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Sample records for criterion predict patient

  1. A NEW CLINICAL PREDICTION CRITERION ACCURATELY DETERMINES A SUBSET OF PATIENTS WITH BILATERAL PRIMARY ALDOSTERONISM BEFORE ADRENAL VENOUS SAMPLING.

    Science.gov (United States)

    Kocjan, Tomaz; Janez, Andrej; Stankovic, Milenko; Vidmar, Gaj; Jensterle, Mojca

    2016-05-01

    Adrenal venous sampling (AVS) is the only available method to distinguish bilateral from unilateral primary aldosteronism (PA). AVS has several drawbacks, so it is reasonable to avoid this procedure when the results would not affect clinical management. Our objective was to identify a clinical criterion that can reliably predict nonlateralized AVS as a surrogate for bilateral PA that is not treated surgically. A retrospective diagnostic cross-sectional study conducted at Slovenian national endocrine referral center included 69 consecutive patients (mean age 56 ± 8 years, 21 females) with PA who underwent AVS. PA was confirmed with the saline infusion test (SIT). AVS was performed sequentially during continuous adrenocorticotrophic hormone (ACTH) infusion. The main outcome measures were variables associated with nonlateralized AVS to derive a clinical prediction rule. Sixty-seven (97%) patients had a successful AVS and were included in the statistical analysis. A total of 39 (58%) patients had nonlateralized AVS. The combined criterion of serum potassium ≥3.5 mmol/L, post-SIT aldosterone AVS. The best overall classification accuracy (50/67 = 75%) was achieved using the post-SIT aldosterone level AVS. Our clinical prediction criterion appears to accurately determine a subset of patients with bilateral PA who could avoid unnecessary AVS and immediately commence with medical treatment.

  2. Prediction of Hot Tearing Using a Dimensionless Niyama Criterion

    Science.gov (United States)

    Monroe, Charles; Beckermann, Christoph

    2014-08-01

    The dimensionless form of the well-known Niyama criterion is extended to include the effect of applied strain. Under applied tensile strain, the pressure drop in the mushy zone is enhanced and pores grow beyond typical shrinkage porosity without deformation. This porosity growth can be expected to align perpendicular to the applied strain and to contribute to hot tearing. A model to capture this coupled effect of solidification shrinkage and applied strain on the mushy zone is derived. The dimensionless Niyama criterion can be used to determine the critical liquid fraction value below which porosity forms. This critical value is a function of alloy properties, solidification conditions, and strain rate. Once a dimensionless Niyama criterion value is obtained from thermal and mechanical simulation results, the corresponding shrinkage and deformation pore volume fractions can be calculated. The novelty of the proposed method lies in using the critical liquid fraction at the critical pressure drop within the mushy zone to determine the onset of hot tearing. The magnitude of pore growth due to shrinkage and deformation is plotted as a function of the dimensionless Niyama criterion for an Al-Cu alloy as an example. Furthermore, a typical hot tear "lambda"-shaped curve showing deformation pore volume as a function of alloy content is produced for two Niyama criterion values.

  3. A New Criterion for Prediction of Hot Tearing Susceptibility of Cast Alloys

    Science.gov (United States)

    Nasresfahani, Mohamad Reza; Niroumand, Behzad

    2014-08-01

    A new criterion for prediction of hot tearing susceptibility of cast alloys is suggested which takes into account the effects of both important mechanical and metallurgical factors and is believed to be less sensitive to the presence of volume defects such as bifilms and inclusions. The criterion was validated by studying the hot tearing tendency of Al-Cu alloy. In conformity with the experimental results, the new criterion predicted reduction of hot tearing tendency with increasing the copper content.

  4. The mean lung dose (MLD). Predictive criterion for lung damage

    Energy Technology Data Exchange (ETDEWEB)

    Geyer, Peter; Appold, Steffen [Dresden University of Technology (TU Dresden), Clinic and Polyclinic for Radiotherapy and Radiation Oncology, Carl Gustav Carus Medical Faculty, Dresden (Germany); Herrmann, Thomas

    2015-07-15

    The purpose of this work was to prove the validity of the mean lung dose (MLD), widely used in clinical practice to estimate the lung toxicity of a treatment plan, by reevaluating experimental data from mini pigs. A total of 43 mini pigs were irradiated in one of four dose groups (25, 29, 33, and 37 Gy). Two regimens were applied: homogeneous irradiation of the right lung or partial irradiation of both lungs - including parts with lower dose - but with similar mean lung doses. The animals were treated with five fractions with a linear accelerator applying a CT-based treatment plan. The clinical lung reaction (breathing frequency) and morphological changes in CT scans were examined frequently during the 48 weeks after irradiation. A clear dose-effect relationship was found for both regimens of the trial. However, a straightforward relationship between the MLD and the relative number of responders with respect to different grades of increased breathing frequency for both regimens was not found. A morphologically based parameter NTCP{sub lung} was found to be more suitable for this purpose. The dependence of this parameter on the MLD is markedly different for the two regimens. In clinical practice, the MLD can be used to predict lung toxicity of a treatment plan, except for dose values that could lead to severe side effects. In the latter mentioned case, limitations to the predictive value of the MLD are possible. Such severe developments of a radiation-induced pneumopathy are better predicted by the NTCP{sub lung} formalism. The predictive advantage of this parameter compared to the MLD seems to remain in the evaluation and comparison of widely differing dose distributions, like in the investigated trial. (orig.) [German] Es soll unter Reevaluation von Tierversuchsdaten am Minischwein geprueft werden, ob die in der klinischen Praxis zur Beurteilung der Lungentoxizitaet eines Bestrahlungsregims regelhaft verwendete mittlere Lungendosis (MLD) eine zuverlaessige

  5. A critical analysis of the Mises stress criterion used in frequency domain fatigue life prediction

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    Adam Niesłony

    2016-10-01

    Full Text Available Multiaxial fatigue failure criteria are formulated in time and frequency domain. The number of frequency domain criteria is rather small and the most popular one is the equivalent von Mises stress criterion. This criterion was elaborated by Preumont and Piefort on the basis of well-known von Mises stress concept, first proposed by Huber in 1907, and well accepted by the scientific community and engineers. It is important to know, that the criterion was developed to determine the yield stress and material effort under static load. Therefore the direct use of equivalent von Mises stress criterion for fatigue life prediction can lead to some incorrectness of theoretical and practical nature. In the present study four aspects were discussed: influence of the value of fatigue strength of tension and torsion, lack of parallelism of the SN curves, abnormal behaviour of the criterion under biaxial tensioncompression and influence of phase shift between particular stress state components. Information contained in this article will help to prevent improper use of this criterion and contributes to its better understanding

  6. A simple criterion to predict the glass forming ability of metallic alloys

    International Nuclear Information System (INIS)

    Falcao de Oliveira, Marcelo

    2012-01-01

    A new and simple criterion with which to quantitatively predict the glass forming ability (GFA) of metallic alloys is proposed. It was found that the critical cooling rate for glass formation (R C ) correlates well with a proper combination of two factors, the minimum topological instability (λ min ) and the Δh parameter, which depends on the average work function difference (Δφ) and the average electron density difference (Δn ws 1/3 ) among the constituent elements of the alloy. A correlation coefficient (R 2 ) of 0.76 was found between R c and the new criterion for 68 alloys in 30 different metallic systems. The new criterion and the Uhlmann's approach were used to estimate the critical amorphous thickness (Z C ) of alloys in the Cu-Zr system. The new criterion underestimated R C in the Cu-Zr system, producing predicted Z C values larger than those observed experimentally. However, when considering a scale factor, a remarkable similarity was observed between the predicted and the experimental behavior of the GFA in the binary Cu-Zr. When using the same scale factor and performing the calculation for the ternary Zr-Cu-Al, good agreement was found between the predicted and the actual best GFA region, as well as between the expected and the observed critical amorphous thickness.

  7. Earing Prediction in Cup Drawing using the BBC2008 Yield Criterion

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    Vrh, Marko; Halilovič, Miroslav; Starman, Bojan; Štok, Boris; Comsa, Dan-Sorin; Banabic, Dorel

    2011-08-01

    The paper deals with constitutive modelling of highly anisotropic sheet metals. It presents FEM based earing predictions in cup drawing simulation of highly anisotropic aluminium alloys where more than four ears occur. For that purpose the BBC2008 yield criterion, which is a plane-stress yield criterion formulated in the form of a finite series, is used. Thus defined criterion can be expanded to retain more or less terms, depending on the amount of given experimental data. In order to use the model in sheet metal forming simulations we have implemented it in a general purpose finite element code ABAQUS/Explicit via VUMAT subroutine, considering alternatively eight or sixteen parameters (8p and 16p version). For the integration of the constitutive model the explicit NICE (Next Increment Corrects Error) integration scheme has been used. Due to the scheme effectiveness the CPU time consumption for a simulation is comparable to the time consumption of built-in constitutive models. Two aluminium alloys, namely AA5042-H2 and AA2090-T3, have been used for a validation of the model. For both alloys the parameters of the BBC2008 model have been identified with a developed numerical procedure, based on a minimization of the developed cost function. For both materials, the predictions of the BBC2008 model prove to be in very good agreement with the experimental results. The flexibility and the accuracy of the model together with the identification and integration procedure guarantee the applicability of the BBC2008 yield criterion in industrial applications.

  8. Failure criterion effect on solid production prediction and selection of completion solution

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    Dariush Javani

    2017-12-01

    Full Text Available Production of fines together with reservoir fluid is called solid production. It varies from a few grams or less per ton of reservoir fluid posing only minor problems, to catastrophic amount possibly leading to erosion and complete filling of the borehole. This paper assesses solid production potential in a carbonate gas reservoir located in the south of Iran. Petrophysical logs obtained from the vertical well were employed to construct mechanical earth model. Then, two failure criteria, i.e. Mohr–Coulomb and Mogi–Coulomb, were used to investigate the potential of solid production of the well in the initial and depleted conditions of the reservoir. Using these two criteria, we estimated critical collapse pressure and compared them to the reservoir pressure. Solid production occurs if collapse pressure is greater than pore pressure. Results indicate that the two failure criteria show different estimations of solid production potential of the studied reservoir. Mohr–Coulomb failure criterion estimated solid production in both initial and depleted conditions, where Mogi–Coulomb criterion predicted no solid production in the initial condition of reservoir. Based on Mogi–Coulomb criterion, the well may not require completion solutions like perforated liner, until at least 60% of reservoir pressure was depleted which leads to decrease in operation cost and time.

  9. Using the Predictability Criterion for Selecting Extended Verbs for Shona Dictionaries

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    Emmanuel Chabata

    2012-09-01

    Full Text Available

    The paper examines the "predictability criterion", a classificatory tool which is used in selecting affixed word forms for dictionary entries. It focuses on the criterion as it has been used by the African Languages Lexical (ALLEX Project for selecting extended verbs to enter as headwords in the Project's first monolingual Shona dictionary Duramazwi ReChiShona. The article also examines the status of Shona verbal extensions in terms of their semantic input to the verb stems they are attached to. The paper was originally motivated by two observations: (a that predictability seems to be a matter of degree; and (b that the predictability criterion tended to be used inconsistently in the selection of extended verbs and senses for Duramazwi ReChiShona. An analysis of 412 productively extended verbs that were entered as headwords in Duramazwi ReChiShona shows that verbal extensions can bring both predictable and unpredictable senses to the verb stems they are attached to. The paper demonstrates that for an effective use of the predictability criterion for selecting extended verbs for Shona dictionaries, there is need for the lexicographer to have an in-depth understanding of the kinds of semantic movements that are caused when verb stems are extended. It shows the need to view verbal extensions in Shona as derivational morphemes, not inflectional morphemes as some earlier scholars have concluded.

     

     

    Die gebruik van die voorspelbaarheidskriterium om uitgebreide werkwoorde te selekteer vir Shonawoordeboeke

    Hierdie artikel ondersoek die "voorspelbaarheidskriterium", 'n klassifikasiehulpmiddel wat gebruik word om geaffigeerde woordvorme te selekteer as woordeboekinskrywings. Dit fokus op die kriterium soos dit gebruik is deur die African Language Lexical (ALLEX Project vir die selektering van uitgebreide werkwoorde as lemmas in die Projek se eerste eentalige Shonawoordeboek Duramazwi ReChiShona. In

  10. Genetic Gain Increases by Applying the Usefulness Criterion with Improved Variance Prediction in Selection of Crosses.

    Science.gov (United States)

    Lehermeier, Christina; Teyssèdre, Simon; Schön, Chris-Carolin

    2017-12-01

    A crucial step in plant breeding is the selection and combination of parents to form new crosses. Genome-based prediction guides the selection of high-performing parental lines in many crop breeding programs which ensures a high mean performance of progeny. To warrant maximum selection progress, a new cross should also provide a large progeny variance. The usefulness concept as measure of the gain that can be obtained from a specific cross accounts for variation in progeny variance. Here, it is shown that genetic gain can be considerably increased when crosses are selected based on their genomic usefulness criterion compared to selection based on mean genomic estimated breeding values. An efficient and improved method to predict the genetic variance of a cross based on Markov chain Monte Carlo samples of marker effects from a whole-genome regression model is suggested. In simulations representing selection procedures in crop breeding programs, the performance of this novel approach is compared with existing methods, like selection based on mean genomic estimated breeding values and optimal haploid values. In all cases, higher genetic gain was obtained compared with previously suggested methods. When 1% of progenies per cross were selected, the genetic gain based on the estimated usefulness criterion increased by 0.14 genetic standard deviation compared to a selection based on mean genomic estimated breeding values. Analytical derivations of the progeny genotypic variance-covariance matrix based on parental genotypes and genetic map information make simulations of progeny dispensable, and allow fast implementation in large-scale breeding programs. Copyright © 2017 by the Genetics Society of America.

  11. Clinical assessment scoring system for tracheostomy (CASST) criterion: Objective criteria to predict pre-operatively the need for a tracheostomy in head and neck malignancies.

    Science.gov (United States)

    Gupta, Karan; Mandlik, Dushyant; Patel, Daxesh; Patel, Purvi; Shah, Bankim; Vijay, Devanhalli G; Kothari, Jagdish M; Toprani, Rajendra B; Patel, Kaustubh D

    2016-09-01

    Tracheostomy is a mainstay modality for airway management for patients with head-neck cancer undergoing surgery. This study aims to define factors predicting need of tracheostomy and define an effective objective criterion to predict tracheostomy need. 486 patients undergoing composite resections were studied. Factors analyzed were age, previous surgery, extent of surgery, trismus, extent of mandibular resection and reconstruction etc. Factors were divided into major and minor, using the clinical assessment scoring system for tracheostomy (CASST) criterion. Sixty seven (13.7%) patients required tracheostomy for their peri-operative management. Elective tracheostomies were done in 53 cases during surgery and post-operatively in 14 patients. All patients in whom tracheostomies were anticipated had a score of seven or more. A decision on whether or not an elective tracheotomy in head and neck surgery is necessary and can be facilitated using CASST criterion, which has a sensitivity of 95.5% and a negative predictive value (NPV) of 99.3%. It may reduce post-operative complications and contribute to safer treatment. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  12. Prediction of fracture initiation in square cup drawing of DP980 using an anisotropic ductile fracture criterion

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    Park, N.; Huh, H.; Yoon, J. W.

