the focus for screening should be extended to all family members. The prevalence of AKU among Jordanian is likely to be greater than the prevalence rates worldwide due to high rates of consanguineous marriages. Further studies and effective screening programs are needed to detect undiagnosed cases of AKU, to provide genetic counseling, and ultimately to prevent the occurrence of new cases of AKU in Jordan.

Molecular dynamics study on the effect of boundary heating rate on the phase change characteristics of thin film liquid

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

Hasan, Mohammad Nasim, E-mail: nasim@me.buet.ac.bd.com; Morshed, A. K. M. Monjur, E-mail: shavik@me.buet.ac.bd.com; Rabbi, Kazi Fazle, E-mail: rabbi35.me10@gmail.com

2016-07-12

In this study, theoretical investigation of thin film liquid phase change phenomena under different boundary heating rates has been conducted with the help of molecular dynamics simulation. To do this, the case of argon boiling over a platinum surface has been considered. The study has been conducted to get a better understanding of the nano-scale physics of evaporation/boiling for a three phase system with particular emphasis on the effect of boundary heating rate. The simulation domain consisted of liquid and vapor argon atoms placed over a platinum wall. Initially the whole system was brought to an equilibrium state at 90more » K with the help of equilibrium molecular dynamics and then the temperature of the bottom wall was increased to a higher temperature (250 K/130 K) over a finite heating period. Depending on the heating period, the boundary heating rate has been varied in the range of 1600×10{sup 9} K/s to 8×10{sup 9} K/s. The variations of argon region temperature, pressure, net evaporation number with respect to time under different boundary heating rates have been determined and discussed. The heat fluxes normal to platinum wall for different cases were also calculated and compared with theoretical upper limit of maximum possible heat transfer to elucidate the effect of boundary heating rate.« less

Significant Adverse Events and Outcomes After Medical Abortion

PubMed Central

Cleland, Kelly; Creinin, Mitchell D.; Nucatola, Deborah; Nshom, Montsine; Trussell, James

2013-01-01

Objective To analyze rates of significant adverse events and outcomes in women having a medical abortion at Planned Parenthood health centers in 2009 and 2010, and to identify changes in the rates of adverse events and outcomes between the 2 years. Methods In this database review we analyzed data from Planned Parenthood affiliates that provided medical abortion in 2009 and 2010, almost exclusively using an evidence-based buccal misoprostol regimen. We evaluated the incidence of six clinically significant adverse events (hospital admission, blood transfusion, emergency room treatment, intravenous antibiotics administration, infection, and death) and two significant outcomes (ongoing pregnancy and ectopic pregnancy diagnosed after medical abortion treatment was initiated). We calculated an overall rate as well as rates for each event and identified changes between the 2 years. Results Amongst 233,805 medical abortions provided in 2009 and 2010, significant adverse events or outcomes were reported in 1,530 cases (0.65%). There was no statistically significant difference in overall rates between years. The most common significant outcome was ongoing intrauterine pregnancy (0.50%); significant adverse events occurred in 0.16% of cases. One patient death occurred due to an undiagnosed ectopic pregnancy. Only rates for emergency room treatment and blood transfusion differed by year, and were slightly higher in 2010. Conclusion Review of this large dataset reinforces the safety of the evidence-based medical abortion regimen. PMID:23262942

Eclampsia a 5 years retrospective review of 216 cases managed in two teaching hospitals in Addis Ababa.

PubMed

Abate, Misganaw; Lakew, Zufan

2006-01-01

to measure the magnitude of eclampsia and its maternal and perinatal outcome. A 5 years retrospective descriptive study was conducted on 216 eclamptic cases diagnosed, admitted and managed from October 1994 to September 1999 in the two teaching hospitals of Addis Ababa; namely Tikur Anbessa and St Paul's Hospitals. There were 257 mothers with eclampsia treated in the given period and 35741 deliveries making the incidence of eclampsia 7.1/1000 deliveries. Eighty-four women (38.9%) had any antenatal care, 157 (72.7%) were nulli-parous and 69 (31.8%) were aged below 20. Convulsion occurred ante-partum in 133 (61.6%), intrapartum in 49 (22.7%) and postpartum in 34 (15.7%) mothers. The most frequently sited symptoms before convulsion include headache in 83.8%, visual disturbance in 41.6% and epigastric pain in 38.4% of the cases. Ninety nine (45.8%) women were delivered by cesarean section making the cesarean section rate among eclamptic mothers significantly higher than the rate among the general population, which was 16.6% at the same period. (P = 0.0001). The multiple pregnancy rate was 5.7%, which was significantly higher than the rate among the general population of 1.5% at the same time. Seventy-four mothers had repeated convulsion after admission to the hospitals and initiation of the standard treatment. Twenty-eight mothers with eclampsia died making the case fatality rate 13%. Seven mothers (3.2%) died before delivery. Forty-four Stillbirths and twenty-five early neonatal deaths occurred making the perinatal mortality rate 312.2/1000 deliveries. Eclampsia is a common complication still associated with high level of maternal and perinatal mortality as well as morbidity. ANC coverage should be strengthened to detect preclampsia, and prevent eclampsia. Management in the hospital should be optimized to prevent recurrent convulsions and complications after admission.

