Magnetic resonance imaging versus Acute Physiology And Chronic Healthy Evaluation II score in predicting the severity of acute pancreatitis

International Nuclear Information System (INIS)

Tang Wei; Zhang Xiaoming; Xiao Bo; Zeng Nanlin; Pan Huashan; Feng Zhisong; Xu Xiaoxue

2011-01-01

Objective: To study the correlation between established magnetic resonance (MR) imaging criteria of disease severity in acute pancreatitis and the Acute Physiology And Chronic Healthy Evaluation II (APACHE II) score, and to assess the utility of each prognostic indicators in acute pancreatitis. Materials and methods: In this study there were 94 patients with acute pancreatitis (AP), all had abdominal MR imaging. MR findings were categorized into edematous and necrotizing AP and graded according to the MR severity index (MRSI). The APACHE II score was calculated within 24 h of admission, and local complications, death, duration of hospitalization and ICU were recorded. Statistical analysis was performed to determine their correlation. Results: In patients with pancreatitis, no significant correlation can be found between the APACHE II score and the MRSI score (P = 0.196). The MRSI score correlated well with morbidity (P = 0.006) but not with mortality (P = 0.137). The APACHE II score correlated well with mortality (P = 0.002) but not with the morbidity (P = 0.112). The MRSI score was superior to the APACHE II score as a predictor of the length of hospitalization (r = 0.52 vs. r = 0.35). A high MRSI and APACHE II score correlated with the need for being in the intensive care unit (ICU) (P = 0.000 and P = 0.000, respectively). Conclusion: In patients with pancreatitis, MRSI is superior to APACHE II in assessing local complications from pancreatitis but has a limited role in determining systemic complications in which the APACHE II score excels.

Validation of acute physiologic and chronic health evaluation II scoring system software developed at The Aga Khan University, Pakistan.

Science.gov (United States)

Hashmi, M; Asghar, A; Shamim, F; Khan, F H

2016-01-01

To assess the predictive performance of Acute Physiologic and Chronic Health Evaluation II (APACHE II) software available on the hospital intranet and analyze interrater reliability of calculating the APACHE II score by the gold standard manual method or automatically using the software. An expert scorer not involved in the data collection had calculated APACHE II score of 213 patients admitted to surgical Intensive Care Unit using the gold standard manual method for a previous study performed in the department. The same data were entered into the computer software available on the hospital intranet (http://intranet/apacheii) to recalculate the APACHE II score automatically along with the predicted mortality. Receiver operating characteristic curve (ROC), Hosmer-Lemeshow goodness-of-fit statistical test and Pearson's correlation coefficient was computed. The 213 patients had an average APACHE II score of 17.20 ± 8.24, the overall mortality rate was 32.8% and standardized mortality ratio was 1.00. The area under the ROC curve of 0.827 was significantly >0.5 (P test showed a good calibration (H = 5.46, P = 0.71). Interrater reliability using Pearson's product moment correlations demonstrated a strong positive relationship between the computer and the manual expert scorer (r = 0.98, P = 0.0005). APACHE II software available on the hospital's intranet has satisfactory calibration and discrimination and interrater reliability is good when compared with the gold standard manual method.

The customization of APACHE II for patients receiving orthotopic liver transplants

Science.gov (United States)

Moreno, Rui

2002-01-01

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

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

Science.gov (United States)

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

2001-01-01

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

Increased Resistin Levels in Intra-abdominal Sepsis: Correlation with proinflammatory cytokines & Acute Physiology & Chronic Health Evaluation II scores

Directory of Open Access Journals (Sweden)

Tonguç U. Yilmaz

2014-10-01

Full Text Available Objectives: Resistin, a hormone secreted from adipocytes and considered to be a likely cause of insulin resistance, has recently been accepted as a proinflammatory cytokine. This study aimed to determine the correlation between resistin levels in patients with intra-abdominal sepsis and mortality. Methods: Of 45 patients with intraabdominal sepsis, a total of 35 adult patients were included in the study. This study was undertaken from December 2011 to December 2012 and included patients who had no history of diabetes mellitus and who were admitted to the general surgery intensive care units of Gazi University and Bülent Ecevit University School of Medicine, Turkey. Evaluations were performed on 12 patients with sepsis, 10 patients with severe sepsis, 13 patients with septic shock and 15 healthy controls. The patients’ plasma resistin, interleukin-6 (IL-6, tumour necrosis factor alpha (TNF-α, interleukin-1 beta (IL-1β, procalcitonin, lactate and glucose levels and Acute Physiology and Chronic Health Evaluation (APACHE II scores were studied daily for the first five days after admission. A correlation analysis of serum resistin levels with cytokine levels and APACHE II scores was performed. Results: Serum resistin levels in patients with sepsis were significantly higher than in the healthy controls (P <0.001. A significant correlation was found between serum resistin levels and APACHE II scores, serum IL-6, IL-1β, TNF-α, procalcitonin, lactate and glucose levels. Furthermore, a significant correlation was found between serum resistin levels and all-cause mortality (P = 0.02. Conclusion: The levels of resistin were significantly positively correlated with the severity of disease and were a possible mediator of a prolonged inflammatory state in patients with intra-abdominal sepsis.

Various scoring systems for predicting mortality in Intensive Care Unit

African Journals Online (AJOL)

Age, gender, body weight, initial diagnosis, clinic of referral, intubation, comorbidities, APACHE II, APACHE IV, Glasgow coma scale, SAPS III scores, length of hospitalization before referral to ICU, length of stay in ICU, mechanical ventilation were recorded. Results: Most of the patients (54.6%) were consulted from ...

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

Science.gov (United States)

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

2014-11-01

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

Apache 2 Pocket Reference For Apache Programmers & Administrators

CERN Document Server

Ford, Andrew

2008-01-01

Even if you know the Apache web server inside and out, you still need an occasional on-the-job reminder -- especially if you're moving to the newer Apache 2.x. Apache 2 Pocket Reference gives you exactly what you need to get the job done without forcing you to plow through a cumbersome, doorstop-sized reference. This Book provides essential information to help you configure and maintain the server quickly, with brief explanations that get directly to the point. It covers Apache 2.x, giving web masters, web administrators, and programmers a quick and easy reference solution. This pocket r

Apache Maven cookbook

CERN Document Server

Bharathan, Raghuram

2015-01-01

If you are a Java developer or a manager who has experience with Apache Maven and want to extend your knowledge, then this is the ideal book for you. Apache Maven Cookbook is for those who want to learn how Apache Maven can be used for build automation. It is also meant for those familiar with Apache Maven, but want to understand the finer nuances of Maven and solve specific problems.

Uso do escore prognóstico APACHE II e ATN-ISS em insuficiência renal aguda tratada dentro e fora da unidade de terapia intensiva

OpenAIRE

Fernandes,Natáia Maria da Silva; Pinto,Patrícia dos Santos; Lacet,Thiago Bento de Paiva; Rodrigues,Dominique Fonseca; Bastos,Marcus Gomes; Stella,Sérgio Reinaldo; Cendoroglo Neto,Miguel

2009-01-01

INTRODUÇÃO: A insuficiência renal aguda (IRA) mantém alta prevalência, morbidade e mortalidade. OBJETIVO: Comparar o uso do escore prognóstico APACHE II com o ATN-ISS e determinar se o APACHE II pode ser utilizado para pacientes com IRA, fora da UTI. MÉTODOS: Coorte prospectiva, 205 pacientes com IRA. Analisamos dados demográficos, condições pré-existentes, falência de órgãos e características da IRA. Os escores prognósticos foram realizados no dia da avaliação do nefrologista. RESULTADOS: A ...

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

Directory of Open Access Journals (Sweden)

Zhihong Feng

2017-01-01

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

Serial evaluation of the MODS, SOFA and LOD scores to predict ICU mortality in mixed critically ill patients.

Science.gov (United States)

Khwannimit, Bodin

2008-09-01

To perform a serial assessment and compare ability in predicting the intensive care unit (ICU) mortality of the multiple organ dysfunction score (MODS), sequential organ failure assessment (SOFA) and logistic organ dysfunction (LOD) score. The data were collected prospectively on consecutive ICU admissions over a 24-month period at a tertiary referral university hospital. The MODS, SOFA, and LOD scores were calculated on initial and repeated every 24 hrs. Two thousand fifty four patients were enrolled in the present study. The maximum and delta-scores of all the organ dysfunction scores correlated with ICU mortality. The maximum score of all models had better ability for predicting ICU mortality than initial or delta score. The areas under the receiver operating characteristic curve (AUC) for maximum scores was 0.892 for the MODS, 0.907 for the SOFA, and 0.92for the LOD. No statistical difference existed between all maximum scores and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Serial assessment of organ dysfunction during the ICU stay is reliable with ICU mortality. The maximum scores is the best discrimination comparable with APACHE II score in predicting ICU mortality.

Learning Apache Kafka

CERN Document Server

Garg, Nishant

2015-01-01

This book is for readers who want to know more about Apache Kafka at a hands-on level; the key audience is those with software development experience but no prior exposure to Apache Kafka or similar technologies. It is also useful for enterprise application developers and big data enthusiasts who have worked with other publisher-subscriber-based systems and want to explore Apache Kafka as a futuristic solution.

Prognostic factors and scoring system for survival in colonic perforation.

Science.gov (United States)

Komatsu, Shuhei; Shimomatsuya, Takumi; Nakajima, Masayuki; Amaya, Hirokazu; Kobuchi, Taketsune; Shiraishi, Susumu; Konishi, Sayuri; Ono, Susumu; Maruhashi, Kazuhiro

2005-01-01

No ideal and generally accepted prognostic factors and scoring systems exist to determine the prognosis of peritonitis associated with colonic perforation. This study was designed to investigate prognostic factors and evaluate the various scoring systems to allow identification of high-risk patients. Between 1996 and 2003, excluding iatrogenic and trauma cases, 26 consecutive patients underwent emergency operations for colorectal perforation and were selected for this retrospective study. Several clinical factors were analyzed as possible predictive factors, and APACHE II, SOFA, MPI, and MOF scores were calculated. The overall mortality was 26.9%. Compared with the survivors, non-survivors were found more frequently in Hinchey's stage III-IV, a low preoperative marker of pH, base excess (BE), and a low postoperative marker of white blood cell count, PaO2/FiO2 ratio, and renal output (24h). According to the logistic regression model, BE was a significant independent variable. Concerning the prognostic scoring systems, an APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related to poor prognosis. Preoperative BE and postoperative white blood cell count were reliable prognostic factors and early classification using prognostic scoring systems at specific points in the disease process are useful to improve our understanding of the problems involved.

Apache The Definitive Guide

CERN Document Server

Laurie, Ben

2003-01-01

Apache is far and away the most widely used web server platform in the world. This versatile server runs more than half of the world's existing web sites. Apache is both free and rock-solid, running more than 21 million web sites ranging from huge e-commerce operations to corporate intranets and smaller hobby sites. With this new third edition of Apache: The Definitive Guide, web administrators new to Apache will come up to speed quickly, and experienced administrators will find the logically organized, concise reference sections indispensable, and system programmers interested in customizin

The APACHE Project

Directory of Open Access Journals (Sweden)

Giacobbe P.

2013-04-01

Full Text Available First, we summarize the four-year long efforts undertaken to build the final setup of the APACHE Project, a photometric transit search for small-size planets orbiting bright, low-mass M dwarfs. Next, we describe the present status of the APACHE survey, officially started in July 2012 at the site of the Astronomical Observatory of the Autonomous Region of the Aosta Valley, in the Western Italian Alps. Finally, we briefly discuss the potentially far-reaching consequences of a multi-technique characterization program of the (potentially planet-bearing APACHE targets.

Learning Apache Karaf

CERN Document Server

Edstrom, Johan; Kesler, Heath

2013-01-01

The book is a fast-paced guide full of step-by-step instructions covering all aspects of application development using Apache Karaf.Learning Apache Karaf will benefit all Java developers and system administrators who need to develop for and/or operate Karaf's OSGi-based runtime. Basic knowledge of Java is assumed.

Performance of Simplified Acute Physiology Score 3 In Predicting Hospital Mortality In Emergency Intensive Care Unit

Directory of Open Access Journals (Sweden)

Qing-Bian Ma

2017-01-01

Conclusions: The SAPS 3 score system exhibited satisfactory performance even superior to APACHE II in discrimination. In predicting hospital mortality, SAPS 3 did not exhibit good calibration and overestimated hospital mortality, which demonstrated that SAPS 3 needs improvement in the future.

Instant Apache Wicket 6

CERN Document Server

Longo, João Sávio Ceregatti

2013-01-01

Get to grips with a new technology, understand what it is and what it can do for you, and then get to work with the most important features and tasks. This Starter style guide takes the reader through the basic workflow of Apache Wicket in a practical and friendly style.Instant Apache Wicket 6 is for people who want to learn the basics of Apache Wicket 6 and who already have some experience with Java and object-oriented programming. Basic knowledge of web concepts like HTTP and Ajax will be an added advantage.

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

Science.gov (United States)

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

2017-10-01

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

Apache Mahout cookbook

CERN Document Server

Giacomelli, Piero

2013-01-01

Apache Mahout Cookbook uses over 35 recipes packed with illustrations and real-world examples to help beginners as well as advanced programmers get acquainted with the features of Mahout.""Apache Mahout Cookbook"" is great for developers who want to have a fresh and fast introduction to Mahout coding. No previous knowledge of Mahout is required, and even skilled developers or system administrators will benefit from the various recipes presented

Validation of acute physiologic and chronic health evaluation II scoring system software developed at The Aga Khan University, Pakistan

Directory of Open Access Journals (Sweden)

M Hashmi

2016-01-01

Conclusion: APACHE II software available on the hospital′s intranet has satisfactory calibration and discrimination and interrater reliability is good when compared with the gold standard manual method.

SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors.

Science.gov (United States)

Gregoric, Pavle; Pavle, Gregoric; Sijacki, Ana; Ana, Sijacki; Stankovic, Sanja; Sanja, Stankovic; Radenkovic, Dejan; Dejan, Radenkovic; Ivancevic, Nenad; Nenad, Ivancevic; Karamarkovic, Aleksandar; Aleksandar, Karamarkovic; Popovic, Nada; Nada, Popovic; Karadzic, Borivoje; Borivoje, Karadzic; Stijak, Lazar; Stefanovic, Branislav; Branislav, Stefanovic; Milosevic, Zoran; Zoran, Milosević; Bajec, Djordje; Djordje, Bajec

2010-01-01

Early recognition of severe form of acute pancreatitis is important because these patients need more agressive diagnostic and therapeutical approach an can develope systemic complications such as: sepsis, coagulopathy, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), Multiple Organ Failure (MOF). To determine role of the combination of Systemic Inflammatory Response Syndrome (SIRS) score and serum Interleukin-6 (IL-6) level on admission as predictor of illness severity and outcome of Severe Acute Pancreatitis (SAP). We evaluated 234 patients with first onset of SAP appears in last twenty four hours. A total of 77 (33%) patients died. SIRS score and serum IL-6 concentration were measured in first hour after admission. In 105 patients with SIRS score 3 and higher, initial measured IL-6 levels were significantly higher than in the group of remaining 129 patients (72 +/- 67 pg/mL, vs 18 +/- 15 pg/mL). All nonsurvivals were in the first group, with SIRS score 3 and 4 and initial IL-6 concentration 113 +/- 27 pg/mL. The values of C-reactive Protein (CRP) measured after 48h, Acute Physiology and Chronic Health Evaluation (APACHE II) score on admission and Ranson score showed the similar correlation, but serum amylase level did not correlate significantly with Ranson score, IL-6 concentration and APACHE II score. The combination of SIRS score on admission and IL-6 serum concentration can be early, predictor of illness severity and outcome in SAP.

The Jicarilla Apaches. A Study in Survival.

Science.gov (United States)

Gunnerson, Dolores A.

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

Modified poisoning severity score for early prognostic evaluation in acute paraquat poisoning

Directory of Open Access Journals (Sweden)

Feng-lin SONG

2018-04-01

Full Text Available Objective To study the applied value of modified poisoning severity score (PSS for early prognostic evaluation in acute paraquat poisoning. Methods Thirty-seven patients with acute paraquat poisoning from June 2013 to June 2016 were enrolled. The PSS score, the modified PSS score, the acute physiology and the chronic health status Ⅱ score (APACHE Ⅱ of the patients were calculated. The relationship between modified PSS and APACHE Ⅱ was analyzed. Also the factors that affect outcome were analyzed by logistic regression analysis. The work characteristic curve (ROC curve of the PSS, the modified PSS and the APECH Ⅱ were drawn and compared. Results There was a positive correlation between the risk of death and admission time, poisonous dose, the concentration of urine paraquat, and white blood cell count (P<0.05. There was a significant correlation between the modified PSS and the APACHE Ⅱ(P<0.0001. The immediate PSS score, the modified PSS score, and the APACHE Ⅱ score were significant for the prognosis of patients with acute paraquat poisoning. The area under the curve (AUC was in turn 0.774, 0.788, 0.799. Among them, the best bound of the modified PSS score was 6.5 (when the score is greater than 6.5, the risk of death is higher. Further comparison of the area under the three curves showed that there was no significant difference in the area under the ROC curve between the three scores in predicting the prognosis of death [P=0.7633(PSS-DPSS, P=0.7791(PSS-APACHE Ⅱ, P=0.8918(DPSS-APACHE Ⅱ]. Conclusion Modified PSS is helpful in early predicting the prognosis of acute paraquat poisoning. DOI: 10.11855/j.issn.0577-7402.2018.04.13

The Apache OODT Project: An Introduction

Science.gov (United States)

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

2012-12-01

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

[Severity of disease scoring systems and mortality after non-cardiac surgery].

Science.gov (United States)

Reis, Pedro Videira; Sousa, Gabriela; Lopes, Ana Martins; Costa, Ana Vera; Santos, Alice; Abelha, Fernando José

2018-04-05

Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann-Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR=1.24); emergent surgery (OR=4.10), serum sodium (OR=1.06) and FiO 2 at admission (OR=14.31). Serum bicarbonate at admission (OR=0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR=1.02), APACHE II (OR=1.09), emergency surgery (OR=1.82), high-risk surgery (OR=1.61), FiO 2 at admission (OR=1.02), postoperative acute renal failure (OR=1.96), heart rate (OR=1.01) and serum sodium (OR=1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. Some factors influenced both surgical intensive care unit and hospital mortality. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Random Decision Forests on Apache Spark

CERN Multimedia

CERN. Geneva

2016-01-01

About the speaker Tom White has been an Apache Hadoop committer since February 2007, and is a member of the Apache Software Foundation. He works for Cloudera, a company set up to offer Hadoop support and training. Previously he was as an independent Hadoop consultant, work...

Apache Tomcat 7 Essentials

CERN Document Server

Khare, Tanuj

2012-01-01

This book is a step-by-step tutorial for anyone wanting to learn Apache Tomcat 7 from scratch. There are plenty of illustrations and examples to escalate you from a novice to an expert with minimal strain. If you are a J2EE administrator, migration administrator, technical architect, or a project manager for a web hosting domain, and are interested in Apache Tomcat 7, then this book is for you. If you are someone responsible for installation, configuration, and management of Tomcat 7, then too, this book will be of help to you.

Heart valve surgery: EuroSCORE vs. EuroSCORE II vs. Society of Thoracic Surgeons score

Directory of Open Access Journals (Sweden)

Muhammad Sharoz Rabbani

2014-12-01

Full Text Available Background This is a validation study comparing the European System for Cardiac Operative Risk Evaluation (EuroSCORE II with the previous additive (AES and logistic EuroSCORE (LES and the Society of Thoracic Surgeons’ (STS risk prediction algorithm, for patients undergoing valve replacement with or without bypass in Pakistan. Patients and Methods Clinical data of 576 patients undergoing valve replacement surgery between 2006 and 2013 were retrospectively collected and individual expected risks of death were calculated by all four risk prediction algorithms. Performance of these risk algorithms was evaluated in terms of discrimination and calibration. Results There were 28 deaths (4.8% among 576 patients, which was lower than the predicted mortality of 5.16%, 6.96% and 4.94% by AES, LES and EuroSCORE II but was higher than 2.13% predicted by STS scoring system. For single and double valve replacement procedures, EuroSCORE II was the best predictor of mortality with highest Hosmer and Lemmeshow test (H-L p value (0.346 to 0.689 and area under the receiver operating characteristic (ROC curve (0.637 to 0.898. For valve plus concomitant coronary artery bypass grafting (CABG patients actual mortality was 1.88%. STS calculator came out to be the best predictor of mortality for this subgroup with H-L p value (0.480 to 0.884 and ROC (0.657 to 0.775. Conclusions For Pakistani population EuroSCORE II is an accurate predictor for individual operative risk in patients undergoing isolated valve surgery, whereas STS performs better in the valve plus CABG group.

Significance of blood pressure variability in patients with sepsis.

Science.gov (United States)

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

2014-01-01

This study was undertaken to observe the characteristics of blood pressure variability (BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis. Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis. In patients with APACHE II score>19, the values of systolic blood pressure (SBPV), diasystolic blood pressure (DBPV), non-dipper percentage, cortisol (COR), lactate (LAC), platelet count (PLT) and glucose (GLU) were significantly higher than in those with APACHE II score ≤19 (Pblood cell (WBC), creatinine (Cr), PaO2, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH) and tumor necrosis factor α (TNF-α) were not statistically significant (P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV (P0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve (ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively. The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.

Apache Flume distributed log collection for Hadoop

CERN Document Server

D'Souza, Subas

2013-01-01

A starter guide that covers Apache Flume in detail.Apache Flume: Distributed Log Collection for Hadoop is intended for people who are responsible for moving datasets into Hadoop in a timely and reliable manner like software engineers, database administrators, and data warehouse administrators

Instant Apache Maven starter

CERN Document Server

Turatti, Maurizio

2013-01-01

Get to grips with a new technology, understand what it is and what it can do for you, and then get to work with the most important features and tasks.The book follows a starter approach for using Maven to create and build a new Java application or Web project from scratch.Instant Apache Maven Starter is great for Java developers new to Apache Maven, but also for experts looking for immediate information. Moreover, only 20% of the necessary information about Maven is used in 80% of the activities. This book aims to focus on the most important information, those pragmatic parts you actually use

Apache Solr essentials

CERN Document Server

Gazzarini, Andrea

2015-01-01

If you are a competent developer with experience of working with technologies similar to Apache Solr and want to develop efficient search applications, then this book is for you. Familiarity with the Java programming language is required.

Apache Mahout essentials

CERN Document Server

Withanawasam, Jayani

2015-01-01

If you are a Java developer or data scientist, haven't worked with Apache Mahout before, and want to get up to speed on implementing machine learning on big data, then this is the perfect guide for you.

MR imaging of acute pancreatitis: Correlation of abdominal wall edema with severity scores

Energy Technology Data Exchange (ETDEWEB)

Yang, Ru, E-mail: yangru0904@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: jzl325@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: zhangxm@nsmc.edu.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Tang, Wei, E-mail: tw-n-g-up@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Xiao, Bo, E-mail: xiaoboimaging@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: nc_hxh1966@yahoo.com.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: llinyangmd@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Feng, Zhi Song, E-mail: fengzhisong@medmail.com.cn [Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)

2012-11-15

Objective: To study MRI findings of abdominal wall edema (AWE) in acute pancreatitis as well as correlations between AWE and the severity of acute pancreatitis according to the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation III (APACHE III) scoring system. Materials and methods: A total of 160 patients with AP admitted to our institution between December 2009 and March 2011 were included in this study. MRI was performed within 48 h after admission. MRI findings of acute pancreatitis were noted, including AWE on the MRI. The abdominal wall area was divided into quarters, and each area involved was recorded as 1 point to score the severity of AWE. The severity of acute pancreatitis was studied using both the MRSI and the APACHE III scoring system. Spearman correlation of AWE with the MRSI and the APACHE III scoring system was analyzed. Results: In 160 patients with acute pancreatitis, 53.8% had AWE on MRI. The average AWE score was 1.2 {+-} 1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively, according to MRSI. AWE on MRI was correlated with MRSI scores (r = 0.441, p = 0.000). According to APACHE III scores, the averages were 2.0 {+-} 1.1 and 2.6 {+-} 1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE was slightly correlated with the APACHE III scores (r = 0.222, p = 0.005). Conclusion: AWE on MRI in acute pancreatitis is common, which may be a supplementary indicator in determining the severity of AP.

Performance of three prognostic models in patients with cancer in need of intensive care in a medical center in China.

Directory of Open Access Journals (Sweden)

XueZhong Xing

Full Text Available The aim of this study was to evaluate the performance of Acute Physiology and Chronic Health Evaluation II (APACHE II, Simplified Acute Physiology Score 3 (SAPS 3, and Acute Physiology and Chronic Health Evaluation IV (APACHE IV in patients with cancer admitted to intensive care unit (ICU in a single medical center in China.This is a retrospective observational cohort study including nine hundred and eighty one consecutive patients over a 2-year period.The hospital mortality rate was 4.5%. When all 981 patients were evaluated, the area under the receiver operating characteristic curve (AUROC, 95% Confidential Intervals of the three models in predicting hospital mortality were 0.948 (0.914-0.982, 0.863 (0.804-0.923, and 0.873 (0.813-0.934 for SAPS 3, APACHE II and APACHE IV respectively. The p values of Hosmer-Lemeshow statistics for the models were 0.759, 0.900 and 0.878 for SAPS 3, APACHE II and APACHE IV respectively. However, SAPS 3 and APACHE IV underestimated the in-hospital mortality with standardized mortality ratio (SMR of 1.5 and 1.17 respectively, while APACHE II overestimated the in-hospital mortality with SMR of 0.72. Further analysis showed that discrimination power was better with SAPS 3 than with APACHE II and APACHE IV whether for emergency surgical and medical patients (AUROC of 0.912 vs 0.866 and 0.857 or for scheduled surgical patients (AUROC of 0.945 vs 0.834 and 0.851. Calibration was good for all models (all p > 0.05 whether for scheduled surgical patients or emergency surgical and medical patients. However, in terms of SMR, SAPS 3 was both accurate in predicting the in-hospital mortality for emergency surgical and medical patients and for scheduled surgical patients, while APACHE IV and APACHE II were not.In this cohort, we found that APACHE II, APACHE IV and SAPS 3 models had good discrimination and calibration ability in predicting in-hospital mortality of critically ill patients with cancer in need of intensive care. Of

Recursive and non-linear logistic regression: moving on from the original EuroSCORE and EuroSCORE II methodologies.

Science.gov (United States)

Poullis, Michael

2014-11-01

EuroSCORE II, despite improving on the original EuroSCORE system, has not solved all the calibration and predictability issues. Recursive, non-linear and mixed recursive and non-linear regression analysis were assessed with regard to sensitivity, specificity and predictability of the original EuroSCORE and EuroSCORE II systems. The original logistic EuroSCORE, EuroSCORE II and recursive, non-linear and mixed recursive and non-linear regression analyses of these risk models were assessed via receiver operator characteristic curves (ROC) and Hosmer-Lemeshow statistic analysis with regard to the accuracy of predicting in-hospital mortality. Analysis was performed for isolated coronary artery bypass grafts (CABGs) (n = 2913), aortic valve replacement (AVR) (n = 814), mitral valve surgery (n = 340), combined AVR and CABG (n = 517), aortic (n = 350), miscellaneous cases (n = 642), and combinations of the above cases (n = 5576). The original EuroSCORE had an ROC below 0.7 for isolated AVR and combined AVR and CABG. None of the methods described increased the ROC above 0.7. The EuroSCORE II risk model had an ROC below 0.7 for isolated AVR only. Recursive regression, non-linear regression, and mixed recursive and non-linear regression all increased the ROC above 0.7 for isolated AVR. The original EuroSCORE had a Hosmer-Lemeshow statistic that was above 0.05 for all patients and the subgroups analysed. All of the techniques markedly increased the Hosmer-Lemeshow statistic. The EuroSCORE II risk model had a Hosmer-Lemeshow statistic that was significant for all patients (P linear regression failed to improve on the original Hosmer-Lemeshow statistic. The mixed recursive and non-linear regression using the EuroSCORE II risk model was the only model that produced an ROC of 0.7 or above for all patients and procedures and had a Hosmer-Lemeshow statistic that was highly non-significant. The original EuroSCORE and the EuroSCORE II risk models do not have adequate ROC and Hosmer

The outcome of critical illness in decompensated alcoholic liver cirrhosis

DEFF Research Database (Denmark)

Kavli, M; Strøm, T; Carlsson, M

2012-01-01

physiology and chronic health evaluation II (APACHE II) and simplified organ failure assessment (SOFA) in predicting outcome. We hypothesized that in a Scandinavian cohort of ICU patients, APACHE II, SOFA, and simplified acute physiology score (SAPS II) were superior to predict outcome compared...... with the Child-Pugh score. METHODS: A single-centre retrospective cohort analysis was conducted in a university-affiliated ICU. Eighty-seven adult patients with decompensated liver alcoholic cirrhosis were admitted from January 2007 to January 2010. RESULTS: The patients were severely ill with median scores...... alcoholic liver disease should be revised....

Assessment of PANC3 score in predicting severity of acute pancreatitis

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Avreen Singh Shah

2017-01-01

Full Text Available Introduction: Acute pancreatitis is inflammatory process of the pancreas associated with local and systemic complications. At present, there are lots of scores (such as Ransons, APACHE II, bedside index for severity in acute pancreatitis that help us in predicting severity at the time of admission but these are time consuming or require complex calculation and are costly. Material and Methods: PANC3 Scoring System is one of the better systems because the three criteria used (hematocrit, body mass index, and pleural effusion are simple, easy to assess, readily available, and economic. In this prospective study, 100 cases were evaluated to see the prospects of PANC3 scoring in predicting the severity of acute pancreatitis as decided by modified Marshals score. Results: The results showed that PANC3 score had a 96.43% specificity, 75% sensitivity, 80% positive predictive value, and 95.29% negative predictive value. Conclusion: Hence, the PANC3 score is a cost-effective, promising score that helps in predicting the severity of acute pancreatitis leading to prompt treatment and early referral to higher center.

Apaches push privatization

International Nuclear Information System (INIS)

Daniels, S.

1994-01-01

Trying to drum up business for what would be the first private temporary storage facility for spent nuclear fuel rods, the Mescalero Apaches are inviting officials of 30 utilities to convene March 10 at the tribe's New Mexico reservation. The state public utilities commission will also attend the meeting, which grew from an agreement the tribe signed last month with Minneapolis-based Northern States Power Co

Perl and Apache Your visual blueprint for developing dynamic Web content

CERN Document Server

McDaniel, Adam

2010-01-01

Visually explore the range of built-in and third-party libraries of Perl and Apache. Perl and Apache have been providing Common Gateway Interface (CGI) access to Web sites for 20 years and are constantly evolving to support the ever-changing demands of Internet users. With this book, you will heighten your knowledge and see how to usePerl and Apache to develop dynamic Web sites. Beginning with a clear, step-by-step explanation of how to install Perl and Apache on both Windows and Linux servers, you then move on to configuring each to securely provide CGI Services. CGI developer and author Adam

Validación de EuroSCORE II en España

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Antonio García-Valentín

2014-10-01

Conclusiones: Los pacientes españoles presentan un perfil de riesgo alto. La mortalidad cruda es aceptable, más cercana al valor de EuroSCORE II que de EuroSCORE. Ambas escalas muestran mala calibración, EuroSCORE por sobreestimación y EuroSCORE II por infraestimación. El área bajo la curva ROC muestra buena discriminación para ambos modelos.

Mastering Apache Cassandra

CERN Document Server

Neeraj, Nishant

2013-01-01

Mastering Apache Cassandra is a practical, hands-on guide with step-by-step instructions. The smooth and easy tutorial approach focuses on showing people how to utilize Cassandra to its full potential.This book is aimed at intermediate Cassandra users. It is best suited for startups where developers have to wear multiple hats: programmer, DevOps, release manager, convincing clients, and handling failures. No prior knowledge of Cassandra is required.

Apache Cordova 3 programming

CERN Document Server

Wargo, John M

2013-01-01

Written for experienced mobile developers, Apache Cordova 3 Programming is a complete introduction to Apache Cordova 3 and Adobe PhoneGap 3. It describes what makes Cordova important and shows how to install and use the tools, the new Cordova CLI, the native SDKs, and more. If you’re brand new to Cordova, this book will be just what you need to get started. If you’re familiar with an older version of Cordova, this book will show you in detail how to use all of the new stuff that’s in Cordova 3 plus stuff that has been around for a while (like the Cordova core APIs). After walking you through the process of downloading and setting up the framework, mobile expert John M. Wargo shows you how to install and use the command line tools to manage the Cordova application lifecycle and how to set up and use development environments for several of the more popular Cordova supported mobile device platforms. Of special interest to new developers are the chapters on the anatomy of a Cordova application, as well ...

Integrating Seasonal Oscillations into Basel II Behavioural Scoring Models

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Goran Klepac

2007-09-01

Full Text Available The article introduces a new methodology of temporal influence measurement (seasonal oscillations, temporal patterns for behavioural scoring development purposes. The paper shows how significant temporal variables can be recognised and then integrated into the behavioural scoring models in order to improve model performance. Behavioural scoring models are integral parts of the Basel II standard on Internal Ratings-Based Approaches (IRB. The IRB approach much more precisely reflects individual risk bank profile.A solution of the problem of how to analyze and integrate macroeconomic and microeconomic factors represented in time series into behavioural scorecard models will be shown in the paper by using the REF II model.

Apache ZooKeeper essentials

CERN Document Server

Haloi, Saurav

2015-01-01

Whether you are a novice to ZooKeeper or already have some experience, you will be able to master the concepts of ZooKeeper and its usage with ease. This book assumes you to have some prior knowledge of distributed systems and high-level programming knowledge of C, Java, or Python, but no experience with Apache ZooKeeper is required.

EuroSCORE II and STS as mortality predictors in patients undergoing TAVI

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Vitor Emer Egypto Rosa

2016-02-01

Full Text Available SUMMARY Introduction: the EuroSCORE II and STS are the most used scores for surgical risk stratification and indication of transcatheter aortic valve implantation (TAVI. However, its role as a tool for mortality prediction in patients undergoing TAVI is still unclear. Objective: to evaluate the performance of the EuroSCORE II and STS as predictors of in-hospital and 30-day mortality in patients undergoing TAVI. Methods: we included 59 symptomatic patients with severe aortic stenosis that underwent TAVI between 2010 and 2014. The variables were analyzed using Student's t-test and Fisher's exact test and the discriminative power was evaluated using receiver operating characteristic curve (ROC and area under the curve (AUC with a 95% confidence interval. Results: mean age was 81±7.3 years, 42.3% men. The mean EuroSCORE II was 7.6±7.3 % and STS was 20.7±10.3%. Transfemoral procedure was performed in 88.13%, transapical in 3.38% and transaortic in 8.47%. In-hospital mortality was 10.1% and 30-day mortality was 13.5%. Patients who died had EuroSCORE II and STS higher than the survivors (33.7±16.7vs. 18.6±7.3% p=0,0001 for STS and 13.9±16.1 vs. 4.8±3.8% p=0.0007 for EuroSCORE II. The STS showed an AUC of 0.81 and the EuroSCORE II of 0.77 and there were no differences in the discrimination ability using ROC curves (p=0.72. Conclusion: in this cohort, the STS and EuroSCORE II were predictors of in-hospital and 30-days mortality in patients with severe aortic stenosis undergoing TAVI.

The use of perioperative serial blood lactate levels, the APACHE II and the postoperative MELD as predictors of early mortality after liver transplantation O uso da dosagem seriada do lactato sérico no perioperatório, do APACHE II e do MELD pós-operatório como preditores de mortalidade precoce após transplante hepático

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Anibal Basile-Filho

2011-12-01

Full Text Available PURPOSE: To evaluate the accuracy of different parameters in predicting early (one-month mortality of patients submitted to orthotopic liver transplantation (OLT. METHODS: This is a retrospective study of forty-four patients (38 males and 10 females, mean age of 52.2 ± 8.9 years admitted to the Intensive Care Unit of a tertiary hospital. Serial lactate blood levels, APACHE II, MELD post-OLT, creatinine, bilirubin and INR parameters were analyzed by receiver-operator characteristic (ROC curves as evidenced by the area under the curve (AUC. The level of significance was set at 0.05. RESULTS: The mortality of OLT patients within one month was 17.3%. Differences in blood lactate levels became statistically significant between survivors and nonsurvivors at the end of the surgery (pOBJETIVO: Avaliar qual parâmetro é o mais eficiente na predição de mortalidade precoce (um mês de pacientes submetidos a transplante ortotópico de fígado (OLT. MÉTODOS: Estudo retrospectivo em cinqüenta e oito pacientes adultos (44 homens e 14 mulheres, com uma idade média de 51,7 ± 10,1 anos admitidos na Unidade de Terapia Intensiva de um hospital terciário. Os parâmetros como a dosagem seriada de lactato no sangue, APACHE II, MELD pós-OLT, creatinina, bilirrubina e INR foram analisados por curvas ROC (Receiver-operator characteristic, evidenciado pela área abaixo da curva (AUC. O nível de significância foi definido em 0,05. RESULTADOS: A mortalidade dos pacientes OLT em até um mês foi de 17,3%. As diferenças no nível de lactato no sangue tornaram-se estatisticamente significantes entre sobreviventes e não sobreviventes no final da cirurgia (p < 0,05. A AUC foi de 0,726 (95%CI = 0,593-0,835 para APACHE II (p = 0,02; 0,770 (95%CI = 0,596-0,849 para o lactato sérico (L7-L8 (p = 0,03; 0,814 (95%CI = 0,690-0,904 para MELD post-OLT (p < 0,01; 0,550 (95%CI = 0,414-0,651 de creatinina (p = 0,64; 0,705 (95%CI = 0,571-0,818 de bilirrubina (p = 0,05 e 0

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

Science.gov (United States)

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

2018-01-01

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

Intra-abdominal pressure and procalcitonin are valid prognostic markers of acute pancreatitis severity (intra-abdominal pressure and procalcitonin

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Stojanović Maja

2017-01-01

Full Text Available Introduction. Early assessment of the severity and etiology of acute pancreatitis is very important for further treatment procedures. The aim of the study was to investigate the association between intra-abdominal pressure (IAP and procalcitonin as an indicator of severity of acute pancreatitis. Method. The IAP is measured every 12 hours through the urinary catheter placed in the bladder, in 65 patients with acute pancreatitis. Procalcitonin is measured within 24 hours of receipt of the patient, after 48 hours and after 78 hours. These values of procalcitonin and IAP were compared to each other and in relation to the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II scoring system. Patients with APACHE II score > 8 are defined with moderate and severe acute pancreatitis. Results. The values of IAP (18,1 ± 4,5 mmHg vs 8,9 ± 2,67 mmHg; p = 0,01 , procalcitonin (15,43 + 2,25 ng/ml vs 3,14 + 1,12 ng/ml; p =0,031 and APACHE II scoring system (17,3 ± 6,24 vs 6,5 ± 1,0; p = 0,013 were significantly higher in patients with moderate and severe acute pancreatitis. The increase in the value of IAP was accompanied by an increase in the value of procalcitonin (r = 0,581, p = 0,01. The sensitivity in the prediction of severe acute pancreatitis after 24 hours of receiving the patient is 91,7% for the IAP, 87,8% for procalcitonin and 84,9% for APACHE II scoring system. Conclusion. The increase in the value of the IAP is accompanied by an increase in the values of procalcitonin, also patients with higher values of APACHE II scoring sys­tem have higher values of IAP and procalcitonin. The values of IAP and procalcitonin can be used as markers of acute pancreatitis severity.

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

Science.gov (United States)

Sathe, Prachee M; Bapat, Sharda N

2014-01-01

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

Instant Apache Camel message routing

CERN Document Server

Ibryam, Bilgin

2013-01-01

Filled with practical, step-by-step instructions and clear explanations for the most important and useful tasks. This short, instruction-based guide shows you how to perform application integration using the industry standard Enterprise Integration Patterns.This book is intended for Java developers who are new to Apache Camel and message- oriented applications.

Biology and distribution of Lutzomyia apache as it relates to VSV

Science.gov (United States)

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

The evaluation of CRIB II scoring system in predicting mortality in preterm newborns

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Homa Babaei

2015-02-01

Full Text Available Background: The survival rate of premature newborns depends on gestational age, birth weight and condition when they are hospitalized. Different scoring systems to predict mortality in newborns has been designed. The purpose of this study was to evaluate value of CRIB II scoring system in predicting mortality rate of infants with birth weights less than 1500 grams. Material and Methods: In this 8 month cross - sectional study (September 2010 to April 2010 which was conducted in the NICU of Imam Reza hospital in Kermanshah, preterm newborns with birth weight less than 1500 gr and gestational age less than 32 weeks who were admitted within 12 hours after birth in the NICU ,were evaluated based on CRIB II scoring system . Results: 50 neonates out of 1360 (36.8% survived and 86 neonates(63.2% died. Average CRIB II score in newborn survived was 5.8±2.9 and in infants died was 9.8±2.9 (p <0.0001. Based on the AUC, the CRIB II score could predict about 0.85 (CI: 0.77-0.92 of mortality. Also based on the ROC curve cut-off point for scoring CRIB II, was 6.5. Conclusion: Our study showed that CRIB II has a high value( about %85 in predicting mortality in newborns with birth weights less than 1500 grams.

Desempenho de seis modelos de predição prognóstica em pacientes críticos que receberam suporte renal extracorpóreo Performance of six prognostic scores in critically ILL patients receiving renal replacement therapy

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Elizabeth R. Maccariello

2008-06-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Não existe consenso sobre qual modelo prognóstico deva ser utilizado em pacientes com disfunção renal aguda (DRA. O objetivo deste estudo foi avaliar o desempenho de seis escores de prognóstico em pacientes que necessitaram de suporte renal. MÉTODO: Coorte prospectiva de pacientes internados nas unidades de terapia intensiva (UTI de três hospitais terciários que necessitaram de suporte renal por DRA durante 32 meses. Foram excluídos os pacientes crônicos em programa de diálise ou com BACKGROUND AND OBJECTIVES: There is no consensus about prognostic scores for use in patients with acute kidney injury (AKI. The aim of this study was to evaluate the performance of six prognostic scores in predicting hospital mortality in patients with AKI and need for renal replacement therapy (RRT. METHODS: Prospective cohort of patients admitted to the intensive care units (ICU of three tertiary care hospitals that required RRT for AKI over a 32-month period. Patients with end-stage renal disease and those with ICU stay < 24h were excluded. Data from the first 24h of ICU admission were used to calculate SAPS II and APACHE II scores, and data from the first 24h of RRT were used in the calculation of LOD, ODIN, Liaño and Mehta scores. Discrimination was evaluated using the area under ROC curve (AUROC and calibration using the Hosmer-Lemeshow goodness-of-fit test. The hospital mortality was the end-point of interest. RESULTS: 467 patients were evaluated. Hospital mortality rate was 75%. Mean SAPS II and APACHE II scores were 48.5 ±11.2 and 27.4 ± 6.3 points, and median LOD score was 7 (5-8 points. Except for Mehta score (p = 0.001, calibration was appropriate in all models. However, discrimination was uniformly unsatisfactory; AUROC ranged from 0.60 for ODIN to 0.72 for SAPS II and Mehta scores. In addition, except for Mehta, all models tended to underestimate hospital mortality. CONCLUSIONS: Organ dysfunction, general and

Commonly used severity scores are not good predictors of mortality in sepsis from severe leptospirosis: a series of ten patients.

Science.gov (United States)

Velissaris, Dimitrios; Karanikolas, Menelaos; Flaris, Nikolaos; Fligou, Fotini; Marangos, Markos; Filos, Kriton S

2012-01-01

Introduction. Severe leptospirosis, also known as Weil's disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. Methods. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Data were collected retrospectively, with approval from the Institution Ethics Committee. Results. Ten patients with severe leptospirosis were admitted in the Patras University Hospital ICU in a four-year period. Although, based on SOFA scores, predicted mortality was over 80%, seven of 10 patients survived and were discharged from the hospital in good condition. There was no association between SAPS II or SOFA scores and mortality, but survivors had significantly lower APACHE II scores compared to nonsurvivors. Conclusion. Commonly used severity scores do not seem to be useful in predicting mortality in severe leptospirosis. Early ICU admission and resuscitation based on a goal-directed therapy protocol are recommended and may reduce mortality. However, this study is limited by retrospective data collection and small sample size. Data from large prospective studies are needed to validate our findings.

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

Science.gov (United States)

2012-08-24

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

Predictors of post-traumatic stress disorder following critical illness: A mixed methods study.

Science.gov (United States)

Battle, Ceri E; James, Karen; Bromfield, Tom; Temblett, Paul

2017-11-01

Post-traumatic stress disorder has been reported in survivors of critical illness. The aim of this study was to investigate the predictors of post-traumatic stress disorder in survivors of critical illness. Patients attending the intensive care unit (ICU) follow-up clinic completed the UK-Post-Traumatic Stress Syndrome 14-Questions Inventory and data was collected from their medical records. Predictors investigated included age, gender, Apache II score, ICU length of stay, pre-illness psychopathology; delirium and benzodiazepine administration during ICU stay and delusional memories of the ICU stay following discharge. A total of 198 patients participated, with 54 (27%) patients suffering with post-traumatic stress disorder. On multivariable logistic regression, the significant predictors of post-traumatic stress disorder were younger age, lower Apache II score, pre-illness psychopathology and delirium during the ICU stay. The predictors of post-traumatic stress disorder in this study concur with previous research however a lower Apache II score has not been previously reported.

Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients

DEFF Research Database (Denmark)

Granholm, Anders; Møller, Morten Hylander; Kragh, Mette

2016-01-01

PURPOSE: Severity scores including the Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score are used in intensive care units (ICUs) to assess disease severity, predict mortality and in research. We aimed to assess the predictive performance of SAPS II...... compared the discrimination of SAPS II and initial SOFA scores, compared the discrimination of SAPS II in our cohort with the original cohort, assessed the calibration of SAPS II customised to our cohort, and compared the discrimination for 90-day mortality vs. in-hospital mortality for both scores....... Discrimination was evaluated using areas under the receiver operating characteristics curves (AUROC). Calibration was evaluated using Hosmer-Lemeshow's goodness-of-fit Ĉ-statistic. RESULTS: AUROC for in-hospital mortality was 0.80 (95% confidence interval (CI) 0.77-0.83) for SAPS II and 0.73 (95% CI 0...

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

Science.gov (United States)

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

2014-01-01

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

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

Science.gov (United States)

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

2017-05-01

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

Critical Care Nurses Inadequately Assess SAPS II Scores of Very Ill Patients in Real Life

Directory of Open Access Journals (Sweden)

Andreas Perren

2012-01-01

Full Text Available Background. Reliable ICU severity scores have been achieved by various healthcare workers but nothing is known regarding the accuracy in real life of severity scores registered by untrained nurses. Methods. In this retrospective multicentre audit, three reviewers independently reassessed 120 SAPS II scores. Correlation and agreement of the sum-scores/variables among reviewers and between nurses and the reviewers’ gold standard were assessed globally and for tertiles. Bland and Altman (gold standard—nurses of sum scores and regression of the difference were determined. A logistic regression model identifying risk factors for erroneous assessments was calculated. Results. Correlation for sum scores among reviewers was almost perfect (mean ICC = 0.985. The mean (±SD nurse-registered SAPS II sum score was 40.3±20.2 versus 44.2±24.9 of the gold standard (32 points scores. The lowest agreement was found in high SAPS II tertiles for haemodynamics (k = 0.45–0.51. Conclusions. In real life, nurse-registered SAPS II scores of very ill patients are inaccurate. Accuracy of scores was not associated with nurses’ characteristics.

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

Science.gov (United States)

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

2018-01-01

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

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

Science.gov (United States)

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

2018-01-23

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

The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality.

Science.gov (United States)

Barili, Fabio; Pacini, Davide; D'Ovidio, Mariangela; Dang, Nicholas C; Alamanni, Francesco; Di Bartolomeo, Roberto; Grossi, Claudio; Davoli, Marina; Fusco, Danilo; Parolari, Alessandro

2016-10-01

The European System for Cardiac Operation Risk Evaluation (EuroSCORE) II has not been tested yet for predicting long-term mortality. This study was undertaken to evaluate the relationship between EuroSCORE II and long-term mortality and to develop a new algorithm based on EuroSCORE II factors to predict long-term survival after cardiac surgery. Complete data on 10,033 patients who underwent major cardiac surgery during a 7-year period were retrieved from three prospective institutional databases and linked with the Italian Tax Register Information System. Mortality at follow-up was analyzed with time-to-event analysis. The Kaplan-Meier estimates of survival at 1 and 5 were, respectively, 95.0% ± 0.2% and 84.7% ± 0.4%. Both discrimination and calibration of EuroSCORE II decreased in the prediction of 1-year and 5-year mortality. Nonetheless, EuroSCORE II was confirmed to be an independent predictor of long-term mortality with a nonlinear trend. Several EuroSCORE II variables were independent risk factors for long-term mortality in a regression model, most of all very low ejection fraction (less than 20%), salvage operation, and dialysis. In the final model, isolated mitral valve surgery and isolated coronary artery bypass graft surgery were associated with improved long-term survival. The EuroSCORE II cannot be considered a direct estimator of long-term risk of death, as its performance fades for mortality at follow-up longer than 30 days. Nonetheless, it is nonlinearly associated with long-term mortality, and most of its variables are risk factors for long-term mortality. Hence, they can be used in a different algorithm to stratify the risk of long-term mortality after surgery. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Solar Feasibility Study May 2013 - San Carlos Apache Tribe

Energy Technology Data Exchange (ETDEWEB)

Rapp, Jim [Parametrix; Duncan, Ken [San Carlos Apache Tribe; Albert, Steve [Parametrix

2013-05-01

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

Apache, Santa Fe energy units awarded two Myanmar blocks

International Nuclear Information System (INIS)

Anon.

1992-01-01

This paper reports that Myanmar's state oil company has awarded production sharing contracts (PSCs) on two blocks to units of Apache Corp. and Santa Fe Energy Resources Inc., both of Houston. That comes on the heels of a report by County NatWest Woodmac that notes Myanmar's oil production, currently meeting less than half the country's demand, is set to fall further this year. 150 line km of new seismic data could be acquired and one well drilled. During the initial 2 year exploration period on Block EP-3, Apache will conduct geological studies and conduct at least 200 line km of seismic data

Mortality indicators and risk factors for intra-abdominal hypertension in severe acute pancreatitis.

Science.gov (United States)

Zhao, J G; Liao, Q; Zhao, Y P; Hu, Y

2014-01-01

This study assessed the risk factors associated with mortality and the development of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP). To identify significant risk factors, we assessed the following variables in 102 patients with SAP: age, gender, etiology, serum amylase level, white blood cell (WBC) count, serum calcium level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, computed tomography severity index (CTSI) score, pancreatic necrosis, surgical interventions, and multiple organ dysfunction syndrome (MODS). Statistically significant differences were identified using the Student t test and the χ (2) test. Independent risk factors for survival were analyzed by Cox proportional hazards regression. The following variables were significantly related to both mortality and IAH: WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, pancreatic necrosis >50%, and MODS. However, it was found that surgical intervention had no significant association with mortality. MODS and pancreatic necrosis >50% were found to be independent risk factors for survival in patients with SAP. Mortality and IAH from SAP were significantly related to WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, and MODS. However, Surgical intervention did not result in higher mortality. Moreover, MODS and pancreatic necrosis >50% predicted a worse prognosis in SAP patients.

Satellite Imagery Production and Processing Using Apache Hadoop

Science.gov (United States)

Hill, D. V.; Werpy, J.

2011-12-01

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

The sequential organ failure assessment (SOFA) score is an effective triage marker following staggered paracetamol (acetaminophen) overdose.

Science.gov (United States)

Craig, D G; Zafar, S; Reid, T W D J; Martin, K G; Davidson, J S; Hayes, P C; Simpson, K J

2012-06-01

The sequential organ failure assessment (SOFA) score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses. To evaluate the prognostic accuracy of the SOFA score following staggered paracetamol overdose. Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA scores were calculated. A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2-95.7), 94.3 (95% CI 82.5-99.1), and 98.4 (95% CI 84.3-100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA score of paracetamol overdose, is associated with a good prognosis. Both the SOFA and APACHE II scores could improve triage of high-risk staggered paracetamol overdose patients. © 2012 Blackwell Publishing Ltd.

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

Science.gov (United States)

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

2015-04-01

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

Network Intrusion Detection System using Apache Storm

Directory of Open Access Journals (Sweden)

Muhammad Asif Manzoor

2017-06-01

Full Text Available Network security implements various strategies for the identification and prevention of security breaches. Network intrusion detection is a critical component of network management for security, quality of service and other purposes. These systems allow early detection of network intrusion and malicious activities; so that the Network Security infrastructure can react to mitigate these threats. Various systems are proposed to enhance the network security. We are proposing to use anomaly based network intrusion detection system in this work. Anomaly based intrusion detection system can identify the new network threats. We also propose to use Real-time Big Data Stream Processing Framework, Apache Storm, for the implementation of network intrusion detection system. Apache Storm can help to manage the network traffic which is generated at enormous speed and size and the network traffic speed and size is constantly increasing. We have used Support Vector Machine in this work. We use Knowledge Discovery and Data Mining 1999 (KDD’99 dataset to test and evaluate our proposed solution.

Optimizing CMS build infrastructure via Apache Mesos

CERN Document Server

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

2015-12-23

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

Managing Variant Calling Files the Big Data Way: Using HDFS and Apache Parquet

NARCIS (Netherlands)

Boufea, Aikaterini; Finkers, H.J.; Kaauwen, van M.P.W.; Kramer, M.R.; Athanasiadis, I.N.

2017-01-01

Big Data has been seen as a remedy for the efficient management of the ever-increasing genomic data. In this paper, we investigate the use of Apache Spark to store and process Variant Calling Files (VCF) on a Hadoop cluster. We demonstrate Tomatula, a software tool for converting VCF files to Apache

[Predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure supported by extracorporeal membrane oxygenation].

Science.gov (United States)

Wang, R; Sun, B; Li, X Y; He, H Y; Tang, X; Zhan, Q Y; Tong, Z H

2016-09-01

To investigate the predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation (VV-ECMO). Forty-two patients with severe ARF supported by VV-ECMO were enrolled from November 2009 to July 2015.There were 25 males and 17 females. The mean age was (44±18) years (rang 18-69 years). Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ⅲ, Ⅳ, Simplified Acute Physiology Score Ⅱ (SAPS) Ⅱ, Sequential Organ Failure Assessment (SOFA), ECMO net, PRedicting dEath for SEvere ARDS on VVECMO (PRESERVE), and Respiratory ECMO Survival Prediction (RESP) scores were collected within 6 hours before VV-ECMO support. The patients were divided into the survivors group (n=17) and the nonsurvivors group (n=25) by survival at 180 d after receiving VV-ECMO. The patient clinical characteristics and aforementioned scoring systems were compared between groups. Scoring systems for predicting prognosis were assessed using the area under the receiver-operating characteristic (ROC) curve. The Kaplan-Meier method was used to draw the surviving curve, and the survival of the patients was analyzed by the Log-rank test. The risk factors were assessed for prognosis by multiple logistic regression analysis. (1) Positive end expiratory pressure (PEEP) 6 hours prior to VV-ECMO support in the survivors group [(9.7±5.0)cmH2O, (1 cmH2O=0.098 kPa)] was lower than that in the nonsurvivors group [(13.2±5.4)cmH2O, t=-2.134, P=0.039]. VV-ECMO combination with continuous renal replacement therapy(CRRT) in the nonsurvivors group (32%) was used more than in the survivors group (6%, χ(2)=4.100, P=0.043). Duration of VV-ECMO support in the nonsurvivors group [(15±13) d] was longer than that in the survivors group [(12±11)d, t=-2.123, P=0.041]. APACHE Ⅱ, APACHE Ⅲ, APACHE Ⅳ, ECMO net, PRESERVE, and RESP scores in the survivors group were superior to the nonsurvivors

Jicarilla Apache Utility Authority Renewable Energy and Energy Efficiency Strategic Planning

Energy Technology Data Exchange (ETDEWEB)

Rabago, K.R.

2008-06-28

The purpose of this Strategic Plan Report is to provide an introduction and in-depth analysis of the issues and opportunities, resources, and technologies of energy efficiency and renewable energy that have potential beneficial application for the people of the Jicarilla Apache Nation and surrounding communities. The Report seeks to draw on the best available information that existed at the time of writing, and where necessary, draws on new research to assess this potential. This study provides a strategic assessment of opportunities for maximizing the potential for electrical energy efficiency and renewable energy development by the Jicarilla Apache Nation. The report analyzes electricity use on the Jicarilla Apache Reservation in buildings. The report also assesses particular resources and technologies in detail, including energy efficiency, solar, wind, geothermal, biomass, and small hydropower. The closing sections set out the elements of a multi-year, multi-phase strategy for development of resources to the maximum benefit of the Nation.

Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis

Directory of Open Access Journals (Sweden)

Avinash Agarwal

2016-09-01

Full Text Available BackgroundDiabetic ketoacidosis (DKA is characterized by a biochemical triad of hyperglycemia, acidosis, and ketonemia. This condition is life-threatening despite improvements in diabetic care. The purpose of this study was to evaluate the clinical and biochemical prognostic markers of DKA. We assessed correlations in prognostic markers with DKA-associated morbidity and mortality.MethodsTwo hundred and seventy patients that were hospitalized with DKA over a period of 2 years were evaluated clinically and by laboratory tests. Serial assays of serum electrolytes, glucose, and blood pH were performed, and clinical outcome was noted as either discharged to home or death.ResultsThe analysis indicated that significant predictors included sex, history of type 1 diabetes mellitus or type 2 diabetes mellitus, systolic blood pressure, diastolic blood pressure, total leukocyte count, Acute Physiology and Chronic Health Evaluation II (APACHE II score, blood urea nitrogen, serum creatinine, serum magnesium, serum phosphate, serum osmolality, serum glutamic oxaloacetic transaminases, serum glutamic pyruvic transaminases, serum albumin, which were further regressed and subjected to multivariate logistic regression (MLR analysis. The MLR analysis indicated that males were 7.93 times more likely to have favorable outcome compared with female patients (odds ratio, 7.93; 95% confidence interval, 3.99 to 13.51, while decreases in mean APACHE II score (14.83 and serum phosphate (4.38 at presentation may lead to 2.86- and 2.71-fold better outcomes, respectively, compared with higher levels (APACHE II score, 25.00; serum phosphate, 6.04.ConclusionSex, baseline biochemical parameters such as APACHE II score, and phosphate level were important predictors of the DKA-associated mortality.