    2017-09-01

    This paper deals with the prediction of fracture initiation in square cup drawing of DP980 steel sheet with the thickness of 1.2 mm. In an attempt to consider the influence of material anisotropy on the fracture initiation, an uncoupled anisotropic ductile fracture criterion is developed based on the Lou—Huh ductile fracture criterion. Tensile tests are carried out at different loading directions of 0°, 45°, and 90° to the rolling direction of the sheet using various specimen geometries including pure shear, dog-bone, and flat grooved specimens so as to calibrate the parameters of the proposed fracture criterion. Equivalent plastic strain distribution on the specimen surface is computed using Digital Image Correlation (DIC) method until surface crack initiates. The proposed fracture criterion is implemented into the commercial finite element code ABAQUS/Explicit by developing the Vectorized User-defined MATerial (VUMAT) subroutine which features the non-associated flow rule. Simulation results of the square cup drawing test clearly show that the proposed fracture criterion is capable of predicting the fracture initiation with sufficient accuracy considering the material anisotropy.

  13. Use of the Niyama criterion to predict porosity of the mushy zone with deformation

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    S. Polyakov

    2011-10-01

    Full Text Available The article presents new results on the use of the Niyama criterion to estimate porosity appearance in castings under hindered shrinkage. The effect of deformation of the mushy zone on filtration is shown. A new form of the Niyama criterion accounting for the hindered shrinkage and the range of deformation localization has been obtained. The results of this study are illustrated by the examp le of the Niyama criterion calculated for Al-Cu alloys under different diffusion conditions of solidification and rate of deformation in the mushy zone. Derived equations can be used in a mathematical model of the casting solidification as well as for interpretation of the simulation results of casting solidification under hindered shrinkage. The presented study resulted in a new procedure of using the Niyama criterion under mushy zone deformation.

  14. Prediction of forming limit in hydro-mechanical deep drawing of steel sheets using ductile fracture criterion

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    Oh, S.-T.; Chang, H.-J.; Oh, K. H.; Han, H. N.

    2006-04-01

    It has been observed that the forming limit curve at fracture (FLCF) of steel sheets, with a relatively higher ductility limit have linear shapes, similar to those of a bulk forming process. In contrast, the FLCF of sheets with a relatively lower ductility limit have rather complex shapes approaching the forming limit curve at neck (FLCN) towards the equi-biaxial strain paths. In this study, the FLCFs of steel sheets were measured and compared with the fracture strains predicted from specific ductile fracture criteria, including a criterion suggested by the authors, which can accurately describe FLCFs with both linear and complex shapes. To predict the forming limit for hydro-mechanical deep drawing of steel sheets, the ductile fracture criteria were integrated into a finite element simulation. The simulation, results based on the criterion suggested by authors accurately predicted the experimetal, fracture limits of steel sheets for the hydro-mechanical deep drawing process.

  15. An Empirical Model Building Criterion Based on Prediction with Applications in Parametric Cost Estimation.

    Science.gov (United States)

    1980-08-01

    varia- ble is denoted by 7, the total sum of squares of deviations from that mean is defined by n - SSTO - (-Y) (2.6) iul and the regression sum of...squares by SSR - SSTO - SSE (2.7) II 14 A selection criterion is a rule according to which a certain model out of the 2p possible models is labeled "best...dis- cussed next. 1. The R2 Criterion The coefficient of determination is defined by R2 . 1 - SSE/ SSTO . (2.8) It is clear that R is the proportion of

  16. Evaluation of probabilistic flow predictions in sewer systems using grey box models and a skill score criterion

    DEFF Research Database (Denmark)

    Thordarson, Fannar Ørn; Breinholt, Anders; Møller, Jan Kloppenborg

    2012-01-01

    term and a diffusion term, respectively accounting for the deterministic and stochastic part of the models. Furthermore, a distinction is made between the process noise and the observation noise. We compare five different model candidates’ predictive performances that solely differ with respect...... to the diffusion term description up to a 4 h prediction horizon by adopting the prediction performance measures; reliability, sharpness and skill score to pinpoint the preferred model. The prediction performance of a model is reliable if the observed coverage of the prediction intervals corresponds to the nominal...... coverage of the prediction intervals, i.e. the bias between these coverages should ideally be zero. The sharpness is a measure of the distance between the lower and upper prediction limits, and skill score criterion makes it possible to pinpoint the preferred model by taking into account both reliability...

  17. Applying a new criterion to predict glass forming alloys in the Zr–Ni–Cu ternary system

    Energy Technology Data Exchange (ETDEWEB)

    Déo, L.P., E-mail: leonardopratavieira@gmail.com [Universidade de São Paulo, EESC, SMM - Av. Trabalhador São Carlense, 400 – São Carlos, SP 13566-590 (Brazil); Mendes, M.A.B., E-mail: marcio.andreato@gmail.com [Universidade Federal de São Carlos, DEMa - Rod. Washington Luiz, Km 235 – São Carlos, SP 13565-905 (Brazil); Costa, A.M.S., E-mail: alexmatos1980@gmail.com [Universidade de São Paulo, DEMAR, EEL – Polo Urbo-Industrial Gleba AI-6, s/n – Lorena, SP 12600-970 (Brazil); Campos Neto, N.D., E-mail: nelsonddcn@gmail.com [Universidade de São Paulo, EESC, SMM - Av. Trabalhador São Carlense, 400 – São Carlos, SP 13566-590 (Brazil); Oliveira, M.F. de, E-mail: falcao@sc.usp.br [Universidade de São Paulo, EESC, SMM - Av. Trabalhador São Carlense, 400 – São Carlos, SP 13566-590 (Brazil)

    2013-03-15

    Highlights: ► Calculation to predict and select the glass forming ability (GFA) of metallic alloys in Zr–Ni–Cu system. ► Good correlation between theoretical and experimental GFA samples. ► Combination of X-ray diffraction (XRD) and differential scanning calorimetry (DSC) techniques mainly to characterize the samples. ► Oxygen impurity dramatically reduced the GFA. ► The selection criterion used opens the possibility to obtain new amorphous alloys, reducing the experimental procedures of trial and error. -- Abstract: A new criterion has been recently proposed to predict and select the glass forming ability (GFA) of metallic alloys. It was found that the critical cooling rate for glass formation (R{sub c}) correlates well with a proper combination of two factors, the minimum topological instability (λ{sub min}) and the thermodynamic parameter (Δh). The (λ{sub min}) criterion is based on the concept of topological instability of stable crystalline structures and (Δh) depends on the average work function difference (Δϕ) and the average electron density difference Δn{sub ws}{sup 1/3} among the constituent elements of the alloy. In the present work, the selection criterion was applied in the Zr–Ni–Cu system and its predictability was analyzed experimentally. Ribbon-shaped and splat-shaped samples were produced by melt-spinning and splat-cooling techniques respectively. The crystallization content and behavior were analyzed by X-ray diffraction (XRD) and differential scanning calorimetry (DSC), respectively. The results showed a good correlation between the theoretical GFA values and the amorphous phase percentages found in different alloy compositions.

  18. Development of a New Gradient Based Strain-Criterion for Prediction of Bendability in Quality Assurance and FEA

    Science.gov (United States)

    Denninger, Ralf; Liewald, Mathias; Sindel, Manfred

    2011-08-01

    Numerical simulation systems are more and more used in process development of car bodies. Nowadays, also the hemming process is optimised in FEA. Thus, the analysing of process robustness calls for a failure criterion for the specific bending and hemming load condition. For that purpose the experimental determination of bendability under various pre-load conditions that occur in real production, e.g. during deep drawing in press shop, is content of this contribution. Using these experimental results, a new approach for a strain-gradient based failure criterion for bending operations is presented to optimise bendability prediction. The bending-strain-gradient approach can be used both in production related departments of quality assurance as well as for simulative process design or process validation for vehicle manufacturing planning.

  19. Predicting the required number of training samples. [for remotely sensed image data based on covariance matrix estimate quality criterion of normal distribution

    Science.gov (United States)

    Kalayeh, H. M.; Landgrebe, D. A.

    1983-01-01

    A criterion which measures the quality of the estimate of the covariance matrix of a multivariate normal distribution is developed. Based on this criterion, the necessary number of training samples is predicted. Experimental results which are used as a guide for determining the number of training samples are included. Previously announced in STAR as N82-28109

  20. A phenomenological prediction of dryout based on the churn-to-annular flow transition criterion in uniformly heated vertical tubes

    International Nuclear Information System (INIS)

    Hong, Sung-Deok; Chun, Se-Young; Yang, Sun-Kyu; Chung, Moon-Ki; Lashgari, Farbod

    2000-01-01

    A phenomenological model is proposed to predict dryout in uniformly heated vertical tubes. The major point of the study was refining the initial conditions at the onset of annular flow location that starts the liquid film dryout process. The void fraction at the onset of the annular flow location has been derived from the vapor superficial velocity obtained by the churn-to-annular flow criterion with the help of the void-quality relationship. The thermodynamic equilibrium quality calculated through the iteration of flow quality using the profile-fit model to find the accurate starting point of the annular-flow in a tube. The present method was validated by worldwide data covering wide parametric ranges, a diameter of 5.1-37.5, exit quality over 10%, a flow rate of 183-5261 kg/m 2 -s and a system pressure of 0.5-17.7 MPa. The churn-to-annular flow transition criterion of Taitel et al.'s shows better prediction results than the other transition criteria. The present model improved the CHF prediction capability as a mean of 0.97 and root mean square error of 11% for the 3883 experimental data and extended the applicable range to the relatively low quality region. (author)

  1. Criterion and construct validity of the CogState Schizophrenia Battery in Japanese patients with schizophrenia.

    Directory of Open Access Journals (Sweden)

    Taisuke Yoshida

    Full Text Available BACKGROUND: The CogState Schizophrenia Battery (CSB, a computerized cognitive battery, covers all the same cognitive domains as the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS Consensus Cognitive Battery but is briefer to conduct. The aim of the present study was to evaluate the criterion and construct validity of the Japanese language version of the CSB (CSB-J in Japanese patients with schizophrenia. METHODOLOGY/PRINCIPAL FINDINGS: Forty Japanese patients with schizophrenia and 40 Japanese healthy controls with matching age, gender, and premorbid intelligence quotient were enrolled. The CSB-J and the Brief Assessment of Cognition in Schizophrenia, Japanese-language version (BACS-J were performed once. The structure of the CSB-J was also evaluated by a factor analysis. Similar to the BACS-J, the CSB-J was sensitive to cognitive impairment in Japanese patients with schizophrenia. Furthermore, there was a significant positive correlation between the CSB-J composite score and the BACS-J composite score. A factor analysis showed a three-factor model consisting of memory, speed, and social cognition factors. CONCLUSIONS/SIGNIFICANCE: This study suggests that the CSB-J is a useful and rapid automatically administered computerized battery for assessing broad cognitive domains in Japanese patients with schizophrenia.

  2. The provisional ACR/EULAR definition of remission in RA: a comment on the patient global assessment criterion

    NARCIS (Netherlands)

    Vermeer, M.; Kuper, Hillechina H.; van der Bijl, Arie E.; Baan, H.; Posthumus, Marcel D.; Brus, Herman L.M.; van Riel, Piet L.C.M.; van de Laar, Mart A F J

    2012-01-01

    Objectives. The provisional ACR/European League Against Rheumatism (EULAR) definition of remission in RA requires a score of ≤1 on the patient global assessment (PGA, 0–10 scale). We explored the relation between the PGA criterion and the patient's clinical disease state in an observational dataset.

  3. The provisional ACR/EULAR definition of remission in RA : a comment on the patient global assessment criterion

    NARCIS (Netherlands)

    Vermeer, Marloes; Kuper, Hillechiena H.; van der Bijl, Arie E.; Baan, Henriette; Posthumus, Marcel D.; Brus, Herman L. M.; van Riel, Piet L. C. M.; van de Laar, Mart A. F. J.

    Objectives. The provisional ACR/European League Against Rheumatism (EULAR) definition of remission in RA requires a score of 41 on the patient global assessment (PGA, 0-10 scale). We explored the relation between the PGA criterion and the patient's clinical disease state in an observational dataset.

  4. Features of Designing the Criterion-Based Rehabilitation Program for Patients after Arthroscopic Reconstruction of the Anterior Cruciate Ligament

    Directory of Open Access Journals (Sweden)

    I.V. Roy

    2016-04-01

    Full Text Available The article presents an innovative criterion-based rehabilitation program for patients, who underwent arthroscopic reconstruction of the anterior cruciate ligament. The features of the program are described, methodological foundations to perform permissible exercises are presented for each periods of the program, which correspond to a specific motor mode. The degree of preparedness of the patient is determined by the criterion of performance of the test exercises that will permit him to the loads of a new, higher level of trainings. The effectiveness of the developed program is confirmed clinically.

  5. Body composition in elderly people: effect of criterion estimates on predictive equations

    International Nuclear Information System (INIS)

    Baumgartner, R.N.; Heymsfield, S.B.; Lichtman, S.; Wang, J.; Pierson, R.N. Jr.

    1991-01-01

    The purposes of this study were to determine whether there are significant differences between two- and four-compartment model estimates of body composition, whether these differences are associated with aqueous and mineral fractions of the fat-free mass (FFM); and whether the differences are retained in equations for predicting body composition from anthropometry and bioelectric resistance. Body composition was estimated in 98 men and women aged 65-94 y by using a four-compartment model based on hydrodensitometry, 3 H 2 O dilution, and dual-photon absorptiometry. These estimates were significantly different from those obtained by using Siri's two-compartment model. The differences were associated significantly (P less than 0.0001) with variation in the aqueous fraction of FFM. Equations for predicting body composition from anthropometry and resistance, when calibrated against two-compartment model estimates, retained these systematic errors. Equations predicting body composition in elderly people should be calibrated against estimates from multicompartment models that consider variability in FFM composition

  6. Forming limit prediction by an evolving non-quadratic yield criterion considering the anisotropic hardening and r-value evolution

    Science.gov (United States)

    Lian, Junhe; Shen, Fuhui; Liu, Wenqi; Münstermann, Sebastian

    2018-05-01

    The constitutive model development has been driven to a very accurate and fine-resolution description of the material behaviour responding to various environmental variable changes. The evolving features of the anisotropic behaviour during deformation, therefore, has drawn particular attention due to its possible impacts on the sheet metal forming industry. An evolving non-associated Hill48 (enHill48) model was recently proposed and applied to the forming limit prediction by coupling with the modified maximum force criterion. On the one hand, the study showed the significance to include the anisotropic evolution for accurate forming limit prediction. On the other hand, it also illustrated that the enHill48 model introduced an instability region that suddenly decreases the formability. Therefore, in this study, an alternative model that is based on the associated flow rule and provides similar anisotropic predictive capability is extended to chapter the evolving effects and further applied to the forming limit prediction. The final results are compared with experimental data as well as the results by enHill48 model.