Limb Salvage After Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy.

PubMed

Vaudreuil, Nicholas J; Fourman, Mitchell S; Wukich, Dane K

2017-03-01

Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level III, retrospective case series.

Identifying Early Target Cells of Nipah Virus Infection in Syrian Hamsters

PubMed Central

Baseler, Laura; Scott, Dana P.; Saturday, Greg; Horne, Eva; Rosenke, Rebecca; Thomas, Tina; Meade-White, Kimberly; Haddock, Elaine; Feldmann, Heinz

2016-01-01

Background Nipah virus causes respiratory and neurologic disease with case fatality rates up to 100% in individual outbreaks. End stage lesions have been described in the respiratory and nervous systems, vasculature and often lymphoid organs in fatal human cases; however, the initial target organs of Nipah virus infection have not been identified. Here, we detected the initial target tissues and cells of Nipah virus and tracked virus dissemination during the early phase of infection in Syrian hamsters inoculated with a Nipah virus isolate from Malaysia (NiV-M) or Bangladesh (NiV-B). Methodology/Principal Findings Syrian hamsters were euthanized between 4 and 48 hours post intranasal inoculation and tissues were collected and analyzed for the presence of viral RNA, viral antigen and infectious virus. Virus replication was first detected at 8 hours post inoculation (hpi). Nipah virus initially targeted type I pneumocytes, bronchiolar respiratory epithelium and alveolar macrophages in the lung and respiratory and olfactory epithelium lining the nasal turbinates. By 16 hpi, virus disseminated to epithelial cells lining the larynx and trachea. Although the pattern of viral dissemination was similar for both virus isolates, the rate of spread was slower for NiV-B. Infectious virus was not detected in the nervous system or blood and widespread vascular infection and lesions within lymphoid organs were not observed, even at 48 hpi. Conclusions/Significance Nipah virus initially targets the respiratory system. Virus replication in the brain and infection of blood vessels in non-respiratory tissues does not occur during the early phase of infection. However, virus replicates early in olfactory epithelium and may serve as the first step towards nervous system dissemination, suggesting that development of vaccines that block virus dissemination or treatments that can access the brain and spinal cord and directly inhibit virus replication may be necessary for preventing central nervous system pathology. PMID:27812087

Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral.

PubMed

Linsell, L; Dawson, J; Zondervan, K; Rose, P; Randall, T; Fitzpatrick, R; Carr, A

2006-02-01

To estimate the national prevalence and incidence of adults consulting for a shoulder condition and to investigate patterns of diagnosis, treatment, consultation and referral 3 yr after initial presentation. Prevalence and incidence rates were estimated for 658469 patients aged 18 and over in the year 2000 using a primary care database, the IMS Disease Analyzer-Mediplus UK. A cohort of 9215 incident cases was followed-up prospectively for 3 yr beyond the initial consultation. The annual prevalence and incidence of people consulting for a shoulder condition was 2.36% [95% confidence interval (CI) 2.32-2.40%] and 1.47% (95% CI 1.44-1.50%), respectively. Prevalence increased linearly with age whilst incidence peaked at around 50 yr then remained static at around 2%. Around half of the incident cases consulted once only, while 13.6% were still consulting with a shoulder problem during the third year of follow-up. During the 3 yr following initial presentation, 22.4% of patients were referred to secondary care, 30.8% were prescribed non-steroidal anti-inflammatory drugs and 10.6% were given an injection by their general practitioner (GP). GPs tended to use a limited number of generalized codes when recording a diagnosis; just five of 426 possible Read codes relating to shoulder conditions accounted for 74.6% of the diagnoses of new cases recorded by GPs. The prevalence of people consulting for shoulder problems in primary care is substantially lower than community-based estimates of shoulder pain. Most referrals occur within 3 months of initial presentation, but only a minority of patients are referred to orthopaedic specialists or rheumatologists. GPs may lack confidence in applying precise diagnoses to shoulder conditions.

Recurrence of Phaeochromocytoma and Abdominal Paraganglioma After Initial Surgical Intervention

PubMed Central

Mullan, Karen R; Atkinson, A Brew; Eatock, Fiona C; Wallace, Helen; Gray, Moyra; Hunter, Steven J