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

Science.gov (United States)

2010-11-08

... Energy Marketing Corp. Apache Corporation; Notice for Temporary Waivers November 1, 2010. Take notice that on October 29, 2010, BP Canada Energy Marketing Corp. and Apache Corporation filed with the... assistance with any FERC Online service, please e-mail [email protected] , or call (866) 208-3676...

Learning Apache Solr high performance

CERN Document Server

Mohan, Surendra

2014-01-01

This book is an easy-to-follow guide, full of hands-on, real-world examples. Each topic is explained and demonstrated in a specific and user-friendly flow, from search optimization using Solr to Deployment of Zookeeper applications. This book is ideal for Apache Solr developers and want to learn different techniques to optimize Solr performance with utmost efficiency, along with effectively troubleshooting the problems that usually occur while trying to boost performance. Familiarity with search servers and database querying is expected.

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

Science.gov (United States)

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

2017-11-01

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

Conservation priorities in the Apache Highlands ecoregion

Science.gov (United States)

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

2005-01-01

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

Apache Flume distributed log collection for Hadoop

CERN Document Server

Hoffman, Steve

2015-01-01

If you are a Hadoop programmer who wants to learn about Flume to be able to move datasets into Hadoop in a timely and replicable manner, then this book is ideal for you. No prior knowledge about Apache Flume is necessary, but a basic knowledge of Hadoop and the Hadoop File System (HDFS) is assumed.

ASSESSMENT OF SEVERITY OF PERFORATED PERITONITIS USING MODIFIED APACHE II SCORE

Directory of Open Access Journals (Sweden)

L. Rajeswar Reddy

2016-06-01

Full Text Available Acute generalised peritonitis from gastrointestinal hollow viscus perforation is a potentially life threatening condition. It is a common surgical emergency in many general surgical units in the developing countries and it is often associated with high morbidity and mortality. Grading the severity of acute peritonitis has assisted in no small way in decision making and has improved therapy in the management of severely ill patients. Empirically based risk assessment for important clinical events has been extremely useful in evaluating new therapies, in monitoring resources for effective use and improving quality of care. MATERIAL AND METHODS A prospective survey of patients with acute generalised peritonitis due to gastrointestinal perforation was carried out in general surgical wards of KIMS Hospital, Amalapuram during the period starting from July 2013-November 2016. The study population consisted of 50 consecutive patients who had laparotomy during the study period for acute peritonitis due to gastrointestinal perforation, after diagnostic conformation. RESULT AND DISCUSSION The most common cause of peritonitis in our study was perforated duodenal ulcer (31 cases, followed by appendicular perforation (7 cases, followed by stomach perforation (7 cases. Despite delay in seeking treatment, the overall mortality rate (14% was favourably comparable with other published series.

The Apache Point Observatory Galactic Evolution Experiment (APOGEE)

DEFF Research Database (Denmark)

Majewski, Steven R.; Schiavon, Ricardo P.; Frinchaboy, Peter M.

2017-01-01

The Apache Point Observatory Galactic Evolution Experiment (APOGEE), one of the programs in the Sloan Digital Sky Survey III (SDSS-III), has now completed its systematic, homogeneous spectroscopic survey sampling all major populations of the Milky Way. After a three-year observing campaign on the...

Early warning score independently predicts adverse outcome and mortality in patients with acute pancreatitis.

Science.gov (United States)

Jones, Michael J; Neal, Christopher P; Ngu, Wee Sing; Dennison, Ashley R; Garcea, Giuseppe

2017-08-01

The aim of this study was to compare the prognostic value of established scoring systems with early warning scores in a large cohort of patients with acute pancreatitis. In patients presenting with acute pancreatitis, age, sex, American Society of Anaesthesiologists (ASA) grade, Modified Glasgow Score, Ranson criteria, APACHE II scores and early warning score (EWS) were recorded for the first 72 h following admission. These variables were compared between survivors and non-survivors, between patients with mild/moderate and severe pancreatitis (based on the 2012 Atlanta Classification) and between patients with a favourable or adverse outcome. A total of 629 patients were identified. EWS was the best predictor of adverse outcome amongst all of the assessed variables (area under curve (AUC) values 0.81, 0.84 and 0.83 for days 1, 2 and 3, respectively) and was the most accurate predictor of mortality on both days 2 and 3 (AUC values of 0.88 and 0.89, respectively). Multivariable analysis revealed that an EWS ≥2 was independently associated with severity of pancreatitis, adverse outcome and mortality. This study confirms the usefulness of EWS in predicting the outcome of acute pancreatitis. It should become the mainstay of risk stratification in patients with acute pancreatitis.

Early onset of organ failure is the best predictor of mortality in acute pancreatitis El fracaso orgánico precoz como mejor factor predictivo de mortalidad en la pancreatitis aguda

Directory of Open Access Journals (Sweden)

I. Poves Prim

2004-10-01

Full Text Available Background: APACHE II is a multifactorial scoring system for predicting severity in acute pancreatitis (AP. Organ failure (OF has been correlated with mortality in AP. Objectives: to evaluate the usefulness of APACHE II as an early predictor of severity in AP, its correlation with OF, and the relevance of an early establishment of OF during the course of AP. Patients and methods: from January 1999 to November 2001, 447 consecutive cases of AP were studied. APACHE II scores and Atlanta criteria were used for defining severity and OF. Results: twenty-five percent of patients had severe acute pancreatitis (SAP. APACHE II at 24 h after admission showed a sensitivity, specificity, and positive and negative predictive value of 52, 77, 46, and 84%, respectively, for predicting severity. Mortality for SAP was 20.5%. Seventy percent of patients who developed OF did so within the first 24 hours of admission, and their mortality was 52%. Mortality was statistically significant (p Introducción: el APACHE II se ha utilizado como factor predictivo de gravedad en la pancratitis aguda (PA. La instauración de fracaso orgánico (FO en la PA se correlaciona con una mayor mortalidad. Objetivos: evaluar la utilidad del APACHE II como factor predictivo precoz de gravedad en la PA, su correlación con el FO y la relevancia del establecimiento precoz del FO en la PA. Pacientes y métodos: desde enero de 1999 hasta noviembre de 2001 se estudiaron 447 pacientes ingresados consecutivamente por PA. Se utilizó el sistema APACHE II y los criterios de Atlanta para evaluar la gravedad. Resultados: el 25% de los pacientes presentaron una pancreatitis aguda grave (PAG. El APACHE II a las 24 horas del ingreso mostró una sensibilidad, especificidad, valor predictivo positivo y negativo del 52, 77, 46 y 84%, respectivamente, como marcador de gravedad. La mortalidad global de la PAG fue del 20,5%. El 70% de los pacientes que presentaron FO lo hicieron en las primeras 24 horas

Instant Apache Camel messaging system

CERN Document Server

Sharapov, Evgeniy

2013-01-01

Get to grips with a new technology, understand what it is and what it can do for you, and then get to work with the most important features and tasks. A beginner's guide to Apache Camel that walks you through basic operations like installation and setup right through to developing simple applications.This book is a good starting point for Java developers who have to work on an application dealing with various systems and interfaces but who haven't yet started using Enterprise System Buses or Java Business Integration frameworks.

Assessment of three risk evaluation systems for patients aged ≥70 in East China: performance of SinoSCORE, EuroSCORE II and the STS risk evaluation system.

Science.gov (United States)

Shan, Lingtong; Ge, Wen; Pu, Yiwei; Cheng, Hong; Cang, Zhengqiang; Zhang, Xing; Li, Qifan; Xu, Anyang; Wang, Qi; Gu, Chang; Zhang, Yangyang

2018-01-01

To assess and compare the predictive ability of three risk evaluation systems (SinoSCORE, EuroSCORE II and the STS risk evaluation system) in patients aged ≥70, and who underwent coronary artery bypass grafting (CABG) in East China. Three risk evaluation systems were applied to 1,946 consecutive patients who underwent isolated CABG from January 2004 to September 2016 in two hospitals. Patients were divided into two subsets according to their age: elderly group (age ≥70) with a younger group (age evaluation system were 0.78(0.64)%, 1.43(1.14)% and 0.78(0.77)%, respectively. SinoSCORE achieved the best discrimination (the area under the receiver operating characteristic curve (AUC) = 0.829), followed by the STS risk evaluation system (AUC = 0.790) and EuroSCORE II (AUC = 0.769) in the entire cohort. In the elderly group, the observed mortality rate was 4.82% while it was 1.38% in the younger group. SinoSCORE (AUC = .829) also achieved the best discrimination in the elderly group, followed by the STS risk evaluation system (AUC = .730) and EuroSCORE II (AUC = 0.640) while all three risk evaluation systems all had good performances in the younger group. SinoSCORE, EuroSCORE II and the STS risk evaluation system all achieved positive calibrations in the entire cohort and subsets. The performance of the three risk evaluation systems was not ideal in the entire cohort. In the elderly group, SinoSCORE appeared to achieve better predictive efficiency than EuroSCORE II and the STS risk evaluation system.

Spinal Pain and Occupational Disability: A Cohort Study of British Apache AH Mk1 Pilots

Science.gov (United States)

2013-09-01

British RW community. 33 References Apache AH Mk1. 2012. Agusta Westland. http://www.agustawestland.com/ product /apache-ah- mk1-0. Ang, B., and...muscles Physical ex and stretching Continued pt and stretching exercises Use pt session included pumpkin bobs to stretch the neck. No effects noticed

Microalbuminuria in the intensive care unit: Clinical correlates and association with outcomes in 431 patients.

Science.gov (United States)

Gosling, Peter; Czyz, John; Nightingale, Peter; Manji, Mav

2006-08-01

Comparison of urine albumin within 6 hrs of intensive care unit (ICU) admission with demography, clinical classification, outcome, inotrope/vasopressor requirement, clinical assessment of mortality risk, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Urine albumin-creatinine ratio (ACR) was measured on ICU admission (ACR 1) and after 4-6 hrs (ACR 2). A 17-bed general ICU in a university teaching hospital. Unselected medical (206) and surgical (225) patients recruited prospectively. None. Bedside urine ACR was measured by nurses using a Bayer DCA 2000 analyzer and expressed in mg/mmol (reference range Po2/Fio2 ratio 48 hrs after ICU admission and positively correlated with duration of mechanical ventilation and ACR 1 with ICU stay. ACR 2 predicted mortality and ACR 1 inotrope requirement independent of clinical mortality risk assessment and APACHE II and SOFA scores. Urine albumin changes rapidly within the first 6 hrs following ICU admission and predicts ICU mortality and inotrope requirement as well as or better than APACHE II and SOFA scores. Serial urine albumin measurement may provide a means of monitoring the microvascular effects of systemic inflammation.

Factors Predicting Ventilator Dependence in Patients with Ventilator-Associated Pneumonia

Directory of Open Access Journals (Sweden)

Chia-Cheng Tseng

2012-01-01

Full Text Available Objectives. To determine risk factors associated with ventilator dependence in patients with ventilator-associated pneumonia (VAP. Study Design. A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, from January 1, 2007 to January 31, 2008. Methods. This study evaluated 163 adult patients (aged ≥18 years. Eligibility was evaluated according to the criterion for VAP, Sequential Organ Failure Assessment (SOFA score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II score. Oxygenation index, underlying comorbidities, septic shock status, previous tracheostomy status, and factors related to pneumonia were collected for analysis. Results. Of the 163 VAP patients in the study, 90 patients survived, yielding a mortality rate of 44.8%. Among the 90 surviving patients, only 36 (40% had been weaned off ventilators at the time of discharge. Multivariate logistic regression analysis was used to identify underlying factors such as congestive cardiac failure (P=0.009, initial high oxygenation index value (P=0.04, increased SOFA scores (P=0.01, and increased APACHE II scores (P=0.02 as independent predictors of ventilator dependence. Results from the Kaplan-Meier method indicate that initial therapy with antibiotics could increase the ventilator weaning rate (log Rank test, P<0.001. Conclusions. Preexisting cardiopulmonary function, high APACHE II and SOFA scores, and high oxygenation index were the strongest predictors of ventilator dependence. Initial empiric antibiotic treatment can improve ventilator weaning rates at the time of discharge.

The novel EuroSCORE II algorithm predicts the hospital mortality of thoracic aortic surgery in 461 consecutive Japanese patients better than both the original additive and logistic EuroSCORE algorithms.

Science.gov (United States)

Nishida, Takahiro; Sonoda, Hiromichi; Oishi, Yasuhisa; Tanoue, Yoshihisa; Nakashima, Atsuhiro; Shiokawa, Yuichi; Tominaga, Ryuji

2014-04-01

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was developed to improve the overestimation of surgical risk associated with the original (additive and logistic) EuroSCOREs. The purpose of this study was to evaluate the significance of the EuroSCORE II by comparing its performance with that of the original EuroSCOREs in Japanese patients undergoing surgery on the thoracic aorta. We have calculated the predicted mortalities according to the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II algorithms in 461 patients who underwent surgery on the thoracic aorta during a period of 20 years (1993-2013). The actual in-hospital mortality rates in the low- (additive EuroSCORE of 3-6), moderate- (7-11) and high-risk (≥11) groups (followed by overall mortality) were 1.3, 6.2 and 14.4% (7.2% overall), respectively. Among the three different risk groups, the expected mortality rates were 5.5 ± 0.6, 9.1 ± 0.7 and 13.5 ± 0.2% (9.5 ± 0.1% overall) by the additive EuroSCORE algorithm, 5.3 ± 0.1, 16 ± 0.4 and 42.4 ± 1.3% (19.9 ± 0.7% overall) by the logistic EuroSCORE algorithm and 1.6 ± 0.1, 5.2 ± 0.2 and 18.5 ± 1.3% (7.4 ± 0.4% overall) by the EuroSCORE II algorithm, indicating poor prediction (P algorithms were 0.6937, 0.7169 and 0.7697, respectively. Thus, the mortality expected by the EuroSCORE II more closely matched the actual mortality in all three risk groups. In contrast, the mortality expected by the logistic EuroSCORE overestimated the risks in the moderate- (P = 0.0002) and high-risk (P < 0.0001) patient groups. Although all of the original EuroSCOREs and EuroSCORE II appreciably predicted the surgical mortality for thoracic aortic surgery in Japanese patients, the EuroSCORE II best predicted the mortalities in all risk groups.

Analyzing large data sets from XGC1 magnetic fusion simulations using apache spark

Energy Technology Data Exchange (ETDEWEB)

Churchill, R. Michael [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States)

2016-11-21

Apache Spark is explored as a tool for analyzing large data sets from the magnetic fusion simulation code XGCI. Implementation details of Apache Spark on the NERSC Edison supercomputer are discussed, including binary file reading, and parameter setup. Here, an unsupervised machine learning algorithm, k-means clustering, is applied to XGCI particle distribution function data, showing that highly turbulent spatial regions do not have common coherent structures, but rather broad, ring-like structures in velocity space.

Mechanical characterization of densely welded Apache Leap tuff

International Nuclear Information System (INIS)

Fuenkajorn, K.; Daemen, J.J.K.

1991-06-01

An empirical criterion is formulated to describe the compressive strength of the densely welded Apache Leap tuff. The criterion incorporates the effects of size, L/D ratio, loading rate and density variations. The criterion improves the correlation between the test results and the failure envelope. Uniaxial and triaxial compressive strengths, Brazilian tensile strength and elastic properties of the densely welded brown unit of the Apache Leap tuff have been determined using the ASTM standard test methods. All tuff samples are tested dry at room temperature (22 ± 2 degrees C), and have the core axis normal to the flow layers. The uniaxial compressive strength is 73.2 ± 16.5 MPa. The Brazilian tensile strength is 5.12 ± 1.2 MPa. The Young's modulus and Poisson's ratio are 22.6 ± 5.7 GPa and 0.20 ± 0.03. Smoothness and perpendicularity do not fully meet the ASTM requirements for all samples, due to the presence of voids and inclusions on the sample surfaces and the sample preparation methods. The investigations of loading rate, L/D radio and cyclic loading effects on the compressive strength and of the size effect on the tensile strength are not conclusive. The Coulomb strength criterion adequately represents the failure envelope of the tuff under confining pressures from 0 to 62 MPa. Cohesion and internal friction angle are 16 MPa and 43 degrees. The brown unit of the Apache Leap tuff is highly heterogeneous as suggested by large variations of the test results. The high intrinsic variability of the tuff is probably caused by the presence of flow layers and by nonuniform distributions of inclusions, voids and degree of welding. Similar variability of the properties has been found in publications on the Topopah Spring tuff at Yucca Mountain. 57 refs., 32 figs., 29 tabs

Jicarilla Apache Utility Authority. Strategic Plan for Energy Efficiency and Renewable Energy Development

International Nuclear Information System (INIS)

Rabago, K.R.

2008-01-01

The purpose of this Strategic Plan Report is to provide an introduction and in-depth analysis of the issues and opportunities, resources, and technologies of energy efficiency and renewable energy that have potential beneficial application for the people of the Jicarilla Apache Nation and surrounding communities. The Report seeks to draw on the best available information that existed at the time of writing, and where necessary, draws on new research to assess this potential. This study provides a strategic assessment of opportunities for maximizing the potential for electrical energy efficiency and renewable energy development by the Jicarilla Apache Nation. The report analyzes electricity use on the Jicarilla Apache Reservation in buildings. The report also assesses particular resources and technologies in detail, including energy efficiency, solar, wind, geothermal, biomass, and small hydropower. The closing sections set out the elements of a multi-year, multi-phase strategy for development of resources to the maximum benefit of the Nation

Identification of enhanced cytokine generation following sepsis. Dream of magic bullet for mortality prediction and therapeutic evaluation

Directory of Open Access Journals (Sweden)

H Hamishehkar

2010-09-01

Full Text Available "n  "nBackground and the purpose of the study: sepsis is one of the most widespread and lethal disease in Intensive Care Units (ICU. Based on pathophisyology of sepsis, it seems that routine laboratory tests combined with analysis of pro-inflammatory cytokines plasma levels, help clinicians to have more information about disease progress and its correct management. "nMethods:This was a prospective observational study to determine the predictive role of Tumor Necrosis Factor alpha (TNF-α, Interleukin (IL-1β and IL-6 as three main pro-inflammatory cytokines and Acute Physiology and Chronic Health Evaluation (APACHE II and Sequential Organ Failure Assessment (SOFA as two scoring systems in mortality of critically ill patients with severe sepsis. Fifty and five patients with criteria of severe sepsis were included in this study. An exclusion criterion was post Cardiopulmonary Resuscitation (CPR status. Cytokines (TNF-α, IL-1β and IL-6 were assayed in the first, third and seventh days in blood of patients. Results and major conclusion:Among three measured cytokines, sequential levels of TNF-α and IL-6 showed significant differences between survivors and nonsurvivors. IL-6 had a good correlation with outcome and scoring systems during the period of this study. The areas under the receiver operating characteristic (AUROC curve indicated that APACHE II (0.858, 0.848, 0.861 and IL-6 (0.797, 0.799, 0.899 had discriminative power in prediction of mortality during sequental measured days. Multiple logestic regression analysis identified that evaluation of APACHE II and TNF-α in the first day and APACHE II and IL-6 in the third and seventh days of severe septic patients are independent outcome predictors. Results of this study suggest that IL-6 and APACHE II are useful cytokine and scoring systems respectively in prediction of mortality and clinical evaluation of severe septic patients.

Lamanya Persalinan Kala I dan II pada Ibu Multipara dengan Apgar Score Bayi Baru Lahir

Directory of Open Access Journals (Sweden)

Halimatussakdiah Halimatussakdiah

2017-05-01

Full Text Available In the first stage of delivery, some obstacles are usually happened, including irregular contractions, inadequate duration, and unexpected contractions’ frequency. Consequently, the baby will have asphyxia and the duration of the first and the second stage of the childbrith process will be expanded. The objective of this study was to see the correlation between the duration of both deliveries’ stages on mother multigravida toward Newborn Apgar Score. The method of this study was an analytical correlation with a cross-sectional study. The sample was 35 mother obtained with consecutive sampling method. The data instrument was the observation from. The study was done on 5 and 20 August 2016 in Government Hospital Banda Aceh. The data was done analyzed with statistical test analysis using correlation computing devices. The result of the bivariate analysis showed that there is a correlation between the duration of the first stage of delivery with the first minute Apgar Score (p-value 0,010, fifth minute Apgar score (p-value 0,010, while the second stage with the first minute Apgar Score (p-value 0,000, fifth minute Apgar score (p-value 0,000. From this study, it is expected that the chosen of adequate intervention, the duration of delivery of the first and the second stage has not happened so that the asphyxia on the newborns are decreasing. Keywords: Apgar Score, labor, first and second stage Kala I persalinan sering ditemukan hambatan atau kendala. Kendala tersebut antara lain kontraksi rahim yang irreguler, durasi kontraksi yang tidak adekuat dan frekuensi kontraksi yang irreguler sehingga bayi mengalami asfiksia dan menimbulkan perpanjangan waktu kala I dan II persalinan. Tujuan penelitian untuk mengetahui hubungan lamanya persalinan kala I dan II pada ibu bersalin multipara terhadap Apgar Score  Bayi baru lahir. Jenis penelitian Analitik Korelatif, dengan desain Cross Sectional study. Jumlah sampel 35 ibu bersalin multipara tehnik

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

Science.gov (United States)

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

2009-01-01

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

The APACHE II measured on patients' discharge from the Intensive Care Unit in the prediction of mortality APACHE II medido en la salida de los pacientes de la Unidad de Terapia Intensiva en la previsión de la mortalidad APACHE II medido na saída dos pacientes da Unidade de Terapia Intensiva na previsão da mortalidade

Directory of Open Access Journals (Sweden)

Luciana Gonzaga dos Santos Cardoso

2013-06-01

Full Text Available OBJECTIVE: to analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE II, measured based on the data from the last 24 hours of hospitalization in ICU, for patients transferred to the wards. METHOD: an observational, prospective and quantitative study using the data from 355 patients admitted to the ICU between January and July 2010, who were transferred to the wards. RESULTS: the discriminatory power of the AII-OUT prognostic index showed a statistically significant area beneath the ROC curve. The mortality observed in the sample was slightly greater than that predicted by the AII-OUT, with a Standardized Mortality Ratio of 1.12. In the calibration curve the linear regression analysis showed the R2 value to be statistically significant. CONCLUSION: the AII-OUT could predict mortality after discharge from ICU, with the observed mortality being slightly greater than that predicted, which shows good discrimination and good calibration. This system was shown to be useful for stratifying the patients at greater risk of death after discharge from ICU. This fact deserves special attention from health professionals, particularly nurses, in managing human and technological resources for this group of patients. OBJETIVO: analizar el desempeño del Acute Physiology and Chronic Health Evaluation (APACHE II, medido con base en los datos de la últims 24 horas de internación en la UTI, en los pacientes con transferencia para las enfermerías. MÉTODO: estudio observacional, prospectivo y cuantitativo con datos de 355 pacientes admitidos en la UTI entre enero y julio de 2010 que fueron transferidos para las enfermerías. RESULTADOS: el poder discriminatorio del índice pronóstico AII-SALIDA demostró un área debajo de la curva ROC estadísticamente significativa. La mortalidad observada en la muestra fue discretamente mayor que la prevista por el AII-SALIDA, con una Razón de Mortalidad Estandarizada de 1,12. En la curva de

Severity scores in trauma patients admitted to ICU. Physiological and anatomic models.

Science.gov (United States)

Serviá, L; Badia, M; Montserrat, N; Trujillano, J

2018-02-02

The goals of this project were to compare both the anatomic and physiologic severity scores in trauma patients admitted to intensive care unit (ICU), and to elaborate mixed statistical models to improve the precision of the scores. A prospective study of cohorts. The combined medical/surgical ICU in a secondary university hospital. Seven hundred and eighty trauma patients admitted to ICU older than 16 years of age. Anatomic models (ISS and NISS) were compared and combined with physiological models (T-RTS, APACHE II [APII], and MPM II). The probability of death was calculated following the TRISS method. The discrimination was assessed using ROC curves (ABC [CI 95%]), and the calibration using the Hosmer-Lemeshoẃs H test. The mixed models were elaborated with the tree classification method type Chi Square Automatic Interaction Detection. A 14% global mortality was recorded. The physiological models presented the best discrimination values (APII of 0.87 [0.84-0.90]). All models were affected by bad calibration (P<.01). The best mixed model resulted from the combination of APII and ISS (0.88 [0.83-0.90]). This model was able to differentiate between a 7.5% mortality for elderly patients with pathological antecedents and a 25% mortality in patients presenting traumatic brain injury, from a pool of patients with APII values ranging from 10 to 17 and an ISS threshold of 22. The physiological models perform better than the anatomical models in traumatic patients admitted to the ICU. Patients with low scores in the physiological models require an anatomic analysis of the injuries to determine their severity. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Large-Scale Graph Processing Using Apache Giraph

KAUST Repository

Sakr, Sherif

2017-01-07

This book takes its reader on a journey through Apache Giraph, a popular distributed graph processing platform designed to bring the power of big data processing to graph data. Designed as a step-by-step self-study guide for everyone interested in large-scale graph processing, it describes the fundamental abstractions of the system, its programming models and various techniques for using the system to process graph data at scale, including the implementation of several popular and advanced graph analytics algorithms.

Large-Scale Graph Processing Using Apache Giraph

KAUST Repository

Sakr, Sherif; Orakzai, Faisal Moeen; Abdelaziz, Ibrahim; Khayyat, Zuhair

2017-01-01

This book takes its reader on a journey through Apache Giraph, a popular distributed graph processing platform designed to bring the power of big data processing to graph data. Designed as a step-by-step self-study guide for everyone interested in large-scale graph processing, it describes the fundamental abstractions of the system, its programming models and various techniques for using the system to process graph data at scale, including the implementation of several popular and advanced graph analytics algorithms.

Ergonomic and anthropometric issues of the forward Apache crew station

NARCIS (Netherlands)

Oudenhuijzen, A.J.K.

1999-01-01

This paper describes the anthropometric accommodation in the Apache crew systems. These activities are part of a comprehensive project, in a cooperative effort from the Armstrong Laboratory at Wright Patterson Air Force Base (Dayton, Ohio, USA) and TNO Human Factors Research Institute (TNO HFRI) in

The Syrian civil war: The experience of the Surgical Intensive Care Units.

Science.gov (United States)

Ozdogan, Hatice Kaya; Karateke, Faruk; Ozdogan, Mehmet; Cetinalp, Sibel; Ozyazici, Sefa; Gezercan, Yurdal; Okten, Ali Ihsan; Celik, Muge; Satar, Salim

2016-01-01

Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts.

Clinical effects of low-molecular-weight heparin combined with ...

African Journals Online (AJOL)

Tropical Journal of Pharmaceutical Research August 2016; 15 (8): 1787-1792 ... Keywords: Acute pancreatitis, Low-molecular-weight heparin, Multiple organ function syndrome,. APACHE II score ... mediators by lowering the expression of.

East and Central African Journal of Surgery Volume 10 Number 2 ...

African Journals Online (AJOL)

user

generalized septic peritonitis were analyzed in which the Acute Physiology and Chronic Health. Evaluation (APACHE) II score was over 16. This score computates predicted mortality according to temperature, mean blood pressure, pulse, respiratory rate, pO2 or PH, Na+, K+,. Creatinine, Haematocrit, WBC, Glasgow Coma.

Uncomfortable Experience: Lessons Lost in the Apache War

Science.gov (United States)

2015-03-01

the Apache War gripped the focus of American and Mexican citizens throughout Arizona, New Mexico, Chihuahua , and Sonora for a period greater than...Arizona and portions of New Mexico, and Northern Sonora and Chihuahua .5 Although confusion exists as to their true subdivisions, the Chokonen led by...contributed directly to the Victorio War, the Loco and Geronimo campaigns, and the Nana and Chatto- Chihuahua raids that followed.38 Once again, failure to

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

Science.gov (United States)

Susan E. Meyer

2008-01-01

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

Accuracy of a composite score using daily SAPS II and LOD scores for predicting hospital mortality in ICU patients hospitalized for more than 72 h.

Science.gov (United States)

Timsit, J F; Fosse, J P; Troché, G; De Lassence, A; Alberti, C; Garrouste-Orgeas, M; Azoulay, E; Chevret, S; Moine, P; Cohen, Y

2001-06-01

In most databases used to build general severity scores the median duration of intensive care unit (ICU) stay is less than 3 days. Consequently, these scores are not the most appropriate tools for measuring prognosis in studies dealing with ICU patients hospitalized for more than 72 h. To develop a new prognostic model based on a general severity score (SAPS II), an organ dysfunction score (LOD) and evolution of both scores during the first 3 days of ICU stay. Prospective multicenter study. Twenty-eight intensive care units (ICUs) in France. A training data-set was created with four ICUs during an 18-month period (893 patients). Seventy percent of the patients were medical (628) aged 66 years. The median SAPS II was 38. The ICU and hospital mortality rates were 22.7% and 30%, respectively. Forty-seven percent (420 patients) were transferred from hospital wards. In this population, the calibration (Hosmer-Lemeshow chi-square: 37.4, P = 0.001) and the discrimination [area under the ROC curves: 0.744 (95 % CI: 0.714-0.773)] of the original SAPS II were relatively poor. A validation data set was created with a random panel of 24 French ICUs during March 1999 (312 patients). The LOD and SAPS II scores were calculated during the first (SAPS1, LOD1), second (SAPS2, LOD2), and third (SAPS3, LOD3) calendar days. The LOD and SAPS scores alterations were assigned the value "1" when scores increased with time and "0" otherwise. A multivariable logistic regression model was used to select variables measured during the first three calendar days, and independently associated with death. Selected variables were: SAPS II at admission [OR: 1.04 (95 % CI: 1.027-1.053) per point], LOD [OR: 1.16 (95 % CI: 1.085-1.253) per point], transfer from ward [OR: 1.74 (95 % CI: 1.25-2.42)], as well as SAPS3-SAPS2 alterations [OR: 1.516 (95 % CI: 1.04-2.22)], and LOD3-LOD2 alterations [OR: 2.00 (95 % CI: 1.29-3.11)]. The final model has good calibration and discrimination properties in the

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

Science.gov (United States)

Andersen, Douglas C.

1994-01-01

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

Nursing workload in a trauma intensive care unit

Directory of Open Access Journals (Sweden)

Luana Loppi Goulart

2014-06-01

Full Text Available Severely injured patients with multiple and conflicting injuries present themselves to nursing professionals at critical care units faced with care management challenges. The goal of the present study is to evaluate nursing workload and verify the correlation between workload and the APACHE II severity index. It is a descriptive study, conducted in the Trauma Intensive Care Unit of a teaching hospital. We used the Nursing Activities Score and APACHE II as instruments. The sample comprised 32 patients, of which most were male, young adults, presenting polytrauma, coming from the Reference Emergency Unit, in surgical treatment, and discharged from the ICU. The average obtained on the Nursing Activities Score instrument was 72% during hospitalization periods. The data displayed moderate correlation between workload and patient severity. In other words, the higher the score, the higher the patient’s mortality risk. doi: 10.5216/ree.v16i2.22922.

Kelayakan Raspberry Pi sebagai Web Server: Perbandingan Kinerja Nginx, Apache, dan Lighttpd pada Platform Raspberry Pi

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Rahmad Dawood

2014-04-01

Full Text Available Raspberry Pi is a small-sized computer, but it can function like an ordinary computer. Because it can function like a regular PC then it is also possible to run a web server application on the Raspberry Pi. This paper will report results from testing the feasibility and performance of running a web server on the Raspberry Pi. The test was conducted on the current top three most popular web servers, which are: Apache, Nginx, and Lighttpd. The parameters used to evaluate the feasibility and performance of these web servers were: maximum request and reply time. The results from the test showed that it is feasible to run all three web servers on the Raspberry Pi but Nginx gave the best performance followed by Lighttpd and Apache.Keywords: Raspberry Pi, web server, Apache, Lighttpd, Nginx, web server performance

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

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

Seguridad en la configuración del servidor web Apache

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Carlos Eduardo Gómez Montoya

2013-07-01

Full Text Available Apache es el servidor Web con mayor presencia en el mercado mundial. Aunque su configuración es relativamente sencilla, fortalecer sus condiciones de seguridad implica entender y aplicar un conjunto de reglas generales conocidas, aceptadas y disponibles. Por otra parte, a pesar de ser un tema aparentemente resuelto, la seguridad en los servidores HTTP constituye un problema en aumento, y no todas las compañías lo toman en serio. Este artículo identifica y verifica un conjunto de buenas prácticas de seguridad informática aplicadas a la configuración de Apache. Para alcanzar los objetivos, y con el fin de garantizar un proceso adecuado, se eligió una metodología basada en el Círculo de Calidad de Deming, el cual comprende cuatro fases: planear, hacer, verificar y actuar, y su aplicación condujo el desarrollo del proyecto. Este artículo consta de cinco secciones: Introducción, Marco de referencia, Metodología, Resultados y discusión, y Conclusiones.

Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE I and II logistic models.

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Madeira, Sérgio; Rodrigues, Ricardo; Tralhão, António; Santos, Miguel; Almeida, Carla; Marques, Marta; Ferreira, Jorge; Raposo, Luís; Neves, José; Mendes, Miguel

2016-02-01

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been established as a tool for assisting decision-making in surgical patients and as a benchmark for quality assessment. Infective endocarditis often requires surgical treatment and is associated with high mortality. This study was undertaken to (i) validate both versions of the EuroSCORE, the older logistic EuroSCORE I and the recently developed EuroSCORE II and to compare their performances; (ii) identify predictors other than those included in the EuroSCORE models that might further improve their performance. We retrospectively studied 128 patients from a single-centre registry who underwent heart surgery for active infective endocarditis between January 2007 and November 2014. Binary logistic regression was used to find independent predictors of mortality and to create a new prediction model. Discrimination and calibration of models were assessed by receiver-operating characteristic curve analysis, calibration curves and the Hosmer-Lemeshow test. The observed perioperative mortality was 16.4% (n = 21). The median EuroSCORE I and EuroSCORE II were 13.9% interquartile range (IQ) (7.0-35.0) and 6.6% IQ (3.5-18.2), respectively. Discriminative power was numerically higher for EuroSCORE II {area under the curve (AUC) of 0.83 [95% confidence interval (CI), 0.75-0.91]} than for EuroSCORE I [0.75 (95% CI, 0.66-0.85), P = 0.09]. The Hosmer-Lemeshow test showed good calibration for EuroSCORE II (P = 0.08) but not for EuroSCORE I (P = 0.04). EuroSCORE I tended to over-predict and EuroSCORE II to under-predict mortality. Among the variables known to be associated with greater infective endocarditis severity, only prosthetic valve infective endocarditis remained an independent predictor of mortality [odds ratio (OR) 6.6; 95% CI, 1.1-39.5; P = 0.04]. The new model including the EuroSCORE II variables and variables known to be associated with greater infective endocarditis severity showed an AUC of 0

Transport Risk Index of Physiologic Stability, version II (TRIPS-II): a simple and practical neonatal illness severity score.

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Lee, Shoo K; Aziz, Khalid; Dunn, Michael; Clarke, Maxine; Kovacs, Lajos; Ojah, Cecil; Ye, Xiang Y

2013-05-01

Derive and validate a practical assessment of infant illness severity at admission to neonatal intensive care units (NICUs). Prospective study involving 17,075 infants admitted to 15 NICUs in 2006 to 2008. Logistic regression was used to derive a prediction model for mortality comprising four empirically weighted items (temperature, blood pressure, respiratory status, response to noxious stimuli). This Transport Risk Index of Physiologic Stability, version II (TRIPS-II) was then validated for prediction of 7-day and total NICU mortality. TRIPS-II discriminated 7-day (receiver operating curve [ROC] area, 0.90) and total NICU mortality (ROC area, 0.87) from survival. Furthermore, there was a direct association between changes in TRIPS-II at 12 and 24 hours and mortality. There was good calibration across the full range of TRIPS-II scores and the gestational age at birth, and addition of TRIPS-II improved performance of prediction models that use gestational age and baseline population risk variables. TRIPS-II is a validated benchmarking tool for assessing infant illness severity at admission and for up to 24 hours after. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The White Mountain Recreational Enterprise: Bio-Political Foundations for White Mountain Apache Natural Resource Control, 1945–1960

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David C. Tomblin

2016-07-01

Full Text Available Among American Indian nations, the White Mountain Apache Tribe has been at the forefront of a struggle to control natural resource management within reservation boundaries. In 1952, they developed the first comprehensive tribal natural resource management program, the White Mountain Recreational Enterprise (WMRE, which became a cornerstone for fighting legal battles over the tribe’s right to manage cultural and natural resources on the reservation for the benefit of the tribal community rather than outside interests. This article examines how White Mountain Apaches used the WMRE, while embracing both Euro-American and Apache traditions, as an institutional foundation for resistance and exchange with Euro-American society so as to reassert control over tribal eco-cultural resources in east-central Arizona.

Beginning PHP, Apache, MySQL web development

CERN Document Server

Glass, Michael K; Naramore, Elizabeth; Mailer, Gary; Stolz, Jeremy; Gerner, Jason

2004-01-01

An ideal introduction to the entire process of setting up a Web site using PHP (a scripting language), MySQL (a database management system), and Apache (a Web server)* Programmers will be up and running in no time, whether they're using Linux or Windows servers* Shows readers step by step how to create several Web sites that share common themes, enabling readers to use these examples in real-world projects* Invaluable reading for even the experienced programmer whose current site has outgrown the traditional static structure and who is looking for a way to upgrade to a more efficient, user-f

Nonoperative management for perforated peptic ulcer: who can benefit?

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Cao, Feng; Li, Jia; Li, Ang; Fang, Yu; Wang, Ya-Jun; Li, Fei

2014-07-01

Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it. A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with nonoperative management. Of 241 consecutive patients with PPU, 107 successfully received nonoperative management, and 134 required surgery. In multivariable analysis, the following four variables correlated with surgery and were given one point each toward the clinical score: age ≥70 years, fluid collection detection by ultrasound, contrast extravasation detection by water-soluble contrast examination, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥8. Eighty-five percent of patients with a score of 1 or less were successfully treated with nonoperative management, whereas 23 of 29 patients with a score of 3 or more required surgery. The area under the receiver operating characteristic curve was 0.804 (95% confidence interval = 0.717-0.891). By combining clinical, radiological parameters, and APACHE II score, the clinical score allowed early identification of PPU patients who can benefit from nonoperative management. Copyright © 2013. Published by Elsevier B.V.

Comparison of the systemic inflammatory response syndrome between monomicrobial and polymicrobial Pseudomonas aeruginosa nosocomial bloodstream infections

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Wenzel Richard P

2005-10-01

Full Text Available Abstract Background Some studies of nosocomial bloodstream infection (nBSI have demonstrated a higher mortality for polymicrobial bacteremia when compared to monomicrobial nBSI. The purpose of this study was to compare differences in systemic inflammatory response and mortality between monomicrobial and polymicrobial nBSI with Pseudomonas aeruginosa. Methods We performed a historical cohort study on 98 adults with P. aeruginosa (Pa nBSI. SIRS scores were determined 2 days prior to the first positive blood culture through 14 days afterwards. Monomicrobial (n = 77 and polymicrobial BSIs (n = 21 were compared. Results 78.6% of BSIs were caused by monomicrobial P. aeruginosa infection (MPa and 21.4% by polymicrobial P. aeruginosa infection (PPa. Median APACHE II score on the day of BSI was 22 for MPa and 23 for PPa BSIs. Septic shock occurred in 33.3% of PPa and in 39.0% of MPa (p = 0.64. Progression to septic shock was associated with death more frequently in PPa (OR 38.5, CI95 2.9–508.5 than MPa (OR 4.5, CI95 1.7–12.1. Maximal SIR (severe sepsis, septic shock or death was seen on day 0 for PPa BSI vs. day 1 for MPa. No significant difference was noted in the incidence of organ failure, 7-day or overall mortality between the two groups. Univariate analysis revealed that APACHE II score ≥20 at BSI onset, Charlson weighted comorbidity index ≥3, burn injury and respiratory, cardiovascular, renal and hematologic failure were associated with death, while age, malignant disease, diabetes mellitus, hepatic failure, gastrointestinal complications, inappropriate antimicrobial therapy, infection with imipenem resistant P. aeruginosa and polymicrobial nBSI were not. Multivariate analysis revealed that hematologic failure (p Conclusion In this historical cohort study of nBSI with P. aeruginosa, the incidence of septic shock and organ failure was high in both groups. Additionally, patients with PPa BSI were not more acutely ill, as judged by APACHE II

Survival in Patients Receiving Prolonged Ventilation: Factors that Influence Outcome

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A. James Mamary

2011-01-01

Full Text Available Background Prolonged mechanical ventilation is increasingly common. It is expensive and associated with significant morbidity and mortality. Our objective is to comprehensively characterize patients admitted to a Ventilator Rehabilitation Unit (VRU for weaning and identify characteristics associated with survival. Methods 182 consecutive patients over 3.5 years admitted to Temple University Hospital (TUH VRU were characterized. Data were derived from comprehensive chart review and a prospectively collected computerized database. Survival was determined by hospital records and social security death index and mailed questionnaires. Results Upon admission to the VRU, patients were hypoalbuminemic (albumin 2.3 ± 0.6 g/dL, anemic (hemoglobin 9.6 ± 1.4 g/dL, with moderate severity of illness (APACHE II score 10.7 + 4.1, and multiple comorbidities (Charlson index 4.3 + 2.3. In-hospital mortality (19% was related to a higher Charlson Index score ( P = 0.006; OR 1.08-1.6, and APACHE II score ( P = 0.016; OR 1.03-1.29. In-hospital mortality was inversely related to admission albumin levels ( P = 0.023; OR 0.17-0.9. The presence of COPD as a comorbid illness or primary determinant of respiratory failure and higher VRU admission APACHE II score predicted higher long-term mortality. Conversely, higher VRU admission hemoglobin was associated with better long term survival (OR 0.57-0.90; P = 0.0006. Conclusion Patients receiving prolonged ventilation are hypoalbuminemic, anemic, have moderate severity of illness, and multiple comorbidities. Survival relates to these factors and the underlying illness precipitating respiratory failure, especially COPD.

Leptin Is Associated With Persistence of Hyperglycemia in Acute Pancreatitis

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Kennedy, James I.C.; Askelund, Kathryn J.; Premkumar, Rakesh; Phillips, Anthony R.J.; Murphy, Rinki; Windsor, John A.; Petrov, Maxim S.

2016-01-01

Abstract Adipokines have many homeostatic roles, including modulation of glucose metabolism, but their role in the pathophysiology of hyperglycemia associated with acute and critical illnesses in general, and acute pancreatitis (AP) in particular, is largely unknown. This study aimed to investigate the relationship between a panel of adipokines and hyperglycemia in the early course of AP, as well as the role of adipokines as predictors of AP severity. Adiponectin, leptin, omentin, resistin, and visfatin were measured on a daily basis in the first 72 hours after hospital admission. A first set of analyses was undertaken with admission glycemia stratified by severity, and a second set of analyses was undertaken based on persistence of early hyperglycemia. All of the analyses were adjusted for confounders. A total of 32 patients with AP were included in this study. None of the studied adipokines was significantly associated with glucose level on admission. Leptin was significantly (P = 0.003) increased in patients with persistent hyperglycemia. Adiponectin was significantly associated with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in patients with persistent hyperglycemia (P = 0.015), visfatin with APACHE II score in patients with persistent hyperglycemia (P = 0.014), and omentin with APACHE II score in all of the patients regardless of the presence or absence of hyperglycemia (P = 0.021). Leptin is significantly associated with persistent hyperglycemia in the early course of AP. Omentin has a potential to become an accurate predictor of AP severity. PMID:26871770

N-terminal pro-brain natriuretic peptide and cardiac troponin I for the prognostic utility in elderly patients with severe sepsis or septic shock in intensive care unit: A retrospective study.

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Cheng, Hui; Fan, Wei-Ze; Wang, Sheng-Chi; Liu, Zhao-Hui; Zang, Hui-Ling; Wang, Li-Zhong; Liu, Hong-Juan; Shen, Xiao-Hui; Liang, Shao-Qing

2015-06-01

Using biomarkers to predict mortality in patient with severe sepsis or septic shock is of importance, as these patients frequently have high mortality and unsatisfied outcome. N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) play extremely important roles in prognostic value in the mortality of severe sepsis and septic shock. The present study was retrospectively designed to evaluate the predicting mortality of NT-proBNP and cTnI in elderly patients with severe sepsis or septic shock administered in the intensive care unit (ICU) and also to evaluate whether the predicting ability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score or C-reactive protein (CRP) was increased in combination with the biomarkers. A cohort of 430 patients (aged ≥65 years) with severe sepsis or septic shock admitted to our ICU between October 2011 and December 2013 was included in the study. Patient data including clinical, laboratory, and survival and mortality were collected. All patients were examined with NT-proBNP, cTnI, CRP, and APACHE-II score and were categorized as the survived and deceased groups according to the outcome 30 days after ICU treatment. The levels of NT-proBNP and cTnI (P pro-brain natriuretic peptide and cTnI were superior to CRP in predicting mortality. The predicting ability of APACHE-II score was improved only when combined with NT-proBNP and cTnI. Copyright © 2014 Elsevier Inc. All rights reserved.

Prediction of Beck Depression Inventory (BDI-II) Score Using Acoustic Measurements in a Sample of Iium Engineering Students

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Fikri Zanil, Muhamad; Nur Wahidah Nik Hashim, Nik; Azam, Huda

2017-11-01

Psychiatrist currently relies on questionnaires and interviews for psychological assessment. These conservative methods often miss true positives and might lead to death, especially in cases where a patient might be experiencing suicidal predisposition but was only diagnosed as major depressive disorder (MDD). With modern technology, an assessment tool might aid psychiatrist with a more accurate diagnosis and thus hope to reduce casualty. This project will explore on the relationship between speech features of spoken audio signal (reading) in Bahasa Malaysia with the Beck Depression Inventory scores. The speech features used in this project were Power Spectral Density (PSD), Mel-frequency Ceptral Coefficients (MFCC), Transition Parameter, formant and pitch. According to analysis, the optimum combination of speech features to predict BDI-II scores include PSD, MFCC and Transition Parameters. The linear regression approach with sequential forward/backward method was used to predict the BDI-II scores using reading speech. The result showed 0.4096 mean absolute error (MAE) for female reading speech. For male, the BDI-II scores successfully predicted 100% less than 1 scores difference with MAE of 0.098437. A prediction system called Depression Severity Evaluator (DSE) was developed. The DSE managed to predict one out of five subjects. Although the prediction rate was low, the system precisely predict the score within the maximum difference of 4.93 for each person. This demonstrates that the scores are not random numbers.

Integration of event streaming and microservices with Apache Kafka

OpenAIRE

Kljun, Matija

2017-01-01

Over the last decade, the microservice architecture has become a standard for big and successful internet companies, like Netflix, Amazon and LinkedIn. The importance of stream processing, aggregation and exchange of data is growing, as it allows companies to compete better and move faster. In this diploma, we have analyzed the interactions between microservices, described the streaming platform and ordinary message queues. We have described the Apache Kafka platform and how...

Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database.

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Hampshire, Peter A; Welch, Catherine A; McCrossan, Lawrence A; Francis, Katharine; Harrison, David A

2009-01-01

Patients with haematological malignancy admitted to intensive care have a high mortality. Adverse prognostic factors include the number of organ failures, invasive mechanical ventilation and previous bone marrow transplantation. Severity-of-illness scores may underestimate the mortality of critically ill patients with haematological malignancy. This study investigates the relationship between admission characteristics and outcome in patients with haematological malignancies admitted to intensive care units (ICUs) in England, Wales and Northern Ireland, and assesses the performance of three severity-of-illness scores in this population. A secondary analysis of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme Database was conducted on admissions to 178 adult, general ICUs in England, Wales and Northern Ireland between 1995 and 2007. Multivariate logistic regression analysis was used to identify factors associated with hospital mortality. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II and ICNARC score were evaluated for discrimination (the ability to distinguish survivors from nonsurvivors); and the APACHE II, SAPS II and ICNARC mortality probabilities were evaluated for calibration (the accuracy of the estimated probability of survival). There were 7,689 eligible admissions. ICU mortality was 43.1% (3,312 deaths) and acute hospital mortality was 59.2% (4,239 deaths). ICU and hospital mortality increased with the number of organ failures on admission. Admission factors associated with an increased risk of death were bone marrow transplant, Hodgkin's lymphoma, severe sepsis, age, length of hospital stay prior to intensive care admission, tachycardia, low systolic blood pressure, tachypnoea, low Glasgow Coma Score, sedation, PaO2:FiO2, acidaemia, alkalaemia, oliguria, hyponatraemia, hypernatraemia, low haematocrit, and uraemia. The ICNARC model had the best discrimination

Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

Science.gov (United States)

2009-01-01

Introduction Patients with haematological malignancy admitted to intensive care have a high mortality. Adverse prognostic factors include the number of organ failures, invasive mechanical ventilation and previous bone marrow transplantation. Severity-of-illness scores may underestimate the mortality of critically ill patients with haematological malignancy. This study investigates the relationship between admission characteristics and outcome in patients with haematological malignancies admitted to intensive care units (ICUs) in England, Wales and Northern Ireland, and assesses the performance of three severity-of-illness scores in this population. Methods A secondary analysis of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme Database was conducted on admissions to 178 adult, general ICUs in England, Wales and Northern Ireland between 1995 and 2007. Multivariate logistic regression analysis was used to identify factors associated with hospital mortality. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II and ICNARC score were evaluated for discrimination (the ability to distinguish survivors from nonsurvivors); and the APACHE II, SAPS II and ICNARC mortality probabilities were evaluated for calibration (the accuracy of the estimated probability of survival). Results There were 7,689 eligible admissions. ICU mortality was 43.1% (3,312 deaths) and acute hospital mortality was 59.2% (4,239 deaths). ICU and hospital mortality increased with the number of organ failures on admission. Admission factors associated with an increased risk of death were bone marrow transplant, Hodgkin's lymphoma, severe sepsis, age, length of hospital stay prior to intensive care admission, tachycardia, low systolic blood pressure, tachypnoea, low Glasgow Coma Score, sedation, PaO2:FiO2, acidaemia, alkalaemia, oliguria, hyponatraemia, hypernatraemia, low haematocrit, and uraemia. The ICNARC

Predictors of Multidrug Resistant Acinetobacter Baumannii Infections in Surgical Intensive Care Patients: A Retrospective Analysis

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Aynur Camkıran

2011-08-01

Full Text Available Objective: Multidrug resistant Acinetobacter baumannii (MRAB is an important cause of hospital acquired infection and leads to an increasing morbidity and mortality in intensive care units (ICU. The aim of this study was to investigate the predictors of MRAB infection in surgical ICU patients. Material and Method: The charts of the patients who were admitted to the ICU between January 2008 and August 2010 were reviewed to identify patients with MRAB infection. Recorded data were as follows: age, sex, medical history, underlying surgical pathology, Acute Physiology and Chronic Health Evaluation II score (APACHE II and Glasgow Coma Score on ICU admission,presence of invasive procedures (intubation, arterial, central venous lines, urinary catheters, and renal replacement therapy, days in ICU and white blood cells (WBC and lactate count on infection day, infection site, complications (such as organ/system failure, length of stay (LOS in the ICU and hospital, and final outcome. Results: During the study period 25 patients with MRAB infection were identified. When compared with their matched control group (n=25, patients with MRAB infection had a significantly higher mean APACHE II score (p=0.001 and more frequently had an open wound (p=0.002 or required mechanical ventilation (p=0.005, with respiratory system disease (p=0.03, arterial catheterization (p=0.006, and central venous catheterization (p=0.004. Multivariate logistic regression revealed that APACHE II score (OR,1.155; CI, 1.008-1.324; p= 0.038 and open wound (OR, 27.77; CI, 2.020-333.333; p=0.018 were predictors of MRAB infection in these patients. Compared to their controls, patients with MRAB infection hand a longer LOS in ICU (36.44±30.44 days vs 7.80±8.13 days, p<0.000 and hospital (55.12±40.81 days vs 19.04±13.44 days, p<0.000. In hospital mortality rates for patients with MRAB infection and their controls were 56% and 32%, respectively (p=0.154. Conclusion: Our results indicate

Comparison and relationship of thyroid hormones, IL-6, IL-10 and albumin as mortality predictors in case-mix critically ill patients.

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Quispe E, Álvaro; Li, Xiang-Min; Yi, Hong

2016-05-01

To compare the ability of thyroid hormones, IL-6, IL-10, and albumin to predict mortality, and to assess their relationship in case-mix acute critically ill patients. APACHE II scores and serum thyroid hormones (FT3, FT4, and TSH), IL-6, IL-10, and albumin were obtained at EICU admission for 79 cases of mix acute critically ill patients without previous history of thyroid disease. Patients were followed for 28 days with patient's death as the primary outcome. All mean values were compared, correlations assessed with Pearson' test, and mortality prediction assessed by multivariate logistic regression and ROC. Non survivors were older, with higher APACHE II score (p=0.000), IL-6 (p<0.05), IL-10 (p=0.000) levels, and lower albumin (p=0.000) levels compared to survivors at 28 days. IL-6 and IL-10 had significant negative correlation with albumin (p=0.001) and FT3 (p ⩽ 0.05) respectively, while low albumin had a direct correlation with FT3 (p<0.05). In the mortality prediction assessment, IL-10, albumin and APACHE II were independent morality predictors and showed to have a good (0.70-0.79) AUC-ROC (p<0.05). Despite that the entire cohort showed low FT3 serum levels (p=0.000), there was not statistical difference between survivors and non-survivors; neither showed any significance as mortality predictor. IL-6 and IL-10 are correlated with Low FT3 and hypoalbuminemia. Thyroid hormones assessed at EICU admission did not have any predictive value in our study. And finally, high levels of IL-6 and IL-10 in conjunction with albumin could improve our ability to evaluate disease's severity and predict mortality in the critically ill patients. When use in combination with APACHE II scores, our model showed improved mortality prediction. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Risk-adjusted scoring systems in colorectal surgery.

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Leung, Edmund; McArdle, Kirsten; Wong, Ling S

2011-01-01

Consequent to recent advances in surgical techniques and management, survival rate has increased substantially over the last 25 years, particularly in colorectal cancer patients. However, post-operative morbidity and mortality from colorectal cancer vary widely across the country. Therefore, standardised outcome measures are emphasised not only for professional accountability, but also for comparison between treatment units and regions. In a heterogeneous population, the use of crude mortality as an outcome measure for patients undergoing surgery is simply misleading. Meaningful comparisons, however, require accurate risk stratification of patients being analysed before conclusions can be reached regarding the outcomes recorded. Sub-specialised colorectal surgical units usually dedicated to more complex and high-risk operations. The need for accurate risk prediction is necessary in these units as both mortality and morbidity often are tools to justify the practice of high-risk surgery. The Acute Physiology And Chronic Health Evaluation (APACHE) is a system for classifying patients in the intensive care unit. However, APACHE score was considered too complex for general surgical use. The American Society of Anaesthesiologists (ASA) grade has been considered useful as an adjunct to informed consent and for monitoring surgical performance through time. ASA grade is simple but too subjective. The Physiological & Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and its variant Portsmouth POSSUM (P-POSSUM) were devised to predict outcomes in surgical patients in general, taking into account of the variables in the case-mix. POSSUM has two parts, which include assessment of physiological parameters and operative scores. There are 12 physiological parameters and 6 operative measures. The physiological parameters are taken at the time of surgery. Each physiological parameter or operative variable is sub-divided into three or four levels with

Features and treatment of gas-forming synergistic necrotizing cellulitis: a nine-year retrospective study.

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Ling, Xiangwei; Ye, Yuanyuan; Guo, Hailei; Liu, Zhengjun; Xia, Weidong; Lin, Cai

2018-03-01

As many doctors know little about gas-forming synergistic necrotizing cellulitis, we retrospectively explored it in our study. Totally, 30 patients diagnosed with gas-forming synergistic necrotizing cellulitis between November 2006 and September 2015 were included. They were divided into two groups: open drainage group (19 patients) and aggressive debridement group (11 patients). Retrospectively analyzed data comprised demographic characteristics, APACHE II scores, pathogen culture results, bleeding amount during the operation, white blood cell count, length of hospital stay and recovery. The mortality rate was 26% in the open drainage group and 73% in the aggressive debridement group (p=0.023). There was no statistical difference in the APACHE II score before treatment between the open drainageand aggressive debridement groups (16.6±4.5 vs 18.1±7.5, p=0.511). The APACHE II score was significantly higher after treatment in the aggressive debridement group (14.2±5.8 score vs 20.1±9.1, p=0.038). There were no statistical differences in the white blood count cell before and after treatment (13.49 × 109±5.05×109 cells/L vs 17.46×109±6.94×109 cells/L, p=0.082; 10.37×109±3.54×109 cells/L vs 15.47×109 ±7.51×109 cells/L, p=0.055; respectively). The bleeding amount during the operation was significantly more in the aggressive debridement group (315±112 ml vs 105±45 ml, pgas-forming synergistic necrotizing cellulitis, performing open drainage as early as possible isthe most important procedure after admission.

[Predictive value of early phrase echocardiography and cardiac biological markers in patients with severe sepsis: a five-year single-center retrospective study].

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Zang, Xuefeng; Chen, Wei; Sheng, Bo; Zhao, Lei; Gu, Xuyun; Zhen, Jie; Liu, Ping

2018-04-01

To assess the predictive value of early phrase echocardiography and cardiac biomarkers in patients with severe sepsis. A retrospective analysis of severe septic patients (patients with acute coronary syndrome and end stage renal disease were excluded) in department of intensive care unit of Capital Medical University Affiliated Beijing Shijitan Hospital from January 2013 to December 2017 was conducted. The acute physiology and chronic health evaluation II (APACHE II) score, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB) within 6 hours after admission, and bedside echocardiography indexes [left ventricular ejection fraction (LVEF), the ratio of the peak blood flow velocity in the early stage of the mitral valve and the peak blood flow rate of the mitral valve (E/A ratio)] within 6 hours after diagnosis were recorded. The differences of indexes between patients with decreased contractile function (LVEF value in severe sepsis patients. (1) A total of 316 patients were enrolled in the survey period. Decreased cardiac systolic function (LVEF value for prognosis in severe sepsis patient, among which NT-proBNP and cTnI had higher predictive value [the area under ROC curve (AUC) were 0.920 and 0.901 respectively, both P values measured by echocardiography in early phrase were unrelated to 28-day prognosis. APACHE II score, E/A ratio, NT-proBNP, cTnI, MYO, CK and CK-MB were related to 28-day prognosis. APACHE II scores and NT-proBNP were independent prognostic factors in severe sepsis patient.