  7. Malnutrition in Geriatric Rehabilitation: Prevalence, Patient Outcomes, and Criterion Validity of the Scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment.

    Science.gov (United States)

    Marshall, Skye; Young, Adrienne; Bauer, Judith; Isenring, Elizabeth

    2016-05-01

    Accurate identification and management of malnutrition is essential so that patient outcomes can be improved and resources used efficaciously. In malnourished older adults admitted to rehabilitation: 1) report the prevalence, health and aged care use, and mortality of malnourished older adults; 2) determine and compare the criterion (concurrent and predictive) validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA) in diagnosing malnutrition; and 3) identify the Scored PG-SGA score cut-off value associated with malnutrition. Observational, prospective cohort. Participants were 57 older adults (65 years and older; mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia. Scored PG-SGA; MNA; and the International Statistical Classification of Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition were compared to establish concurrent validity and report malnutrition prevalence. Length of stay, discharge location, rehospitalization, admission to a residential aged care facility, and mortality were measured to report health-related outcomes and to establish predictive validity. Malnutrition prevalence varied according to assessment tool (ICD-10-AM: 46%; Scored PG-SGA: 53%; MNA: 28%). Using the ICD-10-AM as the reference standard, the Scored PG-SGA ratings (sensitivity 100%, specificity 87%) and score (sensitivity 92%, specificity 84%, ROC AUC [receiver operating characteristics area under the curve]=0.910±0.038) showed strong concurrent validity, and the MNA had moderate concurrent validity (sensitivity 58%, specificity 97%, receiver operating characteristics area under the curve=0.854±0.052). The Scored PG-SGA rating, Scored PG-SGA score, and MNA showed good predictive validity. Malnutrition can increase the risk of longer rehospitalization length of stay, admission to a residential

  8. Interpretation of ongoing thermal response tests of vertical (BHE) borehole heat exchangers with predictive uncertainty based stopping criterion

    DEFF Research Database (Denmark)

    Poulsen, Søren Erbs; Alberdi Pagola, Maria

    2015-01-01

    A method for real-time interpretation of ongoing thermal response tests of vertical borehole heat exchangers is presented. The method utilizes a statistically based stopping criterion for ongoing tests. The study finds minimum testing times for synthetic and actual TRTs to be in the interval 12–2...

  9. Alpha-fetoprotein level > 1000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria.

    Science.gov (United States)

    Hameed, Bilal; Mehta, Neil; Sapisochin, Gonzalo; Roberts, John P; Yao, Francis Y

    2014-08-01

    Serum alpha-fetoprotein (AFP) has been increasingly recognized as a marker for a poor prognosis after liver transplantation (LT) for hepatocellular carcinoma (HCC). Many published reports, however, have included a large proportion of patients with HCC beyond the Milan criteria, and the effects of incorporating AFP as an exclusion criterion for LT remain unclear. We studied 211 consecutive patients undergoing LT for HCC within the Milan criteria according to imaging under the Model for End-Stage Liver Disease organ allocation system between June 2002 and January 2009. The majority (93.4%) had locoregional therapy before LT. The median follow-up was 4.5 years (minimum = 2 years). The Kaplan-Meier 1- and 5-year patient survival rates were 94.3% and 83.4%, respectively. In a univariate analysis, significant predictors of HCC recurrence included vascular invasion [hazard ratio (HR) = 10, 95% confidence interval (CI) = 3.9-26, P 1000 ng/mL (HR = 4.5, 95% CI = 1.3-15.3, P = 0.02), and an AFP level > 500 ng/mL (HR = 3.1, 95% CI = 1.04-9.4, P = 0.04). In a multivariate analysis, vascular invasion was the only significant predictor of tumor recurrence (HR = 5.6, 95% CI = 1.9-19, P = 0.02). An AFP level > 1000 ng/mL was the strongest pretransplant variable predicting vascular invasion (odds ratio = 6.8, 95% CI = 1.6-19.1, P = 0.006). The 1- and 5-year rates of survival without recurrence were 90% and 52.7%, respectively, for patients with an AFP level > 1000 ng/mL and 95% and 80.3%, respectively, for patients with an AFP level ≤ 1000 ng/mL (P = 0.026). Applying an AFP level > 1000 ng/mL as a cutoff would have resulted in the exclusion of 4.7% of the patients fr m LT and a 20% reduction in HCC recurrence. In conclusion, an AFP level > 1000 ng/mL may be a surrogate for vascular invasion and may be used to predict posttransplant HCC recurrence. Incorporating an AFP level > 1000 ng/mL as an exclusion criterion for LT within the Milan criteria may further improve posttransplant

  10. Early Nonresponse in the Antipsychotic Treatment of Acute Mania : A Criterion for Reconsidering Treatment? Results From an Individual Patient Data Meta-Analysis

    NARCIS (Netherlands)

    Welten, Carlijn C M; Koeter, Maarten W J; Wohlfarth, Tamar D; Storosum, Jitschak G; van den Brink, Wim; Gispen-de Wied, Christine C; Leufkens, Hubert G M; Denys, Damiaan A J P

    OBJECTIVE: To investigate whether early nonresponse to antipsychotic treatment of acute mania predicts treatment failure and, if so, to establish the best definition or criterion of an early nonresponse. DATA SOURCES: Short-term efficacy studies assessing antipsychotics that were submitted to the

  11. Predicted implications of using percentage weight gain as single discharge criterion in management of acute malnutrition in rural southern Ethiopia.

    Science.gov (United States)

    Forsén, Emmanuel; Tadesse, Elazar; Berhane, Yemane; Ekström, Eva-Charlotte

    2015-10-01

    Mid-upper arm circumference (MUAC) is increasingly used in identifying and admitting children with acute malnutrition for treatment. It is easy to use because it does not involve height assessment, but its use calls for alternative discharge criteria. This study examined how use of percentage weight gain as discharge criterion would affect the nutritional status of children admitted into a community-based management programme for acute malnutrition in rural southern Ethiopia. Non-oedematous children (n = 631) aged 6-59 months and having a MUAC of weight was added to admission weight and their nutritional status by weight-for-height z-score (WHZ) was determined at each target. Moderate and severe wasting according to World Health Organization WHZ definitions was used as outcome. Applying the most commonly recommended target of 15% weight gain resulted in 9% of children with admission MUAC weight gain was sufficient to generate a similar result. Children failing to recover were the ones with the poorest nutritional status at admission. Increasing the percentage weight gain targets in the two groups to 20% and 15%, respectively, would largely resolve wasting but likely lead to increased programme costs by keeping already recovered children in the programme. Further research is needed on appropriate discharge procedures in programmes using MUAC for screening and admission. © 2013 John Wiley & Sons Ltd.

  12. Prostate-specific antigen doubling time as a progression criterion in an active surveillance programme for patients with localized prostate cancer

    DEFF Research Database (Denmark)

    Thomsen, Frederik Birkebaek; Christensen, Ib Jarle; Brasso, Klaus

    2014-01-01

    OBJECTIVES: To elucidate the role of prostate-specific antigen (PSA) doubling time (PSAdt) as a progression criterion in patients with low-risk prostate cancer managed by active surveillance (AS). To assess the correlation between PSAdt during AS and final histopathology after radical prostatectomy...

  13. The Distributed Criterion Design

    Science.gov (United States)

    McDougall, Dennis

    2006-01-01

    This article describes and illustrates a novel form of the changing criterion design called the distributed criterion design, which represents perhaps the first advance in the changing criterion design in four decades. The distributed criterion design incorporates elements of the multiple baseline and A-B-A-B designs and is well suited to applied…

  14. Incremental Criterion Validity of the WJ-III COG Clinical Clusters: Marginal Predictive Effects beyond the General Factor

    Science.gov (United States)

    McGill, Ryan J.

    2015-01-01

    The current study examined the incremental validity of the clinical clusters from the Woodcock-Johnson III Tests of Cognitive Abilities (WJ-III COG) for predicting scores on the Woodcock-Johnson III Tests of Achievement (WJ-III ACH). All participants were children and adolescents (N = 4,722) drawn from the nationally representative WJ-III…

  15. Application of the strain energy for fatigue life prediction (LCF) of metals by the energy-based criterion

    International Nuclear Information System (INIS)

    Shahram Shahrooi; Ibrahim Henk Metselaar; Zainul Huda; Ghezavati, H.R.

    2009-01-01

    Full text: In this study, the plastic strain energy under multiaxial fatigue condition has been calculated in the cyclic plasticity models by the stress-strain hysteresis loops. Then, using the results of these models, the fatigue lives in energy-based fatigue model is predicted and compared to experimental data. Moreover, a weighting factor on shear plastic work is presented to decrease the life factors in the model fatigue. (author)

  16. A Fisher’s Criterion-Based Linear Discriminant Analysis for Predicting the Critical Values of Coal and Gas Outbursts Using the Initial Gas Flow in a Borehole

    Directory of Open Access Journals (Sweden)

    Xiaowei Li

    2017-01-01

    Full Text Available The risk of coal and gas outbursts can be predicted using a method that is linear and continuous and based on the initial gas flow in the borehole (IGFB; this method is significantly superior to the traditional point prediction method. Acquiring accurate critical values is the key to ensuring accurate predictions. Based on ideal rock cross-cut coal uncovering model, the IGFB measurement device was developed. The present study measured the data of the initial gas flow over 3 min in a 1 m long borehole with a diameter of 42 mm in the laboratory. A total of 48 sets of data were obtained. These data were fuzzy and chaotic. Fisher’s discrimination method was able to transform these spatial data, which were multidimensional due to the factors influencing the IGFB, into a one-dimensional function and determine its critical value. Then, by processing the data into a normal distribution, the critical values of the outbursts were analyzed using linear discriminant analysis with Fisher’s criterion. The weak and strong outbursts had critical values of 36.63 L and 80.85 L, respectively, and the accuracy of the back-discriminant analysis for the weak and strong outbursts was 94.74% and 92.86%, respectively. Eight outburst tests were simulated in the laboratory, the reverse verification accuracy was 100%, and the accuracy of the critical value was verified.

  17. The A-test: Assessment of functional recovery during early rehabilitation of patients in an orthopedic ward - content, criterion and construct validity

    Directory of Open Access Journals (Sweden)

    Vukomanović Aleksandra

    2014-01-01

    Full Text Available Background/Aim. The A-test was designed for assessment of functional recovery during early rehabilitation of patients in an orthopedic ward. This performance-based test consists of 10 items for assessing basic activities by a six level ordinal scale (0-5. Total scores can range from 0 to 50, i.e. from inability to perform any activity despite the help of therapists to complete independence and safety in performing all activities. The aim of this study was to examine the A-test validity. Methods. This prospective study was conducted in an orthopedic ward and included 120 patients [60 patients with hip osteoarthritis that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF] during early inpatient rehabilitation (1st-5th day. Validity was examined through 3 aspects: content validity - floor and ceiling effect, range, skewness; criterion validity - concurrent validity [correlation with the University of Iowa Level of Assistance Scale (ILAS for patients with hip osteoarthritis, and with the Cumulated Ambulation Score (CAS for patients with HF, Spearman rank correlation] and predictive validity [the New Mobility Score (NMS 4 weeks after surgery, Mann-Whitney U test]; construct validity - 4 hypotheses: 1 on the fifth day of rehabilitation in patients underwent arthroplasty due to hip osteoarthritis, the A-test results will strongly correlate with those of ILAS, while the correlation with the Harris hip score will be less strong; 2 in patients with HF, the A-test results will be significantly better in those with allowed weight bearing as compared to patients whom weight bearing is not allowed while walking; 3 results of the A-test will be significantly better in patients with hip osetoarthritis than in those with HF; 4 the A-test results will be significantly better in patients younger than 65 years than in those aged 65 years and older. Results. The obtained results were: low floor (1% and ceiling (2% effect, range 0

  18. Criterion validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) for use in patients with rheumatoid arthritis: comparison with the SenseWear Armband.

    Science.gov (United States)

    Tierney, M; Fraser, A; Kennedy, N

    2015-06-01

    The International Physical Activity Questionnaire Short Form (IPAQ-SF) is a self-report questionnaire commonly used in patients with rheumatoid arthritis (RA) to measure physical activity. However, despite its frequent use in patients with RA, its validity has not been ascertained in this population. The aim of this study was to examine the criterion validity of energy expenditure from physical activity recorded with the IPAQ-SF in patients with RA compared with the objective criterion measure, the SenseWear Armband (SWA) which has been validated previously in this population. Cross-sectional criterion validation study. Regional hospital outpatient setting. Twenty-two patients with RA attending outpatient rheumatology clinics. Subjects wore an SWA for 7 full consecutive days and completed the IPAQ-SF. Energy expenditure from physical activity recorded by the SWA and the IPAQ-SF. Energy expenditure from physical activity recorded by the IPAQ-SF and the SWA showed a small, non-significant correlation (r=0.407, P=0.60). The IPAQ-SF underestimated energy expenditure from physical activity by 41% compared with the SWA. This was corroborated using Bland and Altman plots, as the IPAQ-SF was found to overestimate energy expenditure from physical activity in nine of the 22 individuals, and underestimate energy expenditure from physical activity in the remaining 13 individuals. The IPAQ-SF has limited use as an accurate and absolute measure for estimating energy expenditure from physical activity in patients with RA. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  19. Early Nonresponse in the Antipsychotic Treatment of Acute Mania: A Criterion for Reconsidering Treatment? Results From an Individual Patient Data Meta-Analysis.

    Science.gov (United States)

    Welten, Carlijn C M; Koeter, Maarten W J; Wohlfarth, Tamar D; Storosum, Jitschak G; van den Brink, Wim; Gispen-de Wied, Christine C; Leufkens, Hubert G M; Denys, Damiaan A J P

    2016-09-01

    To investigate whether early nonresponse to antipsychotic treatment of acute mania predicts treatment failure and, if so, to establish the best definition or criterion of an early nonresponse. Short-term efficacy studies assessing antipsychotics that were submitted to the Dutch Medicines Evaluation Board during an 11-year period as part of the marketing authorization application for the indication of acute manic episode of bipolar disorder. Pharmaceutical companies provided their raw patient data, which enabled us to perform an individual patient data meta-analysis. All double-blind, randomized, placebo-controlled trials assessing the efficacy of antipsychotics for acute manic episode of bipolar disorder were included (10 trials). All patients with data available for completer analysis (N = 1,243), symptom severity scores on the Young Mania Rating Scale (YMRS) at weeks 0, 1, and 2 and at study end point (week 3 or 4). The a priori chances of nonresponse and nonremission at study end point were 40.9% (95% CI, 38.2%-43.6%) and 65.3% (95% CI, 62.0%-68.6%), respectively. Early nonresponse in weeks 1 and 2, defined by cutoff scores ranging from a ≤ 10% to a ≤ 50% reduction in symptoms compared to baseline on the YMRS, significantly predicted nonresponse (≤ 0% symptom reduction) and nonremission (YMRS score higher than 8) in week 3. The predictive value of early nonresponse (PVnr_se) at week 1 for both nonresponse and nonremission at study end point declined linearly with increasing cutoff scores of early nonresponse; nonresponse: 76.0% (95% CI, 69.7%-82.3%) for a ≤ 10% response to 48.7% (95% CI, 45.5%-51.9%) for a ≤ 50% response; nonremission: 92.2% (95% CI, 88.3%-96.1%) for a ≤ 10% response to 76.8% (95% CI, 74.4%-79.5%) for a ≤ 50% response. A similar linear decline was observed for increasing cutoff scores of early nonresponse at week 2 for nonresponse, but not for nonremission at end point: nonresponse 90.3% (95% CI, 84.6%-96.0%) for a ≤ 10% response

  20. On the Jeans criterion

    International Nuclear Information System (INIS)

    Whitworth, A.P.