2015-01-01

Background Clinical and biochemical follow up after surgery for phaeochromocytoma is essential with long term studies demonstrating recurrence frequencies between 6% and 23%. Aim To examine the characteristics and frequency of tumour recurrence in a regional endocrine referral centre, in patients with surgical resection of phaeochromocytoma (P) and abdominal paraganglioma (AP). Methods We identified a cohort of 52 consecutive patients who attended our Regional Endocrinology & Diabetes Centre and retrospectively reviewed their clinical, biochemical and radiological data (between 2002 and 2013). After confirmation of early post-operative remission by negative biochemical testing, tumour recurrence was defined by demonstration of catecholamine excess with confirmatory imaging. Results Phaeochromocytoma was confirmed histologically in all cases (43:P, 9:AP, mean-age:53years). Open adrenalectomy was performed in 20 cases and laparoscopically in 32. Hereditary phaeochromocytoma was confirmed by genetic analysis in 12 (23%) patients. Median follow up time from initial surgery was 47 months, (range: 12 - 296 months), 49 patients had no evidence of tumour recurrence at latest follow-up. Three patients (6%) demonstrated tumour development, one in a patient with VHL which occurred in a contralateral adrenal gland, one sporadic case had local recurrence, and an adrenal tumour occurred in a patient with a SDHB gene mutation who had a previous bladder tumour. After initial surgery, the tumours occurred at 8.6, 12.0 and 17.7 years respectively. Conclusion In this study tumour development occurred in 6% of patients. Although tumour rates were low, careful and sustained clinical and biochemical follow up is advocated, as new tumour development or recurrence may occur long after the initial surgery is performed. PMID:26170485

Laboratory findings in neurosyphilis patients with epileptic seizures alone as the initial presenting symptom.

PubMed

Tong, Man-Li; Liu, Li-Li; Zeng, Yan-Li; Zhang, Hui-Lin; Liu, Gui-Li; Zheng, Wei-Hong; Dong, Jie; Wu, Jing-Yi; Su, Yuan-Hui; Lin, Li-Rong; Yang, Tian-Ci

2013-04-01

A retrospective chart review was performed to characterize the clinical presentation, the characteristic combination of serologic and cerebrospinal fluid (CSF) abnormalities, and the neuroimaging findings of neurosyphilis (NS) patients who had epileptic seizures alone as an initial presenting symptom. In a 6.75-year period, 169 inpatients with NS were identified at Zhongshan Hospital (from June 2005 to February 2012). We demonstrated that 13 (7.7%) of the 169 NS patients had epileptic seizures alone as an initial presenting feature. Epileptic seizures occurred in NS patients with syphilitic meningitis (2 cases), meningovascular NS (5 cases), and general paresis (6 cases). The types of epileptic seizures included simple partial, complex partial with secondary generalization (including status epilepticus), and generalized seizures (no focal onset reported). Nine of NS patients with only epileptic seizures as primary symptom were misdiagnosed, and the original misdiagnosis was 69.23% (9/13). Ten (10/13, 76.9%) patients had an abnormal magnetic resonance imaging, and 7 (7/13 53.8%) patients had abnormal electroencephalogram recordings. In addition, the sera rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) from all 13 patients were positive. The overall positive rates of the CSF-RPR and CSF-TPPA were 61.5% and 69.2%, respectively. Three patients demonstrated CSF pleocytosis, and 9 patients exhibited elevated CSF protein levels. Therefore, NS with only epileptic seizures at the initial presentation exhibits a lack of specificity. It is recommended that every patient with clinically evident symptoms of epileptic seizures should have a blood test performed for syphilis. When the serology results are positive, all of the patients should undergo a CSF examination to diagnose NS. Copyright © 2013 Elsevier Inc. All rights reserved.

Initial experience with laparoscopic sleeve gastrectomy by a novice bariatric team in an established bariatric center--a review of literature and initial results.

PubMed

Dey, Ashish; Mittal, Tarun; Malik, Vinod K

2013-04-01

Laparoscopic sleeve gastrectomy (LSG) is a highly successful approach to morbid obesity with low incidence of complications. The literature suggests a learning curve of 50-100 cases for attaining proficiency and reducing the complication rates for laparoscopic bariatric surgery. The aims of this paper were to review the literature of initial cases by bariatric surgeons worldwide and to report the experience of initial 50 cases of LSG by a novice bariatric team in a single center. The objective was to evaluate the outcomes for laparoscopic bariatric surgery in the first 50 patients by a novice team of bariatric surgeons in an already established bariatric surgery program with short-term follow-up. All surgeries were done by a new bariatric team who underwent laparoscopic fellowship training under a bariatric team with an experience of over 600 bariatric procedures. Fifty consecutive patients from March 2010 to January 2012 were offered LSG and followed up for a minimum of 6 months. Weight loss and comorbidity resolution were tabulated and assessed. Mean preoperative and postoperative BMIs were 46.6 and 35.7 kg/m2, respectively. There were no life threatening postoperative complications or mortality. The median percent excess weight loss was 50.3% at the end of 6 months. Comorbidity resolution values were 96% for obstructive sleep apnea, 89% for diabetes mellitus, and 87% for joint pains, among the most common comorbidities. LSG is effective in achieving weight loss and in improving comorbidities with minimal complications even at the hands of novice bariatric surgeons with good laparoscopic skills and adequate bariatric training.