The normal transverse mesocolon and involvement of the mesocolon in acute pancreatitis: an MRI study.

Science.gov (United States)

Chi, Xiao Xiao; Zhang, Xiao Ming; Chen, Tian Wu; Huang, Xiao Hua; Yang, Lin; Tang, Wei; Xiao, Bo

2014-01-01

To study the MRI findings of the normal transverse mesocolon and the involvement of the mesocolon in acute pancreatitis (AP) as well as the relationship between the involvement of the mesocolon and the severity of AP. Forty patients without pancreatic disorders were retrospectively analyzed to observe the normal transverse mesocolon using MRI; 210 patients with AP confirmed by clinical and laboratory tests were retrospectively analyzed using MRI to observe transverse-mesocolon involvement (TMI). The severity of TMI was recorded as zero points (no abnormalities and transverse-mesocolon vessel involvement), one point (linear and patchy signal in the transverse mesocolon) or two points (transverse-mesocolon effusion). The AP severity was graded by the MRI severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation II (APACHE II) scoring system. The correlations of TMI with MRSI and APACHE-II were analyzed. In a normal transverse mesocolon, the display rates of the middle colic artery, the middle colic vein and the gastrocolic trunk on MRI were 95.0%, 82.5% and 100.0%, respectively. Of the 210 patients with AP, 130 patients (61.9%) had TMI. According to the TMI grading, 40%, 39% and 20% of the patients were graded at zero, one and two points, respectively. TMI was strongly correlated with the MRSI score (r = 0.759, P = 0.000) and the APACHE-II score (r = 0.384, P = 0.000). MRI could be used to visualize transverse-mesocolon involvement. The severity of TMI could reflect that of AP in the clinical setting and imaging. TMI might be a supplementary indicator of the severity of AP.

Combined enteral feeding and total parenteral nutritional support improves outcome in surgical intensive care unit patients.

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Hsu, Min-Hui; Yu, Ying E; Tsai, Yueh-Miao; Lee, Hui-Chen; Huang, Ying-Che; Hsu, Han-Shui

2012-09-01

For intensive care unit (ICU) patients with gastrointestinal dysfunction and in need of total parenteral nutrition (TPN) support, the benefit of additional enteral feeding is not clear. This study aimed to investigate whether combined TPN with enteral feeding is associated with better outcomes in surgical intensive care unit (SICU) patients. Clinical data of 88 patients in SICU were retrospectively collected. Variables used for analysis included route and percentage of nutritional support, total caloric intake, age, gender, body weight, body mass index, admission diagnosis, surgical procedure, Acute Physiology and Chronic Health Evaluation (APACHE) II score, comorbidities, length of hospital stay, postoperative complications, blood glucose values and hospital mortality. Wound dehiscence and central catheter infection were observed more frequently in the group of patients receiving TPN calories less than 90% of total calorie intake (p = 0.004 and 0.043, respectively). APACHE II scores were higher in nonsurvivors than in survivors (p = 0.001). More nonsurvivors received TPN calories exceeding 90% of total calorie intake and were in need of dialysis during ICU admission (p = 0.005 and 0.013, respectively). Multivariate analysis revealed that the percentage of TPN calories over total calories and APACHE II scores were independent predictors of ICU mortality in patients receiving supplementary TPN after surgery. In SICU patients receiving TPN, patients who could be fed enterally more than 10% of total calories had better clinical outcomes than patients receiving less than 10% of total calorie intake from enteral feeding. Enteral feeding should be given whenever possible in severely ill patients. 2012 Published by Elsevier B.V

Association Between National Board Dental Examination Part II Scores and Comprehensive Examinations at Harvard School of Dental Medicine.

Science.gov (United States)

Lee, Min Kyeong; Allareddy, Veerasathpurush; Howell, T Howard; Karimbux, Nadeem Y

2011-01-01

Harvard School of Dental Medicine (HSDM) uses a hybrid problem-based approach to teaching in the predoctoral program. The objective structured clinical examination (OSCE) is a formative examination designed to assess the performance of students in the problem-based learning (PBL) curriculum. At HSDM three comprehensive examinations with OSCE components are administered during the third and fourth years of clinical training. The National Board Dental Examination (NBDE) Part II is taken in the final year of the predoctoral program. This study examines the association between the NBDE Part II and the comprehensive exams held at HSDM. Predoctoral students from the HSDM classes of 2005 and 2006 were included in this study. The outcome variable of interest was the scores obtained by students in the NBDE Part II, and the main independent variable of interest was the performance of students in the comprehensive exams (honors, pass, make-up exam to pass). The Mann-Whitney U-test was used to examine the association between the grades obtained in the each of the three comprehensive exams and the NBDE Part II scores. Multivariable linear regression analysis was also used to examine the association between the NBDE Part II scores and the comprehensive exam grades. The effect of potential confounding factors including age, sex, and race/ethnicity was adjusted. The results suggest that students who performed well in the comprehensive exams performed better on the NBDE Part II, even after adjusting for confounding factors. Future studies will examine the long-term impact of PBL on postdoctoral plans and career choices.

San Carlos Apache Tribe - Energy Organizational Analysis

Energy Technology Data Exchange (ETDEWEB)

Rapp, James; Albert, Steve

2012-04-01

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

Phosphate is a potential biomarker of disease severity and predicts adverse outcomes in acute kidney injury patients undergoing continuous renal replacement therapy.

Directory of Open Access Journals (Sweden)

Su-Young Jung

Full Text Available Hyperphosphatemia is associated with mortality in patients with chronic kidney disease, and is common in critically ill patients with acute kidney injury (AKI; however, its clinical implication in these patients is unknown. We conducted an observational study in 1144 patients (mean age, 63.2 years; male, 705 [61.6%] with AKI who received continuous renal replacement therapy (CRRT between January 2009 and September 2016. Phosphate levels were measured before (0 h and 24 h after CRRT initiation. We assessed disease severity using various clinical parameters. Phosphate at 0 h positively correlated with the Acute Physiology and Chronic Health Evaluation II (APACHE II; P < 0.001 and Sequential Organ Failure Assessment (SOFA; P < 0.001 scores, and inversely with mean arterial pressure (MAP; P = 0.02 and urine output (UO; P = 0.01. In a fully adjusted linear regression analysis for age, sex, Charlson comorbidity index (CCI, MAP, and estimated glomerular filtration rate (eGFR, higher 0 h phosphate level was significantly associated with high APACHE II (P < 0.001 and SOFA (P = 0.04 scores, suggesting that phosphate represents disease severity. A multivariable Cox model also showed that hyperphosphatemia was significantly associated with increased 28-day (HR 1.05, 95% CI 1.02-1.08, P = 0.001 and 90-day (HR 1.05, 95% CI 1.02-1.08, P = 0.001 mortality. Furthermore, patients with increased phosphate level during 24 h were at higher risk of death than those with stable or decreased phosphate levels. Finally, c-statistics significantly increased when phosphate was added to a model that included age, sex, CCI, body mass index, eGFR, MAP, hemoglobin, serum albumin, C-reactive protein, and APACHE II score. This study shows that phosphate is a potential biomarker that can reflect disease severity and predict mortality in critically ill patients receiving CRRT.

CMS Analysis and Data Reduction with Apache Spark

Energy Technology Data Exchange (ETDEWEB)

Gutsche, Oliver [Fermilab; Canali, Luca [CERN; Cremer, Illia [Magnetic Corp., Waltham; Cremonesi, Matteo [Fermilab; Elmer, Peter [Princeton U.; Fisk, Ian [Flatiron Inst., New York; Girone, Maria [CERN; Jayatilaka, Bo [Fermilab; Kowalkowski, Jim [Fermilab; Khristenko, Viktor [CERN; Motesnitsalis, Evangelos [CERN; Pivarski, Jim [Princeton U.; Sehrish, Saba [Fermilab; Surdy, Kacper [CERN; Svyatkovskiy, Alexey [Princeton U.

2017-10-31

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

A scoring system based on artificial neural network for predicting 10-year survival in stage II A colon cancer patients after radical surgery

Science.gov (United States)

Jiang, Wu; Lu, Shi-Xun; Lu, Zhen-Hai; Li, Pei-Xing; Yun, Jing-Ping; Zhang, Rong-Xin; Pan, Zhi-Zhong; Wan, De-Sen

2016-01-01

Nearly 20% patients with stage II A colon cancer will develop recurrent disease post-operatively. The present study aims to develop a scoring system based on Artificial Neural Network (ANN) model for predicting 10-year survival outcome. The clinical and molecular data of 117 stage II A colon cancer patients from Sun Yat-sen University Cancer Center were used for training set and test set; poor pathological grading (score 49), reduced expression of TGFBR2 (score 33), over-expression of TGF-β (score 45), MAPK (score 32), pin1 (score 100), β-catenin in tumor tissue (score 50) and reduced expression of TGF-β in normal mucosa (score 22) were selected as the prognostic risk predictors. According to the developed scoring system, the patients were divided into 3 subgroups, which were supposed with higher, moderate and lower risk levels. As a result, for the 3 subgroups, the 10-year overall survival (OS) rates were 16.7%, 62.9% and 100% (P < 0.001); and the 10-year disease free survival (DFS) rates were 16.7%, 61.8% and 98.8% (P < 0.001) respectively. It showed that this scoring system for stage II A colon cancer could help to predict long-term survival and screen out high-risk individuals for more vigorous treatment. PMID:27008710

A scoring system based on artificial neural network for predicting 10-year survival in stage II A colon cancer patients after radical surgery.

Science.gov (United States)

Peng, Jian-Hong; Fang, Yu-Jing; Li, Cai-Xia; Ou, Qing-Jian; Jiang, Wu; Lu, Shi-Xun; Lu, Zhen-Hai; Li, Pei-Xing; Yun, Jing-Ping; Zhang, Rong-Xin; Pan, Zhi-Zhong; Wan, De Sen

2016-04-19

Nearly 20% patients with stage II A colon cancer will develop recurrent disease post-operatively. The present study aims to develop a scoring system based on Artificial Neural Network (ANN) model for predicting 10-year survival outcome. The clinical and molecular data of 117 stage II A colon cancer patients from Sun Yat-sen University Cancer Center were used for training set and test set; poor pathological grading (score 49), reduced expression of TGFBR2 (score 33), over-expression of TGF-β (score 45), MAPK (score 32), pin1 (score 100), β-catenin in tumor tissue (score 50) and reduced expression of TGF-β in normal mucosa (score 22) were selected as the prognostic risk predictors. According to the developed scoring system, the patients were divided into 3 subgroups, which were supposed with higher, moderate and lower risk levels. As a result, for the 3 subgroups, the 10-year overall survival (OS) rates were 16.7%, 62.9% and 100% (P < 0.001); and the 10-year disease free survival (DFS) rates were 16.7%, 61.8% and 98.8% (P < 0.001) respectively. It showed that this scoring system for stage II A colon cancer could help to predict long-term survival and screen out high-risk individuals for more vigorous treatment.

Outcomes of decompressive craniectomy in patients after traumatic brain injury.

Science.gov (United States)

Nambiar, Mithun; MacIsaac, Christopher; Grabinski, Rafal; Liew, Danny; Kavar, Bhadrakant

2015-06-01

Traumatic brain injury (TBI) can result in cerebral oedema and vascular changes resulting in an increase in intracranial pressure (ICP), which can lead to further secondary damage. Decompressive craniectomy (DC) is a surgical option in the management of ICP. We aimed to investigate outcomes of DC after TBI. We performed a retrospective audit of 57 adult patients (aged > 15 years) who underwent DC after TBI, at the Royal Melbourne Hospital from 1 January 2005 to 30 June 2011. Our functional outcome measure was the Extended Glasgow Outcome Scale (GOSE). Patients had a median age of 30 years (range, 17- 73 years). The hospital mortality rate was 47% (27 patients). A higher postoperative median ICP was the most significant predictor of hospital mortality (OR, 1.1; 95% CI, 1-1.3). There was a mean decrease of 7.7mmHg in ICP between the mean preoperative and postoperative ICP values (95% CI, - 10.5 to - 5.0mmHg). There was a mean decrease of 3.5mmHg in the mean cerebral perfusion pressure (CPP) from preoperative to postoperative CPP values (95% CI, - 6.2 to - 0.8mmHg). At the 6-month follow-up, a poor outcome (GOSE score, 1-4) was seen in 39 patients (68%), while a good outcome (GOSE score, 5- 8) was noted in 15 patients (26%). A high APACHE II score on admission was the most significant predictor of a worse GOSE score at 6 months (OR, 1.3; 95% CI, 1.1-1.5). Analysis of the APACHE II and IMPACT scores as models for predicting mortality at 6 months showed an area under the curve (AUC) of 0.792 and 0.805, respectively, and for predicting poor outcome at 6 months, showed an AUC of 0.862 and 0.883, respectively. DC decreased ICP postoperatively. The IMPACT and APACHE II scores are good models for prediction of death and poor outcome at 6 months.

LHCbDIRAC as Apache Mesos microservices

CERN Multimedia

Couturier, Ben

2016-01-01

The LHCb experiment relies on LHCbDIRAC, an extension of DIRAC, to drive its offline computing. This middleware provides a development framework and a complete set of components for building distributed computing systems. These components are currently installed and ran on virtual machines (VM) or bare metal hardware. Due to the increased load of work, high availability is becoming more and more important for the LHCbDIRAC services, and the current installation model is showing its limitations. Apache Mesos is a cluster manager which aims at abstracting heterogeneous physical resources on which various tasks can be distributed thanks to so called "framework". The Marathon framework is suitable for long running tasks such as the DIRAC services, while the Chronos framework meets the needs of cron-like tasks like the DIRAC agents. A combination of the service discovery tool Consul together with HAProxy allows to expose the running containers to the outside world while hiding their dynamic placements. Such an arc...

Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: A retrospective observational evaluation.

Science.gov (United States)

Simpson, Joanna P; Taylor, Andrew; Sudhan, Nazneen; Menon, David K; Lavinio, Andrea

2016-12-01

High-volume fluid resuscitation and the administration of sodium bicarbonate and diuretics have a theoretical renoprotective role in patients at high risk of acute kidney injury (AKI) following rhabdomyolysis. Abnormally elevated creatine kinase has previously been used as a biological marker for the identification of patients at high risk of AKI following rhabdomyolysis. To assess the sensitivity and specificity of plasma creatine kinase (admission and peak values) for the prediction of AKI requiring renal replacement therapy (RRT) or of death in patients with confirmed rhabdomyolysis. To compare the diagnostic performance of creatine kinase with the McMahon score. Retrospective observational study. Data collection included McMahon and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores; daily creatine kinase; daily creatinine and electrolytes; ICU length of stay and mortality. Neurosciences and Trauma Critical Care Unit (Cambridge, UK). In total, 232 adults with confirmed rhabdomyolysis (creatine kinase > 1000 Ul) admitted to Neurosciences and Trauma Critical Care Unit between 2002 and 2012. AKI, RRT and mortality. Forty-five (19%) patients developed AKI and 29 (12.5%) patients required RRT. Mortality was significantly higher in patients who developed AKI (62 vs. 18%, P rhabdomyolysis. Although a PEAK creatine kinase of at least 5000 Ul has sensitivity acceptable for screening purposes, this is often a delayed finding. A McMahon score of at least 6 calculated on admission allows for a more sensitive, specific and timely identification of patients who may benefit from high-volume fluid resuscitation.

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

Science.gov (United States)

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

2002-01-01

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

Urinary neutrophil gelatinase-associated lipocalin is an excellent predictor of mortality in intensive care unit patients

Directory of Open Access Journals (Sweden)

Haifa M. Algethamy

2017-07-01

Full Text Available Objectives: To assess urine neutrophil gelatinase-associated lipocalin (uNGAL level as a potential predictor of acute kidney injury (AKI, and both intensive care unit (ICU and in-hospital mortality. Methods: Patients presenting to our ICU with a systolic blood pressure (SBP less than 90 mmHg or mean arterial pressure (MAP less than 65 mmHg, and no prior kidney disease were followed prospectively. Baseline data were collected on patient demographics, admission diagnosis, APACHE II and SOFA scores, SBP, MAP, serum creatinine and cystatin C, and uNGAL. Patients were monitored throughout hospitalization, including daily uNGAL, serum creatinine and cystatin C, and continuous MAP. Bivariate analysis compared those dying in the ICU and in-hospital versus survivors; with hierarchical binary logistic regression used to identify predictors of mortality. Areas under receiver-operating-characteristic curves (AUC were used to measure sensitivity and specificity at different uNGAL thresholds. Results: Among 75 patients followed, 16 died in the ICU, and another 24 prior to hospital discharge. Mortality rates were greatest in trauma and sepsis patients. The ICU survivors differed from non-survivors in almost all clinical variables; but only 2 predicted ICU mortality on multivariate analysis: day one uNGAL (p=0.01 and 24-hour APACHE II score (p=0.07. Only the APACHE II score significantly predicted in-hospital mortality (p=0.003. The AUC for day one uNGAL was greater for ICU (AUC=0.85 than in-hospital mortality (AUC=0.74. Conclusions: Day one uNGAL is a highly accurate predictor of ICU, but less so for in-hospital mortality.

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

Science.gov (United States)

Zhou, Lianjie; Chen, Nengcheng; Chen, Zeqiang

2017-04-10

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

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

Directory of Open Access Journals (Sweden)

Lianjie Zhou

2017-04-01

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

Evaluation of Apache Hadoop for parallel data analysis with ROOT

International Nuclear Information System (INIS)

Lehrack, S; Duckeck, G; Ebke, J

2014-01-01

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

Evaluation of Apache Hadoop for parallel data analysis with ROOT

Science.gov (United States)

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

2014-06-01

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

Nutrición enteral total vs. nutrición parenteral total en pacientes con pancreatitis aguda grave Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis

Directory of Open Access Journals (Sweden)

M. Casas

2007-05-01

Full Text Available Objetivo: comparar la eficacia de la instauración precoz de nutrición enteral total (NET frente a nutrición parenteral total (NPT en pacientes con pancreatitis aguda grave (PAG. Métodos: estudio prospectivo aleatorio. Se incluyeron consecutivamente 22 pacientes con PAG aplicando los criterios APACHE II, valores de PCR y graduación de Balthazar en la TC. El grupo I (n = 11 recibió NPT y el grupo II (n = 12 NET. Se valoró la respuesta inflamatoria (PCR, TNF-alfa, IL-6, las proteínas viscerales (pre-albúmina, albúmina, la tasa de complicaciones (síndrome de respuesta inflamatoria sistémica, fallo multiorgánico, infecciones, las intervenciones quirúrgicas, la estancia hospitalaria y la mortalidad. Resultados: no hubo diferencias significativas en los primeros 10 días entre los dos grupos en la evolución de los criterios APACHE II, en las concentraciones de PCR, TNF-alfa e IL-6 ni tampoco en los valores de pre-albúmina y albúmina. Siete pacientes del grupo I presentaron complicaciones graves frente a 4 del grupo II. Requirieron intervención quirúrgica 3 pacientes del grupo I. La estancia hospitalaria fue similar en los dos grupos. Dos pacientes del grupo I fallecieron. Conclusiones: se ha observado una tendencia a una mejor evolución de los pacientes con PAG que utilizaron NET frente a los que utilizaron NPT.Objective: to compare the efficacy of early total enteral nutrition (TEN vs. total parenteral nutrition (TPN in patients with severe acute pancreatitis (SAP. Methods: a total of 22 consecutive patients with SAP were randomized to receive TPN (group I or TEN (group II. SAP was defined applying APACHE II score, C-reactive protein (CRP measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-alpha, IL-6, visceral proteins (pre-albumin, albumin, complications (systemic inflammatory response syndrome, multiorgan failure, infections, surgical interventions, length of hospital stay and mortality were

77 FR 18997 - Rim Lakes Forest Restoration Project; Apache-Sitgreavese National Forest, Black Mesa Ranger...

Science.gov (United States)

2012-03-29

... DEPARTMENT OF AGRICULTURE Forest Service Rim Lakes Forest Restoration Project; Apache-Sitgreavese National Forest, Black Mesa Ranger District, Coconino County, AZ AGENCY: Forest Service, USDA. ACTION: Notice of intent to prepare an environmental impact statement. SUMMARY: The U.S. Forest Service (FS) will...

Validation of the 12-gene colon cancer recurrence score as a predictor of recurrence risk in stage II and III rectal cancer patients.

Science.gov (United States)

Reimers, Marlies S; Kuppen, Peter J K; Lee, Mark; Lopatin, Margarita; Tezcan, Haluk; Putter, Hein; Clark-Langone, Kim; Liefers, Gerrit Jan; Shak, Steve; van de Velde, Cornelis J H

2014-11-01

The 12-gene Recurrence Score assay is a validated predictor of recurrence risk in stage II and III colon cancer patients. We conducted a prospectively designed study to validate this assay for prediction of recurrence risk in stage II and III rectal cancer patients from the Dutch Total Mesorectal Excision (TME) trial. RNA was extracted from fixed paraffin-embedded primary rectal tumor tissue from stage II and III patients randomized to TME surgery alone, without (neo)adjuvant treatment. Recurrence Score was assessed by quantitative real time-polymerase chain reaction using previously validated colon cancer genes and algorithm. Data were analysed by Cox proportional hazards regression, adjusting for stage and resection margin status. All statistical tests were two-sided. Recurrence Score predicted risk of recurrence (hazard ratio [HR] = 1.57, 95% confidence interval [CI] = 1.11 to 2.21, P = .01), risk of distant recurrence (HR = 1.50, 95% CI = 1.04 to 2.17, P = .03), and rectal cancer-specific survival (HR = 1.64, 95% CI = 1.15 to 2.34, P = .007). The effect of Recurrence Score was most prominent in stage II patients and attenuated with more advanced stage (P(interaction) ≤ .007 for each endpoint). In stage II, five-year cumulative incidence of recurrence ranged from 11.1% in the predefined low Recurrence Score group (48.5% of patients) to 43.3% in the high Recurrence Score group (23.1% of patients). The 12-gene Recurrence Score is a predictor of recurrence risk and cancer-specific survival in rectal cancer patients treated with surgery alone, suggesting a similar underlying biology in colon and rectal cancers. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

[Survival in acute renal failure with conventional therapy or continuous replacement therapy].

Science.gov (United States)

Santibáñez-Velázquez, Martín; Sánchez-Montoya, Felipe; Alvirde-Gutiérrez, Luis

2014-01-01

To know the survival rate in patients with RIFLE I and II stages on acute renal failure, treated with supportive care or continuous renal replacement therapy with PRISMA machine, at an intensive care unit. There were included patients of both sexes, aged 16 to 69 years, with acute renal failure in RIFLE I and II stages and score of scale APACHE II lower than 36 points. The sample studied was divided in two groups: a group was treated with supportive care, and the other group received continuous renal replacement therapy via PRISMA machine. We compared mortality between both groups and the association with the RIFLE stages with Pearson's chi-squared test. The average score of the scale APACHE I was 14 points, and the probability of death was 15 %. The patients with acute renal failure RIFLE I were 54.5 % and RIFLE II 45.5 %, with mortality of 30.4 % and 38.8 %, respectively. Patients in RIFLE I stage who received supportive care and continuous replacement therapy had non-statistical differences in mortality (p = 0.356). The mortality in patients with acute renal failure in RIFLE II stage treated with continuous replacement therapy was higher (p = 0.000). Because of its accessibility and lower mortality, supportive care should be the initial procedure in patients with acute renal failure in RIFLE I and II stages.

Prognostic value of N-terminal pro-brain natriuretic peptide in hospitalised patients with community-acquired pneumonia.

Science.gov (United States)

Jeong, Ki Young; Kim, Kyuseok; Kim, Tae Yun; Lee, Christopher C; Jo, Si On; Rhee, Joong Eui; Jo, You Hwan; Suh, Gil Joon; Singer, Adam J

2011-02-01

The prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with community-acquired pneumonia (CAP) has not been evaluated. The aim of the present study was to investigate whether NT-proBNP level could predict mortality in hospitalised CAP patients. We performed a structured medical record review of all hospitalised CAP patients from May 2003 to October 2006, and classified patients into the 30-day survival and non-survival group. Data included demographic and clinical characteristics, and laboratory findings including NT-proBNP levels. The APACHE II scores, PSI (pneumonia severity index) and CURB65 (confusion, urea, respiratory rate, blood pressure and aged 65 or more) scores were calculated. Comparisons between survivors and non-survivors were made with χ(2), non-parametric tests and logistic regression and ROC analysis were used to compare the ability of NT-proBNP (adjusted for age, heart failure and creatinine), APACHE II, PSI and CURB65 to predict mortality. Of 502 patients, 61 (12.2%) died within 30 days. NT-proBNP levels were measured in 167 patients and were significantly higher in non-survivors compared to survivors (median 841.7 (IQR 267.1-3137.3) pg/ml vs 3658.0 (1863.0-7025.0) pg/ml, p=0.019). NT-proBNP was an independent predictor of mortality (adjusted OR 1.53; 95% CI 1.16 to 2.02, p=0.002). The AUC for NT-proBNP was 0.712 (95% CI, 0.613 to 0.812), which was comparable to those of PSI (0.749, p=0.531) and CURB65 (0.698, p=0.693), but inferior to that of APACHE II (0.831, p=0.037). Adding NT-proBNP to APACHE II, PSI and CURB65 did not significantly increase the AUCs, respectively. NT-proBNP level is an independent predictor of mortality in hospitalised CAP patients. The performance of NT-proBNP level is comparable to those of PSI and CURB65 in predicting mortality.

After critical care: patient support after critical care. A mixed method longitudinal study using email interviews and questionnaires.

Science.gov (United States)

Pattison, Natalie; O'Gara, Geraldine; Rattray, Janice

2015-08-01

To explore experiences and needs over time, of patients discharged from ICU using the Intensive Care Experience (ICE-q) questionnaire, Hospital Anxiety and Depression Scale (HADS) and EuroQoL (EQ-5D), associated clinical predictors (APACHE II, TISS, Length of stay, RIKER scores) and in-depth email interviewing. A mixed-method, longitudinal study of patients with >48hour ICU stays at 2 weeks, 6 months, 12 months using the ICE-q, HADS, EQ-5D triangulated with clinical predictors, including age, gender, length of stay (ICU and hospital), APACHE II and TISS. In-depth qualitative email interviews were completed at 1 month and 6 months. Grounded Theory analysis was applied to interview data and data were triangulated with questionnaire and clinical data. Data was collected from January 2010 to March 2012 from 77 participants. Both mean EQ-5D visual analogue scale, utility scores and HADS scores improved from 2 weeks to 6 months, (p=Email interviews offer a convenient method of gaining in-depth interview data and could be used as part of ICU follow-up. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

2010-03-25

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

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

Science.gov (United States)

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

2018-01-01

Perforation peritonitis continues to be one of the most common surgical emergencies that need a surgical intervention most of the times. Anesthesiologists are invariably involved in managing such cases efficiently in perioperative period. The assessment and evaluation of Acute Physiology and Chronic Health Evaluation II (APACHE II) score at presentation and 24 h after goal-directed optimization, administration of empirical broad-spectrum antibiotics, and definitive source control postoperatively. Outcome assessment in terms of duration of hospital stay and mortality in with or without optimization was also measured. It is a prospective, randomized, double-blind controlled study in hospital setting. One hundred and one patients aged ≥18 years, of the American Society of Anesthesiologists physical Status I and II (E) with clinical diagnosis of perforation peritonitis posted for surgery were enrolled. Enrolled patients were randomly divided into two groups. Group A is optimized by goal-directed optimization protocol in the preoperative holding room by anesthesiology residents whereas in Group S, managed by surgery residents in the surgical wards without any fixed algorithm. The assessment of APACHE II score was done as a first step on admission and 24 h postoperatively. Duration of hospital stay and mortality in both the groups were also measured and compared. Categorical data are presented as frequency counts (percent) and compared using the Chi-square or Fisher's exact test. The statistical significance for categorical variables was determined by Chi-square analysis. For continuous variables, a two-sample t -test was applied. The mean APACHE II score on admission in case and control groups was comparable. Significant lowering of serial scores in case group was observed as compared to control group ( P = 0.02). There was a significant lowering of mean duration of hospital stay seen in case group (9.8 ± 1.7 days) as compared to control group ( P = 0

Overview of the SDSS-IV MaNGA Survey: Mapping nearby Galaxies at Apache Point Observatory

NARCIS (Netherlands)

Bundy, Kevin; Bershady, Matthew A.; Law, David R.; Yan, Renbin; Drory, Niv; MacDonald, Nicholas; Wake, David A.; Cherinka, Brian; Sánchez-Gallego, José R.; Weijmans, Anne-Marie; Thomas, Daniel; Tremonti, Christy; Masters, Karen; Coccato, Lodovico; Diamond-Stanic, Aleksandar M.; Aragón-Salamanca, Alfonso; Avila-Reese, Vladimir; Badenes, Carles; Falcón-Barroso, Jésus; Belfiore, Francesco; Bizyaev, Dmitry; Blanc, Guillermo A.; Bland-Hawthorn, Joss; Blanton, Michael R.; Brownstein, Joel R.; Byler, Nell; Cappellari, Michele; Conroy, Charlie; Dutton, Aaron A.; Emsellem, Eric; Etherington, James; Frinchaboy, Peter M.; Fu, Hai; Gunn, James E.; Harding, Paul; Johnston, Evelyn J.; Kauffmann, Guinevere; Kinemuchi, Karen; Klaene, Mark A.; Knapen, Johan H.; Leauthaud, Alexie; Li, Cheng; Lin, Lihwai; Maiolino, Roberto; Malanushenko, Viktor; Malanushenko, Elena; Mao, Shude; Maraston, Claudia; McDermid, Richard M.; Merrifield, Michael R.; Nichol, Robert C.; Oravetz, Daniel; Pan, Kaike; Parejko, John K.; Sanchez, Sebastian F.; Schlegel, David; Simmons, Audrey; Steele, Oliver; Steinmetz, Matthias; Thanjavur, Karun; Thompson, Benjamin A.; Tinker, Jeremy L.; van den Bosch, Remco C. E.; Westfall, Kyle B.; Wilkinson, David; Wright, Shelley; Xiao, Ting; Zhang, Kai

We present an overview of a new integral field spectroscopic survey called MaNGA (Mapping Nearby Galaxies at Apache Point Observatory), one of three core programs in the fourth-generation Sloan Digital Sky Survey (SDSS-IV) that began on 2014 July 1. MaNGA will investigate the internal kinematic

Analysis of oil-bearing Cretaceous sandstone hydrocarbon reservoirs, exclusive of the Dakota Sandstone, on the Jicarilla Apache Indian Reservation, New Mexico; TOPICAL

International Nuclear Information System (INIS)

Ridgley, Jennie; Wright Dunbar, Robyn

2000-01-01

This is the Phase One contract report to the United States Department of Energy, United State Geological Survey and the Jicarilla Apache Indian Tribe on the project entitled''Outcrop Analysis of the Cretaceous Mesaverde Group: Jicarilla Apache Reservation, New Mexico.'' Field work for this project was conducted during July and August 1998, at which time fourteen measured sections were described and correlated on or adjacent to Jicarilla Apache Reservation lands. A fifteen section, described east of the main field area, is included in this report, although its distant location precluded use in the correlation's and cross-sections presented herein. Ground-based photo mosaics were shot for much of the exposed Mesaverde outcrop belt and were used to assist in correlation. Outcrop gamma-ray surveys at six of the fifteen measured sections using a GAD-6 scintillometer was conducted. The raw gamma-ray data are included in this report, however, analysis of those data is part of the ongoing Phase Two of this project

A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis.

Science.gov (United States)

Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

2017-01-01

The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755-0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691-0.783) and 0.742 (0.698-0.785), p machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction.

Clinical Features of Kidney Transplant Recipients Admitted to the Intensive Care Unit.

Science.gov (United States)

Freitas, Flávio Geraldo Rezende; Lombardi, Fábio; Pacheco, Eduardo Souza; Sandes-Freitas, Tainá Veras de; Viana, Laila Almeida; Junior, Hélio Tedesco-Silva; Medina-Pestana, José Osmar; Bafi, Antônio Tonete; Machado, Flavia Ribeiro

2018-03-01

There is a paucity of data regarding the complications in kidney transplant patients who may require intensive care unit (ICU) management, despite being the most common solid organ transplant worldwide. To identify the main reasons for ICU admission and to determine the factors associated with hospital mortality in kidney transplant recipients. This single-center retrospective cohort study was conducted between September 2013 and June 2014, including all consecutive kidney transplant patients requiring ICU admission. We collected data on patient demographics, transplant characteristics, clinical data, and prognostic scores. The independent determinants of hospital mortality were identified by multiple logistic regression analysis. We also assessed the performance of Simplified Acute Physiology Score 3 (SAPS 3) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. We analyzed data from 413 patients, the majority of whom were admitted late after renal transplantation (1169 days; 63-3003 days). The main reason for admission was sepsis (33.2%), followed by cardiovascular disease (16%). Age (odds ratio [OR] 1.05, confidence interval [CI], 1.01-1.09), SAPS 3 score (OR 1.04, CI, 1.01-1.08), the need for mechanical ventilation (OR 26.47, CI, 10.30-68.08), and vasopressor use (OR 3.34, CI, 1.37-8.13) were independently associated with hospital mortality. The performance of SAPS 3 and APACHE II scores was poor in this population and overestimated the mortality rates. Sepsis was the main reason for ICU admission in kidney transplant recipients, followed by cardiovascular disease. Age and disease severity were associated with hospital mortality.

The APACHE survey hardware and software design: Tools for an automatic search of small-size transiting exoplanets

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Lattanzi M.G.

2013-04-01

Full Text Available Small-size ground-based telescopes can effectively be used to look for transiting rocky planets around nearby low-mass M stars using the photometric transit method, as recently demonstrated for example by the MEarth project. Since 2008 at the Astronomical Observatory of the Autonomous Region of Aosta Valley (OAVdA, we have been preparing for the long-term photometric survey APACHE, aimed at finding transiting small-size planets around thousands of nearby early and mid-M dwarfs. APACHE (A PAthway toward the Characterization of Habitable Earths is designed to use an array of five dedicated and identical 40-cm Ritchey-Chretien telescopes and its observations started at the beginning of summer 2012. The main characteristics of the survey final set up and the preliminary results from the first weeks of observations will be discussed.

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

Science.gov (United States)

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

2016-06-01

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

[The association between early blood glucose fluctuation and prognosis in critically ill patients].

Science.gov (United States)

Tang, Jian; Gu, Qin

2012-01-01

To investigate the association between early blood glucose level fluctuation and prognosis of critically ill patients. A retrospective study involving 95 critically ill patients in intensive care unit (ICU) was conducted. According to the 28-day outcome after admission to ICU, the patients were divided into nonsurvivors (43 cases) and survivors (52 cases), and the blood glucose level in them was monitored in the first 72 hours. Blood glucose concentration at admission (BGadm), mean blood glucose level (MBG), hyperglycemia index (HGI), glycemic lability index (GLI), incidence of hypoglycemia and total dosage of intravenous insulin for each patient were compared. The index as an independent risk factor of mortality was determined by multivariate logistic regression analysis and the predictor value by comparing the area under the receiver operating characteristic curve (ROC curve, AUC) of each index. The BGadm (mmol/L), MBG (mmol/L), HGI and the incidence of hypoglycemia showed no significant differences between nonsurvivors and survivors [BGadm: 9.87 ± 4.48 vs. 9.26 ± 3.07, MBG: 8.59 ± 1.23 vs. 8.47 ± 1.01, HGI(6.0): 2.45 ± 0.94 vs. 1.68 ± 1.05, HGI(8.3): 0.84 ± 0.70 vs. 0.68 ± 0.51, the incidence of hypoglycemia: 9.30% vs. 5.77%, all P > 0.05], but acute physiology and chronic health evaluation II (APACHE II ) score, GLI and the total dosage of intravenous insulin (U) were significantly higher in nonsurvivors than survivors [APACHE II score: 23 ± 6 vs. 19 ± 6, GLI: 56.96 (65.43) vs. 23.87 (41.62), the total dosage of intravenous insulin: 65.5 (130.5) vs. 12.5 (90.0), all P curve was plotted, the AUC of APACHE II score and GLI was respectively 0.69 and 0.71, and there was no significant difference (P > 0.05). Early fluctuation of blood glucose is a significant independent risk factor of mortality in critically ill patients. Control the early fluctuation of blood glucose concentration might improve the patients' outcome.

Evaluation of the Apache II and the oncologic history, as indicative predictions of mortality in the unit of intensive care of the INC September 1996 -December 1997

International Nuclear Information System (INIS)

Camargo, David O; Gomez, Clara; Martinez, Teresa

1999-01-01

They are multiple the indexes of severity that have been carried out to value the predict and the quality of a patient's life, especially when this it enters to the unit of intensive care (UIC); however, the oncologic patient presents particularities in their mobility, that it supposes a different behavior in the results of the Indexes. Presently work is compared the Apache scale and the oncologic history like morbid mortality as predictors in the UCI. 207 patients were included that entered the UCI between September of 1996 and December of 1997. It was a mortality of 29%, the stay of most of this group of patient smaller than 24 hours or bigger than 8 days. To the entrance, 50% of the patients presented superior averages at 15 in the Apache Scale and at the 48 hours, alone 30.4% continued with this value. The patients with hematologic neoplasia presented superior average at 15 in 87%, with a mortality of 63.3% with average between 15 and 24 to the entrance, the risk of dying was 9.8 times but that with inferior average. In the hematologic patient, the risk of dying was 5.7 times but regarding the solid tumors. The system but altered it was the breathing one, with an increase in the risk of dying from 2,8 times for each increment utility in the scale. Contrary to described in the literature, the oncologic diagnoses and the neoplasia statistic they didn't influence in the mortality of the patients

Analysis of readmission rates to the intensive care unit after implementation of a rapid response team in a University Hospital.

Science.gov (United States)

Bergamasco E Paula, R; Tanita, M T; Festti, J; Queiroz Cardoso, L T; Carvalho Grion, C M

2017-10-01

To compare readmission rates to the intensive care unit (ICU) before and after the implementation of a rapid response team (RRT), and to identify risk factors for readmission. A quasi-experimental before-after study was carried out. A University Hospital. All patients discharged from the ICU from January to December 2008 (control group) and from January 2010 to December 2012 (intervention group). Implementation of an RRT. The data included demographic parameters, diagnoses upon admission, ICU readmission, APACHE II, SOFA, and TISS 28 scores, and routine daily assessment by an RRT of patients discharged from the ICU. During the study interval, 380 patients were analyzed in the period prior to the implementation of the RRT and 1361 after implementation. There was a tendency toward decreased readmission rates one year after RRT implementation. The APACHE II score and SOFA score at ICU discharge were independent factors associated to readmission, as well as clinical referral to the ICU. The RRT intervention resulted in a sustained decrease in readmission rates one year after implementation of this service. The use of a specialized team in health institutions can be recommended for ICU survivors. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

High-dose Sulbactam Treatment for Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant

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In Beom Jeong

2016-11-01

Full Text Available Background Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. Methods Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. Results Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023 and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046 were associated with 30-day mortality. Conclusions High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.

Carbapenem-resistant Enterobacteriaceae colonization and infection in critically ill patients: a retrospective matched cohort comparison with non-carriers.

Science.gov (United States)

Dickstein, Y; Edelman, R; Dror, T; Hussein, K; Bar-Lavie, Y; Paul, M

2016-09-01

To examine whether carbapenem-resistant Enterobacteriaceae (CRE) carriage is associated with incidence of clinical infection as a means of assessing whether the morbidity and mortality associated with these bacteria are mediated by underlying conditions or intrinsic properties of CRE. This retrospective matched cohort study compared the incidence of invasive infections in CRE-colonized patients and matched non-carriers in the intensive care unit (ICU). The primary outcome was infection caused by CRE of the same species as the colonizing strain among CRE carriers, and infections caused by carbapenem-sensitive strains of the same organism in non-carriers. Hospital discharge and death were considered as competing events. Competing-risks hazard analysis was performed for the entire cohort and for a nested cohort matched by Acute Physiology and Chronic Health Evaluation (APACHE) II scores, stratified by matching. In total, 146 CRE carriers were compared with 292 non-carriers. Patients were well matched for most risk factors for Enterobacteriaceae infection, including age, renal failure, previous invasive infection, previous hospitalization, APACHE II score, length of mechanical ventilation, length of hospitalization and CRE carriage. On regression analysis, colonization with CRE was independently associated with Enterobacteriaceae infection {cause-specific hazard ratio (CSHR) 2.06 [95% confidence interval (CI) 1.03-4.09]}. On regression analysis of the APACHE-II-matched cohort (N=284), colonization with CRE remained significantly associated with Enterobacteriaceae infection [CSHR 3.32 (95% CI 1.31-8.43)]. Colonization with CRE was associated with at least a two-fold increased risk of infection by the colonizing strain amongst ICU patients. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

SIDELOADING – INGESTION OF LARGE POINT CLOUDS INTO THE APACHE SPARK BIG DATA ENGINE

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J. Boehm

2016-06-01

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

[Analysis of risk factors of fatal outcome in pregnant and puerperant patients with severe H1N1 influenza].

Science.gov (United States)

Zabolotskikh, I B; Penzhoian, G A; Musaeva, T S; Goncharenko, S I

2010-01-01

As well as previous epidemics and pandemias of influenza, the 2009 H1N1 influenza pandemia increases the risk of severe illness in pregnant. Data were reported for 28 pregnant and 2 postpartum women who have been hospitalized in ICUs of Krasnodar Region with H1N1 influenza diagnosis. The laboratory tests for H1N1 were negative in 53.3% of suspected cases of H1N1 influenza (16 of 30). The major lethal risk factor in pregnant with H1N1 influenza is a development of septic shock with low PaO2\\FiO2 ratio (less than 140) and high Murray's Acute Lung Injury Score (higher than 2.5). High Apache II, Apache III, SAPS 2, SAPS 3 and SOFA scores are the additional lethal risk factors. Lethal outcomes were more frequent in the end of the second trimester of pregnancy.

Retrospective study on prognostic importance of serum procalcitonin and amino - terminal pro - brain natriuretic peptide levels as compared to Acute Physiology and Chronic Health Evaluation IV Score on Intensive Care Unit admission, in a mixed Intensive Care Unit population

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Chitra Mehta

2016-01-01

Full Text Available Background: Timely decision making in Intensive Care Unit (ICU is very essential to improve the outcome of critically sick patients. Conventional scores like Acute Physiology and Chronic Health Evaluation (APACHE IV are quite cumbersome with calculations and take minimum 24 hours. Procalcitonin has shown to have prognostic value in ICU/Emergency department (ED in disease states like pneumonia, sepsis etc. NTproBNP has demonstrated excellent diagnostic and prognostic importance in cardiac diseases. It has also been found elevated in non-cardiac diseases. We chose to study the prognostic utility of these markers on ICU admission. Settings and Design: Retrospective observational study. Materials and Methods: A Retrospective analysis of 100 eligible patients was done who had undergone PCT and NTproBNP measurements on ICU admission. Their correlations with all cause mortality, length of hospital stay, need for ventilator support, need for vasopressors were performed. Results: Among 100 randomly selected ICU patients, 28 were non-survivors. NTproBNP values on admission significantly correlated with all cause mortality (P = 0.036, AUC = 0.643 and morbidity (P = 0.000, AUC = 0.763, comparable to that of APACHE-IV score. PCT values on admission did not show significant association with mortality, but correlated well with morbidity and prolonged hospital length of stay (AUC = 0.616, P = 0.045. Conclusion: The current study demonstrated a good predictive value of NTproBNP, in terms of mortality and morbidity comparable to that of APACHE-IV score. Procalcitonin, however, was found to have doubtful prognostic importance. These findings need to be confirmed in a prospective larger study.

Outcome of Hematopoietic Stem Cell Recipients Who Were Mechanically Ventilated and Admitted to Intensive Care Units

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Tsung-Ming Yang

2007-01-01

Conclusion: The ICU mortality rate of mechanically ventilated HSCT recipients was high. Factors associated with ICU mortality were older age, high APACHE II score, presence of shock, and higher respiratory or heart rate at the time of ICU admission. SLB might provide specific diagnosis in HSCT recipients with unexplained pulmonary infiltrates and aid modification of treatment. [J Formos Med Assoc 2007;106(4:295-301

Lupus eritematoso sistémico en la Unidad de cuidados intensivos de medicina del Hospital Nacional Cayetano Heredia.

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Sergio Vásquez Kunze

2007-10-01

Full Text Available Objetivos: Describir las características clínicas y factores pronósticos del Lupus Eritematoso Sistémico (LES en la Unidad de Cuidados Intensivos (UCI de Medicina del Hospital Nacional Cayetano Heredia (HNCH. Material y métodos: Colección retrospectiva de hallazgos clínicos y de laboratorio de historias clínicas de pacientes con LES en la UCI del HNCH en el periodo 1999-2004. Se hizo estudio estadístico descriptivo y análisis univariado para variables continuas y discretas. Se calculó el score APACHE II y se evaluó su significado pronóstico. Resultados: Hubo 26 pacientes con LES de los cuales se encontraron historias clínicas de 21 de ellos. La frecuencia de LES en la UCI del HNCH es de 1,49%, es la patología reumática más frecuente en UCI. La mortalidad fue de 57,69%. El motivo de admisión más frecuente fue insuficiencia respiratoria (52,4%, mayormente debido a causa infecciosa.Las variables que se asociaron significativamente a mortalidad fueron: velocidad de sedimentación globular (VSG alta, anemia severa, hipoalbuminemia severa, la relación presión arterial de oxígeno entre la fracción inspirada de oxígeno (PaFi < 200 al ingreso. El score APACHE II en el grupo de fallecidos fue significativamente más alto (19,9 (p < 0,01. La insuficiencia renal aguda que requirió hemodiálisis y la necesidad de ventilación mecánica se asociaron significativamente a mayor mortalidad. Conclusiones: El LES en la UCI del HNCH tiene una alta mortalidad, mayor que la reportada en estudios previos. Los factores de mal pronóstico fueron VSG alta, anemia severa, hipoalbuminemia severa, PaFi<200, score APACHE II alto, necesidad de hemodiálisis y de ventilación mecánica. (Rev Med Hered 2007;18: 192-199.

The severity assessment of critically ill preeclamptic women: a case-control study A avaliação de gravidade de mulheres em estado grave por pré-eclâmpsia: estudo caso-controle

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João Paulo Souza

2006-03-01

Full Text Available BACKGROUND AND OBJECTIVES: The assessment of illness severity and prognosis of obstetric patients by scoring systems is still a controversial issue. Preeclampsia is a leading cause of severe maternal morbidity and mortality, and a major cause of obstetric admission to intensive care unit. There is paucity of data regarding the predictability of critically ill preeclamptic women and the application of scoring systems to this population. This study aimed to evaluate and compare the application of APACHE II, SAPS II and MPM II scoring systems between a preeclamptic population and a non obstetric female population. METHODS: A case-control study was conducted on 28 preeclamptic women and 56 non obstetric female patients, admitted to a general intensive care unit over a period of 10 years. The predictive accuracy of the prognostic evaluation systems was estimated by the area under the receiver operator characteristic curve. RESULTS: The mortality rate was 21.4% (6:28 for the study group and 35.7% (20:56 for the control group, with an OR = 0.49 (95%CI = 0.17-1.41. The main causes of ICU admission of preeclamptic women were HELLP syndrome, coma and pulmonary edema. In the preeclamptic population, only the MPM II score showed an area under the ROC curve statistically different from 0.500, while in the control group, all scoring systems had their areas under the ROC curves statistically different from 0.500. CONCLUSIONS: The application of APACHE II and SAPS II to evaluate critically ill preeclamptic women may be not appropriate.JUSTIFICATIVA E OBJETIVOS: A avaliação de gravidade e do prognóstico de pacientes obstétricas através de escores é ainda tema controverso, sendo escassa a informação sobre mulheres com pré-eclâmpsia. Esta é uma das maiores causas de morbidade materna grave e de mortalidade materna, além de ser também uma das principais causas de internação obstétrica em UTI. Os objetivos deste estudo foram avaliar e comparar a

Prediction of the survival and functional ability of severe stroke patients after ICU therapeutic intervention

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Aoun-Bacha Zeina

2008-06-01

Full Text Available Abstract Background This study evaluated the benefits and impact of ICU therapeutic interventions on the survival and functional ability of severe cerebrovascular accident (CVA patients. Methods Sixty-two ICU patients suffering from severe ischemic/haemorrhagic stroke were evaluated for CVA severity using APACHE II and the Glasgow coma scale (GCS. Survival was determined using Kaplan-Meier survival tables and survival prediction factors were determined by Cox multivariate analysis. Functional ability was assessed using the stroke impact scale (SIS-16 and Karnofsky score. Risk factors, life support techniques and neurosurgical interventions were recorded. One year post-CVA dependency was investigated using multivariate analysis based on linear regression. Results The study cohort constituted 6% of all CVA (37.8% haemorrhagic/62.2% ischemic admissions. Patient mean(SD age was 65.8(12.3 years with a 1:1 male: female ratio. During the study period 16 patients had died within the ICU and seven in the year following hospital release. The mean(SD APACHE II score at hospital admission was 14.9(6.0 and ICU mean duration of stay was 11.2(15.4 days. Mechanical ventilation was required in 37.1% of cases. Risk ratios were; GCS at admission 0.8(0.14, (p = 0.024, APACHE II 1.11(0.11, (p = 0.05 and duration of mechanical ventilation 1.07(0.07, (p = 0.046. Linear coefficients were: type of CVA – haemorrhagic versus ischemic: -18.95(4.58 (p = 0.007, GCS at hospital admission: -6.83(1.08, (p = 0.001, and duration of hospital stay -0.38(0.14, (p = 0.40. Conclusion To ensure a better prognosis CVA patients require ICU therapeutic interventions. However, as we have shown, where tests can determine the worst affected patients with a poor vital and functional outcome should treatment be withheld?

Acute Kidney Injury Classification in Neuro-ICU Patient Group

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Canan Akıncı

2012-12-01

Full Text Available Objective: To investigate the role of acute kidney injury (AKI classification system for kidney injury outcome in neuro-Intensive care unit (ICU patients. Material and Method: Total 432 patients who admitted to ICU between 2005 and 2009 evaluated in this study. All patients’ AKI stage, Acute Physiology and Chronic Health Evaluation (APACHE-II, Sequential Organ Failure Assessment Score (SOFA, Glasgow Coma Score (GCS, Glasgow Outcome Score (GOS, mortality rate, length of ICU stay, need for intubation, and mechanical ventilation were recorded. Results: AKI was found in 24 of all 432 patents’ (5.5%. We found that, patients with AKI had higher APHACE-II score, SOFA score and mortality rates; longer ICU stay, duration of mechanical ventilation and intubation and lower GCS and GOS than without AKI group. Conclusion: Length of ICU stay and mortality rate were higher in AKI positive group.

Plasma Monocyte Chemoattractant Protein-1 Level as a Predictor of the Severity of Community-Acquired Pneumonia

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Kok-Khun Yong

2016-01-01

Full Text Available Monocyte chemoattractant protein (MCP-1 increases in the serum of immunocompetent patients with community-acquired pneumonia (CAP. However, the correlation between the circulating level of MCP-1 and severity of CAP remains unclear. This study investigated differential changes in the plasma MCP-1 levels of patients with CAP before and after an antibiotic treatment and further analyzes the association between the CAP severity and MCP-1 levels. We measured the plasma MCP-1 levels of 137 patients with CAP and 74 healthy controls by using a commercial enzyme-linked immunosorbent assay. Upon initial hospitalization, Acute Physiology and Chronic Health Evaluation II (APACHE II; confusion, urea level, respiratory rate, blood pressure, and age of >64 years (CURB-65; and pneumonia severity index (PSI scores were determined for assessing the CAP severity in these patients. The antibiotic treatment reduced the number of white blood cells (WBCs and neutrophils as well as the level of C-reactive protein (CRP and MCP-1. The plasma MCP-1 level, but not the CRP level or WBC count, correlated with the CAP severity according to the PSI (r = 0.509, p < 0.001, CURB-65 (r = 0.468, p < 0.001, and APACHE II (r = 0.360, p < 0.001 scores. We concluded that MCP-1 levels act in the development of CAP and are involved in the severity of CAP.

Endocan Levels in Peripheral Blood Predict Outcomes of Acute Respiratory Distress Syndrome

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Ling Tang

2014-01-01

Full Text Available Purpose. To investigate the prognostic significance of endocan, compared with procalcitonin (PCT, C-reactive protein (CRP,white blood cells (WBC, neutrophils (N, and clinical severity scores in patients with ARDS. Methods. A total of 42 patients with ARDS were initially enrolled, and there were 20 nonsurvivors and 22 survivors based on hospital mortality. Plasma levels of biomarkers were measured and the acute physiology and chronic health evaluation II (APACHE II was calculated on day 1 after the patient met the defining criteria of ARDS. Results. Endocan levels significantly correlated with the APACHE II score in the ARDS group (r=0.676, P=0.000, n=42. Of 42 individuals with ARDS, 20 were dead, and endocan was significantly higher in nonsurvivors than in survivors (median (IQR 5.01 (2.98–8.44 versus 3.01 (2.36–4.36 ng/mL, P=0.017. According to the results of the ROC-curve analysis and COX proportional hazards models, endocan can predict mortality of ARDS independently with a hazard ratio of 1.374 (95% CI, 1.150–1.641 and an area of receiver operator characteristic curve (AUROC of 0.715 (P=0.017. Moreover, endocan can predict the multiple-organ dysfunction of ARDS. Conclusion. Endocan is a promising biomarker to predict the disease severity and mortality in patients with ARDS.

Analysis of 230 cases of emergent surgery for obstructing colon cancer--lessons learned.

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Aslar, Ahmet Kessaf; Ozdemir, Süleyman; Mahmoudi, Hatim; Kuzu, Mehmet Ayhan

2011-01-01

We aimed to identify prognostic factors affecting clinical outcomes in emergent primary resection. A retrospective analysis of prospectively acquired data of 230 consecutive emergent patients between August 1994 and January 2005 were evaluated in this study. Sixty-nine patients applied with right colon obstruction and 161 patients with left. Resection and primary anastomosis was carried out in 128 patients and resection and stoma in 102 patients. The patients were divided into two cohorts: patients who developed poor outcome within 30 days after surgery and those who did not. Major morbidity or mortality were reported in 60 (26.1%) patients. Analysis revealed that the most important prognostic factors for poor outcome were American Anesthesiology Association (ASA) grade ≥3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥11, age >60 years, presence of peritonitis, and surgery during on-call hours. Age >60 years and on-call surgery were determinant factors in right-sided obstructions, whereas ASA grade ≥3, APACHE II score ≥11, and presence of peritonitis were determinant factors in left-sided obstructions. All these factors but the timing of the operation emphasize the pivotal role of the patient's physiological condition on admission. Accurate preoperative evaluation might predict the clinical outcome and help in establishing the most appropriate treatment.

LHCbDIRAC as Apache Mesos microservices

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Haen, Christophe; Couturier, Benjamin

2017-10-01

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

Prognosis of patients with rheumatic diseases admitted to intensive care.

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Beil, M; Sviri, S; de la Guardia, V; Stav, I; Ben-Chetrit, E; van Heerden, P V

2017-01-01

Variable mortality rates have been reported for patients with rheumatic diseases admitted to an intensive care unit (ICU). Due to the absence of appropriate control groups in previous studies, it is not known whether the presence of a rheumatic disease constitutes a risk factor. Moreover, the accuracy of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score for predicting outcome in this group of patients has been questioned. The primary goal of this study was to compare outcome of patients with rheumatic diseases admitted to a medical ICU to those of controls. The records of all patients admitted between 1 April 2003 and 30 June 2014 (n=4020) were screened for the presence of a rheumatic disease during admission (n=138). The diagnosis of a rheumatic disease was by standard criteria for these conditions. An age- and gender-matched control group of patients without a rheumatic disease was extracted from the patient population in the database during the same period (n=831). Mortality in ICU, in hospital and after 180 days did not differ significantly between patients with and without rheumatic diseases. There was no difference in the performance of the APACHE II score for predicting outcome in patients with rheumatic diseases and controls. This score, as well as a requirement for the use of inotropes or vasopressors, accurately predicted hospital mortality in the group of patients with rheumatic diseases. In conclusion, patients with a rheumatic condition admitted to intensive care do not do significantly worse than patients without such a disease.

Personalized Risk Scoring for Critical Care Prognosis Using Mixtures of Gaussian Processes.

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Alaa, Ahmed M; Yoon, Jinsung; Hu, Scott; van der Schaar, Mihaela

2018-01-01

In this paper, we develop a personalized real-time risk scoring algorithm that provides timely and granular assessments for the clinical acuity of ward patients based on their (temporal) lab tests and vital signs; the proposed risk scoring system ensures timely intensive care unit admissions for clinically deteriorating patients. The risk scoring system is based on the idea of sequential hypothesis testing under an uncertain time horizon. The system learns a set of latent patient subtypes from the offline electronic health record data, and trains a mixture of Gaussian Process experts, where each expert models the physiological data streams associated with a specific patient subtype. Transfer learning techniques are used to learn the relationship between a patient's latent subtype and her static admission information (e.g., age, gender, transfer status, ICD-9 codes, etc). Experiments conducted on data from a heterogeneous cohort of 6321 patients admitted to Ronald Reagan UCLA medical center show that our score significantly outperforms the currently deployed risk scores, such as the Rothman index, MEWS, APACHE, and SOFA scores, in terms of timeliness, true positive rate, and positive predictive value. Our results reflect the importance of adopting the concepts of personalized medicine in critical care settings; significant accuracy and timeliness gains can be achieved by accounting for the patients' heterogeneity. The proposed risk scoring methodology can confer huge clinical and social benefits on a massive number of critically ill inpatients who exhibit adverse outcomes including, but not limited to, cardiac arrests, respiratory arrests, and septic shocks.