    1980-01-01

    The Jeans criterion is first stated and distinguished from the Virial Theorem. Then it is discussed how the Jeans criterion can be derived from the Virial Theorem and the inherent shortcomings in this derivation. Finally, it is indicated how these shortcomings might be overcome. The Jeans criterion is a fragmentation - or condensation -criterion. An expression is given, connecting the fragmentation of an unstable extended medium into masses Msub(J). Rather than picturing the background medium fragmenting, it is probably more appropriate to envisage these masses Msub(J) 'condensing' out of the background medium. On the condensation picture some fraction of the background material separates out into coherent bound nodules under the pull of its self-gravity. For this reason the Jeans criterion is discussed as a condensation condition, reserving the term fragmentation for a different process. The Virial Theorem provides a contraction criterion. This is described with reference to a spherical cloud and is developed to derive the Jeans criterion. (U.K.)

  1. Assessment of performance validity in the Stroop Color and Word Test in mild traumatic brain injury patients: a criterion-groups validation design.

    Science.gov (United States)

    Guise, Brian J; Thompson, Matthew D; Greve, Kevin W; Bianchini, Kevin J; West, Laura

    2014-03-01

    The current study assessed performance validity on the Stroop Color and Word Test (Stroop) in mild traumatic brain injury (TBI) using criterion-groups validation. The sample consisted of 77 patients with a reported history of mild TBI. Data from 42 moderate-severe TBI and 75 non-head-injured patients with other clinical diagnoses were also examined. TBI patients were categorized on the basis of Slick, Sherman, and Iverson (1999) criteria for malingered neurocognitive dysfunction (MND). Classification accuracy is reported for three indicators (Word, Color, and Color-Word residual raw scores) from the Stroop across a range of injury severities. With false-positive rates set at approximately 5%, sensitivity was as high as 29%. The clinical implications of these findings are discussed. © 2012 The British Psychological Society.

  2. Development of a Microsoft Excel tool for applying a factor retention criterion of a dimension coefficient to a survey on patient safety culture.

    Science.gov (United States)

    Chien, Tsair-Wei; Shao, Yang; Jen, Dong-Hui

    2017-10-27

    Many quality-of-life studies have been conducted in healthcare settings, but few have used Microsoft Excel to incorporate Cronbach's α with dimension coefficient (DC) for describing a scale's characteristics. To present a computer module that can report a scale's validity, we manipulated datasets to verify a DC that can be used as a factor retention criterion for demonstrating its usefulness in a patient safety culture survey (PSC). Microsoft Excel Visual Basic for Applications was used to design a computer module for simulating 2000 datasets fitting the Rasch rating scale model. The datasets consisted of (i) five dual correlation coefficients (correl. = 0.3, 0.5, 0.7, 0.9, and 1.0) on two latent traits (i.e., true scores) following a normal distribution and responses to their respective 1/3 and 2/3 items in length; (ii) 20 scenarios of item lengths from 5 to 100; and (iii) 20 sample sizes from 50 to 1000. Each item containing 5-point polytomous responses was uniformly distributed in difficulty across a ± 2 logit range. Three methods (i.e., dimension interrelation ≥0.7, Horn's parallel analysis (PA) 95% confidence interval, and individual random eigenvalues) were used for determining one factor to retain. DC refers to the binary classification (1 as one factor and 0 as many factors) used for examining accuracy with the indicators sensitivity, specificity, and area under receiver operating characteristic curve (AUC). The scale's reliability and DC were simultaneously calculated for each simulative dataset. PSC real data were demonstrated with DC to interpret reports of the unit-based construct validity using the author-made MS Excel module. The DC method presented accurate sensitivity (=0.96), specificity (=0.92) with a DC criterion (≥0.70), and AUC (=0.98) that were higher than those of the two PA methods. PA combined with DC yielded good sensitivity (=0.96), specificity (=1.0) with a DC criterion (≥0.70), and AUC (=0.99). Advances in computer

  3. Brief report: enhancement of patient recruitment in rheumatoid arthritis clinical trials using a multi-biomarker disease activity score as an inclusion criterion.

    Science.gov (United States)

    van Vollenhoven, Ronald F; Bolce, Rebecca; Hambardzumyan, Karen; Saevarsdottir, Saedis; Forslind, Kristina; Petersson, Ingemar F; Sasso, Eric H; Hwang, C C; Segurado, Oscar G; Geborek, Pierre

    2015-11-01

    Rheumatoid arthritis (RA) clinical trials often exclude patients who have low C-reactive protein (CRP) levels, which slows enrollment into the trial. The purpose of this study was to determine whether high Multi-Biomarker Disease Activity (MBDA) scores (>44) in RA patients with low CRP levels (≤10 mg/liter) could be used as a complement to CRP levels >10 mg/liter to enhance patient recruitment without affecting clinical trial outcomes. We evaluated patients from the Swedish Pharmacotherapy (SWEFOT) trial, which did not include any selection criteria for CRP levels. Clinical outcomes were assessed after 3 months of methotrexate (MTX) monotherapy in MTX-naive RA patients (n = 220) and after 3-10 months of add-on therapy in patients who were incomplete responders to MTX alone (MTX-IR) (n = 127). Radiographic outcomes were assessed at 1 year in all patients. Within each cohort, the outcomes were compared between patients with a CRP level of ≤10 mg/liter and an MBDA score of >44 at the start of the respective treatment interval versus those with a CRP level of >10 mg/liter. Patients with both a CRP level of ≤10 mg/liter and an MBDA score of >44 at baseline had clinical and radiographic outcomes that were comparable to those in patients with a CRP level of >10 mg/liter at baseline. This broadened definition of the inclusion criteria identified an additional 24% of patients in the MTX-naive cohort and 47% in the MTX-IR cohort. Patient recruitment into RA clinical trials may be substantially enhanced, without any decrease in clinical and radiographic outcomes, by using as an inclusion criterion "a CRP level of >10 mg/liter and/or an MBDA score of >44." © 2015 The Authors. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

  4. Increased serum ferritin levels in patients with Crimean-Congo hemorrhagic fever: can it be a new severity criterion?

    Science.gov (United States)

    Barut, Sener; Dincer, Fatma; Sahin, Idris; Ozyurt, Huseyin; Akkus, Mehmet; Erkorkmaz, Unal

    2010-01-01

    Serum ferritin is one of the markers indicating hemophagocytosis that may have a role in the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF). This study was designed to determine any correlation between serum ferritin and routine diagnostic laboratory markers of CCHF, and to investigate the relationship between serum ferritin levels and disease severity. Sixty-six patients with CCHF admitted to the hospital during the spring and summer months of 2006 and 2007 were included in the study. Serum ferritin levels were measured in sera obtained during the initial days of hospitalization. Data from 53 patients showing decreasing platelet counts over the first three days were used for further analysis and these patients were divided into two groups according to disease severity: group A included severe cases with lowest platelet counts 20x10(9)/l. Forty patients (60.6%) were male (mean age 43+/-17 years). Three patients died, thus the fatality rate was 4.5%. Fifty-one patients (77.3%) had abnormal serum ferritin levels, with levels above 500 ng/ml in 62.1%. There was a significant negative correlation between ferritin levels and concordant platelet counts (p or =1862ng/ml had a sensitivity of 87.5% and a specificity of 83.8% in differentiating severe cases from mild ones. Increased serum ferritin levels may suggest a significant role of hemophagocytosis in the pathogenesis of CCHF and may be a useful marker for diagnosis, disease activity, and prognosis. Copyright 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  5. Fuel-pin cladding transient failure strain criterion

    International Nuclear Information System (INIS)

    Bard, F.E.; Duncan, D.R.; Hunter, C.W.

    1983-01-01

    A criterion for cladding failure based on accumulated strain was developed for mixed uranium-plutonium oxide fuel pins and used to interpret the calculated strain results from failed transient fuel pin experiments conducted in the Transient Reactor Test (TREAT) facility. The new STRAIN criterion replaced a stress-based criterion that depends on the DORN parameter and that incorrectly predicted fuel pin failure for transient tested fuel pins. This paper describes the STRAIN criterion and compares its prediction with those of the stress-based criterion

  6. Can We Predict Patient Wait Time?

    Science.gov (United States)

    Pianykh, Oleg S; Rosenthal, Daniel I

    2015-10-01

    The importance of patient wait-time management and predictability can hardly be overestimated: For most hospitals, it is the patient queues that drive and define every bit of clinical workflow. The objective of this work was to study the predictability of patient wait time and identify its most influential predictors. To solve this problem, we developed a comprehensive list of 25 wait-related parameters, suggested in earlier work and observed in our own experiments. All parameters were chosen as derivable from a typical Hospital Information System dataset. The parameters were fed into several time-predicting models, and the best parameter subsets, discovered through exhaustive model search, were applied to a large sample of actual patient wait data. We were able to discover the most efficient wait-time prediction factors and models, such as the line-size models introduced in this work. Moreover, these models proved to be equally accurate and computationally efficient. Finally, the selected models were implemented in our patient waiting areas, displaying predicted wait times on the monitors located at the front desks. The limitations of these models are also discussed. Optimal regression models based on wait-line sizes can provide accurate and efficient predictions for patient wait time. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  7. Pro B-type natriuretic peptide plasma value: a new criterion for the prediction of short- and long-term outcomes after transcatheter aortic valve implantation.

    Science.gov (United States)

    López-Otero, Diego; Trillo-Nouche, Ramiro; Gude, Francisco; Cid-Álvarez, Belen; Ocaranza-Sanchez, Raimundo; Alvarez, Melisa Santas; Lear, Pamela V; Gonzalez-Juanatey, José R

    2013-09-30

    To determine the prognostic value of pro B-type natriuretic peptide (pro-BNP) to predict mortality after transcatheter aortic valve implantation (TAVI). Logistic EuroSCORE (LES) overestimates observed mortality after TAVI. A new risk score specific to TAVI is needed to accurately assess mortality and outcome. Eighty-five patients were included. Indications for TAVI were nonoperable or surgically high-risk patients (LES>20%). Pro-BNP was measured 24h before the procedure. Cox proportional hazards model was used to evaluate clinical factors. The predictive accuracy of these Cox models was determined by using time-dependent receiver operating characteristic (ROC) curves. Pro-BNP levels (log-transformed) were significantly higher in non-survivors than in survivors at 30 days (3.36 ± 0.43 vs. 3.81 ± 0.43, p<0.004) and at the end of follow-up (3.34 ± 0.42 vs. 3.63 ± 0.48, p<0.011). Multivariate analysis revealed that only increased log pro-BNP levels were associated with higher mortality rate at short [hazard ratio (HR) (95% confidence intervals (CI)]=5.35 (1.74-16.5), p=0.003] and long-term follow-ups [HR=11 (CI: 1.51-81.3), p=0.018]. LES was not associated with increased mortality at either time point [HR=1.03 (CI: 0.95-1.10), p=0.483 and HR=1.03 (CI: 0.98-1.07), p=0.230, respectively]. At 30, 90, 180, and 365 days, the c-index was 0.72 for log pro-BNP and 0.63 for LES (p=0.044). Pre-procedure log transform of plasma pro-BNP levels are an independent and strong predictor of short- and long-term outcomes after TAVI and are more discriminatory than LES. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. Weight and height prediction of immobilized patients

    OpenAIRE

    Rabito,Estela Iraci; Vannucchi,Gabriela Bergamini; Suen,Vivian Marques Miguel; Castilho Neto,Laércio Lopes; Marchini,Júlio Sérgio

    2006-01-01

    OBJECTIVE: To confirm the adequacy of the formula suggested in the literature and/or to develop appropriate equations for the Brazilian population of immobilized patients based on simple anthropometric measurements. METHODS: Hospitalized patients were submitted to anthropometry and methods to estimate weight and height of bedridden patients were developed by multiple linear regression. RESULTS: Three hundred sixty eight persons were evaluated at two hospital centers and five weight-predicting...

  9. General Criterion for Harmonicity

    Science.gov (United States)

    Proesmans, Karel; Vandebroek, Hans; Van den Broeck, Christian

    2017-10-01

    Inspired by Kubo-Anderson Markov processes, we introduce a new class of transfer matrices whose largest eigenvalue is determined by a simple explicit algebraic equation. Applications include the free energy calculation for various equilibrium systems and a general criterion for perfect harmonicity, i.e., a free energy that is exactly quadratic in the external field. As an illustration, we construct a "perfect spring," namely, a polymer with non-Gaussian, exponentially distributed subunits which, nevertheless, remains harmonic until it is fully stretched. This surprising discovery is confirmed by Monte Carlo and Langevin simulations.

  10. Using the Existential Criterion for Assessing the Personality of Overprotective and Overly Demanding Parents in the Families of Patients Who Have Sought Psychological Counseling for Parent-Child Problems

    Science.gov (United States)

    Kapustin, S. A.

    2016-01-01

    The article presents the results of applying the existential criterion of normal and abnormal personalities for assessing the personality of overprotective and overly demanding parents in 176 families of patients who have sought psychological counseling. It is shown that the position of overprotective parents is one-sided in relation to the…

  11. Unified Bohm criterion

    Energy Technology Data Exchange (ETDEWEB)

    Kos, L. [LECAD Laboratory, Faculty of Mechanical Engineering, University of Ljubljana, SI-1000 Ljubljana (Slovenia); Tskhakaya, D. D.; Jelić, N. [Institute for Theoretical Physics, Fusion@ÖAW, University of Innsbruck, A-6020 Innsbruck (Austria)

    2015-09-15

    Recent decades have seen research into the conditions necessary for the formation of the monotonic potential shape in the sheath, appearing at the plasma boundaries like walls, in fluid, and kinetic approximations separately. Although either of these approaches yields a formulation commonly known as the much-acclaimed Bohm criterion (BC), the respective results involve essentially different physical quantities that describe the ion gas behavior. In the fluid approach, such a quantity is clearly identified as the ion directional velocity. In the kinetic approach, the ion behavior is formulated via a quantity (the squared inverse velocity averaged by the ion distribution function) without any clear physical significance, which is, moreover, impractical. In the present paper, we try to explain this difference by deriving a condition called here the Unified Bohm Criterion, which combines an advanced fluid model with an upgraded explicit kinetic formula in a new form of the BC. By introducing a generalized polytropic coefficient function, the unified BC can be interpreted in a form that holds, irrespective of whether the ions are described kinetically or in the fluid approximation.