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

PubMed Central

Kim, Jae-Hong; Kim, Jung-Hee; Kong, Min-Ho; Song, Kwan-Young

2011-01-01

Objective There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. Methods Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. Results The mean ages were 69.4±12.1 and 55.6±9.3 years in the small and large craniotomy groups, respectively. The recurrence of hematomas requiring reoperation occurred in 50% and 10% of the small and large craniotomy patients, respectively (p<0.001). There were no significant differences in postoperative neurological status, complications, or days of hospital stay between these two groups. Conclusion Among the cases of CSDH initially requiring craniotomy, the large craniotomy with extended membranectomy technique reduced the reoperation rate, compared to that of the small craniotomy with partial membranectomy technique. PMID:22053228

Decomposition of plant materials in marine sediment exposed to different electron acceptors (O 2, NO 3-, and SO 42-), with emphasis on substrate origin, degradation kinetics, and the role of bioturbation

NASA Astrophysics Data System (ADS)

Kristensen, Erik; Holmer, Marianne

2001-02-01

Carbon mineralization of fresh and aged diatoms ( Skeletonema costatum) and barley hay ( Hordeum vulgare) was followed for 23 to 35 d in sandy and silty sediment. By the use of a thin-layer flow-through technique, it was possible to expose the sediment selectively for oxygen, nitrate or sulfate as electron acceptors in the terminal oxidation of organic carbon. Decomposition took place in two basic stages. Mineralization of the rapidly leachable fraction of the fresh materials occurred rapidly and with the same constant rate regardless of the electron acceptor available, indicating that the dissolved organic carbon released initially was labile and readily available for all heterotrophic respirers. In the case of diatoms, decay of the remaining, more refractory, particulate fraction of fresh and aged diatoms were strikingly similar, although both were degraded 5 to 10 times faster under oxic than anoxic conditions. Most of the particulate remains of diatoms after leaching apparently belong to one fraction, which maintains the same degradability even after prolonged aging. With respect to hay, the late divergence in rates of aerobic and anaerobic decay (a factor of 4 to 5 for aged hay only after 20 d) indicated that the larger hay particles (<500 μm) became exhausted in labile organic matter much slower through time than fine-particulate diatoms (˜20 μm). Anaerobic carbon mineralization rates of diatoms and hay particulates with sulfate and nitrate as electron acceptors were similar or up to two times faster with sulfate. The generally low levels of dissolved organic carbon in all incubations after the initial leaching phase suggest that the limiting step of decomposition under both aerobic and anaerobic decay is the initial hydrolytic attack on the complex particulate remains. Based on a volumetric model, we show that the exposure of anoxic subsurface sediment containing partly degraded organic material to oxygen via irrigated worm burrows or by reworking may significantly enhance total sediment carbon oxidation. The enhancement in the irrigation case increases linearly with density (up to 80%) and is higher than the density-independent enhancement (10%) in the reworking case when abundance is above a lower limit of ˜400 individuals/m 2.

Necrotizing cellulitis with multiple abscesses on the leg caused by Serratia marcescens.

PubMed

Hau, Estelle; Bouaziz, Jean-David; Lafaurie, Matthieu; Saussine, Anne; Masson, Vincent; Rausky, Jonathan; Bagot, Martine; Guibal, Fabien

2016-03-01

Serratia marcescens is an unusual cause of severe skin infection initially described in immunocompromised patients. We report a case of necrotizing cellulitis of the leg caused by S marcescens in a 68-year-old woman with diabetes mellitus and a history of chronic lymphoedema of the leg. We reviewed the literature and found 49 cases of severe skin infections from S marcescens that included 20 cases of necrotizing fasciitis (NF) as well as 29 cases of severe skin infections without NF (non-NF cases). Patients were immunocompromised in 59% to 70% of cases. The mortality rate was high in NF cases (60%) versus non-NF cases (3%). Surgery was required in 95% of NF cases and in 24% of non-NF cases. The other clinical manifestations of S marcescens skin infection reported in the literature included disseminated papular eruptions in patients infected with human immunodeficiency virus with folliculitis on the trunk. Serratia marcescens is naturally resistant to amoxicillin alone and amoxicillin associated with clavulanic acid. Broad-spectrum antibiotics are indicated to treat S marcescens skin infections, and surgery should be promptly considered in cases of severe skin infections if appropriate antibiotic therapy does not lead to rapid improvement.

Examining attrition rates at one specialty addiction treatment provider in the United States: a case study using a retrospective chart review.

PubMed

Loveland, David; Driscoll, Hilary

2014-09-25

Engaging individuals who have a substance use disorder (SUD) in treatment continues to be a challenge for the specialty addiction treatment field. Research has consistently revealed high rates of missed appointments at each step of the enrollment process: 1. between calling for services and assessment, 2. between assessment and enrollment, and 3. between enrollment and completion of treatment. Extensive research has examined each step of the process; however, there is limited research examining the overall attrition rate across all steps. A single case study of a specialty addiction treatment agency was used to examine the attrition rates across the first three steps of the enrollment process. Attrition rates were tracked between August 1, 2011 and July 31, 2012. The cohort included 1822 unique individuals who made an initial request for addiction treatment services. Monthly retrospective reviews of medical records, phone logs, and billing data were used to calculate attrition rates. Attrition rates reported in the literature were collected and compared to the rates found at the target agency. Median time between request for treatment and assessment was 6 days (mean 7.5) and between assessment and treatment enrollment was 8 days (mean 12.5). An overall attrition rate of 80% was observed, including 45% between call and assessment, 32% between assessment and treatment enrollment (another 17% could not be determined), and 37% left or were removed from treatment before 30 days. Women were less likely to complete 30 days of treatment compared to men. No other demographics were related to attrition rates. One out of every five people who requested treatment completed a minimum of 30 days of a treatment. The attrition rate was high, yet similar to rates noted in the literature. Limitations of the single case study are noted. Attrition rates in the U.S. are high with approximately 75% to 80% of treatment seekers disengaging at one of the multiple stages of the enrollment and treatment process. Significant changes in the system are needed to improve engagement rates.