Lot 4 AH-64E Apache Attack Helicopter Follow-on Operational Test and Evaluation Report

Science.gov (United States)

2014-12-01

engine is tested to determine its Engine Torque Factor ( ETF ) rating.6 To meet contract specifications, a new engine must have an ETF of 1.0. The...published AH-64E operator’s manual estimates performance based on engines with an ETF of 1.0, and pilots normally plan missions anticipating the 717...pound shortfall in hover performance at KPP conditions. The Apache Program Manager reports that new engines are delivered with an average ETF of

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

Science.gov (United States)

2014-08-01

pp. 201–215, 2003. 2. K. Crowston, K. Wei, J. Howison, and A. Wiggins, “Free/ libre open-source software devel- opment: What we know and what we do not...Understanding the process of participating in open source communities,” in International Workshop on Emerging Trends in Free/ Libre /Open Source Software ...Noname manuscript No. (will be inserted by the editor) Developer Initiation and Social Interactions in OSS: A Case Study of the Apache Software

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

Science.gov (United States)

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

2013-12-01

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

Factors among patients receiving prone positioning for the acute respiratory distress syndrome found useful for predicting mortality in the intensive care unit.

Science.gov (United States)

Modrykamien, Ariel M; Daoud, Yahya

2018-01-01

Optimal mechanical ventilation management in patients with the acute respiratory distress syndrome (ARDS) involves the use of low tidal volumes and limited plateau pressure. Refractory hypoxemia may not respond to this strategy, requiring other interventions. The use of prone positioning in severe ARDS resulted in improvement in 28-day survival. To determine whether mechanical ventilation strategies or other parameters affected survival in patients undergoing prone positioning, a retrospective analysis was conducted of a consecutive series of patients with severe ARDS treated with prone positioning. Demographic and clinical information involving mechanical ventilation strategies, as well as other variables associated with prone positioning, was collected. The rate of in-hospital mortality was obtained, and previously described parameters were compared between survivors and nonsurvivors. Forty-three patients with severe ARDS were treated with prone positioning, and 27 (63%) died in the intensive care unit. Only three parameters were significant predictors of survival: APACHE II score ( P = 0.03), plateau pressure ( P = 0.02), and driving pressure ( P = 0.04). The ability of each of these parameters to predict mortality was assessed with receiver operating characteristic curves. The area under the curve values for APACHE II, plateau pressure, and driving pressure were 0.74, 0.69, and 0.67, respectively. In conclusion, in a group of patients with severe ARDS treated with prone positioning, only APACHE II, plateau pressure, and driving pressure were associated with mortality in the intensive care unit.

Predictive Performance of SYNTAX Score II in Patients With Left Main and Multivessel Coronary Artery Disease - Analysis of CREDO-Kyoto Registry

NARCIS (Netherlands)

C.A.M. Campos (Carlos); D. van Klaveren (David); A. Iqbal (Anwarul); Y. Onuma (Yoshinobu); Y. Zhang (Ying); H.M. Garcia-Garcia (Hector); M.-A. Morel (Marie-Angel); V. Farooq (Vasim); Shiomi, H; Furukawa, Y; Nakagawa, Y; Kadota, K; P.A. Lemos Neto (Pedro); T. Kimura (Takeshi); E.W. Steyerberg (Ewout); P.W.J.C. Serruys (Patrick)

2014-01-01

textabstractBackground: SYNTAX score II (SSII) provides individualized estimates of 4-year mortality after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in order to facilitate decision-making between these revascularization methods. The purpose of the present

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

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

2018-01-01

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

Valor predictivo del EuroSCORE II y el STS score en pacientes sometidos a cirugía cardiaca valvular por el abordaje mínimamente invasivo

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Catalina María Martínez Ochoa

2016-09-01

Conclusiones: El valor predictivo del EuroSCORE II y el STS fue similar. El desarrollo y la validación de las escalas locales ayudarían a mejorar la estratificación de riesgo en nuestra población y reflejar verdaderamente nuestra práctica clínica. Se requieren estudios multicéntricos con mayor tamaño de la muestra para estimar la utilidad de las escalas disponibles y para proponer una propia para este tipo de intervención.

Continuous oscillation: outcome in critically ill patients.

Science.gov (United States)

Traver, G A; Tyler, M L; Hudson, L D; Sherrill, D L; Quan, S F

1995-09-01

To compare turning by an oscillating bed to standard 2-hour turning. Outcomes were survival, length of stay (LOS), duration of mechanical ventilation, and incidence of pneumonia. One hundred and three intensive care patients were randomly assigned to standard turning or turning by an oscillating bed. Data, collected at baseline, daily for 7 days, and then three times weekly until study discharge, included demographics, initial Acute Physiology and Chronic Health Evaluation (APACHE II) score, ventilatory/gas exchange parameters, indicators of pneumonia, nursing measures, and chest roentgenograph. There were no significant differences for LOS, duration of ventilation, nor incidence of pneumonia. Higher survival for subjects on the oscillating bed reached borderline significance (P = .056) for subjects with APACHE II greater than or equal to 20. Longitudinal data were analyzed using the random effects model. No differences in ventilatory or gas exchange parameters were identified. Among subjects who developed pneumonia there was a significantly higher respiratory score (nursing acuity scale) for subjects on the oscillating bed. In selected critically ill patients oscillating therapy may improve survival and improve airway clearance. The frequency and degree of turning needed to prevent complications and improve outcome remains unclear. These newer beds should be used with discrimination so as to not increase hospital costs unnecessarily.

[Contraindications to succinylcholine in the intensive care unit. A prevalence study].

Science.gov (United States)

Muñoz-Martínez, T; Garrido-Santos, I; Arévalo-Cerón, R; Rojas-Viguera, L; Cantera-Fernández, T; Pérez-González, R; Díaz-Garmendia, E

2015-03-01

To determine the prevalence of contraindications to succinylcholine in patients admitted to the ICU. An observational study was carried out, describing the frequency of succinylcholine contraindication by stays, and associating the contraindications to population variables. The adult general ICU of a reference hospital. Clinical-surgical critically ill patients. Thirty consecutive days were analyzed. None. Population variables: age, sex, APACHE II and SOFA scores, illness, days of hospitalization, mechanical ventilation and renal replacement therapy. hyperkalemia, bedridden patients, rhabdomyolysis, muscle trauma, burns, infusion of neuromuscular blocking agents, acute renal failure, chronic renal failure, intraocular hypertension, intracranial hypertension, statin use, malignant hyperthermia, neuromuscular disease, spinal cord sectioning, bradycardia bedridden patients (n=140), neuromuscular blocking agents (n=101), acute renal failure (n=126), statin use (n=167), neuromuscular disease (n=159) and bradycardia (n=76). We recorded 74 stays (11.3%) at high risk of complications, secondary to hyperkalemic risk associated to receptor dysregulation. A high risk of complications was associated to advanced age, prolonged hospitalization, prolonged length of stay in the ICU, higher APACHE II and SOFA scores, mechanical ventilation and renal replacement therapy. Given the high prevalence of contraindications to succinylcholine observed, we discourage its use in patients admitted to the ICU. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Quadratic prediction of factor scores

NARCIS (Netherlands)

Wansbeek, T

1999-01-01

Factor scores are naturally predicted by means of their conditional expectation given the indicators y. Under normality this expectation is linear in y but in general it is an unknown function of y. II is discussed that under nonnormality factor scores can be more precisely predicted by a quadratic

Enhancing organization and maintenance of big data with Apache Solr in IBM WebSphere Commerce deployments

OpenAIRE

Grigel, Rudolf

2015-01-01

The main objective of this thesis was to enhance the organization and maintenance of big data with Apache Solr in IBM WebSphere Commerce deployments. This objective can be split into several subtasks: reorganization of data, fast and optimised exporting and importing, efficient update and cleanup operations. E-Commerce is a fast growing and frequently changing environment. There is a constant flow of data that is rapidly growing larger and larger every day which is becoming an ...

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

Energy Technology Data Exchange (ETDEWEB)

Ridgley, Jennie; Dunbar, Robin Wright

2001-04-24

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

Epidemiology of Adult-population Sepsis in India: A Single Center 5 Year Experience.

Science.gov (United States)

Chatterjee, Sharmila; Bhattacharya, Mahuya; Todi, Subhash Kumar

2017-09-01

Sepsis is a major worldwide cause of morbidity and mortality. Most sepsis epidemiologic data are from the Western literature. Sparse data from India describe the epidemiology of infection rather than sepsis which is a host response to infection. This study describes the epidemiology of sepsis in the Intensive Care Unit (ICU) of an Indian tertiary care hospital. A prospective study conducted between June 2006 and May 2011. All consecutively admitted patients during the 5 year study >=18 years of age were included and data obtained from hospital in-patient records. Variables measured were the incidence of severe sepsis, ICU, hospital, and 28-day mortality, the median length of ICU stay, median Acute Physiology and Chronic Health Evaluation II (APACHE II) score, infection site, and microbial profile. There were 4711 admissions during the study with 282 (6.2%, 95% confidence interval 2.3, 13.1) admissions with severe sepsis. ICU mortality, hospital mortality, and 28-day mortality were 56%, 63.6%, and 62.8%, respectively. Predominant infection site was respiratory tract. The most common organisms were Gram-negative microbes. The most common microbe was Acinetobacter baumanni. Median APACHE II score on admission was 22 (interquartile range 16-28) and median length of ICU stay was 8 days. Severe sepsis attributable mortality was 85%. Severe sepsis is common in Indian ICUs and is mainly due to Gram-negative organisms. ICU mortality is high in this group and care is resource intensive due to increased length of stay.

The Value of the SYNTAX Score II in Predicting Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation.

Science.gov (United States)

Ryan, Nicola; Nombela-Franco, Luis; Jiménez-Quevedo, Pilar; Biagioni, Corina; Salinas, Pablo; Aldazábal, Andrés; Cerrato, Enrico; Gonzalo, Nieves; Del Trigo, María; Núñez-Gil, Iván; Fernández-Ortiz, Antonio; Macaya, Carlos; Escaned, Javier

2017-11-27

The predictive value of the SYNTAX score (SS) for clinical outcomes after transcatheter aortic valve implantation (TAVI) is very limited and could potentially be improved by the combination of anatomic and clinical variables, the SS-II. We aimed to evaluate the value of the SS-II in predicting outcomes in patients undergoing TAVI. A total of 402 patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI were included. Preprocedural TAVI angiograms were reviewed and the SS-I and SS-II were calculated using the SS algorithms. Patients were stratified in 3 groups according to SS-II tertiles. The coprimary endpoints were all-cause death and major adverse cardiovascular events (MACE), a composite of all-cause death, cerebrovascular event, or myocardial infarction at 1 year. Increased SS-II was associated with higher 30-day mortality (P=.036) and major bleeding (P=.015). The 1-year risk of death and MACE was higher among patients in the 3rd SS-II tertile (HR, 2.60; P=.002 and HR, 2.66; P<.001) and was similar among patients in the 2nd tertile (HR, 1.27; P=.507 and HR, 1.05; P=.895) compared with patients in the 1st tertile. The highest SS-II tertile was an independent predictor of long-term mortality (P=.046) and MACE (P=.001). The SS-II seems more suited to predict clinical outcomes in patients undergoing TAVI than the SS-I. Increased SS-II was associated with poorer clinical outcomes at 1 and 4 years post-TAVI, independently of the presence of coronary artery disease. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

The Decrease of Peripheral Blood CD4+ T Cells Indicates Abdominal Compartment Syndrome in Severe Acute Pancreatitis.

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Yao Liu

Full Text Available Few data are available on the role of T lymphocytes and inflammatory cytokines in abdominal compartment syndrome (ACS in severe acute pancreatitis (SAP. We conducted a retrospective study to assess the risk factors associated with ACS in SAP.A total of 76 SAP patients who were admitted within 24 hours after symptom onset in our study. There were 36 patients suffering from ACS and 40 from intra-abdominal hypertension (IAH. On the 1st, 3rd and 7th days after hospital admission, the following variables were assessed: serum value of C-reactive protein (CRP, and the proportions of peripheral CD4+ and CD8+ T lymphocytes. Acute Physiology and Chronic Health Evaluation II (APACHE II score, and computed tomography severity index (CTSI score were assessed on days 1 and 7 after hospitalization.Compared with the patients with IAH, ACS patients showed statistically higher CRP value on 7th day after hospital admission, proportions of CD4+ T cells on days 1, 3, 7 and CD4+/CD8+ ratio on day 1 were significantly lower (P < 0.05, respectively. A CD4+ T cell proportion of 30.3% on the 1st day indicated ACS with an area under the curve (AUC of 0.774, a sensitivity with 82.5% and specificity with 72.0%, respectively. Sensitivity/specificity for predicting ACS in SAP patients on day 1 was 70.0%/68.0% for CD4+/CD8+ ratio, 72.2%/65.0% for APACHE II score.The reduction of peripheral blood CD4+ T lymphocytes is associated with ACS in SAP, and may act as a potential predictor of ACS in SAP.

Are the MDS-UPDRS-based composite scores clinically applicable?

Science.gov (United States)

Makkos, Attila; Kovács, Márton; Aschermann, Zsuzsanna; Harmat, Márk; Janszky, József; Karádi, Kázmér; Kovács, Norbert

2018-02-28

The International Parkinson and Movement Disorder Society-sponsored UPDRS (MDS-UPDRS) is a powerful clinical outcome measure. To evaluate the feasibility of various MDS-UPDRS-based composite scores and determine their minimal clinically important difference threshold values. Overall, 1,113 paired investigations of 452 patients were reviewed implementing three different techniques simultaneously. Based on the ordinal regression modeling, the MDS-UPDRS II+III, MDS-UPDRS I+II+III, and the total score of MDS-UPDRS are clinically applicable outcome measures. Any improvement greater than 4.9 points or any worsening more than 4.2 points on MDS-UPDRS II+III represent a minimal, yet clinically meaningful, change. In reference to MDS-UPDRS I+II+III, the smallest changes considered clinically relevant were 6.7 and 5.2 points for improvement and deterioration, respectively. The thresholds for the total score of MDS-UPDRS were 7.1 points for improvement and 6.3 points for worsening. Our findings support the application of various MDS-UPDRS-based composite scores. © 2018 International Parkinson and Movement Disorder Society. © 2018 International Parkinson and Movement Disorder Society.

Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients.

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Weijs, Peter J M; Looijaard, Wilhelmus G P M; Dekker, Ingeborg M; Stapel, Sandra N; Girbes, Armand R; Oudemans-van Straaten, H M; Beishuizen, Albertus

2014-01-13

Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship. This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm2 for females and 170 cm2 for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables. This study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m2. Muscle area for females was significantly lower than that for males (102 ± 23 cm2 versus 158 ± 33 cm2; P muscle area was observed in 63% of patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P = 0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P = 0.008) and in males (32.3% versus 7.5%; P muscle area, sex, and APACHE II score, whereas BMI and admission diagnosis were not. Odds ratio for low-muscle area was 4.3 (95% confidence interval, 2.0 to 9.0, P muscle mass appeared as primary predictor, not sex. Low skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not

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

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

2016-10-01

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

[Influence of clinical nutritional support on the effects of mechanical ventilation].

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Xu, Xiujuan; Zhang, Geng; Hu, Mahong; Ji, Chunlian; Meng, Jianbiao; Lai, Zhizhen; Dai, Muhua; Pang, Lisha; Zhang, Wei

2018-03-01

To study the influence of clinical nutritional support on the effects of mechanical ventilation (MV), and to find the factors affecting the outcome of patients undergoing MV. A case-control study was conducted. The clinical data of 235 patients undergoing MV admitted to intensive care unit (ICU) of Tongde Hospital of Zhejiang Province from January 2015 to June 2017 were retrospectively analyzed. The patients were divided into two groups according to whether weaning successfully within 7 days. The clinical data of patients in the two groups were collected including gender, age, acute physiology and chronic health evaluation II (APACHE II) score, underlying disease, nutritional indicators, nutritional support, and complications. The outcome of withdrawal within 7 days was served as a dependent variable, all observed indicators were served as independent variables, and Logistic regression analysis was carried out to screen the influencing factors of the weaning results within 7 days. 235 patients undergoing MV were enrolled, 128 patients were successfully withdrawn within 7 days, and 107 were unsuccessfully withdrawn. Compared with the successful weaning group, the patients of weaning failure group were older, and had higher APACHE II score and lower albumin (Alb) and hemoglobin (Hb), more patients with internal medical underlying diseases and receiving parenteral nutrition (PN) and mixed nutrition, and the incidences of secondary infection, vomiting, abdominal distension, abnormal bowel sound, gastric retention, and diarrhea were higher. However, there was no statistical significance in gender between the two groups. The variables of statistical significance in univariate analysis were enrolled in the multifactor analysis model showing that age [odds ratio (OR) = 1.269, 95% confidence interval (95%CI) = 1.119-1.439, P nutrition (EN; OR = 0.191, 95%CI = 0.098-0.372, P nutrition (OR = 0.375, 95%CI = 0.150-0.938, P = 0.037) were protective factors of successful weaning

Mycobacterial and nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus infection: A prospective, cohort study

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Afessa Bekele

2001-09-01

Full Text Available Abstract Background A prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV infection. Methods The study included 1,225 consecutive hospital admissions of 599 HIV-infected patients treated from April 1995 through March 1998. Data included demographics, risk factors for HIV infection, Acute Physiology and Chronic Health Evaluation (APACHE II score, pulmonary complications, CD4+ lymphocyte count, hospital stay and case-fatality rate. Results Patient age (mean ± SD was 38.2 ± 8.9 years, 62% were men, and 84% were African American. The median APACHE II score was 14, and median CD4+ lymphocyte count was 60/μL. Pulmonary complications were Pneumocystis carinii pneumonia (85 in 78 patients, Mycobacterium avium complex (51 in 38, Mycobacterium tuberculosis (40 in 35, Mycobacterium gordonae (11 in 11, Mycobacterium kansasii (10 in 9, Cytomegalovirus (10 in 10, Nocardia asteroides (3 in 3, fungus ball (2 in 2, respiratory syncytial virus (1, herpes simplex virus (1, Histoplasma capsulatum (1, lymphoma (3 in 3, bronchogenic carcinoma (2 in 2, and Kaposi sarcoma (1. The case-fatality rate of patients was 11% with Pneumocystis carinii pneumonia; 5%, Mycobacterium tuberculosis; 6%, Mycobacterium avium complex; and 7%, noninfectious pulmonary complications. Conclusion Most pulmonary complications in hospitalized patients with HIV are from Pneumocystis and mycobacterial infection.

Nosocomial pneumonia in the ICU: a prospective cohort study.

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Hyllienmark, Petra; Gårdlund, Bengt; Persson, Jan-Olov; Ekdahl, Karl

2007-01-01

Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection among patients requiring mechanical ventilation. A prospective surveillance programme of all patients has been implemented at the ICU, Karolinska University Hospital, Sweden since 2001. Within this programme, incidence and risk factors for ICU-acquired pneumonia and associated death over a 2-y period have been studied. Of 329 patients enrolled in the study, 221 required mechanical ventilation. 33 of 221 patients (15%) developed VAP, corresponding to a rate of 29 VAP/1000 ventilator d. Risk factors for VAP were aspiration (hazard ratio 3.79; 95% CI 1.48-9.68), recent surgery (HR 3.58; 95% CI 1.15-11.10) and trauma (HR 3.00; 95% CI 1.03-8.71). 11 patients of 33 (33%) with VAP died within 28 d compared to 46 of 288 (16%) without ICU-acquired pneumonia (odds ratio 2.73; 95% CI 0.97-7.63). We conclude that: 1) incidence of VAP was 15% and the most important risk factor was aspiration; 2) APACHE II score > or = 20 is a stronger predictor for poor outcome than VAP; 3) a minority of patients with APACHE II score > or = 20 develop VAP; and 4) continuous surveillance programmes are feasible and provide valuable data for improvement of quality of care.

Incidence and risk factors for delirium development in ICU patients - a prospective observational study.

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Kanova, Marcela; Sklienka, Peter; Roman, Kula; Burda, Michal; Janoutova, Jana

2017-06-01

Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

Multidrug Resistance Acinetobacter Bacteremia Secondary to Ventilator-Associated Pneumonia: Risk Factors and Outcome.

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Brotfain, Evgeni; Borer, Abraham; Koyfman, Leonid; Saidel-Odes, Lisa; Frenkel, Amit; Gruenbaum, Shaun E; Rosenzweig, Vsevolod; Zlotnik, Alexander; Klein, Moti

2017-10-01

Acinetobacter baumannii is a multidrug resistant (MDR), gram-negative bacterium commonly implicated in ventilator-associated pneumonia (VAP) in critically ill patients. Patients in the intensive care unit (ICU) with VAP often subsequently develop A baumannii bacteremia, which may significantly worsen outcomes. In this study, we retrospectively reviewed the clinical and laboratory records of 129 ICU patients spanning 6 years with MDR A baumannii VAP; 46 (35%) of these patients had concomitant MDR A baumannii bacteremia. The ICU mortality rate was higher in patients with VAP having A baumannii bacteremia compared to nonbacteremic patients (32.4% vs 9.6% respectively, P 65 years, an Acute Physiology and Chronic Health Evaluation II (APACHE-II) score higher than 20, a Sequential Organ Failure Assessment (SOFA) score higher than 7 on the day of bacteremia, and the presence of comorbid disease (chronic obstructive pulmonary disease [COPD] and chronic renal failure) were found to be independent risk factors for in-hospital mortality in this population. Multidrug resistant A baumannii was not an independent risk factor for mortality. Although the presence of comorbid diseases (COPD and chronic renal failure) and severity of disease (APACHE > 20 and SOFA >7) were found to be independent risk factors for ICU mortality, MDR A baumannii bacteremia was not an independent risk factor for mortality in our critically ill population.

Soluble Triggering Receptor Expressed on Myeloid Cells-1 as a Novel Marker for Abdominal Sepsis.

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Song, Xiaofei; Song, Yucheng; Zhang, Xuedong; Xue, Huanzhou

2017-07-01

The aim of the study was to investigate the concentration and diagnostic significance of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in acute abdominal conditions. Plasma specimens were obtained from 68 patients with abdominal sepsis, 60 patients with systemic inflammatory response syndrome (SIRS), and 60 healthy individuals. The sepsis group was divided into the survival and death groups according to the 28-d outcome. Plasma sTREM-1, procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count were measured. A receiver operating characteristic curve (ROC) was used to compare the diagnostic values of sTREM-1, PCT, CRP, and WBC count. In addition, the correlation between plasma sTREM-1 and the Acute Physiology and Chronic Health Evaluation (APACHE) II score in the sepsis group was assessed by Spearman correlation analysis. The plasma concentration of sTREM-1 in the sepsis group was significantly higher than that in the SIRS and healthy groups (both p sepsis vs. SIRS showed that the area under the curve of sTREM-1 (0.82) was greater than that of PCT (0.77), CRP (0.72), and WBC count (0.70). Additionally, in the sepsis group, the plasma sTREM-1 concentration correlated positively with the APACHE II score (r = 0.41; p sepsis.

Ventilator-associated pneumonia in surgical emergency intensive care unit.

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Ertugrul, Bulent M; Yildirim, Ayse; Ay, Pinar; Oncu, Serkan; Cagatay, Atahan; Cakar, Nahit; Ertekin, Cemalettin; Ozsut, Halit; Eraksoy, Haluk; Calangu, Semra

2006-01-01

To investigate the incidence, risk factors and the etiology of ventilator-associated pneumonia (VAP) in surgical emergency intensive care unit (ICU) patients. We conducted this prospective cohort study in the surgical emergency ICU of Istanbul Medical Faculty between December 1999 and May 2001. We included 100 mechanically ventilated patients in this study. We diagnosed VAP according to the current diagnostic criteria. We identified the etiology of VAP cases by both quantitative cultures of endotracheal aspiration and blood cultures. To analyze the predisposing factors for the development of VAP, we recorded the following variables: age, gender, acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma scale (GCS), sequential organ failure assessment (SOFA) score, serum albumin level, duration of mechanical ventilation (MV) prior to the development of VAP, and underlying diseases. We determined the VAP incidence rate as 28%. We found the APACHE II score and the duration of MV to be statistically significant variables for the development of VAP. There were no significant differences regarding age, gender, GCS, SOFA score, albumin level, or underlying diseases for the development of VAP. The isolated bacteria among VAP cases were as follows: Staphylococcus aureus (n=12, 43%), Acinetobacter spp. (n=6, 21%), coagulase-negative Staphylococci (n=4, 15%), Pseudomonas aeruginosa (n=3, 10.7%) and Klebsiella pneumoniae (n=3, 10.7%). Ventilator-associated pneumonia is a common infection, and certain interventions might affect the incidence of VAP. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to minimize the risk of VAP.

High performance Spark best practices for scaling and optimizing Apache Spark

CERN Document Server

Karau, Holden

2017-01-01

Apache Spark is amazing when everything clicks. But if you haven’t seen the performance improvements you expected, or still don’t feel confident enough to use Spark in production, this practical book is for you. Authors Holden Karau and Rachel Warren demonstrate performance optimizations to help your Spark queries run faster and handle larger data sizes, while using fewer resources. Ideal for software engineers, data engineers, developers, and system administrators working with large-scale data applications, this book describes techniques that can reduce data infrastructure costs and developer hours. Not only will you gain a more comprehensive understanding of Spark, you’ll also learn how to make it sing. With this book, you’ll explore: How Spark SQL’s new interfaces improve performance over SQL’s RDD data structure The choice between data joins in Core Spark and Spark SQL Techniques for getting the most out of standard RDD transformations How to work around performance issues i...

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

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Becker, Matthias; Böckmann, Britta

2016-01-01

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

Factors affecting the success of weaning in patients with chronic obstructive pulmonary disease

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Turgut Teke

2011-09-01

Full Text Available Objectives: Weaning failure rate was higher in patients with chronic obstructive pulmonary disease (COPD and many factors affect it. The aim of this study was to investigate the factors affecting the success of weaning in COPD patients receiving invasive mechanical ventilation (IMV.Materials and methods: Totally 43 COPD patients who received IMV in intensive care unit were included. Clinical and laboratory results and Acute Physiology Assessment and Chronic Health Evaluation (APACHE II scores were recorded and affecting factors on weaning success were investigated.Results: In 43 patients, 25 had successful weaning (58.1%. Patients with high APACHE II score prior to intubation was found as associated with weaning failure. High Glasgow coma scale (GCS scores before entubation and weaning are associated with weaning success. Pre-weaning anxiety, positive endotracheal aspirate culture, pulmonary arterial pressure value, enteral feeding, pre-weaning tachycardia, pre-weaning cuff leaking and FiO2 values were found to be associated with weaning failure. Pre-weaning cortisol levels were associated with weaning success. In successful weaning group, measured NIF and VT in spontaneous mode were found as higher and f/VT ratio was lower compared with unsuccessful group. T-tube during the 15th and 30th minutes of the symptoms of fatigue (sweating assets were associated with weaning failure. IMV duration and longer extubation duration of weaning, and more number of t-tube insertion attempts were found as associated with failure of weaning.Conclusions: Infection in patients with COPD, the presence of anxiety, and hemodynamic and respiratory instability significantly increases the weaning failure.

Soluble membrane receptors, interleukin 6, procalcitonin and C reactive protein as prognostic markers in patients with severe sepsis and septic shock.

Directory of Open Access Journals (Sweden)

Juan-Jesús Ríos-Toro

Full Text Available The objective of this study was to explore the diagnostic and prognostic value of soluble triggering receptor expressed on myeloid cell 1 (sTREM-1, soluble cluster of differentiation 14 (sCD14, soluble cluster of differentiation 163 (sCD163, interleukin-6 (IL-6, procalcitonin (PCT, and C-reactive protein (CRP serum levels for patients with severe sepsis and septic shock in an intensive care unit (ICU.Fifty patients admitted at the ICU with the diagnosis of severe sepsis or septic shock were studied. SOFA and APACHE II scores as well as serum biomarkers were measured at days 0, 2 and 5. The influence of these variables on 28-day mortality was analyzed. Twenty healthy individuals served as controls.Baseline serum concentrations of sTREM-1, sCD163, IL-6 and PCT correlated with SOFA score. Only sTREM-1 levels correlated with APACHE II score. The 28-day mortality rate for all patients was 42%. The absence of risk factors for infection, presence of septic shock, baseline values of sCD14 and decrease of PCT and IL-6 from baseline to day 5 were variables associated to mortality in the univariate analysis. The unique independent factor associated to mortality in the multivariate analysis was a decrease of PCT higher than 50% from days 0 to 5.Serum levels of sTREM-1 are correlated with the severity of sepsis. A 50% decrease of PCT was the unique variable associated with survival in the multivariate analysis.

The course and outcome of Renal Transplant Recipients admitted to the Intensive Care Unit at a Tertiary Hospital in Saudi Arabia

International Nuclear Information System (INIS)

Al-Dawood, A.

2007-01-01

Renal transplantation is the treatment of choice for most patients with end stage renal disease (ESRD). This procedure provides a survival benefit compared to hemodialysis and is also cost effective. The aim of this study is to identify the types and incidence rates of complications that effect renal transplant recipients admitted to the intensive care unit (ICU) during long-term follow-up and to examine the impact of these complications on the length of hospital stay as well as mortality in a tertiary closed ICU in Saudi Arabia. We reviewed the data of all adult renal transplant recipients who were admitted to the ICU at the King Abdulaziz Medical City, Riyadh between May 1999 and October 2006. During the stay period, 80 patients had a total of 96 ICU admissions; 49% were females. The admission APACHE II score and expected mortality was 25+7 and 48+23 respectively. The hospital mortality rate was 42%. Sepsis was major indication for ICU admission and pneumonia was the main cause of sepsis. In multivariate analysis the following variables were introduced in the model: APACHE II score, age, Glasgow Coma Score and need for hemodialysis in the ICU. We found only the need for hemodialysis during the ICU as an independent risk factor for mortality (P<0.02). We found in this study that the main reason for ICU admissions among renal transplant recipients was infections. Mortality rates for this particular population are relatively high and are primarily linked to the need for dialysis. (author)

APOGEE-2: The Second Phase of the Apache Point Observatory Galactic Evolution Experiment in SDSS-IV

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Sobeck, Jennifer; Majewski, S.; Hearty, F.; Schiavon, R. P.; Holtzman, J. A.; Johnson, J.; Frinchaboy, P. M.; Skrutskie, M. F.; Munoz, R.; Pinsonneault, M. H.; Nidever, D. L.; Zasowski, G.; Garcia Perez, A.; Fabbian, D.; Meza Cofre, A.; Cunha, K. M.; Smith, V. V.; Chiappini, C.; Beers, T. C.; Steinmetz, M.; Anders, F.; Bizyaev, D.; Roman, A.; Fleming, S. W.; Crane, J. D.; SDSS-IV/APOGEE-2 Collaboration

2014-01-01

The second phase of the Apache Point Observatory Galactic Evolution Experiment (APOGEE-2), a part of the Sloan Digital Sky Survey IV (SDSS-IV), will commence operations in 2014. APOGEE-2 represents a significant expansion over APOGEE-1, not only in the size of the stellar sample, but also in the coverage of the sky through observations in both the Northern and Southern Hemispheres. Observations on the 2.5m Sloan Foundation Telescope of the Apache Point Observatory (APOGEE-2N) will continue immediately after the conclusion of APOGEE-1, to be followed by observations with the 2.5m du Pont Telescope of the Las Campanas Observatory (APOGEE-2S) within three years. Over the six-year lifetime of the project, high resolution (R˜22,500), high signal-to-noise (≥100) spectroscopic data in the H-band wavelength regime (1.51-1.69 μm) will be obtained for several hundred thousand stars, more than tripling the total APOGEE-1 sample. Accurate radial velocities and detailed chemical compositions will be generated for target stars in the main Galactic components (bulge, disk, and halo), open/globular clusters, and satellite dwarf galaxies. The spectroscopic follow-up program of Kepler targets with the APOGEE-2N instrument will be continued and expanded. APOGEE-2 will significantly extend and enhance the APOGEE-1 legacy of scientific contributions to understanding the origin and evolution of the elements, the assembly and formation history of galaxies like the Milky Way, and fundamental stellar astrophysics.

Validation of the 12-gene colon cancer recurrence score in NSABP C-07 as a predictor of recurrence in patients with stage II and III colon cancer treated with fluorouracil and leucovorin (FU/LV) and FU/LV plus oxaliplatin.

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Yothers, Greg; O'Connell, Michael J; Lee, Mark; Lopatin, Margarita; Clark-Langone, Kim M; Millward, Carl; Paik, Soonmyung; Sharif, Saima; Shak, Steven; Wolmark, Norman

2013-12-20

Accurate assessments of recurrence risk and absolute treatment benefit are needed to inform colon cancer adjuvant therapy. The 12-gene Recurrence Score assay has been validated in patients with stage II colon cancer from the Cancer and Leukemia Group B 9581 and Quick and Simple and Reliable (QUASAR) trials. We conducted an independent, prospectively designed clinical validation study of Recurrence Score, with prespecified end points and analysis plan, in archival specimens from patients with stage II and III colon cancer randomly assigned to fluorouracil (FU) or FU plus oxaliplatin in National Surgical Adjuvant Breast and Bowel Project C-07. Recurrence Score was assessed in 892 fixed, paraffin-embedded tumor specimens (randomly selected 50% of patients with tissue). Data were analyzed by Cox regression adjusting for stage and treatment. Continuous Recurrence Score predicted recurrence (hazard ratio for a 25-unit increase in score, 1.96; 95% CI, 1.50 to 2.55; P < .001), as well as disease-free and overall survival (both P < .001). Recurrence Score predicted recurrence risk (P = .001) after adjustment for stage, mismatch repair, nodes examined, grade, and treatment. Recurrence Score did not have significant interaction with stage (P = .90) or age (P = .76). Relative benefit of oxaliplatin was similar across the range of Recurrence Score (interaction P = .48); accordingly, absolute benefit of oxaliplatin increased with higher scores, most notably in patients with stage II and IIIA/B disease. The 12-gene Recurrence Score predicts recurrence risk in stage II and stage III colon cancer and provides additional information beyond conventional clinical and pathologic factors. Incorporating Recurrence Score into the clinical context may better inform adjuvant therapy decisions in stage III as well as stage II colon cancer.

TBscore II

DEFF Research Database (Denmark)

Rudolf, Frauke; Lemvik, Grethe; Abate, Ebba

2013-01-01

Abstract Background: The TBscore, based on simple signs and symptoms, was introduced to predict unsuccessful outcome in tuberculosis patients on treatment. A recent inter-observer variation study showed profound variation in some variables. Further, some variables depend on a physician assessing...... them, making the score less applicable. The aim of the present study was to simplify the TBscore. Methods: Inter-observer variation assessment and exploratory factor analysis were combined to develop a simplified score, the TBscore II. To validate TBscore II we assessed the association between start...

Historical review of uranium-vanadium in the eastern Carrizo Mountains, San Juan County, New Mexico and Apache County, Arizona

International Nuclear Information System (INIS)

Chenoweth, W.L.

1980-03-01

This report is a brief review of the uranium and/or vanadium mining in the eastern Carrizo Mountains, San Juan County, New Mexico and Apache County, Arizona. It was prepared at the request of the Navajo Tribe, the New Mexico Energy and Minerals Department, and the Arizona Bureau of Geology and Mineral Technology. This report deals only with historical production data. The locations of the mines and the production are presented in figures and tables

The Apache Point Observatory Galactic Evolution Experiment (APOGEE)

Science.gov (United States)

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

2017-09-01

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

SCORE - Sounding-rocket Coronagraphic Experiment

Science.gov (United States)

Fineschi, Silvano; Moses, Dan; Romoli, Marco

The Sounding-rocket Coronagraphic Experiment - SCORE - is a The Sounding-rocket Coronagraphic Experiment - SCORE - is a coronagraph for multi-wavelength imaging of the coronal Lyman-alpha lines, HeII 30.4 nm and HI 121.6 nm, and for the broad.band visible-light emission of the polarized K-corona. SCORE has flown successfully in 2009 acquiring the first images of the HeII line-emission from the extended corona. The simultaneous observation of the coronal Lyman-alpha HI 121.6 nm, has allowed the first determination of the absolute helium abundance in the extended corona. This presentation will describe the lesson learned from the first flight and will illustrate the preparations and the science perspectives for the second re-flight approved by NASA and scheduled for 2016. The SCORE optical design is flexible enough to be able to accommodate different experimental configurations with minor modifications. This presentation will describe one of such configurations that could include a polarimeter for the observation the expected Hanle effect in the coronal Lyman-alpha HI line. The linear polarization by resonance scattering of coronal permitted line-emission in the ultraviolet (UV) can be modified by magnetic fields through the Hanle effect. Thus, space-based UV spectro-polarimetry would provide an additional new tool for the diagnostics of coronal magnetism.

A Differential Approach to Choosing Extracorporeal Detoxification Methods for Abdominal Sepsis

Directory of Open Access Journals (Sweden)

L. Ye Shukevich

2005-01-01

Full Text Available A differential approach to choosing the methods of extracorporeal detoxification in the complex treatment of abdominal sepsis in the context of endogenous intoxication in order to enhance the efficiency of medical measures was pathogeneti-cally substantiated. In 51 patients diagnosed as having abdominal sepsis, the latter was characterized as the endogenous intoxication syndrome in relation to the accumulation of low and medium molecular-weight substances (plasma and red blood cells in the body and their physiological elimination with urine. An original formula was used to calculate the integral marker – the endogenous intoxication index correlating with the routine severity rating scales APACHE II and SOFA and reflecting the severity of endotoxicosis. According to the values of the endogenous intoxication index and to the sum of scores by the APACHE II and SOFA scales, the patients were divided into 3 groups of the clinicopathogenetic types of endogenous intoxication. According to the type of endogenous intoxication, the authors proposed a differential approach to choosing the modes of efferent therapy for abdominal sepsis: high-volume plasmapheresis in the subcompensated type and prolonged venovenous hemofiltration, which improved the results of treatment and reduced mortality rates.

Enteral Feeding in Abdominal Compartment Syndrome

Directory of Open Access Journals (Sweden)

Ye. V Grigoryev

2009-01-01

Full Text Available Objective: to substantiate the choice of a gastrointestinal tract (GIT function support regimen as a mode for correction of the abdominal compartment syndrome (ACS. Subjects and methods. Forty-three patients with different causes of inadequate GIT function of various origin and ACS (disseminated peritonitis (45%, pancreatitis (24%, and severe concomitant injury (31% were examined. Group 1 (control received complete parenteral nutritional feeding (n=23; APACHE II scores, 21±4; calculated probability of fatal outcome, 33.5%. In Group II (study, complete parenteral feeding in the first 24 hours after stabilization was supplemented with GIT function support with Pepsisorb (Nutricia in doses of 500, 1000, and 1500 ml on days 1, 2, and 3, respectively (n=20; APACHE II scores, 20±6; calculated probability of fatal outcome, 37.1%. During early enteral nutritional support, the SOFA score was significantly less than that in Group 1 on days 2—3; the oxygenation index significantly increased on day 3; the value of intra-abdominal hypertension decreased to the control values. The positive effect of the GIT function support regimen on regression of the multiple organ dysfunction syndrome (MODS was confirmed by the lowered levels of biological markers (von Willebrand factor (WF and endothelin-1 as markers of endothelial damage of MODS. Correlation analysis showed a direct correlation between the markers of endothelial damage and the SOFA scores (r=0.34; p=0.05 for WF and r=0.49;p=0.03 for endothelin. Conclusion. The GIT function support regimen via early enteral alimentation with Peptisorb, which was initiated in the first 24 hours after admission, is able to level off the manifestations of the early stages of the abdominal compartment syndrome, with the acceptable values of oxygen balance and water-electrolyte and osmotic homeostasis being achieved. Key words: abdominal compartment syndrome, nutritional support, biological markers, oxygenation index

Hardening en servidor web Linux Apache, PHP y configurar el firewall de aplicaciones modsecurity para mitigar ataques al servidor

OpenAIRE

Espol; Delgado Quishpe, Byron Alberto

2017-01-01

Realizar un hardening al servidor web, se procederá a revisar las directivas en los archivos de configuración del servicio Apache, PHP, y se procederá a realizar instalación y configuración de un firewall de aplicaciones llamado mod_security la cual nos permitirá mitigar ataques a nuestro servidor web. realizando un análisis de vulnerabilidades encontrado en el servidor. Guayaquil Magíster en Seguridad Informática Aplicada

Effect of continuous blood purification in treatment of patients with severe acute pancreatitis and multiple organ dysfunction syndrome

Directory of Open Access Journals (Sweden)

ZHANG Yong

2016-02-01

Full Text Available ObjectiveTo observe the effect of continuous blood purification (CBP on serum inflammatory mediators in patients with severe acute pancreatitis (SAP and multiple organ dysfunction syndrome (MODS. MethodsSixty-five SAP patients with MODS who were treated in General Hospital of Chengdu Command Area of Chinese PLA from April 2008 to December 2013 were enrolled and divided into two groups. The 33 patients in the control group received comprehensive internal medicine treatment, and the 32 patients in the treatment group received comprehensive internal medicine treatment and CBP. Changes in APACHE II score, MODS score, and the serum levels of tumor necrosis factor α (TNFα, C-reactive protein (CRP, interleukin 6 (IL-6, IL-18, platelet-activating factor (PAF, and nitric oxide (NO after treatment were observed. Independent-samples t test was applied for comparison of continuous data between the two groups, and paired t test was applied for before-after comparison within the same group; chi-squared test was applied for comparison of categorical data between the two groups. ResultsIn both groups, APACHE II score, MODS score, and the serum levels of TNFα, CRP, IL-6, IL-18, PAF, and NO decreased significantly after treatment (all P＜0.05, and the treatment group had significantly greater decreases in these values than the control group (all P＜0.001; the survival rates in the treatment group and the control group were 90.6% (29/32 and 78.8% (26/33, respectively, with no significant difference between the two groups (χ2=1.749, P=0.186. ConclusionIn SAP patients with MODS, CBP can effectively clear the serum inflammatory mediators to block systemic inflammatory response and improve organ function, and, therefore, it is an effective method to treat SAP.

Safety and tolerability of tigecycline for the treatment of complicated skin and soft-tissue and intra-abdominal infections: an analysis based on five European observational studies.

Science.gov (United States)

Guirao, Xavier; Sánchez García, Miguel; Bassetti, Matteo; Bodmann, Klaus Friedrich; Dupont, Hervé; Montravers, Philippe; Heizmann, Wolfgang R; Capparella, Maria Rita; Simoneau, Damien; Eckmann, Christian

2013-07-01

Tigecycline is approved for the treatment of complicated skin and soft-tissue infections (cSSTIs) and complicated intra-abdominal infections (cIAIs) in adults. In this analysis the safety and tolerability profile of tigecycline (used alone or in combination) for the treatment of patients with approved indications of cSSTI and cIAI were examined under real-life clinical conditions. Individual patient-level data were pooled from five European observational studies (July 2006 to October 2011). A total of 254 cSSTI and 785 cIAI patients were included. The mean age was 63 years; 34.4% and 56.6% were in intensive care units, 90.9% and 88.1% had at least one comorbidity and mean Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the beginning of treatment were 15.0 ± 7.9 and 16.9 ± 7.6, respectively. Data on adverse events (AEs) were available for 198 cSSTI and 590 cIAI patients in three studies. Nausea and vomiting were reported in ≤ 2% of patients. The most common serious AEs were multi-organ failure (4.0% and 10.0% in cSSTI and cIAI patients, respectively) and sepsis (4.0% and 6.1%, respectively). Death was recorded for 24/254 (9.4%) cSSTI and 147/785 (18.7%) cIAI patients. Mortality rates were higher in the group with a baseline APACHE II score of >15 compared with those with a score of ≤ 15 (18.7% versus 3.5% for cSSTI patients and 23.8% versus 16.0% for cIAI patients). A similar trend was seen when cIAI patients were stratified by Sequential Organ Failure Assessment (SOFA) score. The safety and tolerability of tigecycline, alone and in combination, are consistent with the level of critical illness among patients in these real-life studies.

Aplikasi Search Engine Perpustakaan Petra Berbasis Android dengan Apache SOLR

Directory of Open Access Journals (Sweden)

Andreas Handojo

2016-07-01

Full Text Available Abstrak: Pendidikan merupakan kebutuhan yang penting bagi manusia untuk meningkatkan kemampuan serta taraf hidupnya.Selain melalui pendidikan formal, ilmu juga dapat diperoleh melalui media cetak atau buku.Perpustakaan merupakan salah satu sarana yang penting dalam menunjang hal tersebut.Meskipun sangat bermanfaat, terdapat kesulitan penggunaan layanan perpustakaan, karena terlalu banyaknya koleksi pustaka yang ada (buku, jurnal, majalah, dan sebagainya sehingga sulit untuk menemukan buku yang ingin dicari.Oleh sebab itu, selain harus berkembang dengan penyediaan koleksi pustaka, perpustakaan harus dapat mengikuti perkembangan zaman yang ada sehingga mempermudah penggunaan layanan perpustakaan.Saat iniperpustakaan Universitas Kristen Petra memiliki perpustakaan dengan kurang lebih 230.000 koleksi fisik maupun digital (berdasarkan data 2014.Dimana daftar koleksi fisik dan dokumen digital dapat diakses melalui website perpustakaan.Adanya koleksi pustaka yang sangat banyak ini menyebabkan kesulitan pengguna dalam melakukan proses pencarian. Sehingga guna menambah fitur layanan yang diberikan maka pada penelitian ini dibuatlah sebuah aplikasi layanan search engine perpustakaan menggunakan platform Apache SOLR dan database PostgreSQL. Selain itu, guna lebih meningkatkan kemudahan akses maka aplikasi ini dibuat dengan menggunakan platform mobile device berbasis Android.Selain pengujian terhadap aplikasi dilakukan juga pengujian dengan mengedarkan kuesioner terhadap 50 calon pengguna.Dari hasil kuestioner tersebut menunjukkan bahwa fitur-fitur yang dibuat telah sesuai dengan kebutuhan pengguna (78%. Kata kunci: SOLR, Mesin Pencarian, Perpustakaan, PostgreSQL Abstract: Education is an essential requirement for people to improve their standard of living. Other than through formal education, science can also be obtained through the print media or books. Library is one important tool supporting it. Although it is useful, there are difficulties use library

Mescalero Apache Tribe Monitored Retrievable Storage (MRS)

Energy Technology Data Exchange (ETDEWEB)

Peso, F.

1992-03-13

The Nuclear Waste Policy Act of 1982, as amended, authorizes the siting, construction and operation of a Monitored Retrievable Storage (MRS) facility. The MRS is intended to be used for the temporary storage of spent nuclear fuel from the nation's nuclear power plants beginning as early as 1998. Pursuant to the Nuclear Waste Policy Act, the Office of the Nuclear Waste Negotiator was created. On October 7, 1991, the Nuclear Waste Negotiator invited the governors of states and the Presidents of Indian tribes to apply for government grants in order to conduct a study to assess under what conditions, if any, they might consider hosting an MRS facility. Pursuant to this invitation, on October 11, 1991 the Mescalero Apache Indian Tribe of Mescalero, NM applied for a grant to conduct a phased, preliminary study of the safety, technical, political, environmental, social and economic feasibility of hosting an MRS. The preliminary study included: (1) An investigative education process to facilitate the Tribe's comprehensive understanding of the safety, environmental, technical, social, political, and economic aspects of hosting an MRS, and; (2) The development of an extensive program that is enabling the Tribe, in collaboration with the Negotiator, to reach an informed and carefully researched decision regarding the conditions, (if any), under which further pursuit of the MRS would be considered. The Phase 1 grant application enabled the Tribe to begin the initial activities necessary to determine whether further consideration is warranted for hosting the MRS facility. The Tribe intends to pursue continued study of the MRS in order to meet the following objectives: (1) Continuing the education process towards a comprehensive understanding of the safety, environmental, technical, social and economic aspects of the MRS; (2) Conducting an effective public participation and information program; (3) Participating in MRS meetings.

Mescalero Apache Tribe Monitored Retrievable Storage (MRS)

International Nuclear Information System (INIS)

Peso, F.

1992-01-01

The Nuclear Waste Policy Act of 1982, as amended, authorizes the siting, construction and operation of a Monitored Retrievable Storage (MRS) facility. The MRS is intended to be used for the temporary storage of spent nuclear fuel from the nation's nuclear power plants beginning as early as 1998. Pursuant to the Nuclear Waste Policy Act, the Office of the Nuclear Waste Negotiator was created. On October 7, 1991, the Nuclear Waste Negotiator invited the governors of states and the Presidents of Indian tribes to apply for government grants in order to conduct a study to assess under what conditions, if any, they might consider hosting an MRS facility. Pursuant to this invitation, on October 11, 1991 the Mescalero Apache Indian Tribe of Mescalero, NM applied for a grant to conduct a phased, preliminary study of the safety, technical, political, environmental, social and economic feasibility of hosting an MRS. The preliminary study included: (1) An investigative education process to facilitate the Tribe's comprehensive understanding of the safety, environmental, technical, social, political, and economic aspects of hosting an MRS, and; (2) The development of an extensive program that is enabling the Tribe, in collaboration with the Negotiator, to reach an informed and carefully researched decision regarding the conditions, (if any), under which further pursuit of the MRS would be considered. The Phase 1 grant application enabled the Tribe to begin the initial activities necessary to determine whether further consideration is warranted for hosting the MRS facility. The Tribe intends to pursue continued study of the MRS in order to meet the following objectives: (1) Continuing the education process towards a comprehensive understanding of the safety, environmental, technical, social and economic aspects of the MRS; (2) Conducting an effective public participation and information program; (3) Participating in MRS meetings

Extent of early ischemic changes on computed tomography (CT) before thrombolysis: prognostic value of the Alberta Stroke Program Early CT Score in ECASS II.

Science.gov (United States)

Dzialowski, Imanuel; Hill, Michael D; Coutts, Shelagh B; Demchuk, Andrew M; Kent, David M; Wunderlich, Olaf; von Kummer, Rüdiger

2006-04-01

The significance of early ischemic changes (EICs) on computed tomography (CT) to triage patients for thrombolysis has been controversial. The Alberta Stroke Program Early CT Score (ASPECTS) semiquantitatively assesses EICs within the middle cerebral artery territory using a10-point grading system. We hypothesized that dichotomized ASPECTS predicts response to intravenous thrombolysis and incidence of secondary hemorrhage within 6 hours of stroke onset. Data from the European-Australian Acute Stroke Study (ECASS) II study were used in which 800 patients were randomized to recombinant tissue plasminogen activator (rt-PA) or placebo within 6 hours of symptom onset. We retrospectively assessed all baseline CT scans, dichotomized ASPECTS at 7, defined favorable outcome as modified Rankin Scale score 0 to 2 after 90 days, and secondary hemorrhage as parenchymal hematoma 1 (PH1) or PH2. We performed a multivariable logistic regression analysis and assessed for an interaction between rt-PA treatment and baseline ASPECTS score. We scored ASPECTS >7 in 557 and < or =7 in 231 patients. There was no treatment-by-ASPECTS interaction with dichotomized ASPECTS (P=0.3). This also applied for the 0- to 3-hour and 3- to 6-hour cohorts. However, a treatment-by-ASPECTS effect modification was seen in predicting PH (0.043 for the interaction term), indicating a much higher likelihood of thrombolytic-related parenchymal hemorrhage in those with ASPECTS < or =7. In ECASS II, the effect of rt-PA on functional outcome is not influenced by baseline ASPECTS. Patients with low ASPECTS have a substantially increased risk of thrombolytic-related PH.

The Apache Point Observatory Galactic Evolution Experiment (APOGEE)

International Nuclear Information System (INIS)

Majewski, Steven R.; Brunner, Sophia; Burton, Adam; Chojnowski, S. Drew; Pérez, Ana E. García; Hearty, Fred R.; Lam, Charles R.; Schiavon, Ricardo P.; Frinchaboy, Peter M.; Prieto, Carlos Allende; Carrera, Ricardo; Barkhouser, Robert; Bizyaev, Dmitry; Blank, Basil; Henderson, Chuck; Cunha, Kátia; Epstein, Courtney; Johnson, Jennifer A.; Fitzgerald, Greg; Holtzman, Jon A.

2017-01-01

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

The Apache Point Observatory Galactic Evolution Experiment (APOGEE)

Energy Technology Data Exchange (ETDEWEB)

Majewski, Steven R.; Brunner, Sophia; Burton, Adam; Chojnowski, S. Drew; Pérez, Ana E. García; Hearty, Fred R.; Lam, Charles R. [Department of Astronomy, University of Virginia, Charlottesville, VA 22904-4325 (United States); Schiavon, Ricardo P. [Gemini Observatory, 670 N. A’Ohoku Place, Hilo, HI 96720 (United States); Frinchaboy, Peter M. [Department of Physics and Astronomy, Texas Christian University, Fort Worth, TX 76129 (United States); Prieto, Carlos Allende; Carrera, Ricardo [Instituto de Astrofísica de Canarias, E-38200 La Laguna, Tenerife (Spain); Barkhouser, Robert [Department of Physics and Astronomy, Johns Hopkins University, Baltimore, MD 21218 (United States); Bizyaev, Dmitry [Apache Point Observatory and New Mexico State University, P.O. Box 59, Sunspot, NM, 88349-0059 (United States); Blank, Basil; Henderson, Chuck [Pulse Ray Machining and Design, 4583 State Route 414, Beaver Dams, NY 14812 (United States); Cunha, Kátia [Observatório Nacional, Rio de Janeiro, RJ 20921-400 (Brazil); Epstein, Courtney; Johnson, Jennifer A. [The Ohio State University, Columbus, OH 43210 (United States); Fitzgerald, Greg [New England Optical Systems, 237 Cedar Hill Street, Marlborough, MA 01752 (United States); Holtzman, Jon A. [New Mexico State University, Las Cruces, NM 88003 (United States); and others

2017-09-01

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

Evaluation of modified alvarado score in the diagnosis of acute appendicitis

International Nuclear Information System (INIS)

Jan, H.

2007-01-01

To evaluate Modified Alvarado Score in patients with right iliac fossa pain. One hundred consecutive patients with right right iliac fossa pain. Both male and female patients with ages >14 years were included. Basic data of all the patients was collected. They were divided into two groups on the basis of modified Alvarado score. Group-I: Alvarado score greater then 7. Group-II: Alvarado score smaller than 7. In Group-I 61 patients underwent surgery; amongst them 52 had acute appendicitis while nine had other pathology. In Group-II there were 39 patients; amongst them six underwent surgery later on because of increase in their scores during observation, all of them had acute appendicitis. The negative appendicectomy rate was 14.75% and positive predictive value 85.21%. Alvarado Score is an easy and simple complementary aid in the diagnosis of acute appendicitis. It works well in patients with a score of greater than 7. (author)

Characteristics and outcome of critically ill patients with 2009 H1N1 influenza infection in Syria

Science.gov (United States)

Alsadat, Reem; Dakak, Abdulrahman; Mazlooms, Mouna; Ghadhban, Ghasan; Fattoom, Shadi; Betelmal, Ibrahim; Abouchala, Nabil; Kherallah, Mazen

2012-01-01

Objectives: To describe the epidemiologic characteristics, clinical features, and outcome of severe cases of 2009 H1N1 influenza A infections who were admitted to the intensive care units (ICUs) in Damascus, Syria. Materials and Methods: Retrospectively, we collected clinical data on all patients who were admitted to the ICU with confirmed or suspected diagnosis of severe 2009 H1N1 influenza A with respiratory failure at 4 major tertiary care hospitals in Damascus, Syria. Acute Physiology and Chronic Health Evaluation (APACHE) II system was used to assess the severity of illness within the first 24 h after admission. The outcome was overall hospital mortality. Results: Eighty patients were admitted to the ICU with severe 2009 H1N1 infection. The mean age was 40.7 years; 69.8% of patients had ≥1 of the risk factors: asthmatics 20%, obesity 23.8%, and pregnancy 5%; and 72.5% had acute lung injury or adult respiratory distress syndrome, 12.5% had viral pneumonia, 42.5% had secondary bacterial pneumonia, and 15% had exacerbation of airflow disease. Mechanical ventilation was required in 73.7% of cases. The mean hospital length of stay was 11.7 days (median 8 days, range 0–77 days, IQR: 5–14 days). The overall mortality rate was 51% for a mean APACHE II score of 15.2 with a predicted mortality of 21% (standardized mortality ratio of 2.4, 95% confidence interval: 1.7–3.2, P value < 0.001). Conclusion: Critically ill patients with severe 2009 H1N1 infection in this limited resource country had a much higher mortality rate than the predicted APACHE II mortality rate or when compared with the reported mortality rates for severe cases in other countries during 2009 H1N1 pandemic. PMID:23210019

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

Science.gov (United States)

Chełkowski, Tadeusz; Gloor, Peter; Jemielniak, Dariusz

2016-01-01

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

Patient-related barriers to pain management: the Barriers Questionnaire II (BQ-II).

Science.gov (United States)

Gunnarsdottir, Sigridur; Donovan, Heidi S; Serlin, Ronald C; Voge, Catherine; Ward, Sandra

2002-10-01

Patients' beliefs can act as barriers to optimal management of cancer pain. The Barriers Questionnaire (BQ) is a tool used to evaluate such barriers. Here, the BQ has been revised to reflect changes in pain management practices, resulting in the Barriers Questionnaire-II (BQ-II), a 27-item, self report instrument. This paper presents the results from two studies where the psychometric properties of the BQ-II were evaluated. In the first study, the responses of 27 nurses trained in pain management were compared to responses of a convenience sample of 12 patients with cancer. The results indicated that patients with cancer had higher mean scores on the BQ-II than did nurses trained in pain management. In the second study, a convenience sample of 172 patients with cancer responded to the BQ-II and a set of pain and quality of life (QOL) measures. A factor analysis supported four factors. Factor one, physiological effects, consists of 12 items addressing the beliefs that side effects of analgesics are inevitable and unmanageable, concerns about tolerance, and concerns about not being able to monitor changes in one's body when taking strong pain medications. Factor two, Fatalism, consists of three items addressing fatalistic beliefs about cancer pain and its management. Factor three, Communication, consists of six items addressing the concern that reports of pain distract the physician from treating the underlying disease, and the belief that 'good' patients do not complain of pain. The fourth and final factor, harmful effects, consists of six items addressing fear of becoming addicted to pain medication and the belief that pain medications harm the immune system. The BQ-II total had an internal consistency of 0.89, and alpha for the subscales ranged from 0.75 to 0.85. Mean (SD) scores on the total scale was 1.52 (0.73). BQ-II scores were related to measures of pain intensity and duration, mood, and QOL. Patients who used adequate analgesics for their levels of pain had

FEASIBILITY STUDY FOR A PETROLEUM REFINERY FOR THE JICARILLA APACHE TRIBE

International Nuclear Information System (INIS)

Jones, John D.