  12. A comparative study on the forming limit diagram prediction between Marciniak-Kuczynski model and modified maximum force criterion by using the evolving non-associated Hill48 plasticity model

    Science.gov (United States)

    Shen, Fuhui; Lian, Junhe; Münstermann, Sebastian

    2018-05-01

    Experimental and numerical investigations on the forming limit diagram (FLD) of a ferritic stainless steel were performed in this study. The FLD of this material was obtained by Nakajima tests. Both the Marciniak-Kuczynski (MK) model and the modified maximum force criterion (MMFC) were used for the theoretical prediction of the FLD. From the results of uniaxial tensile tests along different loading directions with respect to the rolling direction, strong anisotropic plastic behaviour was observed in the investigated steel. A recently proposed anisotropic evolving non-associated Hill48 (enHill48) plasticity model, which was developed from the conventional Hill48 model based on the non-associated flow rule with evolving anisotropic parameters, was adopted to describe the anisotropic hardening behaviour of the investigated material. In the previous study, the model was coupled with the MMFC for FLD prediction. In the current study, the enHill48 was further coupled with the MK model. By comparing the predicted forming limit curves with the experimental results, the influences of anisotropy in terms of flow rule and evolving features on the forming limit prediction were revealed and analysed. In addition, the forming limit predictive performances of the MK and the MMFC models in conjunction with the enHill48 plasticity model were compared and evaluated.

  13. The criterion-related validity of the Northwick Park Dependency Score as a generic nursing dependency instrument for different rehabilitation patient groups

    NARCIS (Netherlands)

    Plantinga, E.; Tiesinga, L. J.; van der Schans, C. P.; Middel, B.

    2006-01-01

    Objective: To investigate the criterion or concurrent validity of the Northwick Park Dependency Score (NPDS) for determining nursing dependence in different rehabilitation groups, with the Barthel Index (BI) and the Care Dependency Scale (C D S). Design: Cross-sectional study. Setting: Centre for

  14. Malnutrition predicting factors in hemodialysis patients.

    Science.gov (United States)

    Jahromi, Soodeh Razeghi; Hosseini, Saeed; Razeghi, Effat; Meysamie, Ali pasha; Sadrzadeh, Haleh

    2010-09-01

    Malnutrition is a predictor of increased mortality in chronic hemodialysis (HD) patients. Various factors may contribute to malnutrition in these patients including energy and protein intake, inflammation, and comorbidity. To determine the importance of these factors in malnutrition of chronic HD patients, we studied 112 chronic HD patients in two centers was evaluated with the Dialysis Malnutrition Score (DMS) and anthropometric and biochemical indices. Seventy six (67.8%) patients were classified as malnourished. According to DMS score, poor protein intake (r= -0.34, Penergy intake (r= - 0.18, Pmalnutrition in descending order of importance. Multiple regression analysis showed that only poor protein intake was the explanatory variable of anthropometric measurements decline including body mass index, triceps skin fold thick-ness, mid arm circumference, mid arm muscle circumference, fat free mass, fat mass, albumin, creatinine and transferrine. None of the mentioned factors predicted the decrease of biochemical markers. We conclude that the frequency of malnutrition is high in our population and poor protein intake is the primary contributing factor for this condition. Therefore, providing enough protein may be a simple and effective way in preventing malnutrition in these patients.

  15. Illness perceptions predict survival in haemodialysis patients.

    Science.gov (United States)

    Chilcot, Joseph; Wellsted, David; Farrington, Ken

    2011-01-01

    Illness perceptions have been shown to be important determinants of functional and psychosocial outcomes, including quality of life and treatment adherence in end-stage renal disease patients. The aim of this prospective study was to determine whether haemodialysis patients' illness perceptions impact upon survival. Haemodialysis patients from a UK renal service completed the Revised Illness Perception Questionnaire. Over the study period (May 2007 to December 2010), all-cause mortality was recorded as the endpoint. 223 patients were followed up for a median of 15.9 months (min. 10 days, max. 42.7 months). The median dialysis vintage was 17.6 months (min. 4 days, max. 391.3 months). Treatment control perceptions demonstrated a significant association with mortality (HR = 0.91, 95% CI: 0.83-0.99, p = 0.03). After controlling for covariates, including age, albumin, extra renal comorbidity and depression scores, perception of treatment control remained a significant predictor of mortality (HR = 0.89, 95% CI: 0.80-0.99, p = 0.03). Patients' perceptions of treatment control (dialysis therapy) predict survival independently of survival risk factors, including comorbidity. Studies are required to test whether psychological interventions designed to modify maladaptive illness perceptions influence clinical outcomes in this patient setting. Copyright © 2011 S. Karger AG, Basel.

  16. Prediction of cardiovascular and total mortality in Chinese type 2 diabetic patients by the WHO definition for the metabolic syndrome.

    Science.gov (United States)

    Ko, G T-C; So, W-Y; Chan, N N; Chan, W-B; Tong, P C-Y; Li, J; Yeung, V; Chow, C-C; Ozaki, R; Ma, R C-W; Cockram, C S; Chan, J C-N

    2006-01-01

    The aim of this study is to investigate the prevalence of metabolic syndrome (MES) in type 2 diabetic patients and the predictive values of the World Health Organization (WHO) and National Cholesterol Education Programme (NCEP) definitions and the individual components of the MES on total and cardiovascular mortality. A prospective analysis of a consecutive cohort of 5202 Chinese type 2 diabetic patients recruited between July 1994 and April 2001. The prevalence of the MES was 49.2-58.1% depending on the use of various criteria. There were 189 deaths (men: 100 and women: 89) in these 5205 patients during a median (interquartile range) follow-up period of 2.1 (0.3-3.6 years). Of these, 164 (87%) were classified as cardiovascular deaths. Using the NCEP criterion, patients with MES had a death rate similar to those without (3.51 vs. 3.85%). By contrast, based on the WHO criteria, patients with MES had a higher mortality rate than those without (4.3 vs. 2.4%, p = 0.002). Compared to patients with neither NCEP- nor WHO-defined MES, only the group with MES defined by the WHO, but not NCEP, criterion had significantly higher mortality rate (2.6 vs. 6.8%, p hypertension, low BMI and albuminuria were the key predictors for these adverse events. In Chinese type 2 diabetic patients, the WHO criterion has a better discriminative power over the NCEP criterion for predicting death. Among the various components of the MES defined either by WHO or NCEP, hypertension, albuminuria and low BMI were the main predictors of cardiovascular and total mortality.

  17. Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients

    Energy Technology Data Exchange (ETDEWEB)

    Szucs-Farkas, Zsolt; Strautz, Tamara; Patak, Michael A.; Kurmann, Luzia; Vock, Peter; Schindera, Sebastian T. [University Hospital and University of Berne, Department of Diagnostic, Interventional and Paediatric Radiology, Berne (Switzerland)

    2009-08-15

    The objective of this retrospective study was to assess image quality with pulmonary CT angiography (CTA) using 80 kVp and to find anthropomorphic parameters other than body weight (BW) to serve as selection criteria for low-dose CTA. Attenuation in the pulmonary arteries, anteroposterior and lateral diameters, cross-sectional area and soft-tissue thickness of the chest were measured in 100 consecutive patients weighing less than 100 kg with 80 kVp pulmonary CTA. Body surface area (BSA) and contrast-to-noise ratios (CNR) were calculated. Three radiologists analyzed arterial enhancement, noise, and image quality. Image parameters between patients grouped by BW (group 1: 0-50 kg; groups 2-6: 51-100 kg, decadelly increasing) were compared. CNR was higher in patients weighing less than 60 kg than in the BW groups 71-99 kg (P between 0.025 and <0.001). Subjective ranking of enhancement (P=0.165-0.605), noise (P=0.063), and image quality (P=0.079) did not differ significantly across all patient groups. CNR correlated moderately strongly with weight (R=-0.585), BSA (R=-0.582), cross-sectional area (R=-0.544), and anteroposterior diameter of the chest (R=-0.457; P<0.001 all parameters). We conclude that 80 kVp pulmonary CTA permits diagnostic image quality in patients weighing up to 100 kg. Body weight is a suitable criterion to select patients for low-dose pulmonary CTA. (orig.)

  18. The AP diameter of the pelvis: a new criterion for continence in the exstrophy complex?

    International Nuclear Information System (INIS)

    Ait-Ameur, A.; Kalifa, G.; Adamsbaum, C.; Wakim, A.; Dubousset, J.

    2001-01-01

    Reconstructive surgery of bladder exstrophy remains a challenge. By using CT of the pelvis, we suggest a new pre- and post-operative investigative procedure to define the AP diameter (APD) as a predictive criterion for continence in this anomaly. Patients and methods: Three axial CT slices were selected in nine children with exstrophy who had undergone neonatal reconstructive surgery. The three levels selected were the first sacral plate, the mid acetabular plane and the superior pubic spine. We used combined slices to measure: circle APD = distance between the first sacral vertebra and the pubic symphysis. circle Pubic diastasis (PD) circle Three angles defined on the transverse plane of the first sacral vertebra - iliac wing angle, sacropubic angle and acetabular version. In exstrophy, the angles demonstrate opening of the iliac wings and the pubic ramus, and acetabular retroversion compared to controls. Comparisons between controls, continent and incontinent patients reveal that in continent patients, APD increases with growth and seems to be a predictive criterion for continence, independent of diastasis of the pubic symphysis. We believe that CT of the pelvis with measurements of the APD should be performed in all neonates with bladder exstrophy before reconstructive surgery and for better understanding of the malformation. The APD seems to be predictive and may be a major criterion for continence, independent of PD. (orig.)

  19. Numerical and Experimental Validation of a New Damage Initiation Criterion

    Science.gov (United States)

    Sadhinoch, M.; Atzema, E. H.; Perdahcioglu, E. S.; van den Boogaard, A. H.

    2017-09-01

    Most commercial finite element software packages, like Abaqus, have a built-in coupled damage model where a damage evolution needs to be defined in terms of a single fracture energy value for all stress states. The Johnson-Cook criterion has been modified to be Lode parameter dependent and this Modified Johnson-Cook (MJC) criterion is used as a Damage Initiation Surface (DIS) in combination with the built-in Abaqus ductile damage model. An exponential damage evolution law has been used with a single fracture energy value. Ultimately, the simulated force-displacement curves are compared with experiments to validate the MJC criterion. 7 out of 9 fracture experiments were predicted accurately. The limitations and accuracy of the failure predictions of the newly developed damage initiation criterion will be discussed shortly.

  20. A Failure Criterion for Concrete

    DEFF Research Database (Denmark)

    Ottosen, N. S.

    1977-01-01

    A four-parameter failure criterion containing all the three stress invariants explicitly is proposed for short-time loading of concrete. It corresponds to a smooth convex failure surface with curved meridians, which open in the negative direction of the hydrostatic axis, and the trace in the devi......A four-parameter failure criterion containing all the three stress invariants explicitly is proposed for short-time loading of concrete. It corresponds to a smooth convex failure surface with curved meridians, which open in the negative direction of the hydrostatic axis, and the trace...

  1. A nomogram for predicting complications in patients with solid tumours and seemingly stable febrile neutropenia.

    Science.gov (United States)

    Fonseca, Paula Jiménez; Carmona-Bayonas, Alberto; García, Ignacio Matos; Marcos, Rosana; Castañón, Eduardo; Antonio, Maite; Font, Carme; Biosca, Mercè; Blasco, Ana; Lozano, Rebeca; Ramchandani, Avinash; Beato, Carmen; de Castro, Eva Martínez; Espinosa, Javier; Martínez-García, Jerónimo; Ghanem, Ismael; Cubero, Jorge Hernando; Manrique, Isabel Aragón; Navalón, Francisco García; Sevillano, Elena; Manzano, Aránzazu; Virizuela, Juan; Garrido, Marcelo; Mondéjar, Rebeca; Arcusa, María Ángeles; Bonilla, Yaiza; Pérez, Quionia; Gallardo, Elena; Del Carmen Soriano, Maria; Cardona, Mercè; Lasheras, Fernando Sánchez; Cruz, Juan Jesús; Ayala, Francisco

    2016-05-24

    We sought to develop and externally validate a nomogram and web-based calculator to individually predict the development of serious complications in seemingly stable adult patients with solid tumours and episodes of febrile neutropenia (FN). The data from the FINITE study (n=1133) and University of Salamanca Hospital (USH) FN registry (n=296) were used to develop and validate this tool. The main eligibility criterion was the presence of apparent clinical stability, defined as events without acute organ dysfunction, abnormal vital signs, or major infections. Discriminatory ability was measured as the concordance index and stratification into risk groups. The rate of infection-related complications in the FINITE and USH series was 13.4% and 18.6%, respectively. The nomogram used the following covariates: Eastern Cooperative Group (ECOG) Performance Status ⩾2, chronic obstructive pulmonary disease, chronic cardiovascular disease, mucositis of grade ⩾2 (National Cancer Institute Common Toxicity Criteria), monocytes 0.1). The concordance index was 0.855 and 0.831 in each series. Risk group stratification revealed a significant distinction in the proportion of complications. With a ⩾116-point cutoff, the nomogram yielded the following prognostic indices in the USH registry validation series: 66% sensitivity, 83% specificity, 3.88 positive likelihood ratio, 48% positive predictive value, and 91% negative predictive value. We have developed and externally validated a nomogram and web calculator to predict serious complications that can potentially impact decision-making in patients with seemingly stable FN.

  2. Distance criterion for hydrogen bond

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Distance criterion for hydrogen bond. In a D-H ...A contact, the D...A distance must be less than the sum of van der Waals Radii of the D and A atoms, for it to be a hydrogen bond.

  3. Time to Criterion: An Experimental Study.

    Science.gov (United States)

    Anderson, Lorin W.