Introduction of a computer-based surgical platform in the surgical care of patients with newly diagnosed uterine cancer: outcomes and impact on approach.

PubMed

Leitao, Mario M; Briscoe, Gabriel; Santos, Kevin; Winder, Abigail; Jewell, Elizabeth L; Hoskins, William J; Chi, Dennis S; Abu-Rustum, Nadeem R; Sonoda, Yukio; Brown, Carol L; Levine, Douglas A; Barakat, Richard R; Gardner, Ginger J

2012-05-01

To assess the introduction of computer-based surgery (ie, robotic surgery [RBT]) in the treatment of patients with newly diagnosed uterine cancer. We identified all patients who presented to our institution for initial surgical care of newly diagnosed uterine cancer from 5/1/07-12/31/10. Perioperative outcomes of laparotomy cases were compared to those of laparoscopic (LSC) or RBT cases. Complications within 30 days of surgery were graded. Of 752 patients, the planned approach was laparotomy in 103 (14%), LSC in 302 (40%), and RBT in 347 (46%). The rate of laparotomy for any reason (planned or converted) was 39% in 2007 compared to 18% in 2010 (P<0.001). Preoperative characteristics for LSC and RBT cases were similar, except 10% versus 15%, respectively, were morbidly obese (P=0.049). The extent of procedure, total nodal counts, and overall complications were similar between the LSC and RBT cases. The median length of stay was shorter for RBT cases (P<0.001). The median total room and operative times were longer for RBT cases (P<0.001), mainly due to cases in which the surgeon had less than ~40 RBT cases of experience. Robotics can be efficiently introduced into the surgical care of patients with newly diagnosed uterine cancers. RBT cases require the same operative times as LSC cases after accounting for the 40-case learning curve. Both approaches result in similar excellent patient outcomes and remain reasonable approaches for this disease. The introduction of robotics may lead to further reduction in the rate of laparotomy. Copyright © 2012 Elsevier Inc. All rights reserved.

Neonatal encephalopathy in New Zealand: Demographics and clinical outcome.

PubMed

Battin, M; Sadler, L; Masson, V; Farquhar, C

2016-06-01

To establish the incidence of moderate to severe neonatal encephalopathy (NE) in term infants from New Zealand and to document demographic characteristics and neonatal outcomes. Cases were reported monthly via the New Zealand Paediatric Surveillance Unit (NZPSU). Data were collected from paediatricians for neonatal items and lead maternity carers for pregnancy and birth details. Term neonatal deaths in the Perinatal and Maternal Mortality Review Committee dataset that were because of hypoxia and/or neonatal deaths from hypoxic ischaemic encephalopathy were added to the cases identified via the NZPSU, if they had not previously been ascertained. For the period January 2010 to December 2012, there were 227 cases, equivalent to a rate of 1.30/1000 term births (95% CI 1.14-1.48). Rates of NE were high in babies of Pacific and Indian mothers but only reached statistical significance for the comparison between Pacific and NZ European. There was also a significant increase in NE rates with increasing deprivation. Resuscitation at birth was initiated for 209 (92.1%) infants with NE. Mechanical ventilation was required, following neonatal unit admission, in 171 (75.3%) infants. Anticonvulsants were used in 157 (69.2%) infants with phenobarbitone (65.6%), phenytoin (14.5%) and benzodiazapines (21.1%), the most common. Cooling was induced in 168 infants (74%) with 145 (86.3%) reported as commenced within a 6-h window. The rate of NE in New Zealand is consistent with reported international rates. Establishing antecedent factors for NE is an important part of improving care, which may inform strategic efforts to decrease rates of NE. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

[Incidence of tuberculosis at the local level: Marianao Municipality, Havana City, Cuba (1990-2000)].