2004-01-01

A feasibility study for a proposed petroleum refinery for the Jicarilla Apache Indian Reservation was performed. The available crude oil production was identified and characterized. There is 6,000 barrels per day of crude oil production available for processing in the proposed refinery. The proposed refinery will utilize a lower temperature, smaller crude fractionation unit. It will have a Naphtha Hydrodesulfurizer and Reformer to produce high octane gasoline. The surplus hydrogen from the reformer will be used in a specialized hydrocracker to convert the heavier crude oil fractions to ultra low sulfur gasoline and diesel fuel products. The proposed refinery will produce gasoline, jet fuel, diesel fuel, and a minimal amount of lube oil. The refinery will require about $86,700,000 to construct. It will have net annual pre-tax profit of about $17,000,000. The estimated return on investment is 20%. The feasibility is positive subject to confirmation of long term crude supply. The study also identified procedures for evaluating processing options as a means for American Indian Tribes and Native American Corporations to maximize the value of their crude oil production

Perform wordcount Map-Reduce Job in Single Node Apache Hadoop cluster and compress data using Lempel-Ziv-Oberhumer (LZO) algorithm

OpenAIRE

Mirajkar, Nandan; Bhujbal, Sandeep; Deshmukh, Aaradhana

2013-01-01

Applications like Yahoo, Facebook, Twitter have huge data which has to be stored and retrieved as per client access. This huge data storage requires huge database leading to increase in physical storage and becomes complex for analysis required in business growth. This storage capacity can be reduced and distributed processing of huge data can be done using Apache Hadoop which uses Map-reduce algorithm and combines the repeating data so that entire data is stored in reduced format. The paper ...

Association between Accessory Gene Regulator Polymorphism and Mortality among Critically Ill Patients Receiving Vancomycin for Nosocomial MRSA Bacteremia: A Cohort Study

Directory of Open Access Journals (Sweden)

Angélica Cechinel

2016-01-01

Full Text Available Background. Polymorphism of the accessory gene regulator group II (agr in methicillin-resistant Staphylococcus aureus (MRSA is predictive of vancomycin failure therapy. Nevertheless, the impact of group II agr expression on mortality of patients with severe MRSA infections is not well established. Objective. The goal of our study was to evaluate the association between agr polymorphism and all-cause in-hospital mortality among critically ill patients receiving vancomycin for nosocomial MRSA bacteremia. Methods. All patients with documented bacteremia by MRSA requiring treatment in the ICU between May 2009 and November 2011 were included in the study. Cox proportional hazards regression was performed to evaluate whether agr polymorphism was associated with all-cause in-hospital mortality. Covariates included age, APACHE II score, initial C-reactive protein plasma levels, initial serum creatinine levels, vancomycin minimum inhibitory concentration, vancomycin serum levels, and time to effective antibiotic administration. Results. The prevalence of group I and group II agr expression was 52.4% and 47.6%, respectively. Bacteremia by MRSA group III or group IV agr was not documented in our patients. The mean APACHE II of the study population was 24.3 (standard deviation 8.5. The overall cohort mortality was 66.6% (14 patients. After multivariate analysis, initial plasma C-reactive protein levels (P=0.01, initial serum creatinine levels (P=0.008, and expression of group II agr (P=0.006 were positively associated with all-cause in-hospital mortality. Patients with bacteremia by MRSA with group II agr expression had their risk of death increased by 12.6 times when compared with those with bacteremia by MRSA with group I agr expression. Conclusion. Group II agr polymorphism is associated with an increase in mortality in critically ill patients with bacteremia by MRSA treated with vancomycin.

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

Science.gov (United States)

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

2015-11-01

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

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

Science.gov (United States)

2016-01-01

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

The Effect of Lactate, Albumin, C-reactive Protein, PaO2/FiO2 and Glucose Levels of Trauma Patients at the Time of Administration to Intensive Care

Directory of Open Access Journals (Sweden)

Eren Yılmaz

2014-12-01

Full Text Available Objective: Blood analyses are preferred in the observation of cases requiring intensive care unit (ICU following a trauma. The purpose of this study was to examine the relationship of albumin, C-reactive protein (CRP, PaO2/FiO2 and glucose levels of trauma patients at time of admission with mortality. Material and Method: The patients who were admitted into ICU following a trauma between the years of 2010 and 2012 were retrospectively evaluated. 200 trauma cases were included in the study. Their demographic data, APACHE II scores, Glasgow Coma Scales (GCS, and arterial blood gas in the lactate and PaO2/FiO2 ratio, CRP, glucose and albumin levels in the first collected arterial blood gas, as well as, the presence of thoracic, cardiac, renal, abdominal and head trauma, length of ICU stay and mortality were recorded. Results: Of the patients included in the study 84% were male, with an average age of 38.3 and an average APACHE II score of 16.6. 64% suffered from head trauma and the average GCS was calculated to be 11.2. The patients were observed in the ICU for an average of 18.7 days and the rate of mortality was 33.5%. GCS, PaO2/FiO2, age and elevated lactate levels increased mortality as independent risk factors. Conclusion: It has been concluded that parameters like age and the first GCS, lactate, glucose, albumin and PaO2/FiO2 at time of acceptance into the ICU were found to be related with mortality.

Pharmacologic management of constipation in the critically ill patient.

Science.gov (United States)

Patanwala, Asad E; Abarca, Jacob; Huckleberry, Yvonne; Erstad, Brian L

2006-07-01

To compare the effectiveness of common laxatives in producing a bowel movement in patients admitted to a medical intensive care unit (MICU). Retrospective medical record review. MICU of an academic medical center. Ninety-five patients admitted to the MICU from July 1-October 31, 2004. Fifty patients satisfied the inclusion criteria. Patient-specific data such as age, weight, sex, length of MICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score, dietary intake, opioid intake, laxative intake, and bowel movements were recorded during the first 96 hours of admission. Logistic regression analysis was used to compare patients who did and did not have a bowel movement. Of the 50 patients, 25 did not have a bowel movement during the first 96 hours of MICU admission. Patients given a stimulant laxative (senna, bisacodyl) and/or an osmotic laxative (lactulose, milk of magnesia) were more likely to have a bowel movement (odds ratio [OR] 26.6, 95% confidence interval [CI] 3.2-221, p=0.002). Opioid intake, expressed as logarithmic morphine equivalents, was negatively associated with occurrence of a bowel movement (OR 0.76, 95% CI 0.59-0.97, p=0.027). Disease severity, as determined by APACHE II score, was also negatively associated with a bowel movement (OR 0.84, 95% CI 0.7-0.99, p=0.04). Critically ill patients have a high frequency of constipation, and opioid therapy is a significant risk factor. Routine administration of stimulant or osmotic laxatives should be considered for this patient population.

[Combination of NAFLD Fibrosis Score and liver stiffness measurement for identification of moderate fibrosis stages (II & III) in non-alcoholic fatty liver disease].

Science.gov (United States)

Drolz, Andreas; Wehmeyer, Malte; Diedrich, Tom; Piecha, Felix; Schulze Zur Wiesch, Julian; Kluwe, Johannes

2018-01-01

Non-alcoholic fatty liver disease (NAFLD) has become one of the most frequent causes of chronic liver disease. Currently, therapeutic options for NAFLD patients are limited, but new pharmacologic agents are being investigated in the course of clinical trials. Because most of these studies are focusing on patients with fibrosis stages II and III (according to Kleiner), non-invasive identification of patients with intermediate fibrosis stages (II and III) is of increasing interest. Evaluation of NAFLD Fibrosis Score (NFS) and liver stiffness measurement (LSM) for prediction of fibrosis stages II/III. Patients with histologically confirmed NAFLD diagnosis were included in the study. All patients underwent a clinical and laboratory examination as well as a LSM prior to liver biopsy. Predictive value of NFS and LSM with respect to identification of fibrosis stages II/III was assessed. 134 NAFLD patients were included and analyzed. Median age was 53 (IQR 36 - 60) years, 55 patients (41 %) were female. 82 % of our patients were overweight/obese with typical aspects of metabolic syndrome. 84 patients (66 %) had liver fibrosis, 42 (50 %) advanced fibrosis. LSM and NFS correlated with fibrosis stage (r = 0.696 and r = 0.685, respectively; p stages II/III. If both criteria were met, probability of fibrosis stage II/III was 61 %. If none of the two criteria was met, chance for fibrosis stage II/III was only 6 % (negative predictive value 94 %). Combination of LSM and NFS enables identification of patients with significant probability of fibrosis stage II/III. Accordingly, these tests, especially in combination, may be a suitable screening tool for fibrosis stages II/III in NAFLD. The use of these non-invasive methods might also help to avoid unnecessary biopsies. © Georg Thieme Verlag KG Stuttgart · New York.

Evaluation of nutrition deficits in adult and elderly trauma patients.

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Wade, Charles E; Kozar, Rosemary A; Dyer, Carmel B; Bulger, Eileen M; Mourtzakis, Marina; Heyland, Daren K

2015-05-01

As metabolism is often escalated following injury, severely injured trauma patients are at risk for underfeeding and adverse outcomes. From an international database of 12,573 critically ill, adult mechanically ventilated patients, who received a minimum of 3 days of nutrition therapy, trauma patients were identified and nutrition practices and outcomes compared with nontrauma patients. Within the trauma population, we compared nutrition practices and outcomes of younger vs older patients. There were 1279 (10.2%) trauma patients. They were younger, were predominantly male, had lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and had an overall lower body mass index compared with nontrauma patients. Eighty percent of trauma patients received enteral feeding compared with 78% of nontrauma patients. Trauma patients were prescribed more calories and protein yet received similar amounts as nontrauma patients. Nutrition adequacy was reduced in both trauma and nontrauma patients. Survival was higher in trauma patients (86.6%) compared with nontrauma patients (71.8%). When patients who died were included as never discharged, trauma patients were more rapidly discharged from the intensive care unit (ICU) and hospital. Within the trauma population, 17.5% were elderly (≥65 years). The elderly had increased days of ventilation, ICU stay, and mortality compared with younger trauma patients. In a multivariable model, age and APACHE II score, but not nutrition adequacy, were associated with time to discharge alive from the hospital. Significant nutrition deficits were noted in all patients. Elderly trauma patients have worse outcomes compared with younger patients. Further studies are necessary to evaluate whether increased nutrition intake can improve the outcomes of trauma patients, especially geriatric trauma patients. © 2014 American Society for Parenteral and Enteral Nutrition.

The pharmacokinetics of enteral antituberculosis drugs in patients requiring intensive care.

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Koegelenberg, C F N; Nortje, A; Lalla, U; Enslin, A; Irusen, E M; Rosenkranz, B; Seifart, H I; Bolliger, C T

2013-04-05

There is a paucity of data on the pharmacokinetics of fixed-dose combination enteral antituberculosis treatment in critically ill patients. To establish the pharmacokinetic profile of a fixed-dose combination of rifampicin, isoniazid, pyrazinamide and ethambutol given according to weight via a nasogastric tube to patients admitted to an intensive care unit (ICU). We conducted a prospective, observational study on 10 patients (mean age 32 years, 6 male) admitted to an ICU and treated for tuberculosis (TB). Serum concentrations of the drugs were determined at eight predetermined intervals over 24 hours by means of high-performance liquid chromatography. The therapeutic maximum plasma concentration (Cmax) for rifampicin at time to peak concentration was achieved in only 4 patients, whereas 2 did not achieve therapeutic Cmax for isoniazid. No patient reached sub-therapeutic Cmax for pyrazinamide (6 were within and 4 above therapeutic range). Three patients reached sub-therapeutic Cmax for ethambutol, and 6 patients were within and 1 above the therapeutic range. Patients with a sub-therapeutic rifampicin level had a higher mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p=0.03) and a lower estimated glomerular filtration rate (GFR) (p=0.03). A fixed-dose combination tablet, crushed and mixed with water, given according to weight via a nasogastric tube to patients with TB admitted to an ICU resulted in sub-therapeutic rifampicin plasma concentrations in the majority of patients, whereas the other drugs had a more favourable pharmacokinetic profile. Patients with a sub-therapeutic rifampicin concentration had a higher APACHE II score and a lower estimated GFR, which may contribute to suboptimal outcomes in critically ill patients. Studies in other settings have reported similar proportions of patients with 'sub-therapeutic' rifampicin concentrations.

Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitors and/or histamine II receptor blockers.

Science.gov (United States)

Grindlinger, Gene A; Cairo, Sarah B; Duperre, Carole B

2016-12-01

Ventilator-associated pneumonia (VAP) is a common cause of infectious morbidity and mortality in the intensive care unit (ICU). The type of stress-ulcer prophylaxis (SUP) given to ventilated patients may, in part, be responsible. We observed an increase in VAP as ventilator bundle compliance increased and a decrease in VAP when bundle compliance decreased. We reasoned that SUP which raises gastric pH such as proton-pump inhibitors (PPIs) and histamine II (H2) receptor antagonists as opposed to SUP which does not raise pH such as sucralfate (S) may be responsible and also may alter the causative bacteria. This is a single-center retrospective cohort analysis of all intubated, adult surgical patients admitted to the surgical ICU between January and June during the 3-y period 2012-2014. Demographics, APACHE II, Injury Severity Score, VAP occurrence, culprit bacteria, ventilator days, and ICU days were recorded based on the type of SUP given. There were 45 instances of VAP in the 504 study patients, 33 in the PPI/H2 group, and 12 in the S group (P < 0.01). VAP per 1000 ventilator days were 10.2 for PPI/H2 and 3.7 for S (P < 0.01). Culprit bacteria were mostly Pseudomonas, gram-negative bacilli, and methicillin-resistant Staphylococcus aureus in PPI/H2 patients (n = 29) compared with oropharyngeal flora in S patients (n = 6; P < 0.001). There was a substantial difference in VAP occurrence and in the culprit bacteria between S and PPI/H2 treated patients due perhaps to gastric alkalization. Copyright © 2016 Elsevier Inc. All rights reserved.

THE DATA REDUCTION PIPELINE FOR THE APACHE POINT OBSERVATORY GALACTIC EVOLUTION EXPERIMENT

International Nuclear Information System (INIS)

Nidever, David L.; Holtzman, Jon A.; Prieto, Carlos Allende; Mészáros, Szabolcs; Beland, Stephane; Bender, Chad; Desphande, Rohit; Bizyaev, Dmitry; Burton, Adam; García Pérez, Ana E.; Hearty, Fred R.; Majewski, Steven R.; Skrutskie, Michael F.; Sobeck, Jennifer S.; Wilson, John C.; Fleming, Scott W.; Muna, Demitri; Nguyen, Duy; Schiavon, Ricardo P.; Shetrone, Matthew

2015-01-01

The Apache Point Observatory Galactic Evolution Experiment (APOGEE), part of the Sloan Digital Sky Survey III, explores the stellar populations of the Milky Way using the Sloan 2.5-m telescope linked to a high resolution (R ∼ 22,500), near-infrared (1.51–1.70 μm) spectrograph with 300 optical fibers. For over 150,000 predominantly red giant branch stars that APOGEE targeted across the Galactic bulge, disks and halo, the collected high signal-to-noise ratio (>100 per half-resolution element) spectra provide accurate (∼0.1 km s −1 ) RVs, stellar atmospheric parameters, and precise (≲0.1 dex) chemical abundances for about 15 chemical species. Here we describe the basic APOGEE data reduction software that reduces multiple 3D raw data cubes into calibrated, well-sampled, combined 1D spectra, as implemented for the SDSS-III/APOGEE data releases (DR10, DR11 and DR12). The processing of the near-IR spectral data of APOGEE presents some challenges for reduction, including automated sky subtraction and telluric correction over a 3°-diameter field and the combination of spectrally dithered spectra. We also discuss areas for future improvement

Detection of attack-targeted scans from the Apache HTTP Server access logs

Directory of Open Access Journals (Sweden)

Merve Baş Seyyar

2018-01-01

Full Text Available A web application could be visited for different purposes. It is possible for a web site to be visited by a regular user as a normal (natural visit, to be viewed by crawlers, bots, spiders, etc. for indexing purposes, lastly to be exploratory scanned by malicious users prior to an attack. An attack targeted web scan can be viewed as a phase of a potential attack and can lead to more attack detection as compared to traditional detection methods. In this work, we propose a method to detect attack-oriented scans and to distinguish them from other types of visits. In this context, we use access log files of Apache (or ISS web servers and try to determine attack situations through examination of the past data. In addition to web scan detections, we insert a rule set to detect SQL Injection and XSS attacks. Our approach has been applied on sample data sets and results have been analyzed in terms of performance measures to compare our method and other commonly used detection techniques. Furthermore, various tests have been made on log samples from real systems. Lastly, several suggestions about further development have been also discussed.

THE DATA REDUCTION PIPELINE FOR THE APACHE POINT OBSERVATORY GALACTIC EVOLUTION EXPERIMENT

Energy Technology Data Exchange (ETDEWEB)

Nidever, David L. [Department of Astronomy, University of Michigan, Ann Arbor, MI 48109 (United States); Holtzman, Jon A. [New Mexico State University, Las Cruces, NM 88003 (United States); Prieto, Carlos Allende; Mészáros, Szabolcs [Instituto de Astrofísica de Canarias, Via Láctea s/n, E-38205 La Laguna, Tenerife (Spain); Beland, Stephane [Laboratory for Atmospheric and Space Sciences, University of Colorado at Boulder, Boulder, CO (United States); Bender, Chad; Desphande, Rohit [Department of Astronomy and Astrophysics, The Pennsylvania State University, University Park, PA 16802 (United States); Bizyaev, Dmitry [Apache Point Observatory and New Mexico State University, P.O. Box 59, sunspot, NM 88349-0059 (United States); Burton, Adam; García Pérez, Ana E.; Hearty, Fred R.; Majewski, Steven R.; Skrutskie, Michael F.; Sobeck, Jennifer S.; Wilson, John C. [Department of Astronomy, University of Virginia, Charlottesville, VA 22904-4325 (United States); Fleming, Scott W. [Computer Sciences Corporation, 3700 San Martin Dr, Baltimore, MD 21218 (United States); Muna, Demitri [Department of Astronomy and the Center for Cosmology and Astro-Particle Physics, The Ohio State University, Columbus, OH 43210 (United States); Nguyen, Duy [Department of Astronomy and Astrophysics, University of Toronto, Toronto, Ontario, M5S 3H4 (Canada); Schiavon, Ricardo P. [Gemini Observatory, 670 N. A’Ohoku Place, Hilo, HI 96720 (United States); Shetrone, Matthew, E-mail: dnidever@umich.edu [University of Texas at Austin, McDonald Observatory, Fort Davis, TX 79734 (United States)

2015-12-15

The Apache Point Observatory Galactic Evolution Experiment (APOGEE), part of the Sloan Digital Sky Survey III, explores the stellar populations of the Milky Way using the Sloan 2.5-m telescope linked to a high resolution (R ∼ 22,500), near-infrared (1.51–1.70 μm) spectrograph with 300 optical fibers. For over 150,000 predominantly red giant branch stars that APOGEE targeted across the Galactic bulge, disks and halo, the collected high signal-to-noise ratio (>100 per half-resolution element) spectra provide accurate (∼0.1 km s{sup −1}) RVs, stellar atmospheric parameters, and precise (≲0.1 dex) chemical abundances for about 15 chemical species. Here we describe the basic APOGEE data reduction software that reduces multiple 3D raw data cubes into calibrated, well-sampled, combined 1D spectra, as implemented for the SDSS-III/APOGEE data releases (DR10, DR11 and DR12). The processing of the near-IR spectral data of APOGEE presents some challenges for reduction, including automated sky subtraction and telluric correction over a 3°-diameter field and the combination of spectrally dithered spectra. We also discuss areas for future improvement.

Evaluation of the predictors for duration of mechanical ventilation in respiratory intensive care unit

Directory of Open Access Journals (Sweden)

Hira H

2006-01-01

Full Text Available Background: Mechanical ventilation (MV is a life saving modality. Till no method is evolved to predict the duration of this treatment. This study is undertaken to evaluate the clinical and laboratory parameters at initiation and 48 hour of the patient being treated by mechanical ventilation; and correlate these parameters with the duration of MV required. Methods: It was prospective observational study conducted in the respiratory intensive care unit (RICU of a tertiary referral and teaching hospital. Thirty consecutive patients suffering from various medical diseases requiring MV were the participants. Clinical, laboratory, ventilatory parameters and six severity scores viz.; GCS, APACHE-II, SAPS, OSF, ALI/ARDS and Sepsis/Septic shock criteria of each patient, both at initiation and at 48 hour of MV were recorded. Correlation between various severity scores at initiation and at 48 hour of initiation with duration of mechanical ventilation was computed. Results: Based on the duration of mechanical ventilation required, the patients were divided in two groups. Those requiring mechanical ventilation < 7 days and> 7 days were designated Group I and Group II respectively. Three out of 6 severity scores (GCS, APACHE-II, SAPS recorded at 48 hour of MV showed statistically significant difference between the both groups with p value of 0.010, 0.009 and 0.006 respectively. Further stepwise logistic regression analysis showed that SAPS score at 48 hour of initiation was the best predictor of duration of MV. It was found that a cut off value of 15 for SAPS score at 48 hour might predict the duration of MV i.e. < 7days or> 7 days. Based on linear regression analysis a simple equation was formulated by putting the SAPS value at 48 hour, the value of Y was computed. If MV required was less than 7 days, the value of Y was more than - 0.172 and if need of mechanical ventilation was more than 7 days, Y was less than -0.1720. Conclusions: For patients requiring

Soluble CD163 is increased in patients with acute pancreatitis independent of disease severity.

Science.gov (United States)

Karrasch, Thomas; Brünnler, Tanja; Hamer, Okka W; Schmid, Karin; Voelk, Markus; Herfarth, Hans; Buechler, Christa

2015-10-01

Macrophages are crucially involved in the pathophysiology of acute pancreatitis. Soluble CD163 (sCD163) is specifically released from macrophages and systemic levels are increased in inflammatory diseases. Here, sCD163 was measured in serum of 50 patients with acute pancreatitis to find out possible associations with disease activity. Admission levels of systemic sCD163 were nearly three-fold higher in patients with acute pancreatitis compared to controls. In patients sCD163 did not correlate with C-reactive protein and leukocyte count as established markers of inflammation. Levels were not associated with disease severity assessed by the Schroeder score, Balthazar score, Acute Physiology, Age, and Chronic Health Evaluation (Apache) II score and peripancreatic necrosis score. Soluble CD163 was not related to complications of acute pancreatitis. These data show that serum sCD163 is increased in acute pancreatitis indicating activation of macrophages but is not associated with disease severity and outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

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

Energy Technology Data Exchange (ETDEWEB)

Efroymson, R.A.

2002-05-09

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

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

International Nuclear Information System (INIS)

Efroymson, R.A.

2002-01-01

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

Effect of sodium bicarbonate administration on mortality in patients with lactic acidosis: a retrospective analysis.

Directory of Open Access Journals (Sweden)

Hyun Jeong Kim

Full Text Available BACKGROUND: Lactic acidosis is a common cause of high anion gap metabolic acidosis. Sodium bicarbonate may be considered for an arterial pH <7.15 but paradoxically depresses cardiac performance and exacerbates acidosis by enhancing lactate production. This study aimed to evaluate the cause and mortality rate of lactic acidosis and to investigate the effect of factors, including sodium bicarbonate use, on death. METHODS: We conducted a single center analysis from May 2011 through April 2012. We retrospectively analyzed 103 patients with lactic acidosis among 207 patients with metabolic acidosis. We used SOFA and APACHE II as severity scores to estimate illness severity. Multivariate logistic regression analysis and Cox regression analysis models were used to identify factors that affect mortality. RESULTS: Of the 103 patients with a mean age of 66.1±11.4 years, eighty-three patients (80.6% died from sepsis (61.4%, hepatic failure, cardiogenic shock and other causes. The percentage of sodium bicarbonate administration (p = 0.006, catecholamine use, ventilator care and male gender were higher in the non-survival group than the survival group. The non-survival group had significantly higher initial and follow-up lactic acid levels, lower initial albumin, higher SOFA scores and APACHE II scores than the survival group. The mortality rate was significantly higher in patients who received sodium bicarbonate. Sodium bicarbonate administration (p = 0.016 was associated with higher mortality. Independent factors that affected mortality were SOFA score (Exp (B = 1.72, 95% CI = 1.12-2.63, p = 0.013 and sodium bicarbonate administration (Exp (B = 6.27, 95% CI = 1.10-35.78, p = 0.039. CONCLUSIONS: Lactic acidosis, which has a high mortality rate, should be evaluated in patients with metabolic acidosis. In addition, sodium bicarbonate should be prescribed with caution in the case of lactic acidosis because sodium bicarbonate

Is 'subthreshold' bipolar II disorder more difficult to differentiate from borderline personality disorder than formal bipolar II disorder?

Science.gov (United States)

Bayes, Adam; Graham, Rebecca K; Parker, Gordon B; McCraw, Stacey

2018-06-01

Recent research indicates that borderline personality disorder (BPD) can be diagnostically differentiated from the bipolar disorders. However, no studies have attempted to differentiate participants with sub-threshold bipolar disorder or SubT BP (where hypomanic episodes last less than 4 days) from those with a BPD. In this study, participants were assigned a SubT BP, bipolar II disorder (BP II) or BPD diagnosis based on clinical assessment and DSM-IV criteria. Participants completed self-report measures and undertook a clinical interview which collected socio-demographic information, a mood history, family history, developmental history, treatment information, and assessed cognitive, emotional and behavioural functioning. Both bipolar groups, whether SubT BP or BP II, differed to the BPD group on a number of key variables (i.e. developmental trauma, depression correlates, borderline personality scores, self-harm and suicide attempts), and compared to each other, returned similar scores on nearly all key variables. Borderline risk scores resulted in comparable classification rates of 0.74 (for BPD vs BP II) and 0.82 (for BPD vs sub-threshold BP II). Study findings indicate that both SubT BP and BP II disorder can be differentiated from BPD on a set of refined clinical variables with comparable accuracy. Copyright © 2018 Elsevier B.V. All rights reserved.

Corelation among clinical, biochemical and tomographic criteria in order to evaluate the severity in acute pancreatitis Correlación entre criterios clínicos, bioquímicos y tomográficos para evaluar la gravedad de la pancreatitis aguda

Directory of Open Access Journals (Sweden)

L. A. Lujano-Nicolás

2010-06-01

Full Text Available Background: the acute pancreatitis is an inflammatory process that may involve peripancreatic tissue and distant organs. According to the Atlanta criteria, in 10 to 20% of the patients the disease is severe. Nowadays there are different clinical and biochemical severity scales such as the Ranson, APACHE-II (Acute Physiology and Chronic Health Evaluation and hematocrit, which have discrepancies when being compared to tomographic scales such as the Balthazar. There exist few studies that correlate these parameters. Objective: to evaluate the severity of the acute pancreatitis according to the Ranson, APACHE-II and serous hematocrit criteria at the moment of admission of the patient and correlate these scales with the local pancreatic complications according to the Balthazar classification. Patients and method: retrospective, observational and analytic study. There were included patients of any gender above the age of 18, with diagnosis of acute pancreatitis of any etiology, who had performed an abdominal tomography 72 hours after the beginning of the clinical condition in order to stage the pancreatic damage. The diagnosis of acute pancreatitis was established with 2 of the 3 following criteria: a characteristic abdominal pain; b uprising of the amylase and/or lipase more than 3 times above the superior normal limit; and c characteristic finds of acute pancreatitis in the computed tomography. In order to make the correlation, the Pearson or the Spearman tests were used according to the distribution of the variables. Results: there were included 28 patients (21 masculine, 75%. The most frequent etiology was due to alcohol (53.6%, bile (21.4% and hypertriglyceridemia (17.9%. The age average was 38.1 years old. Fifty per cent of the patients had acute severe pancreatitis according to the Atlanta criteria. Of the patients with APACHE-II less than 8 points, 62.5% were classified according to the Balthazar tomographic scale as D or E degree. Ninety

[Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit].

Science.gov (United States)

Topçu, Ismet; Ekici, Zeynep; Sakarya, Melek

2007-07-01

The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma. Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine. There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1+/-1.6 and 9.2+/-1.7) and the number of rib fractures (4+/-1.1 and 6.8+/-2.7) were higher in thoracic epidural analgesia group (pPain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (prib fractures who require intensive care.

Significance of appetite hormone ghrelin and obestatin levels in the assessment of the severity of acute pancreatitis.

Science.gov (United States)

Kanat, Burhan Hakan; Ayten, Refik; Aydın, Süleyman; Girgin, Mustafa; Cetinkaya, Ziya; Ilhan, Yavuz Selim; Yur, Mesut; Catak, Zekiye

2014-06-01

Due to risk of morbidity and mortality, various tests and scoring systems used in the assessment of the diagnosis and severity of acute pancreatitis disease are gaining more importance every day. Most of the current scoring systems, validated by various parameters, have a sophisticated and complex structure. Research is ongoing to establish a method to diagnose the disease and determine the severity by using different and simple parameters. In this trial, we aimed to investigate the role of the orexigenic "ghrelin" and anorexigenic "obestatin" hormones, if any, on the diagnosis and assessment of the severity of acute pancreatitis. A total of 30 patients hospitalized between September 2009 and September 2010 with a diagnosis of acute pancreatitis (AP) and 25 healthy volunteers were enrolled in the trial with a prospective and randomized design. The patients were classified in two groups, mild (Ranson ≤3 and / or Apache II ≤8) and severe (Ranson >3 and/or Apache II >8) cases, as per the Ranson and Apache-II criteria; the ghrelin and obestatin levels in blood samples obtained from the patients were measured using the ELISA method. Twenty-two of the 30 patients (73%) were regarded as mild pancreatitis cases, while 8 cases (27%) were diagnosed as severe pancreatitis. Comparison of the mild and severe pancreatitis groups did not reveal a statistical difference between the two groups in terms of acylated and de-acylated ghrelin values on presentation and following the initiation of oral feeding. Similarly, no significant difference was found in the comparison of the patient and the control groups in terms of acylated and de-acylated ghrelin values on presentation (p=0.863). On the other hand, acylated and de-acylated ghrelin values after initiation of oral feeding were observed to be higher in the patient group (p=0.001, p=0.000). Comparison of these two groups revealed a significant difference in obestatin values, both on presentation and after initiation of oral

The Effect of a Monocular Helmet-Mounted Display on Aircrew Health: A Longitudinal Cohort Study of Apache AH Mk 1 Pilots -(Vision and Handedness)

Science.gov (United States)

2015-05-19

the day, night, and in adverse weather through the use of nose-mounted, forward-looking infrared (FLIR) pilotage and targeting sensors that provide a...sensor video and/or symbology to each crewmember via a helmet display unit (HDU). The HDU contains a 1-inch (in.) diameter cathode ray tube (CRT...American Association for Pediatric Ophthalmology and Strabismus, 12(4): 365–369. Sale, D. F., and Lund, G. J. 1993. AH-64 Apache program update

Características de pacientes com DPOC internados em UTI de um hospital de referência para doenças respiratórias no Brasil Characteristics of COPD patients admitted to the ICU of a referral hospital for respiratory diseases in Brazil

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Mariângela Pimentel Pincelli

2011-04-01

ópolis, Brazil, between October of 2006 and October of 2007. Data related to demographics, causes of hospitalization, pharmacological treatment, ventilatory support, length of hospital stay, in-hospital complications, ICU mortality, and 28-day mortality were obtained from the medical charts of the patients. Acute Physiology and Chronic Health Evaluation II (APACHE II scores were calculated. Mortality at 18 months was assessed by subsequent telephone calls. RESULTS: During the study period, 192 patients were admitted to the ICU, 24 (12.5% of whom were diagnosed with respiratory failure and COPD. The mean length of ICU stay was 12.0 ± 11.1 days. Noninvasive ventilation was used in 10 of the 24 patients (41.66% and failed in 5 of those 10. Invasive mechanical ventilation (IMV was used in a total of 15 patients (62.5%. Overall ICU mortality and 28-day mortality were 20.83% and 33.33%, respectively. However, 18-month mortality was 62.5%. CONCLUSIONS: Respiratory failure associated with COPD was responsible for 12.5% of the ICU admissions. Orotracheal intubation and IMV were necessary in 62.5% of the cases. The ICU mortality rate was in accordance with that predicted by the APACHE II scores. However, late mortality was high.

Characteristics and Outcomes of Patients Readmitted to The Medical Intensive Care Unit: A Retrospective Study in a Tertiary Hospital in Taiwan

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Ching-Lung Liu

2017-12-01

Conclusion: Readmitted ICU patients, especially the geriatric group, had a very poor prognosis. The worsened APACHE score might be a good predictor for readmission survival. The Charlson score was an important hospital survival predictor.

High mortality from respiratory failure secondary to swine-origin influenza A (H1N1) in South Africa.

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Koegelenberg, C F N; Irusen, E M; Cooper, R; Diacon, A H; Taljaard, J J; Mowlana, A; von Groote-Bidlingmaier, F; Bolliger, C T

2010-05-01

The novel influenza A (H1N1) pandemic affected South Africa late during the 2009 Southern hemisphere winter and placed an extra burden on a health care system already dealing with a high prevalence of chronic lung diseases and human immunodeficiency virus (HIV) infection. The aim of this study was to describe the epidemiological characteristics, clinical features, management and outcomes of patients with confirmed influenza A (H1N1) infection complicated by respiratory failure. We included all adult patients with confirmed influenza A (H1N1) infection that were referred to the medical intensive care unit of a large academic hospital in Cape Town for ventilatory support in this prospective observational study. A total of 19 patients (39.5 +/- 14.8 years) needed ventilatory support over a 6-week period. Of these, 15 were female and 16 had identifiable risk factors for severe disease, including pregnancy (n = 6), type 2 diabetes mellitus (n = 6), obesity (n = 4), HIV infection (n = 3), immunosuppressive therapy (n = 3) and active pulmonary tuberculosis (n = 2). The most frequent complications were acute renal failure (n = 13), acute respiratory distress syndrome (n = 12) and ventilator associated pneumonia (n = 10). Thirteen patients died (mortality: 68.4%). Fatal cases were significantly associated with an APACHE II score >or=20 (P = 0.034), but not with a P(a)O(2)/F(I)O(2) or=12 (P = 0.134). The majority of patients with respiratory failure secondary to influenza A (H1N1) infection were young females and had an underlying risk factor for severe disease. The condition had a high mortality, particularly amongst patients with an APACHE II score >or=20.

Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011).

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Olaechea, P M; Álvarez-Lerma, F; Palomar, M; Gimeno, R; Gracia, M P; Mas, N; Rivas, R; Seijas, I; Nuvials, X; Catalán, M

2016-05-01

To describe the case-mix of patients admitted to intensive care units (ICUs) in Spain during the period 2006-2011 and to assess changes in ICU mortality according to severity level. Secondary analysis of data obtained from the ENVN-HELICS registry. Observational prospective study. Spanish ICU. Patients admitted for over 24h. None. Data for each of the participating hospitals and ICUs were recorded, as well as data that allowed to knowing the case-mix and the individual outcome of each patient. The study period was divided into two intervals, from 2006 to 2008 (period 1) and from 2009 to 2011 (period 2). Multilevel and multivariate models were used for the analysis of mortality and were performed in each stratum of severity level. The study population included 142,859 patients admitted to 188 adult ICUs. There was an increase in the mean age of the patients and in the percentage of patients >79 years (11.2% vs. 12.7%, P<0.001). Also, the mean APACHE II score increased from 14.35±8.29 to 14.72±8.43 (P<0.001). The crude overall intra-UCI mortality remained unchanged (11.4%) but adjusted mortality rate in patients with APACHE II score between 11 and 25 decreased modestly in recent years (12.3% vs. 11.6%, odds ratio=0.931, 95% CI 0.883-0.982; P=0.008). This study provides observational longitudinal data on case-mix of patients admitted to Spanish ICUs. A slight reduction in ICU mortality rate was observed among patients with intermediate severity level. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Dynamic changes in amino acid concentration profiles in patients with sepsis.

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Longxiang Su

Full Text Available The goal of this work was to explore the dynamic concentration profiles of 42 amino acids and the significance of these profiles in relation to sepsis, with the aim of providing guidance for clinical therapies.Thirty-five critically ill patients with sepsis were included. These patients were further divided into sepsis (12 cases and severe sepsis (23 cases groups or survivor (20 cases and non-survivor (15 cases groups. Serum samples from the patients were collected on days 1, 3, 5, 7, 10, and 14 following intensive care unit (ICU admission, and the serum concentrations of 42 amino acids were measured.The metabolic spectrum of the amino acids changed dramatically in patients with sepsis. As the disease progressed further or with poor prognosis, the levels of the different amino acids gradually increased, decreased, or fluctuated over time. The concentrations of sulfur-containing amino acids (SAAs, especially taurine, decreased significantly as the severity of sepsis worsened or with poor prognosis of the patient. The serum concentrations of SAAs, especially taurine, exhibited weak negative correlations with the Sequential Organ Failure Assessment (SOFA (r=-0.319 and Acute Physiology and Chronic Health Evaluation (APACHE II (r=-0.325 scores. The areas under the receiver operating characteristic curves of cystine, taurine, and SAA levels and the SOFA and APACHE II scores, which denoted disease prognosis, were 0.623, 0.674, 0.678, 0.86, and 0.857, respectively.Critically ill patients with disorders of amino acid metabolism, especially of SAAs such as cystine and taurine, may provide an indicator of the need for the nutritional support of sepsis in the clinic.ClinicalTrial.gov identifier NCT01818830.

Variants in LTA, TNF, IL1B and IL10 genes associated with the clinical course of sepsis.

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Montoya-Ruiz, Carolina; Jaimes, Fabián A; Rugeles, Maria T; López, Juan Álvaro; Bedoya, Gabriel; Velilla, Paula A

2016-12-01

The aim of this study was to explore the association between some SNPs of the TNF, LTA, IL1B and IL10 genes with cytokine concentrations and clinical course in Colombian septic patients. We conducted a cross-sectional study to genotype 415 septic patients and 205 patients without sepsis for the SNPs -308(G/A) rs1800629 of TNF; +252 (G/A) rs909253 of LTA; -511(A/G) rs16944 and +3953(C/T) rs1143634 of IL1B; and -1082(A/G) rs1800896, -819(C/T) rs1800871 and -592(C/A) rs1800872 of IL10. The association of theses SNPs with the following parameters was evaluated: (1) the presence of sepsis; (2) severity and clinical outcomes; (3) APACHE II and SOFA scores; and (4) procalcitonin, C-reactive protein, tumor necrosis factor, lymphotoxin alpha, interleukin 1 beta and interleukin 10 plasma concentrations. We found an association between the SNP LTA +252 with the development of sepsis [OR 1.29 (1.00-1.68)]; the SNP IL10 -1082 with sepsis severity [OR 0.53 (0.29-0.97)]; the TNF -308 with mortality [OR 0.33 (0.12-0.95)]; and the IL10 -592 and IL10 -1082 with admission to the intensive care unit (ICU) [OR 3.36 (1.57-7.18)] and [OR 0.18 (0.04-0.86)], respectively. None of the SNPs were associated with cytokine levels, procalcitonin and C-reactive protein serum concentrations, nor with APACHE II and SOFA scores. Our results suggest that these genetic variants play an important role in the development of sepsis and its clinical course.

Recombinant human interleukin-11 (IL-11) is a protective factor in severe sepsis with thrombocytopenia: A case-control study.

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Wan, Bing; Zhang, Hao; Fu, Haiyan; Chen, Yikun; Yang, Liping; Yin, Jiangtao; Wan, Yin; Shi, Yongqing

2015-12-01

To examine the platelet recovering and anti-inflammatory effects of IL-11 in the treatment of sepsis, accompanied with thrombocytopenia and to investigate the associated mechanisms via a case-control study. 105 patients enrolled for the study were segregated into (1) IL-11 therapy group and (2) conventional therapy group. The IL-11 therapy group was given additional recombinant human IL-11 treatment. Laboratory examinations of IL-11, IL-6, TNF-α, PT, APTT, WBC, PLT counts in blood routine assays and PCT, CRP and APACHE II scores were performed and the results were recorded. The PLT counts in the IL-11 therapy group were higher than those in the conventional therapy group. No obvious difference in WBC counts or CRP levels was observed between the two groups. The highest levels of TNF-α were observed on day 3 in the conventional therapy group while it was observed on day 1 in the IL-11 therapy group, both of which subsequently declined gradually. The level of IL-6 was significantly lower in the IL-11 therapy group from 3 to 14 days, while there was a gradual elevation of IL-11. IL-11 therapy downregulated the expression of the sepsis indicator PCT and reduced the APACHE II score from 3 to 14 days. The conventional therapy group had a significantly higher mortality rate within 28 days. IL-11 has a protective role and can accelerate recovery of platelets, and remarkably lessen the extent of inflammatory responses, hence reducing the mortality in sepsis patients accompanied with thrombocytopenia. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sequential Oxygenation Index and Organ Dysfunction Assessment within the First 3 Days of Mechanical Ventilation Predict the Outcome of Adult Patients with Severe Acute Respiratory Failure

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Hsu-Ching Kao

2013-01-01

Full Text Available Objective. To determine early predictors of outcomes of adult patients with severe acute respiratory failure. Method. 100 consecutive adult patients with severe acute respiratory failure were evaluated in this retrospective study. Data including comorbidities, Sequential Organ Failure Assessment (SOFA score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II score, PaO2, FiO2, PaO2/FiO2, PEEP, mean airway pressure (mPaw, and oxygenation index (OI on the 1st and the 3rd day of mechanical ventilation, and change in OI within 3 days were recorded. Primary outcome was hospital mortality; secondary outcome measure was ventilator weaning failure. Results. 38 out of 100 (38% patients died within the study period. 48 patients (48% failed to wean from ventilator. Multivariate analysis showed day 3 OI ( and SOFA ( score were independent predictors of hospital mortality. Preexisting cerebrovascular accident (CVA ( was the predictor of weaning failure. Results from Kaplan-Meier method demonstrated that higher day 3 OI was associated with shorter survival time (log-Rank test, . Conclusion. Early OI (within 3 days and SOFA score were predictors of mortality in severe acute respiratory failure. In the future, prospective studies measuring serial OIs in a larger scale of study cohort is required to further consolidate our findings.

Key performance indicators score (KPIs-score) based on clinical and laboratorial parameters can establish benchmarks for internal quality control in an ART program.

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Franco, José G; Petersen, Claudia G; Mauri, Ana L; Vagnini, Laura D; Renzi, Adriana; Petersen, Bruna; Mattila, M C; Comar, Vanessa A; Ricci, Juliana; Dieamant, Felipe; Oliveira, João Batista A; Baruffi, Ricardo L R

2017-06-01

KPIs have been employed for internal quality control (IQC) in ART. However, clinical KPIs (C-KPIs) such as age, AMH and number of oocytes collected are never added to laboratory KPIs (L-KPIs), such as fertilization rate and morphological quality of the embryos for analysis, even though the final endpoint is the evaluation of clinical pregnancy rates. This paper analyzed if a KPIs-score strategy with clinical and laboratorial parameters could be used to establish benchmarks for IQC in ART cycles. In this prospective cohort study, 280 patients (36.4±4.3years) underwent ART. The total KPIs-score was obtained by the analysis of age, AMH (AMH Gen II ELISA/pre-mixing modified, Beckman Coulter Inc.), number of metaphase-II oocytes, fertilization rates and morphological quality of the embryonic lot. The total KPIs-score (C-KPIs+L-KPIs) was correlated with the presence or absence of clinical pregnancy. The relationship between the C-KPIs and L-KPIs scores was analyzed to establish quality standards, to increase the performance of clinical and laboratorial processes in ART. The logistic regression model (LRM), with respect to pregnancy and total KPIs-score (280 patients/102 clinical pregnancies), yielded an odds ratio of 1.24 (95%CI = 1.16-1.32). There was also a significant difference (pclinical pregnancies (total KPIs-score=20.4±3.7) and the group without clinical pregnancies (total KPIs-score=15.9±5). Clinical pregnancy probabilities (CPP) can be obtained using the LRM (prediction key) with the total KPIs-score as a predictor variable. The mean C-KPIs and L-KPIs scores obtained in the pregnancy group were 11.9±2.9 and 8.5±1.7, respectively. Routinely, in all cases where the C-KPIs score was ≥9, after the procedure, the L-KPIs score obtained was ≤6, a revision of the laboratory procedure was performed to assess quality standards. This total KPIs-score could set up benchmarks for clinical pregnancy. Moreover, IQC can use C-KPIs and L-KPIs scores to detect problems

The use of the soluble adhesion molecules sE-selectin, sICAM-1, sVCAM-1, sPECAM-1 and their ligands CD11a and CD49d as diagnostic and prognostic biomarkers in septic and critically ill non-septic ICU patients

DEFF Research Database (Denmark)

Kjaergaard, Anders G; Dige, Anders; Nielsen, Jeppe S.

2016-01-01

Endothelial activation is pivotal in the development and escalation of sepsis. Central to endothelial activation is the endothelial up-regulation of cellular adhesion molecules (CAMs) including E-selectin, ICAM-1, VCAM-1, and PECAM-1. Shed CAMs are also found in circulating soluble forms (s...... critically ill non-septic patients were included. All patients had an APACHE II score above 13 at ICU admission. Fifteen healthy volunteers served as controls. Flow cytometry was used to estimate levels of sE-selectin, sICAM-1, sVCAM-1, sPECAM-1, and the cellular expression of CD11a and CD49d. Levels of s...

Risk factors for peptic ulcer in patients with acute pancreatitis

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LIAO Juan

2013-07-01

Full Text Available ObjectiveTo investigate the clinical characteristics of acute pancreatitis (AP associated with peptic ulcer (PU and to analyze the risk factors for PU in AP patients. MethodsA retrospective analysis was performed on the clinical data of 156 AP patients who were admitted to our hospital from January 2008 to January 2012. All patients underwent gastroscopy within 48 h after admission to detect PU and Helicobacter pylori (Hp infection. The severity of AP was assessed by Ranson score, APACHE Ⅱ score, and CT severity index. The clinical characteristics of AP patients with or without PU were statistically analyzed using independent samples t-test and chi-square test. The univariate and multivariate logistic regression analyses were used to determine the risk factors for PU in AP patients. ResultsAmong the 156 AP patients, 88 (56.4% had PU, but only 28 (31.8% of the 88 cases were infected with Hp. Of the 28 patients, 22 had gastric ulcer, and 6 had both gastric ulcer and duodenal ulcer. Of the 60 PU patients not infected with Hp, 25 had gastric ulcer, 26 had duodenal ulcer, and 9 had both gastric ulcer and duodenal ulcer. The univariate logistic regression analysis showed that male gender, alcohol-induced pancreatitis, smoking, alcohol consumption, high triglyceride level, high C-reactive protein level, and APACHE Ⅱ score ≥8 were significantly associated with PU in AP patients. However, the multivariate logistic regression analysis showed that APACHE Ⅱ score ≥8 was the independent risk factor for PU in AP patients (OR=8.54, 95% CI: 4.52-16.15, P＜0.01. ConclusionAP patients are susceptible to PU, but the infection rate of Hp is low. APACHE Ⅱ score ≥8 is the independent risk factor for PU in AP patients.

Comparison of Risk Scores for Prediction of Complications following Aortic Valve Replacement.

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Wang, Tom Kai Ming; Choi, David Hyun-Min; Haydock, David; Gamble, Greg; Stewart, Ralph; Ruygrok, Peter

2015-06-01

Risk models play an important role in stratification of patients for cardiac surgery, but their prognostic utilities for post-operative complications are rarely studied. We compared the EuroSCORE, EuroSCORE II, Society of Thoracic Surgeon's (STS) Score and an Australasian model (Aus-AVR Score) for predicting morbidities after aortic valve replacement (AVR), and also evaluated seven STS complications models in this context. We retrospectively calculated risk scores for 620 consecutive patients undergoing isolated AVR at Auckland City Hospital during 2005-2012, assessing their discrimination and calibration for post-operative complications. Amongst mortality scores, the EuroSCORE was the best at discriminating stroke (c-statistic 0.845); the EuroSCORE II at deep sternal wound infection (c=0.748); and the STS Score at composite morbidity or mortality (c=0.666), renal failure (c=0.634), ventilation>24 hours (c=0.732), return to theatre (c=0.577) and prolonged hospital stay >14 days post-operatively (c=0.707). The individual STS complications models had a marginally higher c-statistic (c=0.634-0.846) for all complications except mediastinitis, and had good calibration (Hosmer-Lemeshow test P-value 0.123-0.915) for all complications. The STS Score was best overall at discriminating post-operative complications and their composite for AVR. All STS complications models except for deep sternal wound infection had good discrimination and calibration for post-operative complications. Copyright © 2014 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.

A phase I/II study of hypofractionated whole abdominal radiation therapy in patients with chemoresistant ovarian carcinoma: Karnofsky score determines treatment outcome

International Nuclear Information System (INIS)

Faul, Clare; Gerszten, Kristina; Edwards, Robert; Land, Stephanie; D'Angelo, Gina M.S.; Kelley, Joseph; Price, Fredric

2000-01-01

Purpose: Radiation therapy can provide useful palliation in chemorefractory ovarian cancer patients. The purpose of this study was to prospectively study the palliative effect of a hypofractionated radiation treatment regimen. Change in quality-of-life scores (Functional Assessment of Cancer Therapy [FACT], Karnofsky scale), pain score, and tolerance to therapy were also assessed. Methods and Materials: A single-institution Phase I/II trial was initiated in patients with chemoresistant recurrent or progressive ovarian cancer. All patients had symptomatic and measurable intra-abdominal disease. Patients were treated with a single radiation fraction (700 cGy) or two fractions (300 cGy twice a day) to the whole abdomen over 1 day. Quality-of-life scale (FACT G version 2) was assessed at baseline and 1 and 3 months following treatment. Karnofsky scale and pain score were also evaluated in the same time frame. Results: Sixteen patients were prospectively entered into this protocol between February 1996 and September 1998. Twelve patients received a single 700 cGy fraction and four 300 cGy twice a day. All were heavily pretreated and 9 (56%) had a poor performance status prior to treatment. Symptoms needing palliation included pain (14), ascites (10), and bleeding (2). Symptomatic improvement occurred in all patients with pain (5 complete response [CR] and 7 partial response [PR], all patients with bleeding (CR 2), and two (20%) with ascites. Five patients (31%) had a reduction in lesion size documented radiologically in three. The mean duration of response was 22 weeks in patients with a Karnofsky score >70. Thirteen patients developed transient nausea and vomiting which resolved in 48 hours in all. All patients developed a transient lymphopenia. Thirteen patients completed a follow-up quality-of-life scale. There was an improvement in the physical and functional components of the scale in patients with Karnofsky score of 90-100. There was no improvement in quality of

Reliability of Modern Scores to Predict Long-Term Mortality After Isolated Aortic Valve Operations.

Science.gov (United States)

Barili, Fabio; Pacini, Davide; D'Ovidio, Mariangela; Ventura, Martina; Alamanni, Francesco; Di Bartolomeo, Roberto; Grossi, Claudio; Davoli, Marina; Fusco, Danilo; Perucci, Carlo; Parolari, Alessandro

2016-02-01

Contemporary scores for estimating perioperative death have been proposed to also predict also long-term death. The aim of the study was to evaluate the performance of the updated European System for Cardiac Operative Risk Evaluation II, The Society of Thoracic Surgeons Predicted Risk of Mortality score, and the Age, Creatinine, Left Ventricular Ejection Fraction score for predicting long-term mortality in a contemporary cohort of isolated aortic valve replacement (AVR). We also sought to develop for each score a simple algorithm based on predicted perioperative risk to predict long-term survival. Complete data on 1,444 patients who underwent isolated AVR in a 7-year period were retrieved from three prospective institutional databases and linked with the Italian Tax Register Information System. Data were evaluated with performance analyses and time-to-event semiparametric regression. Survival was 83.0% ± 1.1% at 5 years and 67.8 ± 1.9% at 8 years. Discrimination and calibration of all three scores both worsened for prediction of death at 1 year and 5 years. Nonetheless, a significant relationship was found between long-term survival and quartiles of scores (p System for Cardiac Operative Risk Evaluation II, 1.34 (95% CI, 1.28 to 1.40) for the Society of Thoracic Surgeons score, and 1.08 (95% CI, 1.06 to 1.10) for the Age, Creatinine, Left Ventricular Ejection Fraction score. The predicted risk generated by European System for Cardiac Operative Risk Evaluation II, The Society of Thoracic Surgeons score, and Age, Creatinine, Left Ventricular Ejection Fraction scores cannot also be considered a direct estimate of the long-term risk for death. Nonetheless, the three scores can be used to derive an estimate of long-term risk of death in patients who undergo isolated AVR with the use of a simple algorithm. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Retrospective analysis of mortality and Candida isolates of 75 patients with candidemia: a single hospital experience

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Hirano R

2015-07-01

Full Text Available Ryuichi Hirano,1 Yuichi Sakamoto,2 Kumiko Kudo,1 Motoki Ohnishi31Department of Pharmacy, Aomori Prefectural Central Hospital, Aomori, Japan; 2Laboratory Medicine and Blood transfusion, Aomori Prefectural Central Hospital, Aomori, Japan; 3General Medicine, Aomori Prefectural Central Hospital, Aomori, JapanAbstract: The mortality rate for candidemia is approximately 30%–60%. However, prognostic factors in patients with candidemia have not yet been elucidated in detail. The aim of the present study was to analyze prognostic factors for candidemia using the mortality rate and Candida isolates of patients with candidemia. Seventy-five patients with candidemia were analyzed between January 2007 and December 2013. The main outcome of this study was the 30-day mortality rate after the diagnosis of candidemia. The acute physiology and chronic health evaluation II score (APACHE II score was measured in 34 patients (45.3%. Odds ratios (ORs for death due to candidemia were analyzed using a multivariate stepwise logistic regression analysis. Twenty (26.6% patients died within 30 days of being diagnosed with candidemia. Non-survivors had a significantly higher APACHE II score (n=7, mean; 18.9±4.5 than that of survivors (n=27, mean; 14.0±5.0. Advanced age (OR =1.1, 95% confidence interval =1.01–1.23, P=0.04 was a significant risk factor for a high mortality rate, whereas removal of a central venous catheter (OR =0.03, 95% confidence interval =0.002–0.3, P=0.01 was associated with a lower mortality rate. Seventy-six Candida spp. were isolated from blood cultures: Candida albicans 28 (36.8%, Candida parapsilosis 23 (30.2%, Candida guilliermondii 16 (21.0%, Candida glabrata four (5.2%, Candida tropicalis two (2.6%, and Candida spp. three (3.9% that could not be identified. C. parapsilosis was the most frequently isolated species in younger patients (<65 years, whereas C. albicans was the most frequently isolated in elderly patients (≥65 years

Clinical profile and predictors of mortality of severe pandemic (H1N1 2009 virus infection needing intensive care: A multi-centre prospective study from South India

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Kartik Ramakrishna

2012-01-01

Full Text Available Background: This multi-center study from India details the profile and outcomes of patients admitted to the intensive care unit (ICU with pandemic Influenza A (H1N1 2009 virus [P(H1N12009v] infection. Materials and Methods: Over 4 months, adult patients diagnosed to have P(H1N12009v infection by real-time RT-PCR of respiratory specimens and requiring ICU admission were followed up until death or hospital discharge. Sequential organ failure assessment (SOFA scores were calculated daily. Results: Of the 1902 patients screened, 464 (24.4% tested positive for P(H1N12009v; 106 (22.8% patients aged 35±11.9 (mean±SD years required ICU admission 5.8±2.7 days after onset of illness. Common symptoms were fever (96.2%, cough (88.7%, and breathlessness (85.9%. The admission APACHE-II and SOFA scores were 14.4±6.5 and 5.5±3.1, respectively. Ninety-six (90.6% patients required ventilation for 10.1±7.5 days. Of these, 34/96 (35.4% were non-invasively ventilated; 16/34 were weaned successfully whilst 18/34 required intubation. Sixteen patients (15.1% needed dialysis. The duration of hospitalization was 14.0±8.0 days. Hospital mortality was 49%. Mortality in pregnant/puerperal women was 52.6% (10/19. Patients requiring invasive ventilation at admission had a higher mortality than those managed with non-invasive ventilation and those not requiring ventilation (44/62 vs. 8/44, P<0.001. Need for dialysis was independently associated with mortality (P=0.019. Although admission APACHE-II and SOFA scores were significantly (P<0.02 higher in non-survivors compared with survivors on univariate analysis, individually, neither were predictive on multivariate analysis. Conclusions: In our setting, a high mortality was observed in patients admitted to ICU with severe P(H1N12009v infection. The need for invasive ventilation and dialysis were associated with a poor outcome.

Prediction about severity and outcome of sepsis by pro-atrial natriuretic peptide and pro-adrenomedullin.

Science.gov (United States)

Wang, Rui-lan; Kang, Fu-xin

2010-06-01

Measurement of biomarkers is a potential approach to early prediction of the risk of mortality in patients with sepsis. The aim of the present study was to evaluate the prognostic value of pro-atrial natriuretic peptide (pro-ANP) and pro-adrenomedullin (pro-ADM) levels in a cohort of medical intensive care patients and to compare it with that of other known biomarkers and physiological scores. Blood samples of 51 consecutive critically ill patients admitted to the intensive care unit and 53 age-matched healthy control people were evaluated in this prospective study. The prognostic value of pro-ANP and pro-ADM levels was compared with that of acute physiology and chronic health evaluation (APACHE) II scores and various biomarkers such as C-reactive protein, interleukin-6 and procalcitonin. Pro-ANP and pro-ADM were detected by a new sandwich immunoassay. On admission, 25 patients had systemic inflammatory response syndrome (SIRS), 12 sepsis, 9 severe sepsis and 5 septic shock. At that time, the median levels (ng/ml) of pro-ANP and pro-ADM were 87.22 and 0.34 respectively in patients with SIRS, 1533.30 and 2.23 in those with sepsis, 1098.73 and 4.57 in those with severe sepsis, and 1933.94 and 8.21 in those with septic shock. With the increasing severity of disease, the levels of pro-ANP and pro-ADM were gradually increased. On admission, the circulating levels of pro-ANP and pro-ADM in patients with sepsis, severe sepsis, or septic shock were significantly higher in non-survivors than in survivors (P less than 0.05). In a receiver operating characteristic curve analysis for the survival of patients with sepsis, the areas under the curve (AUCs) for pro-ANP and pro-ADM were 0.89 and 0.87 respectively, which was similar to the AUCs for procalcitonin and APACHE II scores. Pro-ANP and pro-ADM are valuable biomarkers for prediction of severity of septic patients.