    The purpose of the study was to investigate the magnitude of individual differences in time-to-criterion and the stability of these differences. Time-to-criterion was defined in two ways: the amount of elapsed time required to attain the criterion level and the amount of on-task time required to attain the criterion level. Ninety students were…

  4. Estimating the brain pathological age of Alzheimer’s disease patients from MR image data based on the separability distance criterion

    Science.gov (United States)

    Li, Yongming; Li, Fan; Wang, Pin; Zhu, Xueru; Liu, Shujun; Qiu, Mingguo; Zhang, Jingna; Zeng, Xiaoping

    2016-10-01

    Traditional age estimation methods are based on the same idea that uses the real age as the training label. However, these methods ignore that there is a deviation between the real age and the brain age due to accelerated brain aging. This paper considers this deviation and searches for it by maximizing the separability distance value rather than by minimizing the difference between the estimated brain age and the real age. Firstly, set the search range of the deviation as the deviation candidates according to prior knowledge. Secondly, use the support vector regression (SVR) as the age estimation model to minimize the difference between the estimated age and the real age plus deviation rather than the real age itself. Thirdly, design the fitness function based on the separability distance criterion. Fourthly, conduct age estimation on the validation dataset using the trained age estimation model, put the estimated age into the fitness function, and obtain the fitness value of the deviation candidate. Fifthly, repeat the iteration until all the deviation candidates are involved and get the optimal deviation with maximum fitness values. The real age plus the optimal deviation is taken as the brain pathological age. The experimental results showed that the separability was apparently improved. For normal control-Alzheimer’s disease (NC-AD), normal control-mild cognition impairment (NC-MCI), and MCI-AD, the average improvements were 0.178 (35.11%), 0.033 (14.47%), and 0.017 (39.53%), respectively. For NC-MCI-AD, the average improvement was 0.2287 (64.22%). The estimated brain pathological age could be not only more helpful to the classification of AD but also more precisely reflect accelerated brain aging. In conclusion, this paper offers a new method for brain age estimation that can distinguish different states of AD and can better reflect the extent of accelerated aging.

  5. Nonparametric adaptive age replacement with a one-cycle criterion

    International Nuclear Information System (INIS)

    Coolen-Schrijner, P.; Coolen, F.P.A.

    2007-01-01

    Age replacement of technical units has received much attention in the reliability literature over the last four decades. Mostly, the failure time distribution for the units is assumed to be known, and minimal costs per unit of time is used as optimality criterion, where renewal reward theory simplifies the mathematics involved but requires the assumption that the same process and replacement strategy continues over a very large ('infinite') period of time. Recently, there has been increasing attention to adaptive strategies for age replacement, taking into account the information from the process. Although renewal reward theory can still be used to provide an intuitively and mathematically attractive optimality criterion, it is more logical to use minimal costs per unit of time over a single cycle as optimality criterion for adaptive age replacement. In this paper, we first show that in the classical age replacement setting, with known failure time distribution with increasing hazard rate, the one-cycle criterion leads to earlier replacement than the renewal reward criterion. Thereafter, we present adaptive age replacement with a one-cycle criterion within the nonparametric predictive inferential framework. We study the performance of this approach via simulations, which are also used for comparisons with the use of the renewal reward criterion within the same statistical framework

  6. Prediction of dementia in primary care patients.

    Directory of Open Access Journals (Sweden)

    Frank Jessen

    Full Text Available BACKGROUND: Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. METHODOLOGY/PRINCIPAL FINDINGS: We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe. After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort. Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV and 97.8% negative predictive value of (NPV for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort the PPV for AD was 39.1% (52% for any dementia in the test cohort. CONCLUSIONS: The prediction score has useful prediction accuracy. It can define individuals (1 sensitively for low cost-low risk interventions, or (2 more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs.

  7. Extensions and applications of the Bohm criterion

    Science.gov (United States)

    Baalrud, Scott D.; Scheiner, Brett; Yee, Benjamin; Hopkins, Matthew; Barnat, Edward

    2015-04-01

    The generalized Bohm criterion is revisited in the context of incorporating kinetic effects of the electron and ion distribution functions into the theory. The underlying assumptions and results of two different approaches are compared: the conventional ‘kinetic Bohm criterion’ and a fluid-moment hierarchy approach. The former is based on the asymptotic limit of an infinitely thin sheath (λD/l = 0), whereas the latter is based on a perturbative expansion of a sheath that is thin compared to the plasma (λD/l ≪ 1). Here λD is the Debye length, which characterizes the sheath length scale, and l is a measure of the plasma or presheath length scale. The consequences of these assumptions are discussed in terms of how they restrict the class of distribution functions to which the resulting criteria can be applied. Two examples are considered to provide concrete comparisons between the two approaches. The first is a Tonks-Langmuir model including a warm ion source (Robertson 2009 Phys. Plasmas 16 103503). This highlights a substantial difference between the conventional kinetic theory, which predicts slow ions dominate at the sheath edge, and the fluid moment approach, which predicts slow ions have little influence. The second example considers planar electrostatic probes biased near the plasma potential using model equations and particle-in-cell simulations. This demonstrates a situation where electron kinetic effects alter the Bohm criterion, leading to a subsonic ion flow at the sheath edge.

  8. Inviscid criterion for decomposing scales

    Science.gov (United States)

    Zhao, Dongxiao; Aluie, Hussein

    2018-05-01

    The proper scale decomposition in flows with significant density variations is not as straightforward as in incompressible flows, with many possible ways to define a "length scale." A choice can be made according to the so-called inviscid criterion [Aluie, Physica D 24, 54 (2013), 10.1016/j.physd.2012.12.009]. It is a kinematic requirement that a scale decomposition yield negligible viscous effects at large enough length scales. It has been proved [Aluie, Physica D 24, 54 (2013), 10.1016/j.physd.2012.12.009] recently that a Favre decomposition satisfies the inviscid criterion, which is necessary to unravel inertial-range dynamics and the cascade. Here we present numerical demonstrations of those results. We also show that two other commonly used decompositions can violate the inviscid criterion and, therefore, are not suitable to study inertial-range dynamics in variable-density and compressible turbulence. Our results have practical modeling implication in showing that viscous terms in Large Eddy Simulations do not need to be modeled and can be neglected.

  9. Predicting recovery from acute kidney injury in critically ill patients

    DEFF Research Database (Denmark)

    Itenov, Theis S; Berthelsen, Rasmus Ehrenfried; Jensen, Jens-Ulrik

    2018-01-01

    these patients. DESIGN: Observational study with development and validation of a risk prediction model. SETTING: Nine academic ICUs in Denmark. PARTICIPANTS: Development cohort of critically ill patients with AKI at ICU admission from the Procalcitonin and Survival Study cohort (n = 568), validation cohort.......1%. CONCLUSION: We constructed and validated a simple model that can predict the chance of recovery from AKI in critically ill patients....

  10. The Goiania accident: release from hospital criterion

    International Nuclear Information System (INIS)

    Falcao, R.C.; Hunt, J.

    1990-01-01

    On the thirteenth of September 1987, a 1357 Ci Cesium source was removed from the 'Instituto de Radiologia de Goiania' - probably two or three days later the source was opened, causing the internal and external contamination of 247 people, and part of the city of Goiania. This paper describes the release from hospital criterion of the contaminated patients, based on radiation protection principles which were developed for this case. The estimate of the biological half-life for cesium is also described. (author) [pt

  11. Significant event of patient radiation protection in radiotherapy (criterion 2.1): declaration and rating on the ASN-SFRO scale - ASN guide nr 16 - Release of the 01/01/2010

    International Nuclear Information System (INIS)

    2010-01-01

    This document brings together all the tools for the management of a significant event in radiation protection concerning a patient in radiotherapy. It contains the declaration form, a model for the reporting of significant events, and the ASN-SFRO scale which allows the event to be rated. After a presentation of the regulatory context and references, of the scope of application, this guide addresses the declaration of a significant event: general principles, definition of the 2.1 criterion, examples, delays and modalities of declaration, addressees of a declaration. It addresses the reporting of a significant event: general principles, sending delays and modalities. It addresses the rating on the ASN-SFRO scale: general principles, scale, and rating process. The last part deals with public information

  12. Significant event of patient radiation protection in radiotherapy (criterion 2.1): declaration and rating on the ASN-SFRO scale - ASN guide no. 16 - Release of 17/07/2015

    International Nuclear Information System (INIS)

    2015-01-01

    This document is an update of the previous version from October 2010. It brings together all the tools for the management of a significant event in radiation protection concerning a patient in radiotherapy. It contains the declaration form, a model for the reporting of significant events, and the ASN-SFRO scale which allows the event to be rated. After a presentation of the regulatory context and references, of the scope of application, this guide addresses the declaration of a significant event: general principles, definition of the 2.1 criterion, examples, delays and modalities of declaration, addressees of a declaration. It addresses the reporting of a significant event: general principles, sending delays and modalities. It addresses the rating on the ASN-SFRO scale: general principles, scale, and rating process. The last part deals with public information

  13. Predicting mortality in patients with heart failure : a pragmatic approach

    NARCIS (Netherlands)

    Bouvy, ML; Heerdink, ER; Leufkens, HGM; Hoes, AW

    Objective: To develop a comprehensive and easily applicable prognostic model predicting mortality risk in patients with moderate to severe heart failure. Design: Prospective follow up study. Setting: Seven general hospitals in the Netherlands. Patients: 152 outpatients with heart failure or patients

  14. Factors predicting malnutrition in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Moncef El M′Barki Kadiri

    2011-01-01

    Full Text Available Signs of protein-energy malnutrition are common in maintenance hemodialyis (HD patients and are associated with increased morbidity and mortality. To evaluate the nutritional status and relationship between various parameters used for assessing malnutrition, we performed a cross-sectional study in 37 HD patients treated with thrice weekly sessions for at least two weeks. Global nutritional status was evaluated by the dual-energy X-ray absorptiometry (DEXA scan. Body weight and several laboratory values, including serum albumin (Salb, serum prealbumin, bicarbonate, cholesterol, serum C-reactive protein (SCRP, and hemoglobin, were recorded. Dose of dialysis was evaluated by urea kinetic modeling. The patients were subdivided into two groups based on body mass index: group I, normal nutritional status (71% and group II, malnutrition (29%. The clinical factors associated with malnutrition included advanced age and cardio-vascular diseases (CVD, decreased fat mass (FM measured by DEXA, low Salb and prealbumin, and severe anemia. The Salb level was not only a predictor of nutritional status, but also was independently influenced by age and SCRP, which was more common in malnourished patients than in patients with normal nutritional status. Both low Kt/V and less weekly dialysis time were associated with malnutrition. The FM and lean body mass (LBM calculated by DEXA correlated with CVD and other markers of malnutrition (Salb, total cholesterol.

  15. Anxiety Predicts Mortality in ICD Patients

    DEFF Research Database (Denmark)

    Kikkenborg Berg, Selina; Caspar Thygesen, Lau; Hastrup Svendsen, Jesper

    2014-01-01

    BACKGROUND: Although highly effective in preventing arrhythmic death, patients receiving an implantable cardioverter defibrillator (ICD) may still experience psychological difficulties such as anxiety, depression, and reduced quality of life. The objectives of this study were to describe patient...... receiving ICD between January 1, 2011 and June 30, 2011 (n = 499). The following instruments were used: SF-36, Hospital Anxiety and Depression Scale, HeartQoL, EQ-5D, and the Multidimensional Fatigue Inventory. RESULTS: The response rate was 72%. Mean age was 65.5 years and 82% patients were males. Fifty...... of perceived health, quality of life, and fatigue; for example, physical health 39.8 versus 44.3 points, compared to secondary prevention indication. Anxiety, poor perceived health, fatigue, and low quality of life were all predictors of mortality, anxiety being the strongest with an adjusted odds ratio of 4...

  16. On the Modified Barkhausen Criterion

    DEFF Research Database (Denmark)

    Lindberg, Erik; Murali, K.

    2016-01-01

    Oscillators are normally designed according to the Modified Barkhausen Criterion i.e. the complex pole pair is moved out in RHP so that the linear circuit becomes unstable. By means of the Mancini Phaseshift Oscillator it is demonstrated that the distortion of the oscillator may be minimized by i...... by introducing a nonlinear ”Hewlett Resistor” so that the complex pole-pair is in the RHP for small signals and in the LHP for large signals i.e. the complex pole pair of the instant linearized small signal model is moving around the imaginary axis in the complex frequency plane....

  17. Extremes of shock index predicts death in trauma patients

    Directory of Open Access Journals (Sweden)

    Stephen R Odom

    2016-01-01

    Full Text Available Context: We noted a bimodal relationship between mortality and shock index (SI, the ratio of heart rate to systolic blood pressure. Aims: To determine if extremes of SI can predict mortality in trauma patients. Settings and Designs: Retrospective evaluation of adult trauma patients at a tertiary care center from 2000 to 2012 in the United States. Materials and Methods: We examined the SI in trauma patients and determined the adjusted mortality for patients with and without head injuries. Statistical Analysis Used: Descriptive statistics and multivariable logistic regression. Results: SI values demonstrated a U-shaped relationship with mortality. Compared with patients with a SI between 0.5 and 0.7, patients with a SI of 1.3 had an odds ratio of death of 3.1. (95% CI 1.6–5.9. Elevated SI is associated with increased mortality in patients with isolated torso injuries, and is associated with death at both low and high values in patients with head injury. Conclusion: Our data indicate a bimodal relationship between SI and mortality in head injured patients that persists after correction for various co-factors. The distribution of mortality is different between head injured patients and patients without head injuries. Elevated SI predicts death in all trauma patients, but low SI values only predict death in head injured patients.

  18. Predicting referral practices of traditional healers of their patients ...

    African Journals Online (AJOL)

    Predicting referral practices of traditional healers of their patients with a mental illness: An application of the Theory of Planned Behaviour. ... From the TPB application, the following cognitive variables were found to predict intentions: attitudes (ß = 0.612, p< 0.01); perceived behavioural control (ß = 0.355, p< 0.01); and past ...

  19. Predictive model for survival in patients with gastric cancer.

    Science.gov (United States)

    Goshayeshi, Ladan; Hoseini, Benyamin; Yousefli, Zahra; Khooie, Alireza; Etminani, Kobra; Esmaeilzadeh, Abbas; Golabpour, Amin

    2017-12-01

    Gastric cancer is one of the most prevalent cancers in the world. Characterized by poor prognosis, it is a frequent cause of cancer in Iran. The aim of the study was to design a predictive model of survival time for patients suffering from gastric cancer. This was a historical cohort conducted between 2011 and 2016. Study population were 277 patients suffering from gastric cancer. Data were gathered from the Iranian Cancer Registry and the laboratory of Emam Reza Hospital in Mashhad, Iran. Patients or their relatives underwent interviews where it was needed. Missing values were imputed by data mining techniques. Fifteen factors were analyzed. Survival was addressed as a dependent variable. Then, the predictive model was designed by combining both genetic algorithm and logistic regression. Matlab 2014 software was used to combine them. Of the 277 patients, only survival of 80 patients was available whose data were used for designing the predictive model. Mean ?SD of missing values for each patient was 4.43?.41 combined predictive model achieved 72.57% accuracy. Sex, birth year, age at diagnosis time, age at diagnosis time of patients' family, family history of gastric cancer, and family history of other gastrointestinal cancers were six parameters associated with patient survival. The study revealed that imputing missing values by data mining techniques have a good accuracy. And it also revealed six parameters extracted by genetic algorithm effect on the survival of patients with gastric cancer. Our combined predictive model, with a good accuracy, is appropriate to forecast the survival of patients suffering from Gastric cancer. So, we suggest policy makers and specialists to apply it for prediction of patients' survival.