PubMed

D'fana Valdés, Jorgelina; Cambell, Shirley; Armas Pérez, Luisa; Fraginal, Bárbaro; González Ochoa, Edilberto

2003-01-01

For the elimination of tuberculosis (TB) is necessary the surveillance of the incidence rate at the local level, as this is the first level of access to the health service. This study is aimed at providing a description of the spread and trend of the tuberculosis incidence rates in Marianao Municipality, Habana City by healthcare areas and age groups throughout the 1990-2000 period. The time series for the 1990-1994 and 1995-2000 incidence rates were analyzed employing a two parameter exponential smoothing method. The total percentage and annual average of variation was estimated. The healthcare areas were stratified. In 1990-1994, the rate rose from 11.1 to 25.8 per 105 inhabitants (33% of increase by year), having been most noticeable in Carlos J. Finlay and Portuondo health areas (respectively annual average 112.7% y 36.2% increases). Taking into account that the control program was strengthened in 1995, the rates dropped by 47.6% in this municipality during the 1995-2000 period. The Finlay and Portuondo areas respectively lowered their rates by 79.9% y 39.7% while the Gonzalez Coro area showed a 58.3% rise and 27 de Noviembre area had no major change. The age and above 60 group had the higher percentage of cases, recording 49.8% of the total and only one case among children under age 15 for the period. During this same period, only six cases of tuberculosis/human inmunodeficiency virus were diagnosed. The 27 de Noviembre area was the only one found to be at the unsatisfactory level according to the stratification. An initially upward trend, followed by a downward trend in tuberculosis was found to exist in the Marianao Municipality throughout the period studied. This disease was predominant among older adults.

Primary Enlarged Craniotomy in Organized Chronic Subdural Hematomas

PubMed Central

CALLOVINI, Giorgio Maria; BOLOGNINI, Andrea; CALLOVINI, Gemma; GAMMONE, Vincenzo

2014-01-01

The aim of the study is to evaluate the efficacy of craniotomy and membranectomy as initial treatment of organized chronic subdural hematoma (OCSH). We retrospectively reviewed a series of 34 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or contrast computer tomography (CCT) in order to establish the degree of organization and determine the intrahematomal architecture. The indication to perform a primary enlarged craniotomy as initial treatment for non-liquefied chronic subdural hematoma (CSDH) with multilayer loculations was based on the hematoma MRI appearance—mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity. The reason why some hematomas evolve towards a complex and organized architecture remains unclear; the most common aspect to come to light was the “long standing” of the CSDHs which, in our series, had an average interval of 10 weeks between head injury and initial scan. Recurrence was found to have occurred in 2 patients (6% of cases) in the form of acute subdural hematoma. One patient died as the result of an intraventricular and subarachnoid haemorrhage, while 2 patients (6%) suffered an haemorrhagic stroke ipsilateral to the OCSH. Eighty-nine percent of cases had a good recovery, while 11% remained unchanged or worsened. In select cases, based on the MRI appearance, primary enlarged craniotomy seems to be the treatment of choice for achieving a complete recovery and a reduced recurrence rate in OCSH. PMID:24305027

Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital.

PubMed

Ali, Safaa; El Sisi, Amel

2016-04-01

To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8-3.5 mm), median weight 8 kg (IQR, 7-10 kg), and median age 10 months (IQR, 8-17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory.

A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes.

PubMed

Malec, J F; Buffington, A L; Moessner, A M; Degiorgio, L

2000-08-01

To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI. Five levels of Vocational Independence Scale (VIS). Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disability as measured by the Rasch-analyzed Staff Mayo-Portland Adaptability Inventory (MPAI), and impaired self-awareness measured by staff rating and the difference between Staff MPAI and Survivor MPAI. At placement, 46% in independent work; 25% in transitional placements; 9% in long-term supported employment; 10% in sheltered work; and 10% not placed. At 1-year follow-up (n = 101), 53% in independent work; 19% in transitional placement; 9% in supported work; 6% in sheltered work; and 13% unemployed. Regression analyses showed time since injury and Rasch Staff MPAI predicted VIS at placement; only VIS at placement independently predicted VIS at 1-year follow-up; Rasch Staff MPAI and preinjury education level predicted time to placement. The MVCCS optimized vocational outcome after BI. Time since injury and impairment/disability best predicted vocational placement. Level of initial placement best predicted employment status at follow-up. Persons with greater disability required more extended time and more extensive rehabilitation services before placement.

Long-term mortality outcome in patients with reactive amyloidosis associated with rheumatoid arthritis.

PubMed

Kuroda, Takeshi; Tanabe, Naohito; Harada, Takashi; Murakami, Syuichi; Hasegawa, Hisashi; Sakatsume, Minoru; Nakano, Masaaki; Gejyo, Fumitake

2006-07-01

It is well established that amyloidosis is a serious clinical complication that can influence the prognosis of patients with rheumatoid arthritis (RA). The purpose of the study was to obtain information on the survival and the hemodialysis (HD) of patients with amyloidosis. Eighty patients (9 men and 71 women) who were diagnosed with amyloidosis by biopsy and definite or classical RA were studied retrospectively. The average duration of RA prior to the diagnosis of amyloidosis was 15.4+/-9.4 years. The average period from the diagnosis of amyloidosis to death was 67.4 months. Forty-nine patients died of the disease (32 cases with HD and 17 cases without HD). Thirty-one patients lived (7 cases with HD and 24 cases without HD). Regarding the survival of these patients, 49 (61.3%) of the 80 patients have died. Survival rate at 28 months was 75%; at 67 months, it was 50%; and at 111 months, it was down to 25%. Mortality rate was 11.9% per year. Survival rate in dialysis at 9.8 months was 75%; at 60.6 months, it dropped to 50%; and at 100.0 months, to 25%. As for patients' survival, high onset age of amyloidosis was the major determining factor for poor survival in these patients (p<0.001). Furthermore, male patients also had poor survival (p=0.07). The long-term results were very encouraging to initiate HD in patients with end-stage renal disease due to reactive amyloidosis associated with RA.