Serum cortisol values, superior vena cava flow and illness severity scores in very low birth weight infants.

LENUS (Irish Health Repository)

Miletin, J

2012-02-01

OBJECTIVE: Recent evidence suggests that high cortisol concentrations are associated with increased morbidity and mortality in very low birth weight (VLBW) infants. Neonatal illness severity and mortality risk scores are reliable in predicting morbidity and mortality. The objectives were (i) to assess the correlation between serum cortisol levels and clinical assessment of multi-organ dysfunction\\/illness severity scores (CRIB II, SNAPPE-II and neonatal multiple organ dysfunction score (NEOMOD)) in first 24 h in VLBW infants and (ii) to assess the relationship between surrogates of end organ blood flow and serum cortisol levels. STUDY DESIGN: A prospective observational cohort study. Neonates with birth weight <1500 g were eligible for enrollment. Echocardiography evaluation of superior vena cava (SVC) flow was carried out in the first 24 h life. Cortisol levels were measured simultaneously and appropriate clinical scores were calculated. RESULT: A total of 54 VLBW neonates were enrolled following parental consent. Two patients were excluded because of congenital malformations. In 14 babies the cortisol value was not simultaneously obtained. The mean birth weight was 1.08 kg, mean gestational age was 27.8 weeks. There was a significant correlation between cortisol and NEOMOD score (P=0.006). There was no correlation between cortisol and CRIB II score (P=0.34), SVC flow (P=0.49) and mean arterial blood pressure respectively (P=0.35). CONCLUSION: There was no correlation between SVC flow and cortisol values or between cortisol and mean blood pressure values. There was a significant correlation between cortisol levels and neonatal organ dysfunction score evaluated suggesting that stressed VLBW infants do mount a cortisol response.

Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II.

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Campos, Carlos M; van Klaveren, David; Farooq, Vasim; Simonton, Charles A; Kappetein, Arie-Pieter; Sabik, Joseph F; Steyerberg, Ewout W; Stone, Gregg W; Serruys, Patrick W

2015-05-21

To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43-1.50). In subjects with low (≤22) anatomical SYNTAX scores, the predicted OR was 0.69 (95% PI 0.34-1.45); in intermediate anatomical SYNTAX scores (23-32), the predicted OR was 0.93 (95% PI 0.53-1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI. Published on behalf of the European Society of Cardiology. All rights reserved. © The

Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan

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Chang, Kuo-Chin; Chuah, Seng-Kee; Changchien, Chi-Sin; Tsai, Tung-Lung; Lu, Sheng-Nan; Chiu, Yi-Chun; Chen, Yaw-Sen; Wang, Chih-Chi; Lin, Jui-Wei; Lee, Chuan-Mo; Hu, Tsung-Hui

2006-01-01

AIM: To analyze 67 cases of splenic abscess in a medical center of Taiwan during a period of 19 years. METHODS: From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APACHE II scores, and mortality rates were analyzed. RESULTS: There were 41 males and 26 females with the mean age of 54.1 ± 14.1 years. Multiple splenic abscesses (MSA) account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixty-seven patients (35.8%) had extrasplenic abscesses, with leading site of liver (34.6%). Microbiological cultures were positive in 58 patients (86.6%), with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus (GNB) infection predominated (55.2%), with leading pathogen of Klebsiella pneumoniae (22.4%), followed by gram positive coccus (GPC) infection (31%). Splenectomy was performed in 26 patients (38.8%), percutaneous drainage or aspiration in 21 (31.3%), and antibiotic therapy alone in 20 patients (29.9%). Eventually, 12 of 67 patients expired (17.9 %). By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC (P = 0.036). Patients with GNB infection (P = 0.009) and multiple abscesses (P = 0.011) experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE II score of 12 expired patients (16.3 ± 3.2) was significantly higher than that of the 55 survivals (7.2 ± 3.8) (P factors. Early surgical intervention should be encouraged when these risk factors are present. PMID:16489650

Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study.

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Divatia, Jigeeshu V; Amin, Pravin R; Ramakrishnan, Nagarajan; Kapadia, Farhad N; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P; Samavedam, Srinivas; Jani, Charu K; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, B D; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee

2016-04-01

To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

Open abdomen management of intra-abdominal infections: analysis of a twenty-year experience.

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Rausei, Stefano; Dionigi, Gianlorenzo; Boni, Luigi; Rovera, Francesca; Minoja, Giulio; Cuffari, Salvatore; Dionigi, Renzo

2014-06-01

No conclusive results on the efficacy and timing of open abdomen (OA) are available, particularly in the setting of intra-abdominal infections. We analyzed outcomes and risk factors retrospectively in a large series of patients managed with an OA during the past 20 y in an effort to clarify this issue. We reviewed the records of 133 patients who underwent treatment with an OA, considering factors related to patient, disease, medical management, and surgical treatment. The end points of the bi-variable analysis were 1-y mortality, calculated from the time of an initial OA procedure, and definitive fascial closure. Most patients (112/133) managed with an OA had one of several types of peritonitis. Many patients had severe clinical conditions (mean Acute Physiology and Chronic Health Evaluation [APACHE] II score was almost 9 points for the study population). With regard to surgical management, the mean (+SD) number of abdominal revisions was 5.9+9.3 during a mean duration of treatment with an OA of 14.3+11.6 d. The overall mortality in the study was 26% (35/133). Bi-variable analysis revealed factors associated with overall mortality to be age, renal and respiratory co-morbidities, edema on an initial chest radiograph, blood pressure, blood glucose and creatinine concentrations; and APACHE II score. The rate of definitive fascial closure was 75% (100/133). Factors associated negatively with fascial closure were respiratory co-morbidity, edema on a first chest radiograph, post-operative mesenteric ischemia as an indication for OA, blood glucose and creatinine concentrations, and duration of an OA. Patients' pre-operative clinical status influences strongly their response to surgical treatment. The management of OA does not affect adversely the survival of patients with intra-abdominal infections, but factors related to the management of OA (duration of OA) seem to affect the possibility of definitive fascial closure.

Oropharyngeal flora in patients admitted to the medical intensive care unit: clinical factors and acid suppressive therapy.

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Frandah, Wesam; Colmer-Hamood, Jane; Mojazi Amiri, Hoda; Raj, Rishi; Nugent, Kenneth

2013-05-01

Acid suppression therapy in critically ill patients significantly reduces the incidence of stress ulceration and gastrointestinal (GI) bleeding; however, recent studies suggest that proton pump inhibitors (PPIs) increase the risk of pneumonia. We wanted to test the hypothesis that acid suppressive therapy promotes alteration in the bacterial flora in the GI tract and leads to colonization of the upper airway tract with pathogenic species, potentially forming the biological basis for the observed increased incidence of pneumonia in these patients. This was a prospective observational study on patients (adults 18 years or older) admitted to the medical intensive care unit (MICU) at a tertiary care centre. Exclusion criteria included all patients with a diagnosis of pneumonia at admission, with infection in the upper airway, or with a history of significant dysphagia. Oropharyngeal cultures were obtained on day 1 and days 3 or 4 of admission. We collected data on demographics, clinical information, and severity of the underlying disease using APACHE II scores. There were 110 patients enrolled in the study. The mean age was 49±16 years, 50 were women, and the mean APACHE II score was 9.8 ± 6.5. Twenty per cent of the patients had used a PPI in the month preceding admission. The first oropharyngeal specimen was available in 110 cases; a second specimen at 72-96 h was available in 68 cases. Seventy-five per cent of the patients admitted to the MICU had abnormal flora. In multivariate logistic regression, diabetes mellitus and PPI use were associated with abnormal oral flora on admission. Chronic renal failure and a higher body mass index reduced the frequency of abnormal oral flora on admission. Most critically ill patients admitted to our MICU have abnormal oral flora. Patients with diabetes and a history of recent PPI use are more likely to have abnormal oral flora on admission.

Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit

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Elizabeth De Fransceco Daher

2014-01-01

Full Text Available Introduction: Acute kidney injury (AKI is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. Methods: This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory findings were evaluated. Results: A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodeficiency virus (HIV infection, HIV/acquired immunodeficiency syndrome (AIDS (30%, tuberculosis (12%, leptospirosis (11% and dengue (4%. Dialysis was performed in 70 cases (27.6%. The patients were classified as risk (4.4%, injury (63.6% or failure (32%. The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%. The Acute Physiology and Chronic Health Evaluation (APACHE II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01 and dengue (68±11, p-value=0.01. Death occurred in 159 cases (62.8%. Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02. A multivariate analysis identified the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. Conclusions: AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases.

Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial

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Cohen, Jason

2010-02-01

Full Text Available Objective: Glycemic control in the critically ill intensive care unit (ICU patient has been shown to improve morbidity and mortality. We sought to investigate the effect of early glycemic control in critically ill emergency department (ED patients in a small pilot trial.Methods: Adult non-trauma, non-pregnant ED patients presenting to a university tertiary referral center and identified as critically ill were eligible for enrollment on a convenience basis. Critical illness was determined upon assignment for ICU admission. Patients were randomized to either ED standard care or glycemic control. Glycemic control involved use of an insulin drip to maintain blood glucose levels between 80-140 mg/dL. Glycemic control continued until ED discharge. Standard patients were managed at ED attending physician discretion. We assessed severity of illness by calculation of APACHE II score. The primary endpoint was in-hospital mortality. Secondary endpoints included vasopressor requirement, hospital length of stay, and mechanical ventilation requirement.Results: Fifty patients were randomized, 24 to the glycemic group and 26 to the standard care cohort. Four of the 24 patients (17% in the treatment arm did not receive insulin despite protocol requirements. While receiving insulin, three of 24 patients (13% had an episode of hypoglycemia. By chance, the patients in the treatment group had a trend toward higher acuity by APACHE II scores. Patient mortality and morbidity were similar despite the acuity difference.Conclusion: There was no difference in morbidity and mortality between the two groups. The benefit of glycemic control may be subject to source of illness and to degree of glycemic control, or have no effect. Such questions bear future investigation. [West J Emerg Med. 2010; 11(1:20-23].

COPD Patients with Acute Exacerbation Who Developed Refeeding Syndrome during Hospitalization Had Poor Outcome: A Retrospective Cohort Study

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Kuen Shan Jih

2018-03-01

Full Text Available Summary: Background: The study retrospectively investigated risk factors for refeeding syndrome in COPD patients with acute exacerbation and its impact on clinical outcomes. Methods: We retrospectively reviewed discharge notes of patients with primary diagnosis of COPD with acute exacerbation from August 2014 to December 2015. Demographic data, BMI, the last post-bronchodilator FEV1, case-mixed index (CMI, APACHE-II score, average daily total energy intake (TEI and adjusted by current BW to obtain average daily total energy intake index (TEII of the first four hospitalization days, the initial ABG with calculated PaO2/FiO2 were collected. Laboratory RFS was arbitrarily defined as either serum P or Mg declined 15% or more after feeding in comparison with the pre-feeding one and fell below the lower limit of normal ranges. Results: 61 patients were eligible for analysis and 38% had RFS. Univariate analyses showed that advanced age, low BMI, high TEII, low post-bronchodilator FEV1, high APACHE-II score, low PaO2/FiO2, high PaCO2, low pH, and leukocytosis at admission were risk factors for RFS. However, multiple logistic regression revealed that only BMI, TEII and the last post-bronchodilator FEV1 were the risk predictors for RFS. Those who developed RFS had high risk to suffer from delirium, be intubated and receive invasive mechanical ventilation with difficult weaning from the ventilator, and have longer LOS. No in-hospital mortality was found. Conclusion: RFS should not be overlooked in COPD patients with acute exacerbation. Awareness of this feeding-related complication is mandatory for early diagnosis and appropriate management to prevent morbidity and mortality. Keywords: refeeding syndrome, COPD with acute exacerbation

Predisposing risk factors for delirium in living donor liver transplantation patients in intensive care units.

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Szu-Han Wang

Full Text Available BACKGROUND: Delirium is one of the main causes of increased length of intensive care unit (ICU stay among patients who have undergone living donor liver transplantation (LDLT. We aimed to evaluate risk factors for delirium after LDLT as well as to investigate whether delirium impacts the length of ICU and hospital stay. METHODS: Seventy-eight patients who underwent LDLT during the period January 2010 to December 2012 at a single medical center were enrolled. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU scale was used to diagnose delirium. Preoperative, postoperative, and hematologic factors were included as potential risk factors for developing delirium. RESULTS: During the study period, delirium was diagnosed in 37 (47.4% patients after LDLT. The mean onset of symptoms occurred 7.0±5.5 days after surgery and the mean duration of symptoms was 5.0±2.6 days. The length of stay in the ICU for patients with delirium (39.8±28.1 days was significantly longer than that for patients without delirium (29.3±19.0 days (p<0.05. Risk factors associated with delirium included history of alcohol abuse [odds ratio (OR = 6.40, 95% confidence interval (CI: 1.85-22.06], preoperative hepatic encephalopathy (OR = 4.45, 95% CI: 1.36-14.51, APACHE II score ≥16 (OR = 1.73, 95% CI: 1.71-2.56, and duration of endotracheal intubation ≥5 days (OR = 1.81, 95% CI: 1.52-2.23. CONCLUSIONS: History of alcohol abuse, preoperative hepatic encephalopathy, APACHE II scores ≥16 and endotracheal intubation ≥5 days were predictive of developing delirium in the ICU following liver transplantation surgery and were associated with increased length of ICU and hospital stay.

[Predictive factors for failure of non-invasive positive pressure ventilation in immunosuppressed patients with acute respiratory failure].

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Jia, Xiangli; Yan, Ci; Xu, Sicheng; Gu, Xingli; Wan, Qiufeng; Hu, Xinying; Li, Jingwen; Liu, Guangming; Caikai, Shareli; Guo, Zhijin

2018-02-01

To evaluate the predictive factors for failure of non-invasive positive pressure ventilation (NIPPV) in immunosuppressed patients with acute respiratory failure (ARF). The clinical data of 118 immuno-deficient patients treated with NIPPV in the respiratory and intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2012 to August 2017 were retrospectively analyzed. The patients were divided into a non-endotracheal intubation (ETI) group (n = 62) and ETI group (n = 56) according to whether ETI was performed during the hospitalization period or not. Each observed indicator was analyzed by univariate analysis, and factors leading to failure of NIPPV were further analyzed by Logistic regression. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of risk factors for failure of NIPPV in immunosuppressed patients with ARF. The non-intubation rate for NIPPV in immunosuppressed patients was 50.8% (60/118). Compared with the non-ETI group, the body temperature, pH value in the ETI group were significantly increased, the partial pressure of arterial carbon dioxide (PaCO 2 ) was significantly decreased, the ratio of oxygenation index (PaO 2 /FiO 2 ) failure of NIPPV. ROC curve analysis showed that the APACHE II score ≥ 20 and PaO 2 /FiO 2 failure of NIPPV, the area under ROC curve (AUC) of the APACHE II score ≥ 20 was 0.787, the sensitivity was 83.93%, the specificity was 69.35%, the positive predict value (PPV) was 71.21%, the negative predict value (NPV) was 82.69%, the positive likelihood ratio (PLR) was 2.74, the negative likelihood ratio (NLR) was 0.23, and Youden index was 0.53; the AUC of PaO 2 /FiO 2 failure of NIPPV in immunocompromised patients.

Functional polymorphisms of interferon-gamma affect pneumonia-induced sepsis.

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Ding Wang

Full Text Available Sepsis is an inflammatory syndrome caused by infection, and both its incidence and mortality are high. Because interferon-gamma (IFN-γ plays an important role in inflammation, this work assessed IFN-γ single nucleotide polymorphism (SNPs that may be associated with sepsis.A total of 196 patients with pneumonia-induced sepsis and 213 age- and sex-matched healthy volunteers participated in our study from July 2012 to July 2013 in Guangzhou, China. Patient clinical information was collected. Clinical pathology was assessed in subgroups defined based on clinical criteria, APACHE II (acute physiology and chronic health evaluation and SOFA (sepsis-related organ failure assessment scores and discharge rate. Four functional SNPs, -1616T/C (rs2069705, -764G/C (rs2069707, +874A/T (rs2430561 and +3234C/T (rs2069718, were genotyped by Snapshot in both sepsis patients and healthy controls. Pearson's chi-square test or Fisher's exact test were used to analyze the distribution of the SNPs, and the probability values (P values, odds ratios (OR and 95% confidence intervals (CIs were calculated.No mutations in the IFN-γ -764G/C SNP were detected among the participants in our study. The +874A/T and +3234C/T SNPs were in strong linkage disequilibrium (LD (r(2 = 0.894. The -1616 TC+TT, +874 AT+AA genotype and the TAC haplotype were significantly associated with sepsis susceptibility, while the CTT haplotype was associated with protection against sepsis incidence. Genotype of -1616 TT wasn't only protective against severity of sepsis, but also against higher APACHE II and SOFA scores as +874 AA and +3234 CC. The TAC haplotype was was protective against progression to severe sepsis either.Our results suggest that functional IFN-γ SNPs and their haplotypes are associated with pneumonia-induced sepsis.

Evaluation of acute myocardial infarction by 201Tl single-photon emission computed tomography using scoring system

International Nuclear Information System (INIS)

Setsuta, Koichi

1991-01-01

In 36 patients with acute myocardial infarction (AMI) 201 Tl single photon emission computed tomography (SPECT) examinations were performed in a relatively early phase of AMI. The short and long axis views of the left ventricle (LV) were divided into 6 segments. Images of each segment were assigned scores (segmental scores) based on a visual evaluation of the extent of 201 Tl accumulations. SPECT scores were compared with max GOT, max LDT, max CPK and max CK-MB, Killip classification and Forrester hemodynamic subset on admission, and LV ejection fraction (LVEF). Segmental scores were compared with LV wall motion evaluated by left ventriculography. The results are as follows: There were significant correlations between SPECT scores and max GOT, max LDH, max CPK and max CK-MB. SPECT scores in patients with Killip group III were significantly higher than in patients with Killip group I+II. However, no significant differences in max GOT, max LDH, max CPK and max CK-MB were observed between patients with Killip group III and those with Killip group I+II. SPECT scores were significantly higher in patients with Forrester group III+IV than in patients with Forrester group I+II. Segmental scores in segments evaluated as akinesis, dyskinesis and aneurysm by left ventriculography were significantly higher than those evaluated as hypokinesis or normal. Segmental scores in segments evaluated as hypokinesis were significantly high in comparison with normal segments. Significant correlations were observed between LVEF and SPECT scores. However, LVEF correlated poorly with max GOT, max LDH and max CPK, and no significant correlation was observed between LVEF and max CK-MB. SPECT examinations were performed in 11 patients in both the acute and chronic phase of AMI. SPECT scores in the chronic phase did not change in 4 patients, decreased in 5, increased in 2. These results suggest that SPECT scores and segmental scores can be useful indices in the evaluation of AMI. (J.P.N.)

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

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

2016-01-01

Spontaneous peritonitis, especially spontaneous fungal peritonitis (SFP), is an important and potentially fatal complication in patients with endstage liver disaese. We evaluated potential risk factors, microbiological findings, and outcome of patients with SFP compared to spontaneous bacterial peritonitis (SBP) in critically ill patients. Retrospective analyses of critically ill patients with suspected spontaneous peritonitis. Out of 205 patients, 20 (10%) had SFP, 28 (14%) had SBP, 48 (24%) had peritonitis without microbiological findings (SP) and 109 (52%) had no-peritonitis (NP). APACHE II and SOFA score were significantly higher in patients with SFP (26; 22-28; pperitonitis could be significantly more often found in patients with SFP (65%; pperitonitis was significantly more often in patients with SFP (85%; pperitonitis.

Usefulness of Plasma YKL-40 in Management of Community-Acquired Pneumonia Severity in Patients

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Hsiang-Ling Wang

2013-11-01

Full Text Available Plasma YKL-40 level has been reported as playing a significant role in community-acquired pneumonia (CAP. However, the correlation between plasma level of YKL-40 and the severity of CAP has not been reported. This study identifies the relationship between plasma level changes of the YKL-40 gene in adult patients hospitalized with CAP. The ELISA was used to measure the plasma YKL-40 level from 61 adult CAP patients before and after antibiotic treatment and from 60 healthy controls. The plasma YKL-40 levels were significantly increased in patients with CAP compared to normal controls. Moreover, the plasma concentration of YKL-40 correlated with the severity of CAP based on the pneumonia severity index (PSI score (r = 0.630, p < 0.001, the CURB-65 (confusion, uremia, respiratory rate, BP, age 65 years score (r = 0.640, p < 0.001, the Acute Physiology And Chronic Health Evaluation II (APACHE II score (r = 0.539, p < 0.001 and length of hospital stay (r = 0.321, p = 0.011, respectively. In conclusion, plasma YKL-40 may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of treatment strategies.

Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score.

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Rodriguez, Alfredo E; Fernandez-Pereira, Carlos; Mieres, Juan; Pavlovsky, Hernan; Del Pozo, Juan; Rodriguez-Granillo, Alfredo M; Antoniucci, David

2018-02-13

In recent years angiographic risk scores have been introduced in clinical practice to stratify different levels of risk after percutaneous coronary interventions (PCI). The SYNTAX score included all intermediate lesions in vessels ≥1.5 mm, consequently, multiple stent implantation was required. Four years ago, we built a new angiographic score in order to guide PCI strategy avoiding stent deployment both in intermediate stenosis as in small vessels, therefore these were not scored (ERACI risk score). The purpose of this mini review is to validate the strategy of PCI guided by this scoring, taking into account long term follow up outcomes of two observational and prospective registries where this policy was used. With this new risk score we have modified risk profile of our patient's candidates for PCI or coronary artery bypass surgery lowering the risk and PCI. The simple exclusion of small vessels and intermediate stenosis from the revascularization approach resulted in clinical outcome comparable with the one of fractional flow reserve guided revascularization. Low events rate at late follow up observed in both studies was also in agreement with guided PCI by functional lesion assessment observed by Syntax II registry, where investigators found lower events rate in spite of a few number of stents implanted per patient. use of ERACI risk scores may significantly reclassify patients into a lower risk category and be associated with low adverse events rate. Copyright © 2018. Published by Elsevier Inc.

s-core network decomposition: A generalization of k-core analysis to weighted networks

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Eidsaa, Marius; Almaas, Eivind

2013-12-01

A broad range of systems spanning biology, technology, and social phenomena may be represented and analyzed as complex networks. Recent studies of such networks using k-core decomposition have uncovered groups of nodes that play important roles. Here, we present s-core analysis, a generalization of k-core (or k-shell) analysis to complex networks where the links have different strengths or weights. We demonstrate the s-core decomposition approach on two random networks (ER and configuration model with scale-free degree distribution) where the link weights are (i) random, (ii) correlated, and (iii) anticorrelated with the node degrees. Finally, we apply the s-core decomposition approach to the protein-interaction network of the yeast Saccharomyces cerevisiae in the context of two gene-expression experiments: oxidative stress in response to cumene hydroperoxide (CHP), and fermentation stress response (FSR). We find that the innermost s-cores are (i) different from innermost k-cores, (ii) different for the two stress conditions CHP and FSR, and (iii) enriched with proteins whose biological functions give insight into how yeast manages these specific stresses.

Outcome and quality of life after aorto-bifemoral bypass surgery.

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Abelha, Fernando J; Botelho, Miguela; Fernandes, Vera; Barros, Henrique

2010-03-18

Aorto-bifemoral bypass (AFB) is commonly performed to treat aorto-iliac disease and a durable long-term outcome is achieved. Most studies documenting beneficial outcomes after AFB have been limited to mortality and morbidity rates, costs and length of hospital stay (LOS). Few studies have examined the dependency of patients and how their perception of their own health changes after surgery. The aim of the present study was to evaluate outcome after AFB and to study its determinants. This retrospective study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. Out of 1597 intensive care patients admitted to the PACU, 75 were submitted to infrarenal AFB and admitted to these intensive care unit (ICU) beds over 2 years. Preoperative characteristics and outcome were evaluated by comparing occlusive disease with aneurysmatic disease patients. Six months after discharge, the patients were contacted to complete a Short Form-36 questionnaire (SF-36) and to have their dependency in Activities of Daily Living (ADL) evaluated. Patient's characteristics and postoperative follow-up data were compared using Mann-Whitney U test, t test for independent groups, chi-square or Fisher's exact test. Patient preoperative characteristics were evaluated for associations with mortality using a multiple logistic regression analysis. The mortality rate was 12% at six months. Multivariate analysis identified congestive heart disease and APACHE II as independent determinants for mortality. Patients submitted to AFB for occlusive disease had worse SF-36 scores in role physical and general health perception. Patients submitted to AFB had worse SF-36 scores for all domains than a comparable urban population and had similar scores to other PACU patients. Sixty-six percent and 23% of patients were dependent in at least one activity in instrumental and personal ADL, respectively, but 64% reported having better general health. This study shows that

Serum Total Cholinesterase Activity on Admission Is Associated with Disease Severity and Outcome in Patients with Traumatic Brain Injury.

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Qing-Hong Zhang

Full Text Available Traumatic brain injury (TBI is one of the leading causes of neurological disability. In this retrospective study, serum total cholinesterase (ChE activities were analyzed in 188 patients for diagnostic as well as predictive values for mortality.Within 72 hours after injury, serum ChE activities including both acetylcholinesterase and butyrylcholinesterase were measured. Disease severity was evaluated with Acute Physiology and Chronic Health Evaluation (APACHE II score, Glasgow Coma Score, length of coma, post-traumatic amnesia and injury feature. Neurocognitive and functional scores were assessed using clinical records. Of 188 patients, 146 (77.7% survived and 42 (22.3% died within 90 days. Lower ChE activities were noted in the non-survivors vs. survivors (5.94±2.19 vs. 7.04±2.16 kU/L, p=0.023, in septic vs. non-infected patients (5.93±1.89 vs. 7.31±2.45 kU/L, p=0.0005 and in patients with extremely severe injury vs. mild injury (6.3±1.98 vs. 7.57±2.48 kU/L, p=0.049. The trajectories of serum ChE levels were also different between non-survivors and survivors, septic and non-infected patients, mild and severely injured patients, respectively. Admission ChE activities were closely correlated with blood cell counts, neurocognitive and functional scores both on admission and at discharge. Receiver operating characteristic analysis showed that the area under the curve for ChE was inferior to that for either APACHE II or white blood cell (WBC count. However, at the optimal cutoff value of 5 kU/L, the sensitivity of ChE for correct prediction of 90-day mortality was 65.5% and the specificity was 86.4%. Kaplan-Meier analysis showed that lower ChE activity (5 kU/L (p=0.04. After adjusting for other variables, ChE was identified as a borderline independent predictor for mortality as analyzed by Binary logistic regression (P=0.078.Lowered ChE activity measured on admission appears to be associated with disease severity and outcome for TBI patients.

Aplicación de las redes neuronales artificiales para la estratificación de riesgo de mortalidad hospitalaria Application of artificial neural networks for risk stratification of hospital mortality

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J. Trujillano

2003-12-01

Full Text Available Objetivo: Comparar la capacidad de predicción de mortalidad hospitalaria de una red neuronal artificial (RNA con el Acute Physiology and Chronic Health Evaluation II (APACHE II y la regresión logística (RL, y comparar la asignación de probabilidades entre los distintos modelos. Método: Se recogen de forma prospectiva las variables necesarias para el cálculo del APACHE II. Disponemos de 1.146 pacientes asignándose aleatoriamente (70 y 30% al grupo de Desarrollo (800 y al de Validación (346. Con las mismas variables se genera un modelo de RL y de RNA (perceptrón de 3 capas entrenado por algoritmo de backpropagation con remuestreo bootstrap y con 9 nodos en la capa oculta en el grupo de desarrollo. Se comparan los tres modelos en función de los criterios de discriminación con el área bajo la curva ROC (ABC [IC del 95%] y de calibración con el test de Hosmer-Lemeshow C (HLC. Las diferencias entre las probabilidades se valoran con el test de Bland-Altman. Resultados: En el grupo de validación, el APACHE II con ABC de 0,79 (0,75-0,84 y HLC de 11 (p = 0,329; modelo RL, ABC de 0,81 (0,76-0,85 y HLC de 29 (p = 0,0001, y en RNA, ABC de 0,82 (0,77-0,86 y HLC de 10 (p = 0,404. Los pacientes con mayores diferencias en la asignación de probabilidad entre RL y RN (8% del total son pacientes con problemas neurológicos. Los peores resultados se obtienen en los pacientes traumáticos (ABC inferior a 0,75 en todos los modelos. En los pacientes respiratorios, la RNA alcanza los mejores resultados (ABC = 0,87 [0,78-0,91]. Conclusiones: Una RNA es capaz de estratificar el riesgo de mortalidad hospitalaria utilizando las variables del sistema APACHE II. La RNA consigue mejores resultados frente a RL, sin alcanzar significación, ya que no trabaja con restricciones lineales ni de independencia de variables, con una diferente asignación de probabilidad individual entre los modelos.Objective: To compare the ability of an artificial neural network (ANN to

Remote sensing analysis of vegetation at the San Carlos Apache Reservation, Arizona and surrounding area

Science.gov (United States)

Norman, Laura M.; Middleton, Barry R.; Wilson, Natalie R.

2018-01-01

Mapping of vegetation types is of great importance to the San Carlos Apache Tribe and their management of forestry and fire fuels. Various remote sensing techniques were applied to classify multitemporal Landsat 8 satellite data, vegetation index, and digital elevation model data. A multitiered unsupervised classification generated over 900 classes that were then recoded to one of the 16 generalized vegetation/land cover classes using the Southwest Regional Gap Analysis Project (SWReGAP) map as a guide. A supervised classification was also run using field data collected in the SWReGAP project and our field campaign. Field data were gathered and accuracy assessments were generated to compare outputs. Our hypothesis was that a resulting map would update and potentially improve upon the vegetation/land cover class distributions of the older SWReGAP map over the 24,000  km2 study area. The estimated overall accuracies ranged between 43% and 75%, depending on which method and field dataset were used. The findings demonstrate the complexity of vegetation mapping, the importance of recent, high-quality-field data, and the potential for misleading results when insufficient field data are collected.

Phenylcarboxylic Acids in The Assessment of The Severity of Patient Condition and The Efficiency of Intensive Treatment in Critical Care Medicine

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V. V. Moroz

2016-01-01

Full Text Available The development of accurate and applicable methods to assess the severity of patient condition is an urgent need in critical care medicine.The goal of the study was to determine whether the quantitave evaluation of phenylcarboxylic acids (PhCAs concentrations in blood might be employed to assess the severity of patient condition and treatment efficiency intensive care unit.Materials and methods. Clinical and laboratory findings in patients (n=58 with acute surgical diseases of abdominal organs were registered on the day of admission to intensive care unit and during follow-up control including lactate level and blood serum PhCA concentrations of phenyllactic (PhLA, p#hydroxyphenyllactic (p-HPhLA and phydroxyphenylacetic (p#HPhAA acids. Patients' condition was assessed using APACHE II and SOFA international scales. PhCA concentrations were determined by gas chromatography. The reference group included healthy blood donors (n=25.Results. PhLA, p-HPhAA, p-HPhLA levels and total concentration of the three PhCAs were shown to be in direct correlation with APACHE II score (rs: 0.624; 0.757; 0.763 and 0.804, respectively; P<0.001. When testing PhCAs as a molecular prognostic criteria, areas under ROC#curves (AUC were within the range of 0.800—0.900 (P<0.001. Therewith the molecular prognostic criteria were comparable with APACHE II multi#parameter scale by accuracy: AUCAPACHE II was 0.897 (P<0.001. Lactate level dynamics as a prognostic criterion was inferior in accuracy to the dynamics of PhCA total concentration: AUCС lactate, % 0.667 (P=0.071 vs AUCС 3PhCAs, % 0.862 (P<0.001. In patients with documented bacterial inflammatory complications PhCA level was 2.5 times higher (P<0,001, n=35 and p#HPhLA level was 1.5 times higher than in patients without infectious complications (P=0.048, n=23.Conclusion. The findings provide evidence for the inclusion of PhCAs (PhLA, p-HPhAA, p-HPhLA, 3PhCAs in clinical practice as biomarkers of the severity of

[Developing indices for caloric restriction related to World War II--a pilot study].

Science.gov (United States)

Vin-Raviv, Neomi; Dekel, Rachel; Barchana, Micha; Linn, Shi; Keinan-Boker, Lital

2011-04-01

The vast numbers of studies regarding caloric restriction (CR) and breast cancer risk are based on war-related extreme situations. Studying the impact of CR in Jews during World War II (WW II) is challenging due to its variance and duration. To develop novel research tools in order to assess CR exposure in Jews that occurred more than 60 years ago during WW II. A pilot study based on Israeli women born in Europe in 1926-45, who lived there during WWII. Primary incident breast cancer patients and population-based controls were interviewed using a detailed questionnaire referring to demographic, obstetric factors and WW II experiences. Exposure to WWII-related CR was assessed by several proxy variables based on this information. The individual hunger score was higher in the exposed cases [mean score 141.06 vs. 130.07 in the controls). The same trend was observed for self perceived hunger score (mean score 2.75 in cases vs. 2.40 in controls) and hunger symptoms score (4.89 vs. 3.56, respectively). The novel research tools are appropriate for comparative assessment of CR exposure in case control studies.

The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part II: Diagnostic value of BIRADS-US classification, Tsukuba score and FLR ratio

OpenAIRE

Dobruch-Sobczak, Katarzyna

2013-01-01

Sonoelastography is a dynamically developing method of ultrasound examination used to differentiate the character of focal lesions in the breasts. The aim of the Part II of the study is to determine the usefulness of sonoelastography in the differentiation diagnosis of focal breast lesions including the evaluation of the diagnostic value of Tsukuba score and FLR ratio in characterizing solid lesions in the breasts. Furthermore, the paper provides a comparison of classic B-mode imaging and son...

EuroSCORE models in a cohort of patients with valvular heart disease and a high prevalence of rheumatic fever submitted to surgical procedures.

Science.gov (United States)

Casalino, Ricardo; Tarasoutchi, Flávio; Spina, Guilherme; Katz, Marcelo; Bacelar, Antonio; Sampaio, Roney; Ranzani, Otavio T; Pomerantzeff, Pablo M; Grinberg, Max

2015-01-01

Epidemiological differences can be found between Brazilian and European valvular heart disease patients. The prevalence of heart valve diseases due to rheumatic disease is significantly higher in the Brazilian compared with the European population. Therefore, they could have different risks during and after cardiac surgery. The aim of this study was to evaluate the applicability of the additive and logistic EuroSCORE and EuroSCORE II in a cohort of high-risk patients with valvular heart disease of predominantly rheumatic aetiology submitted to surgery. Between 1 February and 30 December 2009, 540 consecutive patients scheduled for valvular heart surgery were included in this study. In this set of patients, we examined the performance of the additive, logistic, and EuroSCORE II models for predicting in-hospital mortality. Calibration of each model was assessed by comparing predicted and observed in-hospital mortality and by the goodness of fit of the Hosmer-Lemeshow chi-square test. Discrimination performance of the model was evaluated with the receiver operating characteristic (ROC) curve analysis. The mean age was 56 ± 16 years, 50.6% were female, and the mortality rate was 16.0% (6.0% in elective surgery and 34.0% in emergency/urgency surgery). Mortality rates were estimated according to the additive and logistic EuroSCORE and EuroSCORE II at 6.1%, 8.7%, and 4.3%, respectively. The AUC was 0.76 (95% confidence interval [95% CI] 0.70-0.81) for the additive EuroSCORE, 0.76 (95% CI 0.70-0.81) for the logistic EuroSCORE and 0.81 (95% CI 0.76-0.86) for EuroSCORE II. Hosmer-Lemeshow goodness-of-fit statistics were P = 0.52, P = 0.07, and P = 0.12 for additive, logistic EuroSCORE, and EuroSCORE II. In this cohort of Brazilian patients with valvular heart disease submitted to surgical procedure, the EuroSCORE models had a good discriminatory capacity; however, the calibration was compromised because of an underestimation of the mortality rate.

Association between value-based purchasing score and hospital characteristics

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Borah Bijan J

2012-12-01

Full Text Available Abstract Background Medicare hospital Value-based purchasing (VBP program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are associated with a hospital’s VBP score, and consequently incentive payments. The objective of the study was to assess the association of hospital characteristics with (i the mean VBP score, and (ii specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC score and patient satisfaction score. Methods Observational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS regression and quantile regression (QR, respectively. Results VBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit, smaller bed size (vs. 100–199 beds, East South Central region (vs. New England region and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients were positively associated with mean VBP scores (p Conclusions Although hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.

A simplified score to quantify comorbidity in COPD.

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Nirupama Putcha

Full Text Available Comorbidities are common in COPD, but quantifying their burden is difficult. Currently there is a COPD-specific comorbidity index to predict mortality and another to predict general quality of life. We sought to develop and validate a COPD-specific comorbidity score that reflects comorbidity burden on patient-centered outcomes.Using the COPDGene study (GOLD II-IV COPD, we developed comorbidity scores to describe patient-centered outcomes employing three techniques: 1 simple count, 2 weighted score, and 3 weighted score based upon statistical selection procedure. We tested associations, area under the Curve (AUC and calibration statistics to validate scores internally with outcomes of respiratory disease-specific quality of life (St. George's Respiratory Questionnaire, SGRQ, six minute walk distance (6MWD, modified Medical Research Council (mMRC dyspnea score and exacerbation risk, ultimately choosing one score for external validation in SPIROMICS.Associations between comorbidities and all outcomes were comparable across the three scores. All scores added predictive ability to models including age, gender, race, current smoking status, pack-years smoked and FEV1 (p<0.001 for all comparisons. Area under the curve (AUC was similar between all three scores across outcomes: SGRQ (range 0·7624-0·7676, MMRC (0·7590-0·7644, 6MWD (0·7531-0·7560 and exacerbation risk (0·6831-0·6919. Because of similar performance, the comorbidity count was used for external validation. In the SPIROMICS cohort, the comorbidity count performed well to predict SGRQ (AUC 0·7891, MMRC (AUC 0·7611, 6MWD (AUC 0·7086, and exacerbation risk (AUC 0·7341.Quantifying comorbidity provides a more thorough understanding of the risk for patient-centered outcomes in COPD. A comorbidity count performs well to quantify comorbidity in a diverse population with COPD.

Comparison of mortality prediction models and validation of SAPS II in critically ill burns patients.

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Pantet, O; Faouzi, M; Brusselaers, N; Vernay, A; Berger, M M

2016-06-30

Specific burn outcome prediction scores such as the Abbreviated Burn Severity Index (ABSI), Ryan, Belgian Outcome of Burn Injury (BOBI) and revised Baux scores have been extensively studied. Validation studies of the critical care score SAPS II (Simplified Acute Physiology Score) have included burns patients but not addressed them as a cohort. The study aimed at comparing their performance in a Swiss burns intensive care unit (ICU) and to observe whether they were affected by a standardized definition of inhalation injury. We conducted a retrospective cohort study, including all consecutive ICU burn admissions (n=492) between 1996 and 2013: 5 epochs were defined by protocol changes. As required for SAPS II calculation, stays burned (TBSA) and inhalation injury (systematic standardized diagnosis since 2006). Study epochs were compared (χ2 test, ANOVA). Score performance was assessed by receiver operating characteristic curve analysis. SAPS II performed well (AUC 0.89), particularly in burns burns <40% TBSA. Ryan and BOBI scores were least accurate, as they heavily weight inhalation injury.

Xanthine oxidase activity and free radical generation in patients with sepsis syndrome

DEFF Research Database (Denmark)

Galley, H F; Davies, Michael Jonathan; Webster, N R

1996-01-01

OBJECTIVE: To determine xanthine oxidase activity, free radical concentrations, and lipid peroxidation in patients with sepsis syndrome compared with noninfected critically ill patients. DESIGN: A prospective observational study. SETTING: A nine-bed intensive care unit in a university teaching......). CONCLUSIONS: Patients with sepsis have xanthine oxidase activation, high free-radical concentrations, and evidence of free radical damage. The finding that xanthine oxidase activity was lower in those patients who died, coupled with increased lactate concentrations implies more severe ischemia with incomplete...... to the Acute Physiology and Chronic Health Evaluation (APACHE) II score or to the presence of organ dysfunction. The mean ascorbyl radical concentration (arbitrary units) determined by electron paramagnetic resonance following spin trapping was increased in patients compared with healthy subjects (p

Respiratory Therapy for Acute Lung Lesion, by Using Biphasic Positive Pressure Ventilation

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Yu. V. Marchenkov

2005-01-01

Full Text Available Objective. To comparatively study the efficiency of respiratory support in patients with acute lung lesion, by applying BIPAP, SIMV, and aIPPV.Subjects. Twenty-six patients with acute lung lesion whose pattern included acute respiratory distress syndrome (n=16, pneumonia (и=6, and pneumonitis (n=4 were examined. The severity of disease was 18 to 21 APACHE II scale score.Results. The use of BIPAP leads to a better adaptation of a patient to respiratory support, to a reduction in the number of used myorelaxants and sedatives, and to improvement of gas exchange in the lung and diminishes the negative impact of artificial ventilation on hemodynamics. As compared with other types of assisted ventilation, BIPAP accelerates transfer from total respiratory support to spontaneous breathing.

Customization of a Severity of Illness Score Using Local Electronic Medical Record Data.

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Lee, Joon; Maslove, David M

2017-01-01

Severity of illness (SOI) scores are traditionally based on archival data collected from a wide range of clinical settings. Mortality prediction using SOI scores tends to underperform when applied to contemporary cases or those that differ from the case-mix of the original derivation cohorts. We investigated the use of local clinical data captured from hospital electronic medical records (EMRs) to improve the predictive performance of traditional severity of illness scoring. We conducted a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database, which contains clinical data from the Beth Israel Deaconess Medical Center in Boston, Massachusetts. A total of 17 490 intensive care unit (ICU) admissions with complete data were included, from 4 different service types: medical ICU, surgical ICU, coronary care unit, and cardiac surgery recovery unit. We developed customized SOI scores trained on data from each service type, using the clinical variables employed in the Simplified Acute Physiology Score (SAPS). In-hospital, 30-day, and 2-year mortality predictions were compared with those obtained from using the original SAPS using the area under the receiver-operating characteristics curve (AUROC) as well as the area under the precision-recall curve (AUPRC). Test performance in different cohorts stratified by severity of organ injury was also evaluated. Most customized scores (30 of 39) significantly outperformed SAPS with respect to both AUROC and AUPRC. Enhancements over SAPS were greatest for patients undergoing cardiovascular surgery and for prediction of 2-year mortality. Custom models based on ICU-specific data provided better mortality prediction than traditional SAPS scoring using the same predictor variables. Our local data approach demonstrates the value of electronic data capture in the ICU, of secondary uses of EMR data, and of local customization of SOI scoring. © The Author(s) 2015.

The Apache Longbow-Hellfire Missile Test at Yuma Proving Ground: Ecological Risk Assessment for Missile Firing

International Nuclear Information System (INIS)

Jones, Daniel Steven; Efroymson, Rebecca Ann; Hargrove, William Walter; Suter, Glenn; Pater, Larry

2008-01-01

A multiple stressor risk assessment was conducted at Yuma Proving Ground, Arizona, as a demonstration of the Military Ecological Risk Assessment Framework. The focus was a testing program at Cibola Range, which involved an Apache Longbow helicopter firing Hellfire missiles at moving targets, M60-A1 tanks. This paper describes the ecological risk assessment for the missile launch and detonation. The primary stressor associated with this activity was sound. Other minor stressors included the detonation impact, shrapnel, and fire. Exposure to desert mule deer (Odocoileus hemionus crooki) was quantified using the Army sound contour program BNOISE2, as well as distances from the explosion to deer. Few effects data were available from related studies. Exposure-response models for the characterization of effects consisted of human 'disturbance' and hearing damage thresholds in units of C-weighted decibels (sound exposure level) and a distance-based No Observed Adverse Effects Level for moose and cannonfire. The risk characterization used a weight-of-evidence approach and concluded that risk to mule deer behavior from the missile firing was likely for a negligible number of deer, but that no risk to mule deer abundance and reproduction is expected

Data collection and field experiments at the Apache Leap research site. Annual report, May 1995--1996

International Nuclear Information System (INIS)

Woodhouse, E.G.; Bassett, R.L.; Neuman, S.P.; Chen, G.

1997-08-01

This report documents the research performed during the period May 1995-May 1996 for a project of the U.S. Regulatory Commission (sponsored contract NRC-04-090-051) by the University of Arizona. The project manager for this research in Thomas J. Nicholson, Office of Nuclear Regulatory Research. The objectives of this research were to examine hypotheses and test alternative conceptual models concerning unsaturated flow and transport through fractured rock, and to design and execute confirmatory field and laboratory experiments to test these hypotheses and conceptual models at the Apache Leap Research Site near Superior, Arizona. Each chapter in this report summarizes research related to a specific set of objectives and can be read and interpreted as a separate entity. Topics include: crosshole pneumatic and gaseous tracer field and modeling experiments designed to help validate the applicability of contiuum geostatistical and stochastic concepts, theories, models, and scaling relations relevant to unsaturated flow and transport in fractured porous tuffs; use of geochemistry and aquifer testing to evaluate fracture flow and perching mechanisms; investigations of 234 U/ 238 U fractionation to evaluate leaching selectivity; and transport and modeling of both conservative and non-conservative tracers

Oral Assessment Kit, Levels II & III. Draft.

Science.gov (United States)

Agrelo-Gonzalez, Maria; And Others

The assessment packet includes a series of oral tests to help develop speaking as an integral part of second language instruction at levels II and III. It contains: 8 mini-tests for use at level II; 9 mini-tests for use at level III; a rating scale and score sheet masters for evaluating performance on these tests; and a collection of suggested…

External validation of the Intensive Care National Audit & Research Centre (ICNARC) risk prediction model in critical care units in Scotland.

Science.gov (United States)

Harrison, David A; Lone, Nazir I; Haddow, Catriona; MacGillivray, Moranne; Khan, Angela; Cook, Brian; Rowan, Kathryn M

2014-01-01

Risk prediction models are used in critical care for risk stratification, summarising and communicating risk, supporting clinical decision-making and benchmarking performance. However, they require validation before they can be used with confidence, ideally using independently collected data from a different source to that used to develop the model. The aim of this study was to validate the Intensive Care National Audit & Research Centre (ICNARC) model using independently collected data from critical care units in Scotland. Data were extracted from the Scottish Intensive Care Society Audit Group (SICSAG) database for the years 2007 to 2009. Recoding and mapping of variables was performed, as required, to apply the ICNARC model (2009 recalibration) to the SICSAG data using standard computer algorithms. The performance of the ICNARC model was assessed for discrimination, calibration and overall fit and compared with that of the Acute Physiology And Chronic Health Evaluation (APACHE) II model. There were 29,626 admissions to 24 adult, general critical care units in Scotland between 1 January 2007 and 31 December 2009. After exclusions, 23,269 admissions were included in the analysis. The ICNARC model outperformed APACHE II on measures of discrimination (c index 0.848 versus 0.806), calibration (Hosmer-Lemeshow chi-squared statistic 18.8 versus 214) and overall fit (Brier's score 0.140 versus 0.157; Shapiro's R 0.652 versus 0.621). Model performance was consistent across the three years studied. The ICNARC model performed well when validated in an external population to that in which it was developed, using independently collected data.

Hemophilic arthropathy. A scoring system for magnetic resonance imaging

International Nuclear Information System (INIS)

Soler, R.; Rodriguez, E.; Marini, M.; Lopez-Fernandez, F.

2002-01-01

The aim of this study was to define a system for scoring hemophilic arthropathy (HA) based on MR findings, providing for objective evaluation of the degree of joint involvement and evolution after on-demand administration of FVIII substitutional therapy or prophylactic treatment. A total of 133 MR examinations (89 basal and 44 during follow-up) were performed in 25 patients. Patients were divided in two groups depending on the therapy received and the length of time that the disease had been evolving at the start of the study. Group I was composed of 10 patients with secondary prophylaxis and group II was composed by 15 treated on demand. T1-weighted and T2*-weighted images performed on a 0.5-T unit were prospectively evaluated. The joint involvement was established on a scale of 0 (no abnormalities), I (minimal amount of hemosiderin), II (large amount of hemosiderin and isolated cartilaginous erosion), III (cartilage destruction, bone erosions, and subchondral cysts) to IV (large internal joint derangement, secondary osteoarthritis and/or ankylosis). At basal MR examination, patients of group I showed no abnormalities (n=28, 75.6%), grade I (n=3), and grade II (n=6) of HA. Patients of group II corresponded to MR grades III (n=21) and IV (n=11) of HA. The MR follow-up showed improvement in three joints of group I and worsening in 5 joints in group I and 2 joints in group II. Early signs of HA were detected in 10 joints with MR imaging but were underestimated on plain radiographs. Advanced degrees of HA were classified as severe under both imaging techniques. Magnetic resonance is the preferred imaging technique to assess HA. The earliest signs of joint damage, detected by MR, are overlooked by plain radiography. The MR scoring system can be used for evaluating HA. Follow-up MR should be performed to evaluate regression or worsening of the abnormalities, primarily in the case of patients with prophylaxis who usually suffer normal or early joint involvement not

Hemophilic arthropathy. A scoring system for magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Soler, R.; Rodriguez, E.; Marini, M. [Department of Radiology, Hospital Juan Canalejo, Coruna (Spain); Lopez-Fernandez, F. [Department of Hematology, Hospital Juan Canalejo, Coruna (Spain)

2002-04-01

The aim of this study was to define a system for scoring hemophilic arthropathy (HA) based on MR findings, providing for objective evaluation of the degree of joint involvement and evolution after on-demand administration of FVIII substitutional therapy or prophylactic treatment. A total of 133 MR examinations (89 basal and 44 during follow-up) were performed in 25 patients. Patients were divided in two groups depending on the therapy received and the length of time that the disease had been evolving at the start of the study. Group I was composed of 10 patients with secondary prophylaxis and group II was composed by 15 treated on demand. T1-weighted and T2*-weighted images performed on a 0.5-T unit were prospectively evaluated. The joint involvement was established on a scale of 0 (no abnormalities), I (minimal amount of hemosiderin), II (large amount of hemosiderin and isolated cartilaginous erosion), III (cartilage destruction, bone erosions, and subchondral cysts) to IV (large internal joint derangement, secondary osteoarthritis and/or ankylosis). At basal MR examination, patients of group I showed no abnormalities (n=28, 75.6%), grade I (n=3), and grade II (n=6) of HA. Patients of group II corresponded to MR grades III (n=21) and IV (n=11) of HA. The MR follow-up showed improvement in three joints of group I and worsening in 5 joints in group I and 2 joints in group II. Early signs of HA were detected in 10 joints with MR imaging but were underestimated on plain radiographs. Advanced degrees of HA were classified as severe under both imaging techniques. Magnetic resonance is the preferred imaging technique to assess HA. The earliest signs of joint damage, detected by MR, are overlooked by plain radiography. The MR scoring system can be used for evaluating HA. Follow-up MR should be performed to evaluate regression or worsening of the abnormalities, primarily in the case of patients with prophylaxis who usually suffer normal or early joint involvement not

BANKRUPTCY PREDICTION MODEL WITH ZETAc OPTIMAL CUT-OFF SCORE TO CORRECT TYPE I ERRORS

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Mohamad Iwan

2005-06-01

This research has successfully attained the following results: (1 type I error is in fact 59,83 times more costly compared to type II error, (2 22 ratios distinguish between bankrupt and non-bankrupt groups, (3 2 financial ratios proved to be effective in predicting bankruptcy, (4 prediction using ZETAc optimal cut-off score predicts more companies filing for bankruptcy within one year compared to prediction using Hair et al. optimum cutting score, (5 Although prediction using Hair et al. optimum cutting score is more accurate, prediction using ZETAc optimal cut-off score proved to be able to minimize cost incurred from classification errors.

Transfusão sangüínea no intra-operatório, complicações e prognóstico Transfusión sanguínea en el intraoperatorio, complicaciones y pronóstico Complications and prognosis of intraoperative blood transfusion

Directory of Open Access Journals (Sweden)

João Manoel Silva Junior

2008-10-01

hemoglobina y el número de unidades de concentrados de hematíes utilizados fueron elevados comparados con los estudios que preconizan estrategias restrictivas. Fue encontrada en esa muestra una alta incidencia de complicaciones, principalmente infecciones, y una elevada mortalidad. Los puntajes APACHE II, POSSUM y mayor número de transfusiones fueron factores de riesgos independientes de un peor pronóstico en el postoperatorio.BACKGROUND AND OBJECTIVES: Intraoperative blood transfusions are associated with an increase in postoperative complications and hospital costs. Thus, this study evaluated the characteristics, complications, and probable risk factors for death in surgical patients who needed intraoperative blood transfusions. METHODS: This is a prospective study that spanned a one-year period, undertaken at the surgical suite of a tertiary hospital. Patients older than 18 years who needed intraoperative blood transfusions were included in this study. Jehovah witnesses, patients with a history of prior blood transfusions, coronary failure, and acute brain lesions were excluded. RESULTS: Eighty patients with mean age of 68.4 ± 14.1 years participated in the study. Most patients were ASA II, representing 69.6% of the study group; APACHE and POSSUM scores were 13.6 ± 4.4 and 37.5 ± 11.4, respectively. Mean hemoglobin at the time of transfusion was 8.2 ±1.8 g.dL-1 and 19% of the patients had hemoglobin levels higher than 10 g.dL-1. Patients received an average of 2.2 ± 0.9 IU of packed red blood cells. Hospital mortality was 26.3%. Post-transfusion complications totaled 57.5% of the cases in the postoperative period, and most of them were due to infections. In the logistic regression, independent factors for death included APACHE II (OR = 1.34; 95% CI 1.102-1.622, POSSUM (OR = 1.08; 95% CI 1.008-1.150 and the number of packed red blood cells received (OR = 2.22; 95% CI 1.100-4.463. Thus, the higher the number of transfusions, the greater the incidence of

Use of a semiquantitative procalcitonin kit for evaluating severity and predicting mortality in patients with sepsis

Directory of Open Access Journals (Sweden)

Kenzaka T

2012-05-01

Full Text Available Tsuneaki Kenzaka,1 Masanobu Okayama,2 Shigehiro Kuroki,1 Miho Fukui,3 Shinsuke Yahata,3 Hiroki Hayashi,3 Akihito Kitao,3 Eiji Kajii,2 Masayoshi Hashimoto41Division of General Medicine, 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke; 3Department of General Medicine, Toyooka Public Hospital, Toyooka; 4Department of Family and Community Medicine, Kobe University Graduate School of Medicine, Kobe, JapanBackground: The aim of this study was to evaluate the clinical usefulness of a semiquantitative procalcitonin kit for assessing severity of sepsis and early determination of mortality in affected patients.Methods: This was a prospective, observational study including 206 septic patients enrolled between June 2008 and August 2009. Disseminated intravascular coagulation (DIC, Sequential Organ Failure Assessment (SOFA, Acute Physiology and Chronic Health Evaluation (APACHE II scores were measured, along with semiquantitative procalcitonin concentrations. Patients were divided into three groups based on their semiquantitative procalcitonin concentrations (group A, <2 ng/mL; group B ≥ 2 ng/mL < 10 ng/mL; group C ≥ 10 ng/mL.Results: A significant difference in DIC, SOFA, and APACHE II scores was found between group A and group C and between group B and group C (P < 0.01. Patients with severe sepsis and septic shock had significantly higher procalcitonin concentrations than did patients with less severe disease. The rate of patients with septic shock with high procalcitonin concentrations showed an upward trend. There was a significant (P < 0.01 difference between the three groups with regard to numbers of patients and rates of severe sepsis, septic shock, DIC, and mortality.Conclusion: Semiquantitative procalcitonin concentration testing can be helpful for early assessment of disease severity in patients with sepsis. Furthermore, it may also help in predicting early

Pneumonias e infecção HIV. Algumas particularidades clínicas e factores de prognóstico

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Jorge T. Monteiro

1996-03-01

Full Text Available RESUMO: As pneumonias (PNM constituem uma das principais complicações da infecção HIV. O objectivo deste estudo é comparar 2 grupos de PNM da comunidade internadas na nossa Unidade de Cuidados Intensivos (UCI entre 1990 e 1994: 19 doentes HIV+ (grupo A e 152 doentes HIV- (grupo B. O APACHE II foi semelhante nos 2 grupos. O grupo A. necessitou mais frequentemente de ventilação mecânica (VM (p<0,007 e teve uma P(A-aO2 mais elevada (p<0,004. A acidose metabólica foi também mais frequente neste grupo. Analisando os parâmetros laboratoriais, o grupo A apresentou menor número de linfocitos (p<0,02, DLH mais elevada (p<0,04 e hipoalbuminemia mais marcada (p<0,03. A mortalidade foi maior no grupo A (52,6% do que no grupo B (29,6% (p<0,04. Analisando isoladamente os doentes do grupo A, não encontrámos diferenças significativas entre falecidos e não falecidos, à excepção da hipoalbuminemia, que se correlacionou com a mortalidade (p<0,02. Em conclusão, as PNM dos doentes HIV+ tiveram urn comportamento mais agressivo do que as PNM da comunidade em geral. Na avaliação prognóstica o APACHE II não diferenciou os 2 grupos de PNM. Alguns factores de prognóstico geralmente aceites na análise de PNM oportunistas em doentes HIV+ parecem perder valor em estadios avançados de SIDA, especialmente em doentes necessitando de cuidados intensivos. ABSTRACT: In HIV infections, Pneumonias (PNM have an outstanding place in pulmonary complications. The aim of this work was to compare two groups of patients admitted with PNM in our ICU during the same period (1990-94: Group A, 19 patients HIV+, and Group B, 152 patients HIV-. APACHE II was identical in the 2 groups (p=ns. Group A required more often mechanical ventilation (p<0,007, had a higher P(A-aO2 (p<0,004 and metabolic acidosis was more frequent (p<0,001. Regarding laboratorial parameters Group A had a lower number of linfocytes (p<0,02, a higher LDH (p<0,04 and a more marked hypoalbuminemia (p

Mescalero Apache Tribe Monitored Retrievable Storage (MRS). Phase 1 feasibility study report

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Peso, F.