  20. Towards chaos criterion in quantum field theory

    OpenAIRE

    Kuvshinov, V. I.; Kuzmin, A. V.

    2002-01-01

    Chaos criterion for quantum field theory is proposed. Its correspondence with classical chaos criterion in semi-classical regime is shown. It is demonstrated for real scalar field that proposed chaos criterion can be used to investigate stability of classical solutions of field equations.

  1. Time dependent patient no-show predictive modelling development.

    Science.gov (United States)

    Huang, Yu-Li; Hanauer, David A

    2016-05-09

    Purpose - The purpose of this paper is to develop evident-based predictive no-show models considering patients' each past appointment status, a time-dependent component, as an independent predictor to improve predictability. Design/methodology/approach - A ten-year retrospective data set was extracted from a pediatric clinic. It consisted of 7,291 distinct patients who had at least two visits along with their appointment characteristics, patient demographics, and insurance information. Logistic regression was adopted to develop no-show models using two-thirds of the data for training and the remaining data for validation. The no-show threshold was then determined based on minimizing the misclassification of show/no-show assignments. There were a total of 26 predictive model developed based on the number of available past appointments. Simulation was employed to test the effective of each model on costs of patient wait time, physician idle time, and overtime. Findings - The results demonstrated the misclassification rate and the area under the curve of the receiver operating characteristic gradually improved as more appointment history was included until around the 20th predictive model. The overbooking method with no-show predictive models suggested incorporating up to the 16th model and outperformed other overbooking methods by as much as 9.4 per cent in the cost per patient while allowing two additional patients in a clinic day. Research limitations/implications - The challenge now is to actually implement the no-show predictive model systematically to further demonstrate its robustness and simplicity in various scheduling systems. Originality/value - This paper provides examples of how to build the no-show predictive models with time-dependent components to improve the overbooking policy. Accurately identifying scheduled patients' show/no-show status allows clinics to proactively schedule patients to reduce the negative impact of patient no-shows.

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

    Science.gov (United States)

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

    2013-01-01

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

  3. Bell's theorem based on a generalized EPR criterion of reality

    International Nuclear Information System (INIS)

    Eberhard, P.H.; Rosselet, P.

    1995-01-01

    First, the demonstration of Bell's theorem, i.e., of the nonlocal character of quantum theory, is spelled out using the EPR criterion of reality as premises and a gedanken experiment involving two particles. Then, the EPR criterion is extended to include quantities predicted almost with certainty, and Bell's theorem is demonstrated on these new premises. The same experiment is used but in conditions that become possible in real life, without the requirements of ideal efficiencies and zero background. Very high efficiencies and low background are needed, but these requirements may be met in the future

  4. Bell's theorem based on a generalized EPR criterion of reality

    International Nuclear Information System (INIS)

    Eberhard, P.H.; Rosselet, P.

    1993-04-01

    First, the demonstration of Bell's theorem, i.e. of the non-local character of quantum theory, is spelled out using the EPR criterion of reality as premises and a gedanken experiment involving two particles. Then, the EPR criterion is extended to include quantities predicted almost with certainty, and Bell's theorem is demonstrated on these new premises. The same experiment is used but in conditions that become possible in real life, without the requirements of ideal efficiencies and zero background. Very high efficiencies and low background are needed, but these requirements may be met in the future. (author) 1 fig., 11 refs

  5. Patient-specific prediction of functional recovery after stroke.

    Science.gov (United States)

    Douiri, Abdel; Grace, Justin; Sarker, Shah-Jalal; Tilling, Kate; McKevitt, Christopher; Wolfe, Charles DA; Rudd, Anthony G

    2017-07-01

    Background and aims Clinical predictive models for stroke recovery could offer the opportunity of targeted early intervention and more specific information for patients and carers. In this study, we developed and validated a patient-specific prognostic model for monitoring recovery after stroke and assessed its clinical utility. Methods Four hundred and ninety-five patients from the population-based South London Stroke Register were included in a substudy between 2002 and 2004. Activities of daily living were assessed using Barthel Index) at one, two, three, four, six, eight, 12, 26, and 52 weeks after stroke. Penalized linear mixed models were developed to predict patients' functional recovery trajectories. An external validation cohort included 1049 newly registered stroke patients between 2005 and 2011. Prediction errors on discrimination and calibration were assessed. The potential clinical utility was evaluated using prognostic accuracy measurements and decision curve analysis. Results Predictive recovery curves showed good accuracy, with root mean squared deviation of 3 Barthel Index points and a R 2 of 83% up to one year after stroke in the external cohort. The negative predictive values of the risk of poor recovery (Barthel Index <8) at three and 12 months were also excellent, 96% (95% CI [93.6-97.4]) and 93% [90.8-95.3], respectively, with a potential clinical utility measured by likelihood ratios (LR+:17 [10.8-26.8] at three months and LR+:11 [6.5-17.2] at 12 months). Decision curve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 5% for predictive risk of poor outcomes. Conclusions A recovery curves tool seems to accurately predict progression of functional recovery in poststroke patients.

  6. Prediction of outcome in patients with low back pain

    DEFF Research Database (Denmark)

    Kongsted, Alice; Andersen, Cathrine Hedegaard; Mørk Hansen, Martin

    2016-01-01

    The clinical course of low back pain (LBP) cannot be accurately predicted by existing prediction tools. Therefore clinicians rely largely on their experience and clinical judgement. The objectives of this study were to investigate 1) which patient characteristics were associated with chiropractors...... intensity (0-10) and disability (RMDQ) after 2-weeks, 3-months, and 12-months. The course of LBP in 859 patients was predicted to be short (54%), prolonged (36%), or chronic (7%). Clinicians' expectations were most strongly associated with education, LBP history, radiating pain, and neurological signs......' expectations of outcome from a LBP episode, 2) if clinicians' expectations related to outcome, 3) how accurate clinical predictions were as compared to those of the STarT Back Screening Tool (SBT), and 4) if accuracy was improved by combining clinicians' expectations and the SBT. Outcomes were measured as LBP...

  7. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis.

    Science.gov (United States)

    Dumaresq, Jeannot; Langevin, Stéphanie; Gagnon, Simon; Serhir, Bouchra; Deligne, Benoît; Tremblay, Cécile; Tsang, Raymond S W; Fortin, Claude; Coutlée, François; Roger, Michel

    2013-12-01

    The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle agglutination (TPPA) assay, the fluorescent treponemal antibody absorption (FTA-ABS) assay, and the line immunoassay INNO-LIA Syphilis, for the diagnosis of NS from cerebrospinal fluid (CSF) samples of these patients. NS was defined by a reactive CSF-VDRL test result and/or a CSF white blood cell (WBC) count of >20 cells/μl. Thirty of the 122 patients (24.6%) had early NS. Headache, visual symptoms, a CD4 cell count of FTA-ABS, TPPA, and INNO-LIA assays had sensitivities of 58%, 100%, 68%, and 100%, specificities of 67%, 12%, 49%, and 13%, and negative predictive values of 85%, 100%, 84%, and 100%, respectively. Visual disturbances, headache, uncontrolled HIV-1 viremia, and a CD4 cell count of <500 cells/μl were predictors of NS in HIV-infected patients with early syphilis, while blood serum RPR titers were not; therefore, RPR titers should not be used as the sole criterion for deciding whether to perform an LP in early syphilis. When applied to CSF samples, the INNO-LIA Syphilis assay easily helped rule out NS.

  8. Preventing patient absenteeism: validation of a predictive overbooking model.

    Science.gov (United States)

    Reid, Mark W; Cohen, Samuel; Wang, Hank; Kaung, Aung; Patel, Anish; Tashjian, Vartan; Williams, Demetrius L; Martinez, Bibiana; Spiegel, Brennan M R

    2015-12-01

    To develop a model that identifies patients at high risk for missing scheduled appointments ("no-shows" and cancellations) and to project the impact of predictive overbooking in a gastrointestinal endoscopy clinic-an exemplar resource-intensive environment with a high no-show rate. We retrospectively developed an algorithm that uses electronic health record (EHR) data to identify patients who do not show up to their appointments. Next, we prospectively validated the algorithm at a Veterans Administration healthcare network clinic. We constructed a multivariable logistic regression model that assigned a no-show risk score optimized by receiver operating characteristic curve analysis. Based on these scores, we created a calendar of projected open slots to offer to patients and compared the daily performance of predictive overbooking with fixed overbooking and typical "1 patient, 1 slot" scheduling. Data from 1392 patients identified several predictors of no-show, including previous absenteeism, comorbid disease burden, and current diagnoses of mood and substance use disorders. The model correctly classified most patients during the development (area under the curve [AUC] = 0.80) and validation phases (AUC = 0.75). Prospective testing in 1197 patients found that predictive overbooking averaged 0.51 unused appointments per day versus 6.18 for typical booking (difference = -5.67; 95% CI, -6.48 to -4.87; P < .0001). Predictive overbooking could have increased service utilization from 62% to 97% of capacity, with only rare clinic overflows. Information from EHRs can accurately predict whether patients will no-show. This method can be used to overbook appointments, thereby maximizing service utilization while staying within clinic capacity.

  9. Predictive factors of thyroid cancer in patients with Graves' disease.

    Science.gov (United States)

    Ren, Meng; Wu, Mu Chao; Shang, Chang Zhen; Wang, Xiao Yi; Zhang, Jing Lu; Cheng, Hua; Xu, Ming Tong; Yan, Li

    2014-01-01

    The best preoperative examination in Graves' disease with thyroid cancer still remains uncertain. The objectives of the present study were to investigate the prevalence of thyroid cancer in Graves' disease patients, and to identify the predictive factors and ultrasonographic features of thyroid cancer that may aid the preoperative diagnosis in Graves' disease. This retrospective study included 423 patients with Graves' disease who underwent surgical treatment from 2002 to 2012 at our institution. The clinical features and ultrasonographic findings of thyroid nodules were recorded. The diagnosis of thyroid cancer was determined according to the pathological results. Thyroid cancer was discovered in 58 of the 423 (13.7 %) surgically treated Graves' disease patients; 46 of those 58 patients had thyroid nodules, and the other 12 patients were diagnosed with incidentally discovered thyroid carcinomas without thyroid nodules. Among the 58 patients with thyroid cancer, papillary microcarcinomas were discovered in 50 patients, and multifocality and lymph node involvement were detected in the other 8 patients. Multivariate regression analysis showed younger age was the only significant factor predictive of metastatic thyroid cancer. Ultrasonographic findings of calcification and intranodular blood flow in thyroid nodules indicate that they are more likely to harbor thyroid cancers. Because the influencing factor of metastatic thyroid cancers in Graves' disease is young age, every suspicious nodule in Graves' disease patients should be evaluated and treated carefully, especially in younger patients because of the potential for metastasis.

  10. Predicting blood transfusion in patients undergoing minimally invasive oesophagectomy.

    Science.gov (United States)

    Schneider, Crispin; Boddy, Alex P; Fukuta, Junaid; Groom, William D; Streets, Christopher G

    2014-12-01

    To evaluate predictors of allogenic blood transfusion requirements in patients undergoing minimal invasive oesophagectomy at a tertiary high volume centre for oesophago-gastric surgery. Retrospective analysis of all patients undergoing minimal access oesophagectomy in our department between January 2010 and December 2011. Patients were divided into two groups depending on whether they required a blood transfusion at any time during their index admission. Factors that have been shown to influence perioperative blood transfusion requirements in major surgery were included in the analysis. Binary logistic regression analysis was performed to determine the impact of patient and perioperative characteristics on transfusion requirements during the index admission. A total of 80 patients underwent minimal access oesophagectomy, of which 61 patients had a laparoscopic assisted oesophagectomy and 19 patients had a minimal invasive oesophagectomy. Perioperative blood transfusion was required in 28 patients at any time during hospital admission. On binary logistic regression analysis, a lower preoperative haemoglobin concentration (p blood transfusion requirements. It has been reported that requirement for blood transfusion can affect long-term outcomes in oesophageal cancer resection. Two factors which could be addressed preoperatively; haemoglobin concentration and type of oesophageal resection, may be valuable in predicting blood transfusions in patients undergoing minimally invasive oesophagectomy. Our analysis revealed that preoperative haemoglobin concentration, occurrence of significant complications and type of minimal access oesophagectomy predicted blood transfusion requirements in the patient population examined. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  11. The Bohm criterion for rf discharges

    International Nuclear Information System (INIS)

    Meijer, P.M.; Goedheer, W.J.

    1991-01-01

    The well-known dc Bohm criterion is extended to rf discharges. Both low- (ω rf much-lt ω pi ) and high-(ω pi much-lt ω rf ) frequency regimes are considered. For low frequencies, the dc Bohm criterion holds. This criterion states that the initial energy of the ions entering the sheath must exceed a limit in order to obtain a stable sheath. For high frequencies, a modified limit is derived, which is somewhat lower than that of the dc Bohm criterion. The resulting ion current density in a high-frequency sheath is only a few percent lower than that for the dc case

  12. Survival prediction model for postoperative hepatocellular carcinoma patients.

    Science.gov (United States)

    Ren, Zhihui; He, Shasha; Fan, Xiaotang; He, Fangping; Sang, Wei; Bao, Yongxing; Ren, Weixin; Zhao, Jinming; Ji, Xuewen; Wen, Hao

    2017-09-01

    This study is to establish a predictive index (PI) model of 5-year survival rate for patients with hepatocellular carcinoma (HCC) after radical resection and to evaluate its prediction sensitivity, specificity, and accuracy.Patients underwent HCC surgical resection were enrolled and randomly divided into prediction model group (101 patients) and model evaluation group (100 patients). Cox regression model was used for univariate and multivariate survival analysis. A PI model was established based on multivariate analysis and receiver operating characteristic (ROC) curve was drawn accordingly. The area under ROC (AUROC) and PI cutoff value was identified.Multiple Cox regression analysis of prediction model group showed that neutrophil to lymphocyte ratio, histological grade, microvascular invasion, positive resection margin, number of tumor, and postoperative transcatheter arterial chemoembolization treatment were the independent predictors for the 5-year survival rate for HCC patients. The model was PI = 0.377 × NLR + 0.554 × HG + 0.927 × PRM + 0.778 × MVI + 0.740 × NT - 0.831 × transcatheter arterial chemoembolization (TACE). In the prediction model group, AUROC was 0.832 and the PI cutoff value was 3.38. The sensitivity, specificity, and accuracy were 78.0%, 80%, and 79.2%, respectively. In model evaluation group, AUROC was 0.822, and the PI cutoff value was well corresponded to the prediction model group with sensitivity, specificity, and accuracy of 85.0%, 83.3%, and 84.0%, respectively.The PI model can quantify the mortality risk of hepatitis B related HCC with high sensitivity, specificity, and accuracy.