Testing geopressured geothermal reservoirs in existing wells: Pauline Kraft Well No. 1, Nueces County, Texas. Final report

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

Not Available

1981-01-01

The Pauline Kraft Well No. 1 was originally drilled to a depth of 13,001 feet and abandoned as a dry hole. The well was re-entered in an effort to obtain a source of GEO/sup 2/ energy for a proposed gasohol manufacturing plant. The well was tested through a 5-inch by 2-3/8 inch annulus. The geological section tested was the Frio-Anderson sand of Mid-Oligocene age. The interval tested was from 12,750 to 12,860 feet. A saltwater disposal well was drilled on the site and completed in a Micocene sand section. The disposal interval was perforated from 4710 to 4770 feet andmore » from 4500 to 4542 feet. The test well failed to produce water at substantial rates. Initial production was 34 BWPD. A large acid stimulation treatment increased productivity to 132 BWPD, which was still far from an acceptable rate. During the acid treatment, a failure of the 5-inch production casing occurred. The poor production rates are attributed to a reservoir with very low permeability and possible formation damage. The casing failure is related to increased tensile strain resulting from cooling of the casing by acid and from the high surface injection pressure. The location of the casing failure is now known at this time, but it is not at the surface. Failure as a result of a defect in a crossover joint at 723 feet is suspected.« less

Steady states and outbreaks of two-phase nonlinear age-structured model of population dynamics with discrete time delay.

PubMed

Akimenko, Vitalii; Anguelov, Roumen

2017-12-01

In this paper we study the nonlinear age-structured model of a polycyclic two-phase population dynamics including delayed effect of population density growth on the mortality. Both phases are modelled as a system of initial boundary values problem for semi-linear transport equation with delay and initial problem for nonlinear delay ODE. The obtained system is studied both theoretically and numerically. Three different regimes of population dynamics for asymptotically stable states of autonomous systems are obtained in numerical experiments for the different initial values of population density. The quasi-periodical travelling wave solutions are studied numerically for the autonomous system with the different values of time delays and for the system with oscillating death rate and birth modulus. In both cases it is observed three types of travelling wave solutions: harmonic oscillations, pulse sequence and single pulse.

On the Occurrence of Mass Inflation for the Einstein-Maxwell-Scalar Field System with a Cosmological Constant and an Exponential Price Law

NASA Astrophysics Data System (ADS)

Costa, João L.; Girão, Pedro M.; Natário, José; Silva, Jorge Drumond

2018-03-01

In this paper we study the spherically symmetric characteristic initial data problem for the Einstein-Maxwell-scalar field system with a positive cosmological constant in the interior of a black hole, assuming an exponential Price law along the event horizon. More precisely, we construct open sets of characteristic data which, on the outgoing initial null hypersurface (taken to be the event horizon), converges exponentially to a reference Reissner-Nördstrom black hole at infinity. We prove the stability of the radius function at the Cauchy horizon, and show that, depending on the decay rate of the initial data, mass inflation may or may not occur. In the latter case, we find that the solution can be extended across the Cauchy horizon with continuous metric and Christoffel symbols in {L^2_{loc}} , thus violating the Christodoulou-Chruściel version of strong cosmic censorship.

Initial experience using a femtosecond laser cataract surgery system at a UK National Health Service cataract surgery day care centre

PubMed Central

Dhallu, Sandeep K; Maurino, Vincenzo; Wilkins, Mark R

2016-01-01

Objectives To describe the initial outcomes following installation of a cataract surgery laser system. Setting National Health Service cataract surgery day care unit in North London, UK. Participants 158 eyes of 150 patients undergoing laser-assisted cataract surgery. Interventions Laser cataract surgery using the AMO Catalys femtosecond laser platform. Primary and secondary outcome measures Primary outcome measure: intraoperative complications including anterior and posterior capsule tears. Secondary outcome measures: docking to the laser platform, successful treatment delivery, postoperative visual acuities. Results Mean case age was 67.7±10.8 years (range 29–88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1–20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon). Conclusions Despite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps. PMID:27466243

20 CFR 227.2 - Initial supplemental annuity rate.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Initial supplemental annuity rate. 227.2... COMPUTING SUPPLEMENTAL ANNUITIES § 227.2 Initial supplemental annuity rate. The supplemental annuity rate... supplemental annuity rate is $43 for an employee with 30 or more years of service. ...