1992-03-13

The Nuclear Waste Policy Act of 1982, as amended, authorizes the siting, construction and operation of a Monitored Retrievable Storage (MRS) facility. The MRS is intended to be used for the temporary storage of spent nuclear fuel from the nation`s nuclear power plants beginning as early as 1998. Pursuant to the Nuclear Waste Policy Act, the Office of the Nuclear Waste Negotiator was created. On October 7, 1991, the Nuclear Waste Negotiator invited the governors of states and the Presidents of Indian tribes to apply for government grants in order to conduct a study to assess under what conditions, if any, they might consider hosting an MRS facility. Pursuant to this invitation, on October 11, 1991 the Mescalero Apache Indian Tribe of Mescalero, NM applied for a grant to conduct a phased, preliminary study of the safety, technical, political, environmental, social and economic feasibility of hosting an MRS. The preliminary study included: (1) An investigative education process to facilitate the Tribe`s comprehensive understanding of the safety, environmental, technical, social, political, and economic aspects of hosting an MRS, and; (2) The development of an extensive program that is enabling the Tribe, in collaboration with the Negotiator, to reach an informed and carefully researched decision regarding the conditions, (if any), under which further pursuit of the MRS would be considered. The Phase 1 grant application enabled the Tribe to begin the initial activities necessary to determine whether further consideration is warranted for hosting the MRS facility. The Tribe intends to pursue continued study of the MRS in order to meet the following objectives: (1) Continuing the education process towards a comprehensive understanding of the safety, environmental, technical, social and economic aspects of the MRS; (2) Conducting an effective public participation and information program; (3) Participating in MRS meetings.

Unsupervised deep learning applied to breast density segmentation and mammographic risk scoring

DEFF Research Database (Denmark)

Kallenberg, Michiel Gijsbertus J.; Petersen, Peter Kersten; Nielsen, Mads

2016-01-01

Mammographic risk scoring has commonly been automated by extracting a set of handcrafted features from mammograms, and relating the responses directly or indirectly to breast cancer risk. We present a method that learns a feature hierarchy from unlabeled data. When the learned features are used...... as the input to a simple classifier, two different tasks can be addressed: i) breast density segmentation, and ii) scoring of mammographic texture. The proposed model learns features at multiple scales. To control the models capacity a novel sparsity regularizer is introduced that incorporates both lifetime...... and population sparsity. We evaluated our method on three different clinical datasets. Our state-of-the-art results show that the learned breast density scores have a very strong positive relationship with manual ones, and that the learned texture scores are predictive of breast cancer. The model is easy...

Aplicación de las redes neuronales artificiales para la estratificación de riesgo de mortalidad hospitalaria

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Trujillano J.

2003-01-01

Full Text Available Objetivo: Comparar la capacidad de predicción de mortalidad hospitalaria de una red neuronal artificial (RNA con el Acute Physiology and Chronic Health Evaluation II (APACHE II y la regresión logística (RL, y comparar la asignación de probabilidades entre los distintos modelos. Método: Se recogen de forma prospectiva las variables necesarias para el cálculo del APACHE II. Disponemos de 1.146 pacientes asignándose aleatoriamente (70 y 30% al grupo de Desarrollo (800 y al de Validación (346. Con las mismas variables se genera un modelo de RL y de RNA (perceptrón de 3 capas entrenado por algoritmo de backpropagation con remuestreo bootstrap y con 9 nodos en la capa oculta en el grupo de desarrollo. Se comparan los tres modelos en función de los criterios de discriminación con el área bajo la curva ROC (ABC [IC del 95%] y de calibración con el test de Hosmer-Lemeshow C (HLC. Las diferencias entre las probabilidades se valoran con el test de Bland-Altman. Resultados: En el grupo de validación, el APACHE II con ABC de 0,79 (0,75-0,84 y HLC de 11 (p = 0,329; modelo RL, ABC de 0,81 (0,76-0,85 y HLC de 29 (p = 0,0001, y en RNA, ABC de 0,82 (0,77-0,86 y HLC de 10 (p = 0,404. Los pacientes con mayores diferencias en la asignación de probabilidad entre RL y RN (8% del total son pacientes con problemas neurológicos. Los peores resultados se obtienen en los pacientes traumáticos (ABC inferior a 0,75 en todos los modelos. En los pacientes respiratorios, la RNA alcanza los mejores resultados (ABC = 0,87 [0,78-0,91]. Conclusiones: Una RNA es capaz de estratificar el riesgo de mortalidad hospitalaria utilizando las variables del sistema APACHE II. La RNA consigue mejores resultados frente a RL, sin alcanzar significación, ya que no trabaja con restricciones lineales ni de independencia de variables, con una diferente asignación de probabilidad individual entre los modelos.

Evaluation of the Walking Index for Spinal Cord Injury II (WISCI-II) in children with Spinal Cord Injury (SCI).

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Calhoun Thielen, C; Sadowsky, C; Vogel, L C; Taylor, H; Davidson, L; Bultman, J; Gaughan, J; Mulcahey, M J

2017-05-01

Mixed methods were used in this study. The appropriateness of the levels of the Walking Index for Spinal Cord Injury II (WISCI-II) for application in children was critically reviewed by physical therapists using the Modified Delphi Technique, and the inter- and intra-rater reliability of the WISCI-II in children was evaluated. To examine the construct validity, and to establish reliability of the WISCI-II related to its use in children with spinal cord injury (SCI). United States of America. Using a Modified Delphi Technique, physical therapists critically reviewed the WISCI-II levels for pediatric utilization. Concurrently, ambulatory children under age 18 years with SCI were evaluated using the WISCI-II on two occasions by the same therapist to establish intra-rater reliability. One trial was photographed and de-identified. Each photograph was reviewed by four different physical therapists who gave WISCI-II scores to establish inter-rater reliability. Summary and descriptive statistics were used to calculate the frequency of yes/no responses for each WISCI-II level question and to determine the percent agreement for each question. Inter- and intra-rater reliability was calculated using interclass correlation coefficients (ICCs) with 95% confidence intervals (CI). Construct validity was confirmed after one Delphi round during which at least 80% agreement was established by 51 physical therapists on the appropriateness of the WISCI-II levels for children. Fifty-two children with SCI aged 2-17 years completed repeated WISCI-II assessments and 40 de-identified photographs were scored by four physical therapists. Intra- and inter-rater reliability was high (ICC=0.997, CI=0.995-0.998 and ICC=0.97, CI=0.95-0.98, respectively). This study demonstrates support for the use of the WISCI-II in ambulatory children with SCI. This study was funded by the Craig H Neilsen Foundation, Spinal Cord Injury Research on the Translation Spectrum, Senior Research Award #282592 (Mulcahey

Metabonomics analysis of plasma reveals the lactate to cholesterol ratio as an independent prognostic factor of short-term mortality in acute heart failure.

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Franck Desmoulin

Full Text Available OBJECTIVE: Mortality in heart failure (AHF remains high, especially during the first days of hospitalization. New prognostic biomarkers may help to optimize treatment. The aim of the study was to determine metabolites that have a high prognostic value. METHODS: We conducted a prospective study on a training cohort of AHF patients (n = 126 admitted in the cardiac intensive care unit and assessed survival at 30 days. Venous plasmas collected at admission were used for (1H NMR--based metabonomics analysis. Differences between plasma metabolite profiles allow determination of discriminating metabolites. A cohort of AHF patients was subsequently constituted (n = 74 to validate the findings. RESULTS: Lactate and cholesterol were the major discriminating metabolites predicting 30-day mortality. Mortality was increased in patients with high lactate and low total cholesterol concentrations at admission. Accuracies of lactate, cholesterol concentration and lactate to cholesterol (Lact/Chol ratio to predict 30-day mortality were evaluated using ROC analysis. The Lact/Chol ratio provided the best accuracy with an AUC of 0.82 (P < 0.0001. The acute physiology and chronic health evaluation (APACHE II scoring system provided an AUC of 0.76 for predicting 30-day mortality. APACHE II score, Cardiogenic shock (CS state and Lact/Chol ratio ≥ 0.4 (cutoff value with 82% sensitivity and 64% specificity were significant independent predictors of 30-day mortality with hazard ratios (HR of 1.11, 4.77 and 3.59, respectively. In CS patients, the HR of 30-day mortality risk for plasma Lact/Chol ratio ≥ 0.4 was 3.26 compared to a Lact/Chol ratio of < 0.4 (P = 0.018. The predictive power of the Lact/Chol ratio for 30-day mortality outcome was confirmed with the independent validation cohort. CONCLUSION: This study identifies the plasma Lact/Chol ratio as a useful objective and simple parameter to evaluate short term prognostic and could be integrated into quantitative

Differences of wells scores accuracy, caprini scores and padua scores in deep vein thrombosis diagnosis

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Gatot, D.; Mardia, A. I.

2018-03-01

Deep Vein Thrombosis (DVT) is the venous thrombus in lower limbs. Diagnosis is by using venography or ultrasound compression. However, these examinations are not available yet in some health facilities. Therefore many scoring systems are developed for the diagnosis of DVT. The scoring method is practical and safe to use in addition to efficacy, and effectiveness in terms of treatment and costs. The existing scoring systems are wells, caprini and padua score. There have been many studies comparing the accuracy of this score but not in Medan. Therefore, we are interested in comparative research of wells, capriniand padua score in Medan.An observational, analytical, case-control study was conducted to perform diagnostic tests on the wells, caprini and padua score to predict the risk of DVT. The study was at H. Adam Malik Hospital in Medan.From a total of 72 subjects, 39 people (54.2%) are men and the mean age are 53.14 years. Wells score, caprini score and padua score has a sensitivity of 80.6%; 61.1%, 50% respectively; specificity of 80.65; 66.7%; 75% respectively, and accuracy of 87.5%; 64.3%; 65.7% respectively.Wells score has better sensitivity, specificity and accuracy than caprini and padua score in diagnosing DVT.

Angiotensin II for the Treatment of Vasodilatory Shock.

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Khanna, Ashish; English, Shane W; Wang, Xueyuan S; Ham, Kealy; Tumlin, James; Szerlip, Harold; Busse, Laurence W; Altaweel, Laith; Albertson, Timothy E; Mackey, Caleb; McCurdy, Michael T; Boldt, David W; Chock, Stefan; Young, Paul J; Krell, Kenneth; Wunderink, Richard G; Ostermann, Marlies; Murugan, Raghavan; Gong, Michelle N; Panwar, Rakshit; Hästbacka, Johanna; Favory, Raphael; Venkatesh, Balasubramanian; Thompson, B Taylor; Bellomo, Rinaldo; Jensen, Jeffrey; Kroll, Stew; Chawla, Lakhmir S; Tidmarsh, George F; Deane, Adam M

2017-08-03

Vasodilatory shock that does not respond to high-dose vasopressors is associated with high mortality. We investigated the effectiveness of angiotensin II for the treatment of patients with this condition. We randomly assigned patients with vasodilatory shock who were receiving more than 0.2 μg of norepinephrine per kilogram of body weight per minute or the equivalent dose of another vasopressor to receive infusions of either angiotensin II or placebo. The primary end point was a response with respect to mean arterial pressure at hour 3 after the start of infusion, with response defined as an increase from baseline of at least 10 mm Hg or an increase to at least 75 mm Hg, without an increase in the dose of background vasopressors. A total of 344 patients were assigned to one of the two regimens; 321 received a study intervention (163 received angiotensin II, and 158 received placebo) and were included in the analysis. The primary end point was reached by more patients in the angiotensin II group (114 of 163 patients, 69.9%) than in the placebo group (37 of 158 patients, 23.4%) (odds ratio, 7.95; 95% confidence interval [CI], 4.76 to 13.3; Pthe mean improvement in the cardiovascular Sequential Organ Failure Assessment (SOFA) score (scores range from 0 to 4, with higher scores indicating more severe dysfunction) was greater in the angiotensin II group than in the placebo group (-1.75 vs. -1.28, P=0.01). Serious adverse events were reported in 60.7% of the patients in the angiotensin II group and in 67.1% in the placebo group. Death by day 28 occurred in 75 of 163 patients (46%) in the angiotensin II group and in 85 of 158 patients (54%) in the placebo group (hazard ratio, 0.78; 95% CI, 0.57 to 1.07; P=0.12). Angiotensin II effectively increased blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors. (Funded by La Jolla Pharmaceutical Company; ATHOS-3 ClinicalTrials.gov number, NCT02338843 .).

Comparative Study of Load Testing Tools: Apache JMeter, HP LoadRunner, Microsoft Visual Studio (TFS, Siege

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Rabiya Abbas

2017-12-01

Full Text Available Software testing is the process of verifying and validating the user’s requirements. Testing is ongoing process during whole software development. Software testing is characterized into three main types. That is, in Black box testing, user doesn’t know domestic knowledge, internal logics and design of system. In white box testing, Tester knows the domestic logic of code. In Grey box testing, Tester has little bit knowledge about the internal structure and working of the system. It is commonly used in case of Integration testing.Load testing helps us to analyze the performance of the system under heavy load or under Zero load. This is achieved with the help of a Load Testing Tool. The intention for writing this research is to carry out a comparison of four load testing tools i.e. Apache JMeter, LoadRunner, Microsoft Visual Studio (TFS, Siege based on certain criteria  i.e. test scripts generation , result reports, application support, plug-in supports, and cost . The main focus is to study these load testing tools and identify which tool is better and more efficient . We assume this comparison can help in selecting the most appropriate tool and motivates the use of open source load testing tools.

Regulatory activity based risk model identifies survival of stage II and III colorectal carcinoma.

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Liu, Gang; Dong, Chuanpeng; Wang, Xing; Hou, Guojun; Zheng, Yu; Xu, Huilin; Zhan, Xiaohui; Liu, Lei

2017-11-17

Clinical and pathological indicators are inadequate for prognosis of stage II and III colorectal carcinoma (CRC). In this study, we utilized the activity of regulatory factors, univariate Cox regression and random forest for variable selection and developed a multivariate Cox model to predict the overall survival of Stage II/III colorectal carcinoma in GSE39582 datasets (469 samples). Patients in low-risk group showed a significant longer overall survival and recurrence-free survival time than those in high-risk group. This finding was further validated in five other independent datasets (GSE14333, GSE17536, GSE17537, GSE33113, and GSE37892). Besides, associations between clinicopathological information and risk score were analyzed. A nomogram including risk score was plotted to facilitate the utilization of risk score. The risk score model is also demonstrated to be effective on predicting both overall and recurrence-free survival of chemotherapy received patients. After performing Gene Set Enrichment Analysis (GSEA) between high and low risk groups, we found that several cell-cell interaction KEGG pathways were identified. Funnel plot results showed that there was no publication bias in these datasets. In summary, by utilizing the regulatory activity in stage II and III colorectal carcinoma, the risk score successfully predicts the survival of 1021 stage II/III CRC patients in six independent datasets.

New clinical score to diagnose nonalcoholic steatohepatitis in obese patients

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Pulzi Fernanda BU

2011-02-01

Full Text Available Abstract Background Nonalcoholic fatty liver disease (NAFLD is the most frequent disease associated with abnormal liver tests that is characterized by a wide spectrum of liver damage, ranging from simple macro vesicular steatosis to steatohepatitis (NASH, cirrhosis or liver carcinoma. Liver biopsy is the most precise test to differentiate NASH from other stages of NAFLD, but it is an invasive and expensive method. This study aimed to create a clinical laboratory score capable of identify individual with NASH in severely obese patients submitted to bariatric surgery. Methods The medical records from 66 patients submitted to gastroplasty were reviewed. Their chemistry profile, abdominal ultrasound (US and liver biopsy done during the surgical procedure were analyzed. Patients were classified into 2 groups according to liver biopsy: Non-NASH group - those patients without NAFLD or with grade I, II or III steatosis; and NASH group - those with steatohepatitis or fibrosis. The t-test was used to compare each variable with normal distribution between NASH and Non-NASH groups. When comparing proportions of categorical variables, we used chi-square or z-test, where appropriate. A p-value Results 83% of patients with obesity grades II or III showed NAFLD, and the majority was asymptomatic. Total Cholesterol (TC≥200 mg/dL, alanine aminotransferase (ALT ≥30, AST/ALT ratio (AAR≤ 1, gammaglutaril-transferase (γGT≥30 U/L and abdominal US, compatible with steatosis, showed association with NASH group. We proposed 2 scores: Complete score (TC, ALT, AAR, γGT and US and the simplified score, where US was not included. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH (sensitivity 70%, specificity 88.6%, NPV 91.2%, PPV 63. 6%. Conclusion Alterations in TC, ALT, AAR, γGT and US are related to the most risk for NASH. The combination of biochemical and imaging results improved accuracy to 84.4% the

Factors affecting the student evaluation of teaching scores: evidence from panel data estimation

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Eduardo de Carvalho Andrade

2012-03-01

Full Text Available We use a random-effects model to find the factors that affect the student evaluation of teaching (SET scores. Dataset covers 6 semesters, 496 undergraduate courses related to 101 instructors and 89 disciplines. Our empirical findings are: (i the class size affects negatively the SET score; (ii instructors with more experience are better evaluated, but these gains reduce over time; (iii participating in training programs, designed to improve the quality of teaching, did not increase the SET scores; (iv instructors seem to be able to marginally 'buy' a better evaluation by inflating students' grade. Finally, there are significant changes in the rankings when we adjust the SET score to eliminate the effects of variables beyond instructors' control. Despite these changes, they are not statistically significant.

Self-esteem in adolescents with Angle Class I, II and III malocclusion in a Peruvian sample.

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Florián-Vargas, Karla; Honores, Marcos J Carruitero; Bernabé, Eduardo; Flores-Mir, Carlos

2016-01-01

To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample. A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled. Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion. This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

Risk prediction models for mortality in patients with ventilator-associated pneumonia

DEFF Research Database (Denmark)

Larsson, Johan E; Itenov, Theis Skovsgaard; Bestle, Morten Heiberg

2017-01-01

the receiver operator characteristic curve (AUC). RESULTS: We identified 19 articles studying 7 different models' ability to predict mortality in VAP patients. The models were Acute Physiology and Chronic Health Evaluation (APACHE) II (9 studies, n = 1398); Clinical Pulmonary Infection Score (4 studies, n...... = 303); "Immunodeficiency, Blood pressure, Multilobular infiltrates on chest radiograph, Platelets and hospitalization 10 days before onset of VAP" (3 studies, n = 406); "VAP Predisposition, Insult Response and Organ dysfunction" (2 studies, n = 589); Sequential Organ Failure Assessment (7 studies, n......: The PubMed and EMBASE were searched in February 2016. We included studies in English that evaluated models' ability to predict the risk of mortality in patients with VAP. The reported mortality with the longest follow-up was used in the meta-analysis. Prognostic accuracy was measured with the area under...

Clinical performance of two visual scoring systems in detecting and assessing activity status of occlusal caries in primary teeth

DEFF Research Database (Denmark)

Braga, M M; Ekstrand, K R; Martignon, S

2010-01-01

This study aimed to compare the clinical performance of two sets of visual scoring criteria for detecting caries severity and assessing caries activity status in occlusal surfaces. Two visual scoring systems--the Nyvad criteria (NY) and the ICDAS-II including an adjunct system for lesion activity...

Difference of achalasia subtypes based on clinical symptoms, radiographic findings, and stasis scores

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A. Meillier

2018-01-01

Conclusions: Achalasia subtypes had similar clinical symptoms, except for increased vomiting severity in subtype i. The maximum esophageal diameter in subtype ii was significantly greater than in subtype iii. Esophageal stasis scores were similar. Thus, high-resolution esophageal manometry remains essential in assessing achalasia subtypes.

Value of tomosynthesis for lesion evaluation of small joints in osteoarthritic hands using the OARSI score.

Science.gov (United States)

Martini, K; Becker, A S; Guggenberger, R; Andreisek, G; Frauenfelder, T

2016-07-01

To determine the diagnostic performance of tomosynthesis in depicting osteoarthritic lesions in comparison to conventional radiographs, with use of computed tomography (CT) as standard-of-reference. Imaging of 12 cadaveric hands was performed with tomosynthesis in dorso-palmar (dp) projection, conventional radiographs (dp) and multi-detector CT. Distal interphalangeal joint (DIP)II, DIPIII, proximal interphalangeal joint (PIP)II, PIPIII, first carpometacarpal (CMC) and scaphotrapezotrapezoidal joint (STT) were graded by two independent readers using the Osteoarthritis Research Society International (OARSI) score. The mean score for each feature was calculated for all modalities. Additional wrists were evaluated for presence of calcium pyrophosphate disease (CPPD). CT served as reference-standard. Inter-reader agreement (ICC) was calculated. Comparing tomosynthesis and conventional radiographs to CT, the sensitivity for the presence of osteophytes was 95,7% vs 65,2%; for joint space narrowing 95,8% vs 52,1%; for subchondral sclerosis 61,5% vs 51,3%; for lateral deformity 83.3% vs 83,3%; and for subchondral cysts 45,8% vs 29,2%. Erosions were not present. While tomosynthesis showed no significant difference in OARSI score grading to CT (mean OARSI-score CT: 16.8, SD = 10.6; mean OARSI-score Tomosynthesis: 16.3, SD = 9.6; P = 0.84), conventional radiographs had significant lower mean OARSI scores (mean OARSI-score X-ray: 11.1, SD = 8.3; P = 0.04). Inter-reader agreement for OARSI scoring was excellent (ICC = 0.99). CPPD calcifications present in CT, were also visible with tomosynthesis, but not with conventional radiography. In conclusion, tomosynthesis depicts more osteoarthritic changes in the small joints of the hand than conventional radiography using the OARSI scoring system and CT as the standard of reference. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Outcome of Intravenous Azithromycin Therapy in Patients with Complicated Scrub Typhus Compared with That of Doxycycline Therapy Using Propensity-Matched Analysis

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Jang, Mi-Ok; Jang, Hee-Chang; Kim, Uh Jin; Ahn, Joon Hwan; Kang, Seung-Ji; Jung, Sook-In; Shin, Hee-Young

2014-01-01

There are no well-matched, controlled studies comparing azithromycin with doxycycline for the treatment of complicated scrub typhus. A retrospective propensity score-matched case-control study was performed for patients who presented with complicated scrub typhus and were treated with doxycycline or azithromycin between 2001 and 2011. Data on comorbidities, clinical manifestations, laboratory studies, treatments, and outcomes were extracted for analysis. The clinical characteristics and outcomes of the azithromycin-treated group (n = 73) were compared to those of the doxycycline-treated group (n = 108). Of 181 patients, 73 from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment success and survival rates were not significantly different (89% [65/73 patients] versus 96% [70/73 patients] and 96% [70/73 patients] versus 96% [70/73 patients], respectively [P > 0.05]). No difference was observed in the time to defervescence or length of hospital stay between the two groups (P > 0.05). In complicated scrub typhus patients (n = 181), multivariate analysis showed that only APACHE II score was an independent risk factor for mortality (95% confidence interval, 1.11 to 1.56; P scrub typhus. PMID:24366734

A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism.

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Bova, Carlo; Vanni, Simone; Prandoni, Paolo; Morello, Fulvio; Dentali, Francesco; Bernardi, Enrico; Mumoli, Nicola; Bucherini, Eugenio; Barbar, Sofia; Picariello, Claudio; Enea, Iolanda; Pesavento, Raffaele; Bottino, Fabrizio; Jiménez, David

2018-05-01

The Bova score has shown usefulness in the identification of intermediate-high risk patients with acute pulmonary embolism (PE), but lacks prospective validation. The aim of this study was to prospectively validate the Bova score in different settings from the original derivation cohort. Consecutive, normotensive patients with acute PE recruited at 13 academic or general hospitals were stratified, using their baseline data, into the three Bova risk stages (I-III). The primary outcome was the 30-day composite of PE-related mortality, hemodynamic collapse and non-fatal PE recurrences in the three risk categories. In the study period, 639 patients were enrolled. The primary end point occurred in 45 patients (7.0%; 95% Confidence Intervals, 5.2%-9.3%). Risk stage correlated with the PE-related complication rate (stage I, 2.9%; stage II, 17%; stage III, 27%). Patients classified as stage III by the Bova score had a 6.5-fold increased risk for adverse outcomes (3.1-13.5, p < 0.001) compared with stages I and II combined. Rescue thrombolysis increased from stage I to stage III (0.6%, 12% and 15% respectively). All-cause mortality (5.3%) did not substantially differ among the stages. The Bova score accurately stratifies normotensive patients with acute PE into stages of increasing risk of 30-day PE-related complications. Copyright © 2018 Elsevier Ltd. All rights reserved.

Excess mortality in winter in Finnish intensive care.

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Reinikainen, M; Uusaro, A; Ruokonen, E; Niskanen, M

2006-07-01

In the general population, mortality from acute myocardial infarctions, strokes and respiratory causes is increased in winter. The winter climate in Finland is harsh. The aim of this study was to find out whether there are seasonal variations in mortality rates in Finnish intensive care units (ICUs). We analysed data on 31,040 patients treated in 18 Finnish ICUs. We measured severity of illness with acute physiology and chronic health evaluation II (APACHE II) scores and intensity of care with therapeutic intervention scoring system (TISS) scores. We assessed mortality rates in different months and seasons and used logistic regression analysis to test the independent effect of various seasons on hospital mortality. We defined 'winter' as the period from December to February, inclusive. The crude hospital mortality rate was 17.9% in winter and 16.4% in non-winter, P = 0.003. Even after adjustment for case mix, winter season was an independent risk factor for increased hospital mortality (adjusted odds ratio 1.13, 95% confidence interval 1.04-1.22, P = 0.005). In particular, the risk of respiratory failure was increased in winter. Crude hospital mortality was increased during the main holiday season in July. However, the severity of illness-adjusted risk of death was not higher in July than in other months. An increase in the mean daily TISS score was an independent predictor of increased hospital mortality. Severity of illness-adjusted hospital mortality for Finnish ICU patients is higher in winter than in other seasons.

Effect of Statin Use on Outcomes of Adults with Candidemia

Science.gov (United States)

Cuervo, Guillermo; Garcia-Vidal, Carolina; Nucci, Marcio; Puchades, Francesc; Fernández-Ruiz, Mario; Mykietiuk, Analía; Manzur, Adriana; Gudiol, Carlota; Pemán, Javier; Viasus, Diego; Ayats, Josefina; Carratalà, Jordi

2013-01-01

Background Statins have immunomodulatory properties and hinder Candida growth. However, it is unknown whether they may improve prognosis in patients with candidemia. We sought to determine the effect of prior statin use on the clinical outcomes of patients suffering candidemia. Methods and Findings Multicenter cohort study of hospitalized adults with candidemia between 2005 and 2011 in six hospitals in Spain, Brazil and Argentina. Of 326 candidemias, 44 (13.5%) occurred in statin users and 282 (86.5%) in statin non-users. The median value of APACHE II at candidemia diagnosis was similar between groups (18 vs. 16; p=.36). Candida albicans was the most commonly isolated species, followed by C. parapsilosis, C. tropicalis, C. glabrata, and C. krusei. There were no differences regarding appropriate empirical antifungal treatment. Statin users had a lower early (5 d) case-fatality rate than non-users (4.5 vs. 17%; p=.031). This effect was not observed with other cardiovascular drugs (aspirin, beta blockers and ACE inhibitors). Independent factor related to early case-fatality rate was APACHE II score (AOR, 1.08; 95% CI, 1.03–1.14; p=.002). An appropriate empirical antifungal therapy (AOR, 0.11; 95% CI, 0.04–0.26; p=statin use were independently associated with lower early case-fatality (AOR, 0.17; 95% CI, 0.03–0.93; p=.041). Fourteen days (14d) and overall (30d) case-fatality rates were similar between groups (27% vs. 29%; p=0.77 and 40% vs. 44%; p=.66). Conclusions The use of statins might have a beneficial effect on outcomes of patients with candidemia. This hypothesis deserves further evaluation in randomized trials. PMID:24155941

Comparison of empirical strategies to maximize GENEHUNTER lod scores.

Science.gov (United States)

Chen, C H; Finch, S J; Mendell, N R; Gordon, D

1999-01-01

We compare four strategies for finding the settings of genetic parameters that maximize the lod scores reported in GENEHUNTER 1.2. The four strategies are iterated complete factorial designs, iterated orthogonal Latin hypercubes, evolutionary operation, and numerical optimization. The genetic parameters that are set are the phenocopy rate, penetrance, and disease allele frequency; both recessive and dominant models are considered. We selected the optimization of a recessive model on the Collaborative Study on the Genetics of Alcoholism (COGA) data of chromosome 1 for complete analysis. Convergence to a setting producing a local maximum required the evaluation of over 100 settings (for a time budget of 800 minutes on a Pentium II 300 MHz PC). Two notable local maxima were detected, suggesting the need for a more extensive search before claiming that a global maximum had been found. The orthogonal Latin hypercube design was the best strategy for finding areas that produced high lod scores with small numbers of evaluations. Numerical optimization starting from a region producing high lod scores was the strategy that found the highest maximum observed.

Self-esteem in adolescents with Angle Class I, II and III malocclusion in a Peruvian sample

Directory of Open Access Journals (Sweden)

Karla Florián-Vargas

2016-04-01

Full Text Available ABSTRACT Objective: To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample. Material and Methods: A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled. Results: Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion. Conclusion: This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

The relationship between formative and summative examinations and PANCE scores; can the past predict the future?

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Massey, Scott; Stallman, John; Lee, Louise; Klingaman, Kathy; Holmerud, David

2011-01-01

This paper describes how a systematic analysis of students at risk for failing the Physician Assistant National Certifying Examination (PANCE) may be used to identify which students may benefit from intervention prior to taking the PANCE and thus increase the likelihood of successful completion of the PANCE. The intervention developed and implemented uses various formative and summative examinations to predict students' PANCE scores with a high degree of accuracy. Eight end-of-rotation exams (EOREs) based upon discipline-specific diseases and averaging 100 questions each, a 360-question PANCE simulation (SUMM I), the PACKRAT, and a 700-question summative cognitive examination based upon the NCCPA blueprint (SUMM II) were administered to all students enrolled in the program during the clinical year starting in January 2010 and concluding in December 2010. When the PACKRAT, SUMM I, SUMM II, and the surgery, women's health, and pediatrics EOREs were combined in a regression model, an Rvalue of 0.87 and an R2 of 0.75 were obtained. A predicted score was generated for the class of 2009. The predicted PANCE score based upon this model had a final correlation of 0.790 with the actual PANCE score. This pilot study demonstrated that valid predicted scores could be generated from formative and summative examinations to provide valuable feedback and to identify students at risk of failing the PANCE.

Insulin-like growth factor II mRNA binding protein 3 (IMP3) is overexpressed in prostate cancer and correlates with higher Gleason scores

International Nuclear Information System (INIS)

Ikenberg, Kristian; Behnke, Silvia; Gerhardt, Josefine; Mortezavi, Ashkan; Wild, Peter; Hofstädter, Ferdinand; Burger, Maximilian; Moch, Holger; Kristiansen, Glen; Fritzsche, Florian R; Zuerrer-Haerdi, Ursina; Hofmann, Irina; Hermanns, Thomas; Seifert, Helge; Müntener, Michael; Provenzano, Maurizio; Sulser, Tullio

2010-01-01

The oncofetal protein insulin-like growth factor II mRNA binding protein 3 (IMP3) is an important factor for cell-migration and adhesion in malignancies. Recent studies have shown a remarkable overexpression of IMP3 in different human malignant neoplasms and also revealed it as an important prognostic marker in some tumor entities. To our knowledge, IMP3 expression has not been investigated in prostate carcinomas so far. Immunohistochemical stainings for IMP3 were performed on tissue microarray (TMA) organized samples from 507 patients: 31 normal prostate tissues, 425 primary carcinomas and 51 prostate cancer metastases or castration-resistant prostate cancers (CRPC). IMP3 immunoreactivity was semiquantitatively scored and correlated with clinical-pathologic parameters including survival. IMP3 is significantly stronger expressed in prostate carcinomas compared to normal prostate tissues (p < 0.0001), but did not show significant correlation with the pT-stage, the proliferation index (MIB1), preoperative serum PSA level and the margin status. Only a weak and slightly significant correlation was found with the Gleason score and IMP3 expression failed to show prognostic significance in clinico-pathological correlation-analyses. Although IMP3 is overexpressed in a significant proportion of prostate cancer cases, which might be of importance for novel therapeutic approaches, it does not appear to possess any immediate diagnostic or prognostic value, limiting its potential as a tissue biomarker for prostate cancer. These results might be corroborated by the fact, that two independent tumor cohorts were separately reviewed

Clinical Benefits of Memantine Treatment for Alzheimer's Disease in the Okayama Memantine Study II (OMS II).

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Matsuzono, Kosuke; Yamashita, Toru; Ohta, Yasuyuki; Hishikawa, Nozomi; Koike, Makoto; Sato, Kota; Kono, Syoichiro; Deguchi, Kentaro; Nakano, Yumiko; Abe, Koji

2015-01-01

The clinical benefits of memantine, depending on the baseline cognitive and affective conditions in real world dementia clinics, have not been completely examined. We performed the "Okayama Memantine Study II (OMS II)" to retrospectively evaluate the clinical effects of memantine monotherapy (n = 38) in Alzheimer's disease (AD) patients using seven batteries to assess dementia at the baseline, at 3, 6, and 12 months. Additionally, we divided 163 AD patients treated with memantine into two subgroups depending on the baseline cognitive score of the Mini-Mental State Examination (MMSE): the MMSE OMS II showed that memantine monotherapy improved BPSD until 12 months. The higher baseline cognitive subgroup (MMSE ≥15) and the worse baseline BPSD subgroup were expected to show better effects with memantine.

ORF Alignment: NT_033779 [GENIUS II[Archive

Lifescience Database Archive (English)

Full Text Available m A [Drosophila melanogaster] gb|AAF53342.1| ... CG7885-PA, isoform A [Drosophila melanogaster] ... gb|AAF44826.1| symb...ol=RpII33; synonym=BG:DS00941.10; ... cDNA=method:''sim4'', score:''1000.0''

Feasibility of Using the Helping Alliance Questionnaire II as a Self-Report Measure for Individuals with a Psychiatric Disorder Receiving Music Therapy.

Science.gov (United States)

Hannibal, Niels; Domingo, Maria Rodrigo; Valentin, Jan B; Licht, Rasmus W

2017-11-01

No specific instrument has been developed for measuring alliance during music therapy. To evaluate the feasibility of using the Helping Alliance Questionnaire II (HAq-II) as a self-report measure for individuals receiving treatment for a psychiatric disorder. Specifically, we examined the percent of patients who filled out the questionnaire, and when completed, whether there were any missing items. We also examined internal consistency and associations between patient variables and HAq-II scores. Between October 2013 and April 2014, we invited 45 individuals with a psychiatric disorder, who were also receiving music therapy, to fill out the HAq-II. We also collected clinical data from each person's record. Thirty-one (69%) of the 45 invited patients filled out the HAq-II, and of those completed, only three had missing items. Of the 45 invited patients, thirty (67%) had a diagnosis of schizophrenia or other psychotic disorders, and 11 (24%) were diagnosed with other psychiatric disorders. In terms of diagnosis and other clinical variables, no statistically significant differences were found between the 31 patients who filled out the HAq-II and the 14 patients who did not return the questionnaire. The median HAq-II score was 5.11 (range 3.74-6.00), indicating a relatively high alliance. We did not find any statistically significant associations between the HAq-II scores and potential predictors of interest. The Cronbach's alpha was 0.85. Completion of the HAq-II was fairly high in this group of individuals with psychiatric diagnoses who were receiving music therapy. Internal consistency of the HAq-II was acceptable. Relatively high HAq-II scores suggest a high degree of therapeutic alliance, but the external validity of the HAq-II and the relationship between scores and therapy needs further evaluation. © the American Music Therapy Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Adding the s-Process Element Cerium to the APOGEE Survey: Identification and Characterization of Ce II Lines in the H-band Spectral Window

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Cunha, Katia; Smith, Verne V.; Hasselquist, Sten; Souto, Diogo; Shetrone, Matthew D.; Allende Prieto, Carlos; Bizyaev, Dmitry; Frinchaboy, Peter; García-Hernández, D. Anibal; Holtzman, Jon; Johnson, Jennifer A.; Jőnsson, Henrik; Majewski, Steven R.; Mészáros, Szabolcs; Nidever, David; Pinsonneault, Mark; Schiavon, Ricardo P.; Sobeck, Jennifer; Skrutskie, Michael F.; Zamora, Olga; Zasowski, Gail; Fernández-Trincado, J. G.

2017-08-01

Nine Ce II lines have been identified and characterized within the spectral window observed by the Apache Point Observatory Galactic Evolution Experiment (APOGEE) survey (between λ1.51 and 1.69 μm). At solar metallicities, cerium is an element that is produced predominantly as a result of the slow capture of neutrons (the s-process) during asymptotic giant branch stellar evolution. The Ce II lines were identified using a combination of a high-resolution (R=λ /δ λ ={{100,000}}) Fourier Transform Spectrometer (FTS) spectrum of α Boo and an APOGEE spectrum (R = 22,400) of a metal-poor, but s-process enriched, red giant (2M16011638-1201525). Laboratory oscillator strengths are not available for these lines. Astrophysical gf-values were derived using α Boo as a standard star, with the absolute cerium abundance in α Boo set by using optical Ce II lines that have precise published laboratory gf-values. The near-infrared Ce II lines identified here are also analyzed, as consistency checks, in a small number of bright red giants using archival FTS spectra, as well as a small sample of APOGEE red giants, including two members of the open cluster NGC 6819, two field stars, and seven metal-poor N- and Al-rich stars. The conclusion is that this set of Ce II lines can be detected and analyzed in a large fraction of the APOGEE red giant sample and will be useful for probing chemical evolution of the s-process products in various populations of the Milky Way.

The Goddard Integral Field Spectrograph at Apache Point Observatory: Current Status and Progress Towards Photon Counting

Science.gov (United States)

McElwain, Michael W.; Grady, Carol A.; Bally, John; Brinkmann, Jonathan V.; Bubeck, James; Gong, Qian; Hilton, George M.; Ketzeback, William F.; Lindler, Don; Llop Sayson, Jorge; Malatesta, Michael A.; Norton, Timothy; Rauscher, Bernard J.; Rothe, Johannes; Straka, Lorrie; Wilkins, Ashlee N.; Wisniewski, John P.; Woodgate, Bruce E.; York, Donald G.

2015-01-01

We present the current status and progress towards photon counting with the Goddard Integral Field Spectrograph (GIFS), a new instrument at the Apache Point Observatory's ARC 3.5m telescope. GIFS is a visible light imager and integral field spectrograph operating from 400-1000 nm over a 2.8' x 2.8' and 14' x 14' field of view, respectively. As an IFS, GIFS obtains over 1000 spectra simultaneously and its data reduction pipeline reconstructs them into an image cube that has 32 x 32 spatial elements and more than 200 spectral channels. The IFS mode can be applied to a wide variety of science programs including exoplanet transit spectroscopy, protostellar jets, the galactic interstellar medium probed by background quasars, Lyman-alpha emission line objects, and spectral imaging of galactic winds. An electron-multiplying CCD (EMCCD) detector enables photon counting in the high spectral resolution mode to be demonstrated at the ARC 3.5m in early 2015. The EMCCD work builds upon successful operational and characterization tests that have been conducted in the IFS laboratory at NASA Goddard. GIFS sets out to demonstrate an IFS photon-counting capability on-sky in preparation for future exoplanet direct imaging missions such as the AFTA-Coronagraph, Exo-C, and ATLAST mission concepts. This work is supported by the NASA APRA program under RTOP 10-APRA10-0103.

Developing Online Communities with LAMP (Linux, Apache, MySQL, PHP) - the IMIA OSNI and CHIRAD Experiences.

Science.gov (United States)

Murray, Peter J; Oyri, Karl

2005-01-01

Many health informatics organisations do not seem to use, on a practical basis, for the benefit of their activities and interaction with their members, the very technologies that they often promote for use within healthcare environments. In particular, many organisations seem to be slow to take up the benefits of interactive web technologies. This paper presents an introduction to some of the many free/libre and open source (FLOSS) applications currently available and using the LAMP - Linux, Apache, MySQL, PHP architecture - as a way of cheaply deploying reliable, scalable, and secure web applications. The experience of moving to applications using LAMP architecture, in particular that of the Open Source Nursing Informatics (OSNI) Working Group of the Special Interest Group in Nursing Informatics of the International Medical Informatics Association (IMIA-NI), in using PostNuke, a FLOSS Content Management System (CMS) illustrates many of the benefits of such applications. The experiences of the authors in installing and maintaining a large number of websites using FLOSS CMS to develop dynamic, interactive websites that facilitate real engagement with the members of IMIA-NI OSNI, the IMIA Open Source Working Group, and the Centre for Health Informatics Research and Development (CHIRAD), as well as other organisations, is used as the basis for discussing the potential benefits that could be realised by others within the health informatics community.

The differences in temperament–character traits, suicide attempts, impulsivity, and functionality levels of patients with bipolar disorder I and II

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Izci F

2016-01-01

Full Text Available Filiz Izci,1 Ebru Kanmaz Findikli,2 Serkan Zincir,3 Selma Bozkurt Zincir,4 Merve Iris Koc4 1Department of Psychiatry, School of Medicine, Istanbul Bilim University, Istanbul, 2Department of Psychiatry, School of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, 3Department of Psychiatry, Kocaeli Gölcük Military Hospital, Kocaeli, 4Department of Psychiatry, Erenköy Training and Research Hospital for Psychiatric and Neurological Disorders, Istanbul, Turkey Background: The primary aim of this study was to compare the differences in temperament-character traits, suicide attempts, impulsivity, and functionality levels of patients with bipolar disorder I (BD-I and bipolar disorder II (BD-II.Methods: Fifty-two BD-I patients and 49 BD-II patients admitted to Erenköy Mental and Neurological Disease Training and Research Hospital psychiatry clinic and fifty age- and sex-matched healthy control subjects were enrolled in this study. A structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders, Temperament and Character Inventory, Barrett Impulsiveness Scale-11 (BIS-11, Hamilton Depression Inventory Scale, Young Mania Rating Scale, and Bipolar Disorder Functioning Questionnaire (BDFQ were administered to patients and to control group.Results: No statistically significant difference in sociodemographic features existed between the patient and control groups (P>0.05. Thirty-eight subjects (37.62% in the patient group had a suicide attempt. Twenty-three of these subjects (60.52% had BD-I, and 15 of these subjects (39.47% had BD-II. Suicide attempt rates in BD-I and II patients were 60.52% and 39.47%, respectively (P<0.05. Comparison of BD-I and II patients with healthy control subjects revealed that cooperativeness (C, self-directedness (Sdi, and self-transcendence (ST scores were lower and novelty seeking (NS1 and NS2, harm avoidance (HA4, and reward dependence (RD2 subscale scores

Impacto de la bacteriemia en una cohorte de pacientes con neumonía neumocócica Impact of bacteremia in a cohort of patients with pneumococcal pneumonia

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Ileana Palma

2012-08-01

vaccination (PV. METHODS: Secondary analysis of a cohort of patients with pneumococcal CAP confirmed by blood culture, sputum culture, or urinary antigen testing. Demographic, clinical, radiographic, and biochemical data were collected, as were Acute Physiology and Chronic Health Evaluation II (APACHE II and pneumonia severity index (PSI scores, comorbidities, and PV history. We drew comparisons between patients with bacteremic pneumococcal CAP (BPP and those with non-bacteremic pneumococcal CAP (NBPP. RESULTS: Forty-seven patients had BPP, and 71 had NBPP (confirmed by sputum culture in 45 and by urinary antigen testing in 26; 107 had some indication for PV. None of the BPP patients had received PV, compared with 9 of the NBPP patients (p = 0.043. Among the BPP patients, the mean age was higher (76.4 ± 11.5 vs. 67.5 ± 20.9 years, as were APACHE II and PSI scores (16.4 ± 4.6 vs. 14.1 ± 6.5 and 129.5 ± 36 vs. 105.2 ± 45, respectively, as well as the rate of ICU admission for cardiopathy or chronic renal failure (42.5% vs. 22.5%, whereas hematocrit and plasma sodium levels were lower (35.7 ± 5.8 vs. 38.6 ± 6.7% and 133.9 ± 6.0 vs. 137.1 ± 5.5 mEq/L, respectively, although mortality was similar (29.8% vs. 28.2%. CONCLUSIONS: In this population at high risk for CAP due to S. pneumoniae, the PV rate was extremely low (8.4%. Although BPP patients were more severely ill, mortality was similar between the two groups. Because PV reduces the incidence of BPP, the vaccination rate in at-risk populations should be increased.

Translation, adaptation and validation of a Portuguese version of the Moorehead-Ardelt Quality of Life Questionnaire II.

Science.gov (United States)

Maciel, João; Infante, Paulo; Ribeiro, Susana; Ferreira, André; Silva, Artur C; Caravana, Jorge; Carvalho, Manuel G

2014-11-01

The prevalence of obesity has increased worldwide. An assessment of the impact of obesity on health-related quality of life (HRQoL) requires specific instruments. The Moorehead-Ardelt Quality of Life Questionnaire II (MA-II) is a widely used instrument to assess HRQoL in morbidly obese patients. The objective of this study was to translate and validate a Portuguese version of the MA-II.The study included forward and backward translations of the original MA-II. The reliability of the Portuguese MA-II was estimated using the internal consistency and test-retest methods. For validation purposes, the Spearman's rank correlation coefficient was used to evaluate the correlation between the Portuguese MA-II and the Portuguese versions of two other questionnaires, the 36-item Short Form Health Survey (SF-36) and the Impact of Weight on Quality of Life-Lite (IWQOL-Lite).One hundred and fifty morbidly obese patients were randomly assigned to test the reliability and validity of the Portuguese MA-II. Good internal consistency was demonstrated by a Cronbach's alpha coefficient of 0.80, and a very good agreement in terms of test-retest reliability was recorded, with an overall intraclass correlation coefficient (ICC) of 0.88. The total sums of MA-II scores and each item of MA-II were significantly correlated with all domains of SF-36 and IWQOL-Lite. A statistically significant negative correlation was found between the MA-II total score and BMI. Moreover, age, gender and surgical status were independent predictors of MA-II total score.A reliable and valid Portuguese version of the MA-II was produced, thus enabling the routine use of MA-II in the morbidly obese Portuguese population.

Effect of two yoga-based relaxation techniques on memory scores and state anxiety

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Telles Shirley

2009-08-01

Full Text Available Abstract Background A yoga practice involving cycles of yoga postures and supine rest (called cyclic meditation was previously shown to improve performance in attention tasks more than relaxation in the corpse posture (shavasana. This was ascribed to reduced anxiety, though this was not assessed. Methods In fifty-seven male volunteers (group average age ± S.D., 26.6 ± 4.5 years the immediate effect of two yoga relaxation techniques was studied on memory and state anxiety. All participants were assessed before and after (i Cyclic meditation (CM practiced for 22:30 minutes on one day and (ii an equal duration of Supine rest (SR or the corpse posture (shavasana, on another day. Sections of the Wechsler memory scale (WMS were used to assess; (i attention and concentration (digit span forward and backward, and (ii associate learning. State anxiety was assessed using Spielberger's State-Trait Anxiety Inventory (STAI. Results There was a significant improvement in the scores of all sections of the WMS studied after both CM and SR, but, the magnitude of change was more after CM compared to after SR. The state anxiety scores decreased after both CM and SR, with a greater magnitude of decrease after CM. There was no correlation between percentage change in memory scores and state anxiety for either session. Conclusion A cyclical combination of yoga postures and supine rest in CM improved memory scores immediately after the practice and decreased state anxiety more than rest in a classical yoga relaxation posture (shavasana.

D-score: a search engine independent MD-score.

Science.gov (United States)

Vaudel, Marc; Breiter, Daniela; Beck, Florian; Rahnenführer, Jörg; Martens, Lennart; Zahedi, René P

2013-03-01

While peptides carrying PTMs are routinely identified in gel-free MS, the localization of the PTMs onto the peptide sequences remains challenging. Search engine scores of secondary peptide matches have been used in different approaches in order to infer the quality of site inference, by penalizing the localization whenever the search engine similarly scored two candidate peptides with different site assignments. In the present work, we show how the estimation of posterior error probabilities for peptide candidates allows the estimation of a PTM score called the D-score, for multiple search engine studies. We demonstrate the applicability of this score to three popular search engines: Mascot, OMSSA, and X!Tandem, and evaluate its performance using an already published high resolution data set of synthetic phosphopeptides. For those peptides with phosphorylation site inference uncertainty, the number of spectrum matches with correctly localized phosphorylation increased by up to 25.7% when compared to using Mascot alone, although the actual increase depended on the fragmentation method used. Since this method relies only on search engine scores, it can be readily applied to the scoring of the localization of virtually any modification at no additional experimental or in silico cost. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

WISC-IV and WIAT-II Profiles in Children with High-Functioning Autism

Science.gov (United States)

Mayes, Susan Dickerson; Calhoun, Susan L.

2008-01-01

Children with high-functioning autism earned above normal scores on the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Perceptual Reasoning and Verbal Comprehension Indexes and below normal scores on the Working Memory and Processing Speed Indexes and Wechsler Individual Achievement Test-Second Edition (WIAT-II) Written…

Provision of protein and energy in relation to measured requirements in intensive care patients

DEFF Research Database (Denmark)

Allingstrup, Matilde Jo; Esmailzadeh, Negar; Knudsen, Anne Wilkens

2012-01-01

, also when adjusted for baseline prognostic variables (APACHE II, SOFA scores and age). Provision of energy, measured resting energy expenditure or energy and nitrogen balance was not related to mortality. The possible cause-effect relationship is discussed after a more detailed analysis of the initial......BACKGROUND & AIMS: Adequacy of nutritional support in intensive care patients is still a matter of investigation. This study aimed to relate mortality to provision, measured requirements and balances for energy and protein in ICU patients. DESIGN: Prospective observational cohort study of 113 ICU...... part of the admission. CONCLUSION: In these severely ill ICU patients, a higher provision of protein and amino acids was associated with a lower mortality. This was not the case for provision of energy or measured resting energy expenditure or energy or nitrogen balances. The hypothesis that higher...

Extension of the lod score: the mod score.

Science.gov (United States)

Clerget-Darpoux, F

2001-01-01

In 1955 Morton proposed the lod score method both for testing linkage between loci and for estimating the recombination fraction between them. If a disease is controlled by a gene at one of these loci, the lod score computation requires the prior specification of an underlying model that assigns the probabilities of genotypes from the observed phenotypes. To address the case of linkage studies for diseases with unknown mode of inheritance, we suggested (Clerget-Darpoux et al., 1986) extending the lod score function to a so-called mod score function. In this function, the variables are both the recombination fraction and the disease model parameters. Maximizing the mod score function over all these parameters amounts to maximizing the probability of marker data conditional on the disease status. Under the absence of linkage, the mod score conforms to a chi-square distribution, with extra degrees of freedom in comparison to the lod score function (MacLean et al., 1993). The mod score is asymptotically maximum for the true disease model (Clerget-Darpoux and Bonaïti-Pellié, 1992; Hodge and Elston, 1994). Consequently, the power to detect linkage through mod score will be highest when the space of models where the maximization is performed includes the true model. On the other hand, one must avoid overparametrization of the model space. For example, when the approach is applied to affected sibpairs, only two constrained disease model parameters should be used (Knapp et al., 1994) for the mod score maximization. It is also important to emphasize the existence of a strong correlation between the disease gene location and the disease model. Consequently, there is poor resolution of the location of the susceptibility locus when the disease model at this locus is unknown. Of course, this is true regardless of the statistics used. The mod score may also be applied in a candidate gene strategy to model the potential effect of this gene in the disease. Since, however, it

Amplitude-integrated electroencephalographic activity is suppressed in preterm infants with high scores on illness severity

NARCIS (Netherlands)

ter Horst, Hendrik J.; Jongbloed-Pereboom, Marjolein; van Eykern, Leo A.; Bos, Arend F.

Background: The neonatal acute physiology score. SNAP-II, reflects the severity of illness in newborns. In term newborns, amplitude integrated EEG (aEEG), is depressed following asphyxia. In preterm infants aEEG is discontinuous, and therefore more difficult to assess compared to term infants. Aims:

THE APACHE POINT OBSERVATORY GALACTIC EVOLUTION EXPERIMENT: FIRST DETECTION OF HIGH-VELOCITY MILKY WAY BAR STARS

Energy Technology Data Exchange (ETDEWEB)

Nidever, David L.; Zasowski, Gail; Majewski, Steven R.; Beaton, Rachael L.; Wilson, John C.; Skrutskie, Michael F.; O' Connell, Robert W. [Department of Astronomy, University of Virginia, Charlottesville, VA 22904-4325 (United States); Bird, Jonathan; Schoenrich, Ralph; Johnson, Jennifer A.; Sellgren, Kris [Department of Astronomy and the Center for Cosmology and Astro-Particle Physics, The Ohio State University, Columbus, OH 43210 (United States); Robin, Annie C.; Schultheis, Mathias [Institut Utinam, CNRS UMR 6213, OSU THETA, Universite de Franche-Comte, 41bis avenue de l' Observatoire, F-25000 Besancon (France); Martinez-Valpuesta, Inma; Gerhard, Ortwin [Max-Planck-Institut fuer Extraterrestrische Physik, Giessenbachstrasse, D-85748 Garching (Germany); Shetrone, Matthew [McDonald Observatory, University of Texas at Austin, Fort Davis, TX 79734 (United States); Schiavon, Ricardo P. [Gemini Observatory, 670 North A' Ohoku Place, Hilo, HI 96720 (United States); Weiner, Benjamin [Steward Observatory, 933 North Cherry Street, University of Arizona, Tucson, AZ 85721 (United States); Schneider, Donald P. [Department of Astronomy and Astrophysics, The Pennsylvania State University, University Park, PA 16802 (United States); Allende Prieto, Carlos, E-mail: dln5q@virginia.edu [Instituto de Astrofisica de Canarias, E-38205 La Laguna, Tenerife (Spain); and others

2012-08-20

Commissioning observations with the Apache Point Observatory Galactic Evolution Experiment (APOGEE), part of the Sloan Digital Sky Survey III, have produced radial velocities (RVs) for {approx}4700 K/M-giant stars in the Milky Way (MW) bulge. These high-resolution (R {approx} 22, 500), high-S/N (>100 per resolution element), near-infrared (NIR; 1.51-1.70 {mu}m) spectra provide accurate RVs ({epsilon}{sub V} {approx} 0.2 km s{sup -1}) for the sample of stars in 18 Galactic bulge fields spanning -1 Degree-Sign -32 Degree-Sign . This represents the largest NIR high-resolution spectroscopic sample of giant stars ever assembled in this region of the Galaxy. A cold ({sigma}{sub V} {approx} 30 km s{sup -1}), high-velocity peak (V{sub GSR} Almost-Equal-To +200 km s{sup -1}) is found to comprise a significant fraction ({approx}10%) of stars in many of these fields. These high RVs have not been detected in previous MW surveys and are not expected for a simple, circularly rotating disk. Preliminary distance estimates rule out an origin from the background Sagittarius tidal stream or a new stream in the MW disk. Comparison to various Galactic models suggests that these high RVs are best explained by stars in orbits of the Galactic bar potential, although some observational features remain unexplained.

The dimensionality of stellar chemical space using spectra from the Apache Point Observatory Galactic Evolution Experiment

Science.gov (United States)

Price-Jones, Natalie; Bovy, Jo

2018-03-01

Chemical tagging of stars based on their similar compositions can offer new insights about the star formation and dynamical history of the Milky Way. We investigate the feasibility of identifying groups of stars in chemical space by forgoing the use of model derived abundances in favour of direct analysis of spectra. This facilitates the propagation of measurement uncertainties and does not pre-suppose knowledge of which elements are important for distinguishing stars in chemical space. We use ˜16 000 red giant and red clump H-band spectra from the Apache Point Observatory Galactic Evolution Experiment (APOGEE) and perform polynomial fits to remove trends not due to abundance-ratio variations. Using expectation maximized principal component analysis, we find principal components with high signal in the wavelength regions most important for distinguishing between stars. Different subsamples of red giant and red clump stars are all consistent with needing about 10 principal components to accurately model the spectra above the level of the measurement uncertainties. The dimensionality of stellar chemical space that can be investigated in the H band is therefore ≲10. For APOGEE observations with typical signal-to-noise ratios of 100, the number of chemical space cells within which stars cannot be distinguished is approximately 1010±2 × (5 ± 2)n - 10 with n the number of principal components. This high dimensionality and the fine-grained sampling of chemical space are a promising first step towards chemical tagging based on spectra alone.

A new method for prediction of the hospitalization period in ICU using neural networks

Directory of Open Access Journals (Sweden)

Adel Alinezhad Kolaei

2013-07-01

Full Text Available Introduction:APACHE (Acute Physiologic and Chronic Health Evaluation score is a medical tool designed to measure the severity of disease for adult patients admitted to Intensive Care Units (ICU. However, it is designed based on the American patients’ data and is not well suited to be used for Iranian people. In addition, Iranian hospitals are not equipped with High Dependency Units which is required for original APACHE. Method: We aimed to design an intelligent version of APACHE system for recognition of patients’ hospitalization period in ICUs. The new system can be designed based on Iranian local data and updated locally. Intelligence means that the system has the ability to learn from its previous results and doesn’t need manual update. Results: In this study, this new system is introduced and the technical specifications are presented. It is based on neural networks. It can be trained and is capable of auto-learning. The results obtained from final implemented software show better performance than those obtained from non-local version. Conclusion: Using this method, the efficiency of the prediction has increased from 80% to 90%. Such results were compared with the APACHE outputs to show the superiority of the proposed method.

Subclassification of Recursive Partitioning Analysis Class II Patients With Brain Metastases Treated Radiosurgically

Energy Technology Data Exchange (ETDEWEB)

Yamamoto, Masaaki, E-mail: BCD06275@nifty.com [Katsuta Hospital Mito GammaHouse, Hitachi-naka (Japan); Department of Neurosurgery, Tokyo Women' s Medical University Medical Center East, Tokyo (Japan); Sato, Yasunori [Clinical Research Center, Chiba University Graduate School of Medicine, Chiba (Japan); Serizawa, Toru [Tokyo Gamma Unit Center, Tsukiji Neurologic Clinic, Tokyo (Japan); Kawabe, Takuya [Katsuta Hospital Mito GammaHouse, Hitachi-naka (Japan); Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Sciences, Kyoto (Japan); Higuchi, Yoshinori [Department of Neurosurgery, Chiba University Graduate School of Medicine, Chiba (Japan); Nagano, Osamu [Gamma Knife House, Chiba Cardiovascular Center, Ichihara (Japan); Barfod, Bierta E. [Katsuta Hospital Mito GammaHouse, Hitachi-naka (Japan); Ono, Junichi [Gamma Knife House, Chiba Cardiovascular Center, Ichihara (Japan); Kasuya, Hidetoshi [Department of Neurosurgery, Tokyo Women' s Medical University Medical Center East, Tokyo (Japan); Urakawa, Yoichi [Katsuta Hospital Mito GammaHouse, Hitachi-naka (Japan)

2012-08-01

Purpose: Although the recursive partitioning analysis (RPA) class is generally used for predicting survival periods of patients with brain metastases (METs), the majority of such patients are Class II and clinical factors vary quite widely within this category. This prompted us to divide RPA Class II patients into three subclasses. Methods and Materials: This was a two-institution, institutional review board-approved, retrospective cohort study using two databases: the Mito series (2,000 consecutive patients, comprising 787 women and 1,213 men; mean age, 65 years [range, 19-96 years]) and the Chiba series (1,753 patients, comprising 673 female and 1,080 male patients; mean age, 65 years [range, 7-94 years]). Both patient series underwent Gamma Knife radiosurgery alone, without whole-brain radiotherapy, for brain METs during the same 10-year period, July 1998 through June 2008. The Cox proportional hazard model with a step-wise selection procedure was used for multivariate analysis. Results: In the Mito series, four factors were identified as favoring longer survival: Karnofsky Performance Status (90% to 100% vs. 70% to 80%), tumor numbers (solitary vs. multiple), primary tumor status (controlled vs. not controlled), and non-brain METs (no vs. yes). This new index is the sum of scores (0 and 1) of these four factors: RPA Class II-a, score of 0 or 1; RPA Class II-b, score of 2; and RPA Class II-c, score of 3 or 4. Next, using the Chiba series, we tested whether our index is valid for a different patient group. This new system showed highly statistically significant differences among subclasses in both the Mito series and the Chiba series (p < 0.001 for all subclasses). In addition, this new index was confirmed to be applicable to Class II patients with four major primary tumor sites, that is, lung, breast, alimentary tract, and urogenital organs. Conclusions: Our new grading system should be considered when designing future clinical trials involving brain MET

The Zhongshan Score

Science.gov (United States)

Zhou, Lin; Guo, Jianming; Wang, Hang; Wang, Guomin

2015-01-01

Abstract In the zero ischemia era of nephron-sparing surgery (NSS), a new anatomic classification system (ACS) is needed to adjust to these new surgical techniques. We devised a novel and simple ACS, and compared it with the RENAL and PADUA scores to predict the risk of NSS outcomes. We retrospectively evaluated 789 patients who underwent NSS with available imaging between January 2007 and July 2014. Demographic and clinical data were assessed. The Zhongshan (ZS) score consisted of three parameters. RENAL, PADUA, and ZS scores are divided into three groups, that is, high, moderate, and low scores. For operative time (OT), significant differences were seen between any two groups of ZS score and PADUA score (all P RENAL showed no significant difference between moderate and high complexity in OT, WIT, estimated blood loss, and increase in SCr. Compared with patients with a low score of ZS, those with a high or moderate score had 8.1-fold or 3.3-fold higher risk of surgical complications, respectively (all P RENAL score, patients with a high or moderate score had 5.7-fold or 1.9-fold higher risk of surgical complications, respectively (all P RENAL and PADUA scores. ZS score could be used to reflect the surgical complexity and predict the risk of surgical complications in patients undergoing NSS. PMID:25654399

High-Throughput Scoring of Seed Germination.

Science.gov (United States)

Ligterink, Wilco; Hilhorst, Henk W M

2017-01-01

High-throughput analysis of seed germination for phenotyping large genetic populations or mutant collections is very labor intensive and would highly benefit from an automated setup. Although very often used, the total germination percentage after a nominated period of time is not very informative as it lacks information about start, rate, and uniformity of germination, which are highly indicative of such traits as dormancy, stress tolerance, and seed longevity. The calculation of cumulative germination curves requires information about germination percentage at various time points. We developed the GERMINATOR package: a simple, highly cost-efficient, and flexible procedure for high-throughput automatic scoring and evaluation of germination that can be implemented without the use of complex robotics. The GERMINATOR package contains three modules: (I) design of experimental setup with various options to replicate and randomize samples; (II) automatic scoring of germination based on the color contrast between the protruding radicle and seed coat on a single image; and (III) curve fitting of cumulative germination data and the extraction, recap, and visualization of the various germination parameters. GERMINATOR is a freely available package that allows the monitoring and analysis of several thousands of germination tests, several times a day by a single person.

Re-Scoring the Game’s Score

DEFF Research Database (Denmark)

Gasselseder, Hans-Peter

2014-01-01

This study explores immersive presence as well as emotional valence and arousal in the context of dynamic and non-dynamic music scores in the 3rd person action-adventure video game genre while also considering relevant personality traits of the player. 60 subjects answered self-report questionnai......This study explores immersive presence as well as emotional valence and arousal in the context of dynamic and non-dynamic music scores in the 3rd person action-adventure video game genre while also considering relevant personality traits of the player. 60 subjects answered self......-temporal alignment in the resulting emotional congruency of nondiegetic music. Whereas imaginary aspects of immersive presence are systemically affected by the presentation of dynamic music, sensory spatial aspects show higher sensitivity towards the arousal potential of the music score. It is argued...

[Identification of Zaocys type II collagen and its effect on arthritis in mice with collagen-induced arthritis].

Science.gov (United States)

Wang, Hao; Feng, Zhi-tao; Zhu, Jun-qing; Wu, Xiang-hui; Li, Juan

2014-06-01

To analyze the homology of Zaocys type 1I collagen ( ZC II ) with the C II collagen from other species, and to investigate the effect of ZC II on arthritis in mice with collagen-induced arthritis (CIA). ZC II was purified with restriction pepsin digestion. Then SDS-PAGE gel electrophoresis and UV spectrophotometry were used to identify the protein,the homology of the ZC II peptide was analyzed with Mass Spectrometry. The model of CIA mice were induced by subcutaneous injection of Chicken C II into male C57BL/6 mice from the base of the tails. After immunization,ZC II [H,M,L:40,20 and 10 μg/(kgd) ]was administered orally to mice from day 21 to 28 accordingly. The severity of the arthritis in each limb was evaluated using a macroscopic scoring system, and his- topathological change of joint was observed by light microscope with HE staining. The molecular weight of ZC II protein deter- mined by SDS-PAGE gel electrophoresis was between 110 kD and 140 kD, and UV absorption peak appeared at around 230 nm in wave- length. The peptide mass fingerprinting(PMF) of the purified protein by Mass Spectrometry analysis showed that it had at least 4 peptides matched with other species,and the protein score was greater than 95%. Compared with normal group,the CIA model group had significantly higher scores for arthritis and histopathological changes (P II peptide-treated mice with CIA were significantly lower than the mice from CIA model group(P II has high homology with the C II from other species. Oral administration of ZC II can suppress arthritis in mice with CIA and ameliorate the histopathological changes of the joint.

College Math Assessment: SAT Scores vs. College Math Placement Scores

Science.gov (United States)

Foley-Peres, Kathleen; Poirier, Dawn

2008-01-01

Many colleges and university's use SAT math scores or math placement tests to place students in the appropriate math course. This study compares the use of math placement scores and SAT scores for 188 freshman students. The student's grades and faculty observations were analyzed to determine if the SAT scores and/or college math assessment scores…

Tracers of Chromospheric Structure. I. Observations of Ca II K and Hα in M Dwarfs

Science.gov (United States)

Walkowicz, Lucianne M.; Hawley, Suzanne L.

2009-02-01

We report on our observing program4This paper is based on observations obtained with the Apache Point Observatory 3.5 m telescope, which is owned and operated by the Astrophysical Research Consortium. Some of the data presented herein were obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W. M. Keck Foundation. to capture simultaneous spectra of Ca II and Balmer lines in a sample of nearby M3 dwarfs. Our goal is to investigate the chromospheric temperature structure required to produce these lines at the observed levels. We find a strong positive correlation between instantaneous measurements of Ca II K and the Balmer lines in active stars, although these lines may not be positively correlated in time-resolved measurements. The relationship between Hα and Ca II K remains ambiguous for weak and intermediate activity stars, with Hα absorption corresponding to a range of Ca II K emission. A similar relationship is also observed between Ca II K and the higher-order Balmer lines. As our sample consists of a single spectral type, correlations between these important chromospheric tracers cannot be ascribed to continuum effects, as suggested by other authors. These data confirm prior nonsimultaneous observations of the Hα line behavior with increasing activity, showing an initial increase in the Hα absorption with increasing Ca II K emission, prior to Hα filling in and eventually becoming a pure emission line in the most active stars. We also compare our optical measurements with archival UV and X-ray measurements, finding a positive correlation between the chromospheric and coronal emission for both high and intermediate activity stars. We compare our results with previous determinations of the active fraction of low-mass stars

Field studies at the Apache Leap Research Site in support of alternative conceptual models

Energy Technology Data Exchange (ETDEWEB)

Woodhouse, E.G.; Davidson, G.R.; Theis, C. [eds.] [and others

1997-08-01

This is a final technical report for a project of the U.S Nuclear Regulatory Commission (sponsored contract NRC-04-090-51) with the University of Arizona. The contract was an optional extension that was initiated on July 21, 1994 and that expired on May 31, 1995. The project manager was Thomas J. Nicholson, Office of Nuclear Regulatory Research. The objectives of this contract were to examine hypotheses and conceptual models concerning unsaturated flow and transport through fractured rock, and to design and execute confirmatory field and laboratory experiments to test these hypotheses and conceptual models at the Apache Leap Research Site near Superior, Arizona. The results discussed here are products of specific tasks that address a broad spectrum of issues related to flow and transport through fractures. Each chapter in this final report summarizes research related to a specific set of objectives and can be read and interpreted as a separate entity. The tasks include detection and characterization of historical rapid fluid flow through fractured rock and the relationship to perched water systems using environmental isotopic tracers of {sup 3}H and {sup 14}C, fluid- and rock-derived {sup 2343}U/{sup 238}U measurements, and geophysical data. The water balance in a small watershed at the ALRS demonstrates the methods of acounting for ET, and estimating the quantity of water available for infiltration through fracture networks. Grain density measurements were made for core-sized samples using a newly designed gas pycnometer. The distribution and magnitude of air permeability measurements have been measured in a three-dimensional setting; the subsequent geostatistical analysis is presented. Electronic versions of the data presented here are available from authors; more detailed discussions and analyses are available in technical publications referenced herein, or soon to appear in the professional literature.

Field studies at the Apache Leap Research Site in support of alternative conceptual models

International Nuclear Information System (INIS)

Woodhouse, E.G.; Davidson, G.R.; Theis, C.

1997-08-01

This is a final technical report for a project of the U.S Nuclear Regulatory Commission (sponsored contract NRC-04-090-51) with the University of Arizona. The contract was an optional extension that was initiated on July 21, 1994 and that expired on May 31, 1995. The project manager was Thomas J. Nicholson, Office of Nuclear Regulatory Research. The objectives of this contract were to examine hypotheses and conceptual models concerning unsaturated flow and transport through fractured rock, and to design and execute confirmatory field and laboratory experiments to test these hypotheses and conceptual models at the Apache Leap Research Site near Superior, Arizona. The results discussed here are products of specific tasks that address a broad spectrum of issues related to flow and transport through fractures. Each chapter in this final report summarizes research related to a specific set of objectives and can be read and interpreted as a separate entity. The tasks include detection and characterization of historical rapid fluid flow through fractured rock and the relationship to perched water systems using environmental isotopic tracers of 3 H and 14 C, fluid- and rock-derived 2343 U/ 238 U measurements, and geophysical data. The water balance in a small watershed at the ALRS demonstrates the methods of acounting for ET, and estimating the quantity of water available for infiltration through fracture networks. Grain density measurements were made for core-sized samples using a newly designed gas pycnometer. The distribution and magnitude of air permeability measurements have been measured in a three-dimensional setting; the subsequent geostatistical analysis is presented. Electronic versions of the data presented here are available from authors; more detailed discussions and analyses are available in technical publications referenced herein, or soon to appear in the professional literature

MHC class II+ (HLA-DP-like) cells in the cow reproductive tract: II. Immunolocalization of MHC class II+ cells in oviduct and vagina.

Science.gov (United States)

Eren, U; Kum, S; Sandikçi, M; Eren, V; Ilhan, F

2009-08-01

The aim of this study was to determine and examine the distribution of major frequency MHC II+ cells in the oviduct and vagina of cows during the oestrous and dioestrus phases. Right oviduct (ampulla, isthmus) and vaginal samples taken from a total of twenty seven multiparous cows were used. Tissue samples were processed to obtain both cryostat and paraffin sections. Sections were stained immunocytochemically using StreptABC method using a specific monoclonal antibody to MHC II+ cell population. Intra-epithelial and subepithelial areas along with lamina propria, muscularis mucosae and serosa of both ampulla and isthmus and intra-epithelial/subepithelial areas and mucosae of vagina were examined for the presence of MHC II+ cells. The density of immune positive cells was determined using a subjective scoring system. MHC II+ cells were demonstrated in all areas examined in both oestrus and dioestrus. In oestrus, the density of MHC II+ cells decreased in subepithelial areas (in between the epithelial cells and the basal membrane) of isthmus, whereas the density of immune positive cells was increased in muscularis mucosae of isthmus (P < 0.05), lamina propria and muscularis mucosae of ampulla (P < 0.05) as well as in the mucosae of vagina (P II+ cells observed in the oviduct and vagina increases in the majority of areas examined due to the effect of oestrogen.

Norms for the Beck Depression Inventory (BDI-II) in a Large Dutch Community Sample.

NARCIS (Netherlands)

Roelofs, J.; van Breukelen, G.; de Graaf, L.E.; Beck, A.T.; Arntz, A.; Huibers, M.J.H.

2013-01-01

The Beck Depression Inventory (BDI-II) is a widely used instrument that provides information about the presence and severity of depressive symptoms. Although the BDI-II is a psychometrically sound instrument, relatively little is known about norm scores. This study aimed to develop reliable norms

The Controlling Nutritional Status Score Is a Significant Independent Predictor of Poor Prognosis in Patients With Malignant Pleural Mesothelioma.

Science.gov (United States)

Takamori, Shinkichi; Toyokawa, Gouji; Taguchi, Kenichi; Edagawa, Makoto; Shimamatsu, Shinichiro; Toyozawa, Ryo; Nosaki, Kaname; Seto, Takashi; Hirai, Fumihiko; Yamaguchi, Masafumi; Shoji, Fumihiro; Okamoto, Tatsuro; Takenoyama, Mitsuhiro; Ichinose, Yukito

2017-07-01

Malignant pleural mesothelioma (MPM) is a devastating neoplasm; however, some patients exhibit a good response to chemotherapy or multidisciplinary therapy, including surgery and chemotherapy. It is therefore important to discover the factors that can be used to select patients who will benefit from such treatment. Although the Controlling Nutritional Status (CONUT) score has been used to predict the prognosis in other types of malignancy, its utility in patients with MPM is unknown. The aim of this study was to clarify the clinical significance of the CONUT in patients with MPM. The data of 83 patients, who were treated with surgery, chemotherapy, or multidisciplinary therapy, were analyzed in the present study. A cut-off CONUT score of 2 was used to classify all of the patients into low or high CONUT groups. Fifty-two of the 83 patients were classified into the low CONUT group. A high CONUT score was significantly correlated with chemotherapy alone (P = .011). The high CONUT group had significantly poorer overall survival (OS) (P clinical stage and the CONUT score were found to be independent predictive factors for the OS: clinical stage, I/II and III/IV; P = .001 and CONUT score, ≥ 3 and ≤ 2; P = .011, respectively. The clinical stage and the CONUT score were also independent predictive factors for DFS/PFS: clinical stage, I/II and III/IV; P = .006 and CONUT score, ≥ 3 and ≤ 2; P = .013, respectively. The CONUT score was an independent predictor of a poor prognosis in the patients with MPM. This score provides useful information for selecting patients who will benefit from the treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Spectroscopic Classification of SN 2018bek as a Young Type II Supernova

Science.gov (United States)

Xiang, Danfeng; Wang, Xiaofeng; Zhang, Kaicheng; Li, Wenxiong; DerKacy, James; Baron, Eddie; Brink, Thomas; Zheng, Weikang; Filippenko, Alex; Lin, Han; Rui, Liming; Hu, Lei; Hu, Maokai; Zhang, Tianmeng; Zhang, Jujia

2018-05-01

We obtained a few optical spectra of SN 2018bek,discovered by Jaroslaw Grzegorzek,on UT May 05-09 2018 with the 3.5m telescope (+Dual Imaging Spectrograph) at the Apache Point Observatory, the 2.16-m telescope(+BFOSC) at Xinglong Observatory of NAOC, and the Lick 3.0-m telescope (+Kast) at Lick Observatory.

Association between diet-quality scores, adiposity, total cholesterol and markers of nutritional status in european adults: Findings from the Food4Me study

NARCIS (Netherlands)

Fallaize, R.; Livingstone, K.M.; Celis-Morales, C.; Macready, A.L.; San-Cristobal, R.; Navas-Carretero, S.; Marsaux, C.F.M.; O’Donovan, C.B.; Kolossa, S.; Moschonis, G.; Walsh, M.C.; Gibney, E.R.; Brennan, L.; Bouwman, J.; Manios, Y.; Jarosz, M.; Martinez, J.A.; Daniel, H.; Saris, W.H.M.; Gundersen, T.E.; Drevon, C.A.; Gibney, M.J.; Mathers, J.C.; Lovegrove, J.A.

2018-01-01

Diet-quality scores (DQS), which are developed across the globe, are used to define adherence to specific eating patterns and have been associated with risk of coronary heart disease and type-II diabetes. We explored the association between five diet-quality scores (Healthy Eating Index, HEI;

Exploring a Source of Uneven Score Equity across the Test Score Range

Science.gov (United States)

Huggins-Manley, Anne Corinne; Qiu, Yuxi; Penfield, Randall D.

2018-01-01

Score equity assessment (SEA) refers to an examination of population invariance of equating across two or more subpopulations of test examinees. Previous SEA studies have shown that score equity may be present for examinees scoring at particular test score ranges but absent for examinees scoring at other score ranges. No studies to date have…

RAId_aPS: MS/MS analysis with multiple scoring functions and spectrum-specific statistics.

Science.gov (United States)

Alves, Gelio; Ogurtsov, Aleksey Y; Yu, Yi-Kuo

2010-11-16

Statistically meaningful comparison/combination of peptide identification results from various search methods is impeded by the lack of a universal statistical standard. Providing an E-value calibration protocol, we demonstrated earlier the feasibility of translating either the score or heuristic E-value reported by any method into the textbook-defined E-value, which may serve as the universal statistical standard. This protocol, although robust, may lose spectrum-specific statistics and might require a new calibration when changes in experimental setup occur. To mitigate these issues, we developed a new MS/MS search tool, RAId_aPS, that is able to provide spectrum-specific-values for additive scoring functions. Given a selection of scoring functions out of RAId score, K-score, Hyperscore and XCorr, RAId_aPS generates the corresponding score histograms of all possible peptides using dynamic programming. Using these score histograms to assign E-values enables a calibration-free protocol for accurate significance assignment for each scoring function. RAId_aPS features four different modes: (i) compute the total number of possible peptides for a given molecular mass range, (ii) generate the score histogram given a MS/MS spectrum and a scoring function, (iii) reassign E-values for a list of candidate peptides given a MS/MS spectrum and the scoring functions chosen, and (iv) perform database searches using selected scoring functions. In modes (iii) and (iv), RAId_aPS is also capable of combining results from different scoring functions using spectrum-specific statistics. The web link is http://www.ncbi.nlm.nih.gov/CBBresearch/Yu/raid_aps/index.html. Relevant binaries for Linux, Windows, and Mac OS X are available from the same page.

Performance of the European System for Cardiac Operative Risk Evaluation II: a meta-analysis of 22 studies involving 145,592 cardiac surgery procedures.

Science.gov (United States)

Guida, Pietro; Mastro, Florinda; Scrascia, Giuseppe; Whitlock, Richard; Paparella, Domenico

2014-12-01

A systematic review of the European System for Cardiac Operative Risk Evaluation (euroSCORE) II performance for prediction of operative mortality after cardiac surgery has not been performed. We conducted a meta-analysis of studies based on the predictive accuracy of the euroSCORE II. We searched the Embase and PubMed databases for all English-only articles reporting performance characteristics of the euroSCORE II. The area under the receiver operating characteristic curve, the observed/expected mortality ratio, and observed-expected mortality difference with their 95% confidence intervals were analyzed. Twenty-two articles were selected, including 145,592 procedures. Operative mortality occurred in 4293 (2.95%), whereas the expected events according to euroSCORE II were 4802 (3.30%). Meta-analysis of these studies provided an area under the receiver operating characteristic curve of 0.792 (95% confidence interval, 0.773-0.811), an estimated observed/expected ratio of 1.019 (95% confidence interval, 0.899-1.139), and observed-expected difference of 0.125 (95% confidence interval, -0.269 to 0.519). Statistical heterogeneity was detected among retrospective studies including less recent procedures. Subgroups analysis confirmed the robustness of combined estimates for isolated valve procedures and those combined with revascularization surgery. A significant overestimation of the euroSCORE II with an observed/expected ratio of 0.829 (95% confidence interval, 0.677-0.982) was observed in isolated coronary artery bypass grafting and a slight underestimation of predictions in high-risk patients (observed/expected ratio 1.253 and observed-expected difference 1.859). Despite the heterogeneity, the results from this meta-analysis show a good overall performance of the euroSCORE II in terms of discrimination and accuracy of model predictions for operative mortality. Validation of the euroSCORE II in prospective populations needs to be further studied for a continuous

Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis

Energy Technology Data Exchange (ETDEWEB)

Bruennler, T.; Langgartner, J.; Lang, S.; Salzberger, B.; Schoelmerich, J. [University Hospital of Regensburg, Department of Internal Medicine 1, Regensburg (Germany); Zorger, N.; Herold, T.; Feuerbach, S.; Hamer, O.W. [University Hospital of Regensburg, Department of Radiology, Regensburg (Germany)

2008-08-15

The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery. (orig.)

Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis

International Nuclear Information System (INIS)

Bruennler, T.; Langgartner, J.; Lang, S.; Salzberger, B.; Schoelmerich, J.; Zorger, N.; Herold, T.; Feuerbach, S.; Hamer, O.W.

2008-01-01

The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery. (orig.)

IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

International Nuclear Information System (INIS)

Bacci, M.R.; Leme, R.C.P.; Zing, N.P.C.; Murad, N.; Adami, F.; Hinnig, P.F.; Feder, D.; Chagas, A.C.P.; Fonseca, F.L.A.

2015-01-01

Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI

IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

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M.R. Bacci

2015-05-01

Full Text Available Community-acquired pneumonia (CAP is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II. The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1 and interleukin-6 (IL-6, tumor necrosis factor alpha (TNF-α, C-reactive protein (CRP, and homocystein were collected at the time of admission (day 1 as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1 to 8 pg/mL (day 7 (P=0.016. The median levels of TNF-α were higher in patients: i with acute kidney injury (AKI (P=0.045, ii requiring mechanical ventilation (P=0.040, iii with short hospital stays (P=0.009, iv admitted to the intensive care unit (ICU (P=0.040, v who died early (P=0.003, and vi with worse CRB scores (P=0.013. In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients.

Science.gov (United States)

Bacci, M R; Leme, R C P; Zing, N P C; Murad, N; Adami, F; Hinnig, P F; Feder, D; Chagas, A C P; Fonseca, F L A

2015-05-01

Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

Energy Technology Data Exchange (ETDEWEB)

Bacci, M.R.; Leme, R.C.P.; Zing, N.P.C. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Murad, N. [Departamento de Cardiologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Adami, F.; Hinnig, P.F. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Feder, D. [Departamento de Farmacologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Chagas, A.C.P. [Departamento de Cardiologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Fonseca, F.L.A. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil)

2015-02-24

Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

What Does Change with Nutrition Team in Intensive Care Unit?

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Ahmet Fatih Yılmaz

2016-08-01

Full Text Available Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU, the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Health Evaluation (APACHE II scores, rate of usege of parenteral and enteral products, and the change in expenses per patient within the first year of activity of the nutrition team in comparison to the previous year was presented. Material and Method: In this study a 6-bed GICU was used. The patients who was admitted through retrospective file scanning between 1 January 2012 and 31 December 2012 and between 1 January 2013 and 31 December 2013 were compared. Results: The number of the patients admitted to the GICU was 341 in 2012 and 369 in 2013. The number of the patients who died in 2012 was 86 (25.2%, while it was 106 in 2013 (28.7%. In 2012, 122 patients (35.7% had decubitus ulcers, while this number was 92 (24.7% in 2013. Human albumin usage was reduced by 23% for the 100 mL (225 in 2012, 175 in 2013 and by 33% for the 50 mL doses (122 in 2012, 82 in 2013. Duration of stay in the hospital was 6.3±0.9 vs. 5.8±0.9 (days (p=0.06. The mean APACHE II scores were observed to be 24.7±6.9 vs. 30.5±11.4 (p=0.03. When the distribution of product types were analyzed, it was observed that the ratio of parenteral products: enteral products was 2:1 in 2012, however the ratio of enteral products to parenteral products was 2:1 in 2013. The daily expense of a patient decreased from 100 TL to 55 TL. Conclusion: The nutrition team directly influences the clinical process outcomes of patients under treatment in the ICU. It was thought that using appropriate nutritional

Computation of ancestry scores with mixed families and unrelated individuals.

Science.gov (United States)

Zhou, Yi-Hui; Marron, James S; Wright, Fred A

2018-03-01

The issue of robustness to family relationships in computing genotype ancestry scores such as eigenvector projections has received increased attention in genetic association, and is particularly challenging when sets of both unrelated individuals and closely related family members are included. The current standard is to compute loadings (left singular vectors) using unrelated individuals and to compute projected scores for remaining family members. However, projected ancestry scores from this approach suffer from shrinkage toward zero. We consider two main novel strategies: (i) matrix substitution based on decomposition of a target family-orthogonalized covariance matrix, and (ii) using family-averaged data to obtain loadings. We illustrate the performance via simulations, including resampling from 1000 Genomes Project data, and analysis of a cystic fibrosis dataset. The matrix substitution approach has similar performance to the current standard, but is simple and uses only a genotype covariance matrix, while the family-average method shows superior performance. Our approaches are accompanied by novel ancillary approaches that provide considerable insight, including individual-specific eigenvalue scree plots. © 2017 The Authors. Biometrics published by Wiley Periodicals, Inc. on behalf of International Biometric Society.

The Guy's stone score--grading the complexity of percutaneous nephrolithotomy procedures.

Science.gov (United States)

Thomas, Kay; Smith, Naomi C; Hegarty, Nicholas; Glass, Jonathan M

2011-08-01

To report the development and validation of a scoring system, the Guy's stone score, to grade the complexity of percutaneous nephrolithotomy (PCNL). Currently, no standardized method is available to predict the stone-free rate after PCNL. The Guy's stone score was developed through a combination of expert opinion, published data review, and iterative testing. It comprises 4 grades: grade I, solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade II, solitary stone in upper pole or multiple stones in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy; grade III, multiple stones in a patient with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus; grade IV, staghorn calculus or any stone in a patient with spina bifida or spinal injury. It was assessed for reproducibility using the kappa coefficient and validated on a prospective database of 100 PCNL procedures performed in a tertiary stone center. The complications were graded using the modified Clavien score. The clinical outcomes were recorded prospectively and assessed with multivariate analysis. The Guy's stone score was the only factor that significantly and independently predicted the stone-free rate (P = .01). It was found to be reproducible, with good inter-rater agreement (P = .81). None of the other factors tested, including stone burden, operating surgeon, patient weight, age, and comorbidity, correlated with the stone-free rate. The Guy's stone score accurately predicted the stone-free rate after PCNL. It was easy to use and reproducible. Copyright © 2011 Elsevier Inc. All rights reserved.

Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

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Leonardo Sinnott Silva

2015-01-01

Full Text Available Abstract Background: Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI remains a challenge. Objectives: To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. Methods: The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI, EuroSCORE II (ESII, Society of Thoracic Surgeons (STS score, Ambler score (AS and Guaragna score (GS. The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test and discrimination [area under the receiver–operating characteristic curve (AUC]. Results: The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI: 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42 for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16 for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68 for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64 for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05. Conclusions: In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.

Role of organisational structure in implementation of sedation protocols: a comparison of Canadian and French ICUs.

Science.gov (United States)

Dodek, Peter; Chanques, Gerald; Brown, Glen; Norena, Monica; Grubisic, Maja; Wong, Hubert; Jaber, Samir

2012-09-01

Use of sedation protocols is associated with fewer mechanical ventilation days in critically ill patients. Canadian intensive care units (ICUs) often have a higher nurse-patient ratio and more specialised training of ICU nurses than French ICUs. Considering these differences, the purpose of this study was to compare implementation of sedation protocols as indicated by frequency of sedation assessment and response to levels of sedation between a Canadian and a French ICU. This was a retrospective observational study of 30 patients who were mechanically ventilated for at least 24 h in each of two tertiary care ICUs in Vancouver, Canada and Montpellier, France. The authors tabulated all Richmond Agitation-Sedation Scale scores, frequency of score measurement, target scores, frequency and magnitude of scores that were out of target range, and the response to these scores within 1 h of measurement. Practices between the two hospitals were compared using regression modelling, adjusting for patient age, sex, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Although sedation scores were measured more frequently in the Canadian ICU, there were fewer appropriate adjustments in medications in response to scores that were outside the target range in this ICU than in the French ICU, which had a lower nurse-patient ratio and no specialised training of nurses (OR 0.26 (95% CI 0.13 to 0.50) for scores that were higher than target, and OR 0.14 (95% CI 0.07 to 0.28) for scores that were lower than target). Differences in sedation management between these ICUs are likely related to factors other than nurse-patient ratio or specialised training of ICU nurses.

Bulbar impairment score predicts noninvasive volume-cycled ventilation failure during an acute lower respiratory tract infection in ALS.

Science.gov (United States)

Servera, Emilio; Sancho, Jesús; Bañuls, Pilar; Marín, Julio

2015-11-15

Amyotrophic lateral sclerosis (ALS) patients can suffer episodes of lower respiratory tract infections (LRTI) leading to an acute respiratory failure (ARF) requiring noninvasive ventilation (NIV). To determine whether clinical or functional parameters can predict noninvasive management failure during LRTI causing ARF in ALS. A prospective study involving all ALS patients with ARF requiring NIV in a Respiratory Care Unit. NIV was provided with volume-cycled ventilators. 63 ALS patients were included (APACHE II: 14.93±3.56, Norris bulbar subscore (NBS): 18.78±9.68, ALSFRS-R: 19.90±6.98, %FVC: 40.01±18.07%, MIC: 1.62±0.74L, PCF 2.51±1.15L/s, PImax -34.90±19.44cmH2O, PEmax 51.20±28.84cmH2O). In 73.0% of patients NIV was successful in averting death or endotracheal intubation. Differences were found between the success and failure in the NBS (22.08±6.15 vs 8.66±3.39, pNIV failure was the NBS (OR 0.53, 95% CI 0.31-0.92, p 0.002) with a cut-off point of 12 (S 0.93; E 0.97; PPV 0.76; NPV 0.97). NBS can predict noninvasive management failure during LRTI in ALS. Copyright © 2015 Elsevier B.V. All rights reserved.

Microproteinuria Predicts Organ Failure in Patients Presenting with Acute Pancreatitis

DEFF Research Database (Denmark)

Bertilsson, Sara; Swärd, Per; Håkansson, Anders

2016-01-01

patients were included (14 % with organ failure; 6 % with severe AP). The α1-microglobulin-, albumin-, and IgG/creatinine ratios correlated with high-sensitivity C-reactive protein 48 h after admission (r = 0.47–0.61, p .... Urine samples were collected upon admission, 12–24 h after admission, and 3 months post-discharge for calculation of urine α1-microglobulin-, albumin-, IgG-, and IgM/creatinine ratios. Data regarding AP etiology, severity, and development of organ failure were registered. Results: Overall, 92 AP...... organ failure (p creatinine ratio upon admission predicted organ failure [adjusted odds ratio 1.286, 95 % confidence interval (CI) 1.024–1.614] with similar accuracy (AUROC 0.81, 95 % CI 0.69–0.94) as the more complex APACHE II score (AUROC 0.86, 95 % CI 0...

Evaluation of the quality of the reporting of phase II clinical trials in oncology: A systematic review.

Science.gov (United States)

Rivoirard, Romain; Langrand-Escure, Julien; Oriol, Mathieu; Tinquaut, Fabien; Chauvin, Franck; Rancoule, Chloé; Magné, Nicolas; Bourmaud, Aurélie

2018-05-01

To describe the current state of knowledge concerning the quality of reporting in phase II clinical trials in oncology and to describe the various methods published allowing this quality evaluation. databases including MEDLINE and COCHRANE were searched. Reviews and meta-analyses analyzing the quality of the reporting of phase II trials in oncology were included. Descriptive analysis of the results was performed. Thirteen publications were retained. Only 2 publications adopted a systematic approach of evaluation of the quality of reporting by overall scores. The Key Methodological Score (KMS), proposed by Grellety et al., gathering 3 items, seemed adapted for such an evaluation. A score of 3/3 was found in 16.1% of the 156 phase II trials analysed by this score. The other reviews used a qualitative analysis to evaluate the reporting, via an analysis of a single criterion, generally the statistical plan of the study. This item was considered as having been correctly reported in less than 50% of the analysed articles. The quality of reporting in phase II trials in oncology is a field that has been investigated very little (13 publications). When it is studied, the estimated level of quality is not satisfactory, whatever the method employed. The use of an overall score of evaluation is a path which should be pursued, in order to get reliable results. It also seems necessary to propose strong recommendations, which would create a consensus for the methodology and the reporting of these studies. Copyright © 2018 Elsevier B.V. All rights reserved.

Dancetime! 500 Years of Social Dance. Volume II: 20th Century. [Videotape].

Science.gov (United States)

Teten, Carol

This 50-minute VHS videotape is the second in a 2-volume series that presents 500 years of social dance, music, and fashion. It features dance and music of the 20th century, including; 1910s: animal dances, castle walk, apache, and tango; 1920s: black bottom and charleston; 1930s: marathon, movie musicals, big apple, and jitterbug; 1940s: rumba;…

Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

International Nuclear Information System (INIS)

Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok

2001-01-01

To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

Energy Technology Data Exchange (ETDEWEB)

Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

2001-04-01

To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

Links Among High EPDS Scores, State of Mind Regarding Attachment, and Symptoms of Personality Disorder.

Science.gov (United States)

Smith-Nielsen, Johanne; Steele, Howard; Mehlhase, Heike; Cordes, Katharina; Steele, Miriam; Harder, Susanne; Væver, Mette Skovgaard

2015-12-01

Underlying persistent psychological difficulties have been found to moderate potential adverse effects of maternal postpartum depression (PPD) on parenting and infant development. The authors examined whether mothers presenting postpartum depressive symptoms showed higher levels of personality pathology and more insecure state of mind regarding attachment compared to nondepressed mothers. Participants (N = 85) were assessed with the Edinburgh Postnatal Depression Scale (EPDS), the Present State Examination, the Adult Attachment Interview, and the Structured Clinical Interview for DSM-IV Axis II. Mothers with high EPDS scores were more likely to have a preoccupied insecure state of mind and to have personality disorder compared with mothers scoring below clinical cutoff. Furthermore, multiple regression analysis showed that personality disorder and AAI classification were independently related to EPDS score, and that these two factors together accounted for 48% of the variance in EPDS score. Findings are discussed in terms of heterogeneity in PPD populations and underline the importance of examining potential coexisting psychological difficulties when studying PPD.

WebScore: An Effective Page Scoring Approach for Uncertain Web Social Networks

Directory of Open Access Journals (Sweden)

Shaojie Qiao

2011-10-01

Full Text Available To effectively score pages with uncertainty in web social networks, we first proposed a new concept called transition probability matrix and formally defined the uncertainty in web social networks. Second, we proposed a hybrid page scoring algorithm, called WebScore, based on the PageRank algorithm and three centrality measures including degree, betweenness, and closeness. Particularly,WebScore takes into a full consideration of the uncertainty of web social networks by computing the transition probability from one page to another. The basic idea ofWebScore is to: (1 integrate uncertainty into PageRank in order to accurately rank pages, and (2 apply the centrality measures to calculate the importance of pages in web social networks. In order to verify the performance of WebScore, we developed a web social network analysis system which can partition web pages into distinct groups and score them in an effective fashion. Finally, we conducted extensive experiments on real data and the results show that WebScore is effective at scoring uncertain pages with less time deficiency than PageRank and centrality measures based page scoring algorithms.

Impact of a community based implementation of REACH II program for caregivers of Alzheimer's patients.

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Kristine Lykens

Full Text Available BACKGROUND: In 2009 an estimated 5.3 million people in the United States were afflicted with Alzheimer's disease, a degenerative form of dementia. The impact of this disease is not limited to the patient but also has significant impact on the lives and health of their family caregivers. The Resources for Enhancing Alzheimer's Caregiver Health (REACH II program was developed and tested in clinical studies. The REACH II program is now being delivered by community agencies in several locations. This study examines the impact of the REACH II program on caregiver lives and health in a city in north Texas. STUDY DESIGN: Family caregivers of Alzheimer's patients were assessed using an instrument covering the multi-item domains of Caregiver Burden, Depression, Self-Care, and Social Support upon enrollment in the program and at the completion of the 6 month intervention. The domain scores were analyzed using a multivariate paired t-test and Bonferroni confidence interval for the differences in pre- and post-service domain scores. RESULTS: A total of 494 families were enrolled in the program during the period January 1, 2011 through June 30, 2012. Of these families 177 completed the 6 month program and have pre - and post service domain scores. The median age for the caregivers was 62 years. The domain scores for Depression and Caregiver Burden demonstrated statistically significant improvements upon program completion. CONCLUSION: The REACH II intervention was successfully implemented by a community agency with comparable impacts to those of the clinical trial warranting wider scale implementation.

Evaluation of the quality of guidelines for myasthenia gravis with the AGREE II instrument.

Directory of Open Access Journals (Sweden)

Zhenchang Zhang

Full Text Available Clinical practice guidelines (CPGs are systematically developed statements to assist practitioners in making decisions about appropriate healthcare in specific clinical circumstances. The methodological quality of CPGs for myasthenia gravis (MG are unclear.To critically evaluate the methodological quality of CPGs for MG using AGREE II instrument.A systematical search strategy on PubMed, EMBASE, DynaMed, the National Guideline Clearinghouse (NGC and the Chinese Biomedical Literature database (CBM was performed on September 20th 2013. All guidelines related to MG were evaluated with AGREE II. The software used for analysis was SPSS 17.0.A total of 15 CPGs for MG met the inclusion criteria (12 CPGs in English, 3 CPGs in Chinese. The overall agreement among reviews was moderate or high (ICC >0.70. The mean scores (mean ± SD for al six domains were presented as follows: scope and purpose (60.93% ± 16.62%, stakeholder involvement (40.93% ± 20.04%, rigor of development (37.22% ± 30.46%, clarity of presentation (64.26% ± 16.36%, applicability (28.19% ± 20.56% and editorial independence (27.78% ± 28.28%. Compared with non-evidence-based CPGs, evidence-based CPGs had statistically significant higher quality scores for all AGREE II domains (P0.05. The quality scores of CPGs developed by NGC/AAN were higher than the quality scores of CPGs developed by other organizations for all domains. The difference was statistically significant for all domains with the exception of clarity of presentation (P = 0.07.The qualities of CPGs on MG were generally acceptable with several flaws. The AGREE II instrument should be adopted by guideline developers, particularly in China.

Dynamic detection of N-terminal pro-B-type natriuretic peptide helps to predict the outcome of patients with major trauma.

Science.gov (United States)

Qian, A; Zhang, M; Zhao, G

2015-02-01

NT-proBNP and BNP have been demonstrated to be prognostic markers in cardiac disease and sepsis. However, the prognostic value and the dynamic changes of BNP or NT-proBNP in trauma patients remain unclear. The present study was conducted to investigate the dynamic changes of NT-proBNP in patients with major trauma (injury severity score ≥16), determine whether NT-proBNP could be used as a simple index to predict mortality in major trauma patients. This prospective observational study included 60 patients with major trauma. Serum NT-proBNP levels were measured on the 1st, 3rd and 7th day after injury The NT-proBNP levels in survivors were compared with those in non-survivors. The efficacy of NT-proBNP to predict survival was analyzed using receiver operating characteristic curves. An analysis of correlations between NT-proBNP and various factors, including injury severity score, Glasgow coma score, acute physiology and chronic health evaluation II, central venous pressure, creatine kinase-MB, cardiac troponin I and procalcitonin (PCT) was performed. NT-proBNP levels in patients with traumatic brain injury were compared with those in patients without traumatic brain injury. A comparison of NT-proBNP levels between patients with and without sepsis was also performed at each time point. NT-proBNP levels in non-survivors were significantly higher than those in survivors at all the indicated time points. In the group of non-survivors, NT-proBNP levels on the 7th day were markedly higher than those on the 1st day. In contrast, NT-proBNP levels in survivors showed a reduction over time. The efficacy of NT-proBNP to predict survival was analyzed using ROC curves, and there was no difference in the area under the ROC between NT-proBNP and APACHE II/ISS at the three time points. A significant correlation was found between NT-proBNP and ISS on the 1st day, NT-proBNP and CK-MB, Tn-I and APACHE II on the 3rd day, NT-proBNP and PCT on the 7th day. There were no significant

OVERVIEW OF THE SDSS-IV MaNGA SURVEY: MAPPING NEARBY GALAXIES AT APACHE POINT OBSERVATORY

Energy Technology Data Exchange (ETDEWEB)

Bundy, Kevin [Kavli Institute for the Physics and Mathematics of the Universe (Kavli IPMU, WPI), Todai Institutes for Advanced Study, the University of Tokyo, Kashiwa 277-8583 (Japan); Bershady, Matthew A.; Wake, David A.; Tremonti, Christy; Diamond-Stanic, Aleksandar M. [Department of Astronomy, University of Wisconsin-Madison, 475 North Charter Street, Madison, WI 53706 (United States); Law, David R.; Cherinka, Brian [Dunlap Institute for Astronomy and Astrophysics, University of Toronto, 50 St. George Street, Toronto, Ontario M5S 3H4 (Canada); Yan, Renbin; Sánchez-Gallego, José R. [Department of Physics and Astronomy, University of Kentucky, 505 Rose Street, Lexington, KY 40506-0055 (United States); Drory, Niv [McDonald Observatory, Department of Astronomy, University of Texas at Austin, 1 University Station, Austin, TX 78712-0259 (United States); MacDonald, Nicholas [Department of Astronomy, Box 351580, University of Washington, Seattle, WA 98195 (United States); Weijmans, Anne-Marie [School of Physics and Astronomy, University of St Andrews, North Haugh, St Andrews KY16 9SS (United Kingdom); Thomas, Daniel; Masters, Karen; Coccato, Lodovico [Institute of Cosmology and Gravitation, University of Portsmouth, Portsmouth (United Kingdom); Aragón-Salamanca, Alfonso [School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD (United Kingdom); Avila-Reese, Vladimir [Instituto de Astronomia, Universidad Nacional Autonoma de Mexico, A.P. 70-264, 04510 Mexico D.F. (Mexico); Badenes, Carles [Department of Physics and Astronomy and Pittsburgh Particle Physics, Astrophysics and Cosmology Center (PITT PACC), University of Pittsburgh, 3941 OHara St, Pittsburgh, PA 15260 (United States); Falcón-Barroso, Jésus [Instituto de Astrofísica de Canarias, E-38200 La Laguna, Tenerife (Spain); Belfiore, Francesco [Cavendish Laboratory, University of Cambridge, 19 J. J. Thomson Avenue, Cambridge CB3 0HE (United Kingdom); and others

2015-01-01

We present an overview of a new integral field spectroscopic survey called MaNGA (Mapping Nearby Galaxies at Apache Point Observatory), one of three core programs in the fourth-generation Sloan Digital Sky Survey (SDSS-IV) that began on 2014 July 1. MaNGA will investigate the internal kinematic structure and composition of gas and stars in an unprecedented sample of 10,000 nearby galaxies. We summarize essential characteristics of the instrument and survey design in the context of MaNGA's key science goals and present prototype observations to demonstrate MaNGA's scientific potential. MaNGA employs dithered observations with 17 fiber-bundle integral field units that vary in diameter from 12'' (19 fibers) to 32'' (127 fibers). Two dual-channel spectrographs provide simultaneous wavelength coverage over 3600-10300 Å at R ∼ 2000. With a typical integration time of 3 hr, MaNGA reaches a target r-band signal-to-noise ratio of 4-8 (Å{sup –1} per 2'' fiber) at 23 AB mag arcsec{sup –2}, which is typical for the outskirts of MaNGA galaxies. Targets are selected with M {sub *} ≳ 10{sup 9} M {sub ☉} using SDSS-I redshifts and i-band luminosity to achieve uniform radial coverage in terms of the effective radius, an approximately flat distribution in stellar mass, and a sample spanning a wide range of environments. Analysis of our prototype observations demonstrates MaNGA's ability to probe gas ionization, shed light on recent star formation and quenching, enable dynamical modeling, decompose constituent components, and map the composition of stellar populations. MaNGA's spatially resolved spectra will enable an unprecedented study of the astrophysics of nearby galaxies in the coming 6 yr.

OVERVIEW OF THE SDSS-IV MaNGA SURVEY: MAPPING NEARBY GALAXIES AT APACHE POINT OBSERVATORY

International Nuclear Information System (INIS)

Bundy, Kevin; Bershady, Matthew A.; Wake, David A.; Tremonti, Christy; Diamond-Stanic, Aleksandar M.; Law, David R.; Cherinka, Brian; Yan, Renbin; Sánchez-Gallego, José R.; Drory, Niv; MacDonald, Nicholas; Weijmans, Anne-Marie; Thomas, Daniel; Masters, Karen; Coccato, Lodovico; Aragón-Salamanca, Alfonso; Avila-Reese, Vladimir; Badenes, Carles; Falcón-Barroso, Jésus; Belfiore, Francesco

2015-01-01

We present an overview of a new integral field spectroscopic survey called MaNGA (Mapping Nearby Galaxies at Apache Point Observatory), one of three core programs in the fourth-generation Sloan Digital Sky Survey (SDSS-IV) that began on 2014 July 1. MaNGA will investigate the internal kinematic structure and composition of gas and stars in an unprecedented sample of 10,000 nearby galaxies. We summarize essential characteristics of the instrument and survey design in the context of MaNGA's key science goals and present prototype observations to demonstrate MaNGA's scientific potential. MaNGA employs dithered observations with 17 fiber-bundle integral field units that vary in diameter from 12'' (19 fibers) to 32'' (127 fibers). Two dual-channel spectrographs provide simultaneous wavelength coverage over 3600-10300 Å at R ∼ 2000. With a typical integration time of 3 hr, MaNGA reaches a target r-band signal-to-noise ratio of 4-8 (Å –1 per 2'' fiber) at 23 AB mag arcsec –2 , which is typical for the outskirts of MaNGA galaxies. Targets are selected with M * ≳ 10 9 M ☉ using SDSS-I redshifts and i-band luminosity to achieve uniform radial coverage in terms of the effective radius, an approximately flat distribution in stellar mass, and a sample spanning a wide range of environments. Analysis of our prototype observations demonstrates MaNGA's ability to probe gas ionization, shed light on recent star formation and quenching, enable dynamical modeling, decompose constituent components, and map the composition of stellar populations. MaNGA's spatially resolved spectra will enable an unprecedented study of the astrophysics of nearby galaxies in the coming 6 yr

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

Science.gov (United States)

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

2013-10-01

To assess the impact of chronic liver disease (CLD) on ICU-acquired pneumonia. This was a prospective, observational study of the characteristics, microbiology, and outcomes of 343 consecutive patients with ICU-acquired pneumonia clustered according to the presence of CLD. Sixty-seven (20%) patients had CLD (67% had liver cirrhosis, LC), MELD score 26 ± 9, 20% Child-Pugh class C). They presented higher severity scores than patients without CLD both on admission to the ICU (APACHE II, LC 19 ± 6 vs. other CLD 18 ± 6 vs. no CLD 16 ± 6; p CLD patients. LC patients had higher 28- and 90-day mortality (63 vs. 28%, p CLD patients. Presence of LC was independently associated with decreased 28- and 90-day survival (95% confidence interval [CI], 1.982-17.250; p = 0.001; 95% confidence interval [CI], 2.915-20.699, p = 0.001, respectively). In critically ill patients with ICU-acquired pneumonia, CLD is associated with a more severe clinical presentation and poor clinical outcomes. Moreover, LC is independently associated with 28- and 90-day mortality. The results of this study are important for future trials focused on mortality.

Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone.

Science.gov (United States)

Rasslan, Roberto; da Costa Ferreira Novo, Fernando; Rocha, Marcelo Cristiano; Bitran, Alberto; de Souza Rocha, Manoel; de Oliveira Bernini, Celso; Rasslan, Samir; Utiyama, Edivaldo Massazo

2017-02-01

To present our experience in the management of patients with infected pancreatic necrosis without drainage. The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed. We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died. In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration.

A comparative study of MR imaging scores and MR perfusion imaging in pre-operative grading of intracranial gliomas

International Nuclear Information System (INIS)

Wu Honglin; Chen Junkun; Zhang Zongjun; Lu Guangming; Chen Ziqian; Wang Wei; Ji Xueman; Tang Xiaojun; Li Lin

2005-01-01

Objective: To compare the accuracy of MR imaging scores with MR perfusion imaging in pre-operative grading of intracranial gliomas. Methods: Thirty patients with intracranial gliomas (8 low-grade and 22 high-grade, according to WHO criteria) were examined with MR perfusion imaging pre-operatively. The lesions were evaluated by using an MR imaging score based on nine criteria. rCBV of the lesions were calculated by comparing the CBV of the lesion and that of contralateral normal white matter. The scores and ratios in high-grade and low-grade tumours were compared. Results: The MR imaging score of low grade (grades I and II) gliomas (0.67±0.29) were significantly lower than that of grades III (1.32 ± 0.47) (t=-3.48, P=0.003) and IV (1.56 ± 0.20) (t=-7.36, P=0.000) gliomas. There was no statistical difference when MR imaging scores of grades III and IV gliomas (t=-1.39, P=0.182) were compared. The maximum rCBV ratio of low grade (grades I and II) gliomas (2.38 ± 0.66 ) were significantly lower than that of grades III (5.81 ± 3.20) (t=-3.57, P=0.003) and IV (6.99 ± 2.47) (t=-5.09, P=0.001). There was no statistical difference when rCBV ratios of grades III and IV (t =-0.93, P=0.365) gliomas were compared. The accuracy of MR imaging scores in the noninvasive grading of untreated gliomas was all most the same as that of MR perfusion imaging (90.00% vs 89.29%). Conclusion: The MR imaging scores and MR perfusion imaging are two very useful tools in the evaluation of the histopathologic grade of cerebral gliomas. The overall accuracy in the noninvasive grading of gliomas may be imp roved if MR imaging scores and MR perfusion imaging are combined. (authors)

A Comparison of Two Scoring Methods for an Automated Speech Scoring System

Science.gov (United States)

Xi, Xiaoming; Higgins, Derrick; Zechner, Klaus; Williamson, David

2012-01-01

This paper compares two alternative scoring methods--multiple regression and classification trees--for an automated speech scoring system used in a practice environment. The two methods were evaluated on two criteria: construct representation and empirical performance in predicting human scores. The empirical performance of the two scoring models…

E-learning interventions are comparable to user's manual in a randomized trial of training strategies for the AGREE II

Directory of Open Access Journals (Sweden)

Durocher Lisa D

2011-07-01

Full Text Available Abstract Background Practice guidelines (PGs are systematically developed statements intended to assist in patient and practitioner decisions. The AGREE II is the revised tool for PG development, reporting, and evaluation, comprised of 23 items, two global rating scores, and a new User's Manual. In this study, we sought to develop, execute, and evaluate the impact of two internet interventions designed to accelerate the capacity of stakeholders to use the AGREE II. Methods Participants were randomized to one of three training conditions. 'Tutorial'--participants proceeded through the online tutorial with a virtual coach and reviewed a PDF copy of the AGREE II. 'Tutorial + Practice Exercise'--in addition to the Tutorial, participants also appraised a 'practice' PG. For the practice PG appraisal, participants received feedback on how their scores compared to expert norms and formative feedback if scores fell outside the predefined range. 'AGREE II User's Manual PDF (control condition'--participants reviewed a PDF copy of the AGREE II only. All participants evaluated a test PG using the AGREE II. Outcomes of interest were learners' performance, satisfaction, self-efficacy, mental effort, time-on-task, and perceptions of AGREE II. Results No differences emerged between training conditions on any of the outcome measures. Conclusions We believe these results can be explained by better than anticipated performance of the AGREE II PDF materials (control condition or the participants' level of health methodology and PG experience rather than the failure of the online training interventions. Some data suggest the online tools may be useful for trainees new to this field; however, this requires further study.

NCACO-score: An effective main-chain dependent scoring function for structure modeling

Directory of Open Access Journals (Sweden)

Dong Xiaoxi

2011-05-01

Full Text Available Abstract Background Development of effective scoring functions is a critical component to the success of protein structure modeling. Previously, many efforts have been dedicated to the development of scoring functions. Despite these efforts, development of an effective scoring function that can achieve both good accuracy and fast speed still presents a grand challenge. Results Based on a coarse-grained representation of a protein structure by using only four main-chain atoms: N, Cα, C and O, we develop a knowledge-based scoring function, called NCACO-score, that integrates different structural information to rapidly model protein structure from sequence. In testing on the Decoys'R'Us sets, we found that NCACO-score can effectively recognize native conformers from their decoys. Furthermore, we demonstrate that NCACO-score can effectively guide fragment assembly for protein structure prediction, which has achieved a good performance in building the structure models for hard targets from CASP8 in terms of both accuracy and speed. Conclusions Although NCACO-score is developed based on a coarse-grained model, it is able to discriminate native conformers from decoy conformers with high accuracy. NCACO is a very effective scoring function for structure modeling.

Untitled

African Journals Online (AJOL)

Figure 6. The reasons given by farmers for changing varieties in Kasese, Apach and Arua districts of Uganda and relative impotance of the reasons given for abandoning varieties. V Kasest. (a). NAI. II. Apac. Arul have been influenced by the age of those 1201 interviewed and their ability to remember past 100 experience.

Validation of CRIB II for prediction of mortality in premature babies.

Science.gov (United States)

Rastogi, Pallav Kumar; Sreenivas, V; Kumar, Nirmal

2010-02-01

Validation of Clinical Risk Index for Babies (CRIB II) score in predicting the neonatal mortality in preterm neonates < or = 32 weeks gestational age. Prospective cohort study. Tertiary care neonatal unit. 86 consecutively born preterm neonates with gestational age < or = 32 weeks. The five variables related to CRIB II were recorded within the first hour of admission for data analysis. The receiver operating characteristics (ROC) curve was used to check the accuracy of the mortality prediction. HL Goodness of fit test was used to see the discrepancy between observed and expected outcomes. A total of 86 neonates (males 59.6% mean birthweight: 1228 +/- 398 grams; mean gestational age: 28.3 +/- 2.4 weeks) were enrolled in the study, of which 17 (19.8%) left hospital against medical advice (LAMA) before reaching the study end point. Among 69 neonates completing the study, 24 (34.8%) had adverse outcome during hospital stay and 45 (65.2%) had favorable outcome. CRIB II correctly predicted adverse outcome in 90.3% (Hosmer Lemeshow goodness of fit test P=0.6). Area under curve (AUC) for CRIB II was 0.9032. In intention to treat analysis with LAMA cases included as survivors, the mortality prediction was 87%. If these were included as having died then mortality prediction was 83.1%. The CRIB II score was found to be a good predictive instrument for mortality in preterm infants < or = 32 weeks gestation.

The utility of the clock drawing test in detection of delirium in elderly hospitalised patients.

Science.gov (United States)

Adamis, Dimitrios; Meagher, David; O'Neill, Donagh; McCarthy, Geraldine

2016-09-01

Delirium is common neuropsychiatric condition among elderly inpatients. The clock drawing test (CDT) has been used widely as bedside screening tool in assessing cognitive impairment in elderly people. Previous studies which evaluate its usefulness in delirium reported conflicting results. The objective of this study was to evaluate the utility of CDT to detect delirium in elderly medical patients. Prospective, observational, longitudinal study. All acute medical admissions 70 years of age and above were approached within 72 hours of admission for recruitment. Patients eligible for inclusion were assessed four times, twice weekly during admission. Assessment included Confusion Assessment Method (CAM), Delirium Rating Scale (DRS-98R), Montreal Cognitive Assessment (MoCA), Acute Physiology and Chronic Health Evaluation II (APACHE) II, and CDT. Data was analysed using a linear mixed effect model. Three hundred and twenty-three assessments with the CDT were performed on 200 subjects (50% male, mean age 81.13; standard deviation: 6.45). The overall rate of delirium (CAM+) during hospitalisation was 23%. There was a significant negative correlation between the CDT and DRS-R98 scores (Pearson correlation r = -0.618, p < 0.001), CDT and CAM (Spearman's rho = -0.402, p < 0.001) and CDT and total MoCA score (Pearson's r = 0.767, p < 0.001). However, when the data were analysed longitudinally controlling for all the factors, we found that cognitive function and age were significant factors associated with CDT scores (p < .0001): neither the presence nor the severity of delirium had an additional significant effect on the CDT. CDT score reflects cognitive impairment, independently of the presence or severity of delirium. The CDT is not a suitable test for delirium in hospitalised elderly patients.

Mortality in severe trauma patients attended by emergency services in Navarre, Spain: validation of a new prediction model and comparison with the Revised Injury Severity Classification Score II.

Science.gov (United States)