A benchmark initiative on mantle convection with melting and melt segregation

NASA Astrophysics Data System (ADS)

Schmeling, Harro; Dohmen, Janik; Wallner, Herbert; Noack, Lena; Tosi, Nicola; Plesa, Ana-Catalina; Maurice, Maxime

2015-04-01

In recent years a number of mantle convection models have been developed which include partial melting within the asthenosphere, estimation of melt volumes, as well as melt extraction with and without redistribution at the surface or within the lithosphere. All these approaches use various simplifying modelling assumptions whose effects on the dynamics of convection including the feedback on melting have not been explored in sufficient detail. To better assess the significance of such assumptions and to provide test cases for the modelling community we initiate a benchmark comparison. In the initial phase of this endeavor we focus on the usefulness of the definitions of the test cases keeping the physics as sound as possible. The reference model is taken from the mantle convection benchmark, case 1b (Blanckenbach et al., 1989), assuming a square box with free slip boundary conditions, the Boussinesq approximation, constant viscosity and a Rayleigh number of 1e5. Melting is modelled assuming a simplified binary solid solution with linearly depth dependent solidus and liquidus temperatures, as well as a solidus temperature depending linearly on depletion. Starting from a plume free initial temperature condition (to avoid melting at the onset time) three cases are investigated: Case 1 includes melting, but without thermal or dynamic feedback on the convection flow. This case provides a total melt generation rate (qm) in a steady state. Case 2 includes batch melting, melt buoyancy (melt Rayleigh number Rm), depletion buoyancy and latent heat, but no melt percolation. Output quantities are the Nusselt number (Nu), root mean square velocity (vrms) and qm approaching a statistical steady state. Case 3 includes two-phase flow, i.e. melt percolation, assuming a constant shear and bulk viscosity of the matrix and various melt retention numbers (Rt). These cases should be carried out using the Compaction Boussinseq Approximation (Schmeling, 2000) or the full compaction formulation. Variations of cases 1 - 3 may be tested, particularly studying the effect of melt extraction. The motivation of this presentation is to summarize first experiences, suggest possible modifications of the case definitions and call interested modelers to join this benchmark exercise. References: Blanckenbach, B., Busse, F., Christensen, U., Cserepes, L. Gun¬kel, D., Hansen, U., Har¬der, H. Jarvis, G., Koch, M., Mar¬quart, G., Moore D., Olson, P., and Schmeling, H., 1989: A benchmark comparison for mantle convection codes, J. Geo¬phys., 98, 23 38. Schmeling, H., 2000: Partial melting and melt segregation in a convecting mantle. In: Physics and Chemistry of Partially Molten Rocks, eds. N. Bagdassarov, D. Laporte, and A.B. Thompson, Kluwer Academic Publ., Dordrecht, pp. 141 - 178.

Clinical Risk Factors Associated With Peripartum Maternal Bacteremia.

PubMed

Easter, Sarah Rae; Molina, Rose L; Venkatesh, Kartik K; Kaimal, Anjali; Tuomala, Ruth; Riley, Laura E

2017-10-01

To evaluate risk factors associated with maternal bacteremia in febrile peripartum women. We performed a case-control study of women with fevers occurring between 7 days before and up to 42 days after delivery of viable neonates at two academic hospitals. Women with positive blood cultures were matched with the next two febrile women meeting inclusion criteria with negative blood cultures in the microbiology data without other matching parameters. We compared maternal and neonatal characteristics and outcomes between women in the case group and those in the control group with univariate analysis. We then used logistic regression to examine the association between clinical characteristics and maternal bacteremia. After excluding blood cultures positive only for contaminants, we compared 115 women in the case group with 285 in the control group. Bacteremic women were more likely to experience their initial fever during labor (40.9% compared with 22.8%, P<.01) and more likely to have fever at or above 102°F (62.6% compared with 31.6%, P<.01). These associations persisted in the adjusted analysis: multiparity (adjusted odds ratio [OR] 1.75, 95% CI 1.07-2.87), initial fever during labor (adjusted OR 2.82, 95% CI 1.70-4.70), and fever at or above 102°F (adjusted OR 3.83, 95% CI 2.37-6.19). In an analysis restricted to neonates whose mothers had initial fevers before or in the immediate 24 hours after delivery, neonates born to women in the case group had higher rates of bacteremia compared with those born to women in the control group (9.0% compared with 1.3%, P<.01). Eight of the nine bacteremic neonates born to bacteremic mothers (89%) grew the same organism as his or her mother in blood culture. Maternal bacteremia is associated with multiparity, initial fever during labor, and fever at or above 102°F; however, 37.5% of cases of bacteremia occurred in women with maximum fevers below this threshold. Obstetricians should maintain a heightened suspicion for an infectious source of fever in women with these clinical characteristics.

Endocarditis and Stroke

PubMed Central

GRECU, Nicolae; TIU, Cristina; TERECOASA, Elena; BAJENARU, Ovidiu

2014-01-01

Endocarditis is an important, although less common, cause of cerebral embolism. All forms of endocarditis share an initial common pathophysiologic pathway, best illustrated by the non-bacterial thrombotic form, but also a final potential for embolization. Stroke associated with endocarditis has signifficant mortality and morbidity rates, especially due to the frequent concomitant multiple sites of brain embolization. In this article we aim to briefly review endocarditis with a focus on stroke as a complication, while also presenting case correlates from our department. PMID:25705308