  13. An Elasto-Plastic Damage Model for Rocks Based on a New Nonlinear Strength Criterion

    Science.gov (United States)

    Huang, Jingqi; Zhao, Mi; Du, Xiuli; Dai, Feng; Ma, Chao; Liu, Jingbo

    2018-05-01

    The strength and deformation characteristics of rocks are the most important mechanical properties for rock engineering constructions. A new nonlinear strength criterion is developed for rocks by combining the Hoek-Brown (HB) criterion and the nonlinear unified strength criterion (NUSC). The proposed criterion takes account of the intermediate principal stress effect against HB criterion, as well as being nonlinear in the meridian plane against NUSC. Only three parameters are required to be determined by experiments, including the two HB parameters σ c and m i . The failure surface of the proposed criterion is continuous, smooth and convex. The proposed criterion fits the true triaxial test data well and performs better than the other three existing criteria. Then, by introducing the Geological Strength Index, the proposed criterion is extended to rock masses and predicts the test data well. Finally, based on the proposed criterion, a triaxial elasto-plastic damage model for intact rock is developed. The plastic part is based on the effective stress, whose yield function is developed by the proposed criterion. For the damage part, the evolution function is assumed to have an exponential form. The performance of the constitutive model shows good agreement with the results of experimental tests.

  14. Do Psychosocial Factors Predict Readmission among Diabetic Elderly Patients?

    Science.gov (United States)

    Alavi, Mousa; Baharlooei, Omeleila; AdelMehraban, Marzieh

    2017-01-01

    Despite advances in diabetes treatment, the rate of readmission is still relatively high among these patients, especially in older population. Various factors may predict readmission in these patients; hence, the aim of this study was to assess the role of psychosocial factors in predicting readmission among diabetic elderly hospitalized in selected hospitals of Isfahan. In this cross-sectional study conducted from January to September 2016, 150 diabetic elderly hospitalized in selected hospitals affiliated with Isfahan University of medical sciences were chosen using a convenient sampling method. The initial information was collected by a three-part questionnaire consisting of (a) demographic characteristics, (b) 21-item depression, anxiety, and stress scale (DASS-21), and (c) multidimensional scale of perceived social support (MSPSS). Further information about readmission was gathered 3 months after completing the questionnaires through a phone call follow-up. Descriptive and inferential statistics (discriminant function analysis test) were used to analyze the data. During 3 months after discharge, 44% of hospitalized diabetic elderly were readmitted. Analytical model predicted the readmission status of 109 individuals (of total 150 persons) in the studied units (success rate of 72.2%). Among predicting factors, depression and social support had the most and the least important roles in predicting readmission rate, respectively. Interventions to improve mental status (i.e., decreasing levels of depression, anxiety, and stress) and develop social support are suggested to reduce the risk of readmission among diabetic elderly patients. Nevertheless, future studies are needed to verify the value of such interventions.

  15. Predictive value of nailfold capillaroscopy in patients with Raynaud's phenomenon.

    Science.gov (United States)

    Meli, Madeleine; Gitzelmann, Gabriela; Koppensteiner, Renate; Amann-Vesti, Beatrice R

    2006-03-01

    The objective of this study was to evaluate the long-term follow-up of patients with Raynaud's phenomenon (RP) and pathological nailfold capillaroscopy (NC) in order to analyse the predictive value of specific features of capillaroscopy for the development of a connective tissue disease (CTD). From 1992 to 2002, NC alone or combined with fluorescence videomicroscopy with sodium fluorescein (NaF) was performed in 1024 consecutive patients because of RP. We analysed the follow-up and pathological features of NC in all patients who had neither clinical nor serological signs of a CTD at the time of NC. Of 308 patients with neither serological findings nor clinical signs of CTD but with RP and pathological features in NC suspicious for CTD, follow-up data were available for 133 patients. An additional NaF test had been performed in 51 (38.4%) patients. After a mean follow-up of 6.5 years (range: 1-15 years), 109 patients had developed a CTD and 24 patients did not show any clinical signs or serological markers for a CTD after a mean follow-up of 8.5 years (range: 2-15 years). There were no differences in age, duration of RP or of follow-up in patients who developed a CTD compared to patients who did not. Significantly more giant capillaries (p=0.0001), avascular fields (p=0.02) and irregular architecture (p=0.0001) had been observed in patients who had developed a CTD during the follow-up of 6.5 years. The presence of giant capillaries, avascular fields and irregular architecture of nailfold capillaries is predictive for the development of a CTD in patients with RP.

  16. Preprocedural Prediction Model for Contrast-Induced Nephropathy Patients.

    Science.gov (United States)

    Yin, Wen-Jun; Yi, Yi-Hu; Guan, Xiao-Feng; Zhou, Ling-Yun; Wang, Jiang-Lin; Li, Dai-Yang; Zuo, Xiao-Cong

    2017-02-03

    Several models have been developed for prediction of contrast-induced nephropathy (CIN); however, they only contain patients receiving intra-arterial contrast media for coronary angiographic procedures, which represent a small proportion of all contrast procedures. In addition, most of them evaluate radiological interventional procedure-related variables. So it is necessary for us to develop a model for prediction of CIN before radiological procedures among patients administered contrast media. A total of 8800 patients undergoing contrast administration were randomly assigned in a 4:1 ratio to development and validation data sets. CIN was defined as an increase of 25% and/or 0.5 mg/dL in serum creatinine within 72 hours above the baseline value. Preprocedural clinical variables were used to develop the prediction model from the training data set by the machine learning method of random forest, and 5-fold cross-validation was used to evaluate the prediction accuracies of the model. Finally we tested this model in the validation data set. The incidence of CIN was 13.38%. We built a prediction model with 13 preprocedural variables selected from 83 variables. The model obtained an area under the receiver-operating characteristic (ROC) curve (AUC) of 0.907 and gave prediction accuracy of 80.8%, sensitivity of 82.7%, specificity of 78.8%, and Matthews correlation coefficient of 61.5%. For the first time, 3 new factors are included in the model: the decreased sodium concentration, the INR value, and the preprocedural glucose level. The newly established model shows excellent predictive ability of CIN development and thereby provides preventative measures for CIN. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  17. Breast Cancer Patients' Depression Prediction by Machine Learning Approach.

    Science.gov (United States)

    Cvetković, Jovana

    2017-09-14

    One of the most common cancer in females is breasts cancer. This cancer can has high impact on the women including health and social dimensions. One of the most common social dimension is depression caused by breast cancer. Depression can impairs life quality. Depression is one of the symptom among the breast cancer patients. One of the solution is to eliminate the depression in breast cancer patients is by treatments but these treatments can has different unpredictable impacts on the patients. Therefore it is suitable to develop algorithm in order to predict the depression range.

  18. AN EFFICIENT PATIENT INFLOW PREDICTION MODEL FOR HOSPITAL RESOURCE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Kottalanka Srikanth

    2017-07-01

    Full Text Available There has been increasing demand in improving service provisioning in hospital resources management. Hospital industries work with strict budget constraint at the same time assures quality care. To achieve quality care with budget constraint an efficient prediction model is required. Recently there has been various time series based prediction model has been proposed to manage hospital resources such ambulance monitoring, emergency care and so on. These models are not efficient as they do not consider the nature of scenario such climate condition etc. To address this artificial intelligence is adopted. The issues with existing prediction are that the training suffers from local optima error. This induces overhead and affects the accuracy in prediction. To overcome the local minima error, this work presents a patient inflow prediction model by adopting resilient backpropagation neural network. Experiment are conducted to evaluate the performance of proposed model inter of RMSE and MAPE. The outcome shows the proposed model reduces RMSE and MAPE over existing back propagation based artificial neural network. The overall outcomes show the proposed prediction model improves the accuracy of prediction which aid in improving the quality of health care management.

  19. Plasma sheath criterion in thermal electronegative plasmas

    International Nuclear Information System (INIS)

    Ghomi, Hamid; Khoramabadi, Mansour; Ghorannevis, Mahmod; Shukla, Padma Kant

    2010-01-01

    The sheath formation criterion in electronegative plasma is examined. By using a multifluid model, it is shown that in a collisional sheath there will be upper as well as lower limits for the sheath velocity criterion. However, the parameters of the negative ions only affect the lower limit.

  20. Predictive value of radioculography in patients with lumbago-sciatica

    International Nuclear Information System (INIS)

    Espersen, J.O.; Kosteljanetz, M.; Halaburt, H.; Miletic, T.

    1984-01-01

    One hundred patients with symptoms of lumbo-sacral root compression were prospectively and consecutively assigned to operation based alone on clinical findings. A preoperative myelogram was performed in all patients and described without a knowledge of the clinical features. All patients were explored for the clinically and myelographically relevant disc. When the myelogram was normal (16 patients) both lower lumbar interspaces were exposed. In 58 patients a herniated disc was revealed at surgery. Only 'myelographic herniation' with indentation of the contrast column was accompanied by a high frequency of disc herniation at surgery (73-87%). In cases with normal myelograms only 5% had a disc herniation. The severity of the myelographic finding was clearly correlated to the frequency of positive surgical findings and good outcomes. The preoperative radiculogram gives a high degree of certainty in the preoperative evaluation whether a surgical lesion is present or not and reveals a precise prediction of the outcome of surgery. (Author)

  1. Ten Issues in Criterion-Referenced Testing: A Response to Commonly Heard Criticisms.

    Science.gov (United States)

    Curlette, William L.; Stallings, William M.

    1979-01-01

    The 10 criticisms of criterion-referenced tests addressed in this paper are: the domains tested; pedagogical influence; difficulty of items; cumbersome reports; reliability; arbitrary criteria; local objectives; labeling; predictive validity; and repeated testing. (SJL)

  2. An ethical criterion for geoscientists

    Science.gov (United States)

    Peppoloni, Silvia

    2013-04-01

    Anthropological researches have demonstrated that at some point in human history, man makes an evolutive jump in cultural sense: at first, he is able to perceive himself only as part of a community, later he becomes able to perceive himself as an individual. The analysis of the linguistic roots of the word "Ethics" discloses the traces of this evolutive transition and an original double meaning: on the one hand, "Ethics" contains a sense of belonging to the social fabric, on the other hand, it is related to the individual sphere. These two existential conditions (social and individual) unexpectedly co-exist in the word "Ethics". So, "Geo-Ethics" can be defined as the investigation and reflection on those values upon which to base appropriate behaviours and practices regarding the Geosphere (social dimension), but also as the analysis of the relationships between the geoscientist who acts and his own actions (individual dimension). Therefore, the meaning of the word "Geo-Ethics" calls upon geoscientists to face the responsibility of an ethical behaviour. What does this responsibility consist of and what motivations are necessary to push geoscientists to practice the Earth sciences in an ethical way? An ethical commitment exists if there is research of truth. In their activities, Geoscientists should be searchers and defenders of truth. If geoscientists give up this role, they completely empty of meaning their work. Ethical obligations arise from the possession of specific knowledge that has practical consequences. Geoscientists, as active and responsible part of society, have to serve society and the common good. The ethical criterion for a geoscientist should be rooted in his individual sphere, that is the source of any action even in the social sphere, and should have the intellectual honesty as main requirement. It includes: • respect for the truth that they look for and for other's ideas; • recognition of the value of others as valuable for themselves;

  3. Multimodal movement prediction - towards an individual assistance of patients.

    Directory of Open Access Journals (Sweden)

    Elsa Andrea Kirchner

    Full Text Available Assistive devices, like exoskeletons or orthoses, often make use of physiological data that allow the detection or prediction of movement onset. Movement onset can be detected at the executing site, the skeletal muscles, as by means of electromyography. Movement intention can be detected by the analysis of brain activity, recorded by, e.g., electroencephalography, or in the behavior of the subject by, e.g., eye movement analysis. These different approaches can be used depending on the kind of neuromuscular disorder, state of therapy or assistive device. In this work we conducted experiments with healthy subjects while performing self-initiated and self-paced arm movements. While other studies showed that multimodal signal analysis can improve the performance of predictions, we show that a sensible combination of electroencephalographic and electromyographic data can potentially improve the adaptability of assistive technical devices with respect to the individual demands of, e.g., early and late stages in rehabilitation therapy. In earlier stages for patients with weak muscle or motor related brain activity it is important to achieve high positive detection rates to support self-initiated movements. To detect most movement intentions from electroencephalographic or electromyographic data motivates a patient and can enhance her/his progress in rehabilitation. In a later stage for patients with stronger muscle or brain activity, reliable movement prediction is more important to encourage patients to behave more accurately and to invest more effort in the task. Further, the false detection rate needs to be reduced. We propose that both types of physiological data can be used in an and combination, where both signals must be detected to drive a movement. By this approach the behavior of the patient during later therapy can be controlled better and false positive detections, which can be very annoying for patients who are further advanced in

  4. Predicting the Survival of Gastric Cancer Patients Using

    Science.gov (United States)

    Korhani Kangi, Azam; Bahrampour, Abbas

    2018-02-26

    Introduction and purpose: In recent years the use of neural networks without any premises for investigation of prognosis in analyzing survival data has increased. Artificial neural networks (ANN) use small processors with a continuous network to solve problems inspired by the human brain. Bayesian neural networks (BNN) constitute a neural-based approach to modeling and non-linearization of complex issues using special algorithms and statistical methods. Gastric cancer incidence is the first and third ranking for men and women in Iran, respectively. The aim of the present study was to assess the value of an artificial neural network and a Bayesian neural network for modeling and predicting of probability of gastric cancer patient death. Materials and Methods: In this study, we used information on 339 patients aged from 20 to 90 years old with positive gastric cancer, referred to Afzalipoor and Shahid Bahonar Hospitals in Kerman City from 2001 to 2015. The three layers perceptron neural network (ANN) and the Bayesian neural network (BNN) were used for predicting the probability of mortality using the available data. To investigate differences between the models, sensitivity, specificity, accuracy and the area under receiver operating characteristic curves (AUROCs) were generated. Results: In this study, the sensitivity and specificity of the artificial neural network and Bayesian neural network models were 0.882, 0.903 and 0.954, 0.909, respectively. Prediction accuracy and the area under curve ROC for the two models were 0.891, 0.944 and 0.935, 0.961. The age at diagnosis of gastric cancer was most important for predicting survival, followed by tumor grade, morphology, gender, smoking history, opium consumption, receiving chemotherapy, presence of metastasis, tumor stage, receiving radiotherapy, and being resident in a village. Conclusion: The findings of the present study indicated that the Bayesian neural network is preferable to an artificial neural network for

  5. The Predictive Value of Germline Polymorphisms in Patients with NSCLC

    DEFF Research Database (Denmark)

    Nygaard, Anneli Dowler; Spindler, Karen-Lise Garm; Andersen, Rikke Fredslund

    2010-01-01

    urgently needed. Single Nucleotide Polymorphisms (SNPs) are stable markers of potential clinical value and the study aimed at evaluating their use in lung cancer patients given standard chemotherapy. Genomic DNA was extracted from a pre-treatment blood sample drawn from patients with advanced Non....... Haplotypes were estimated and analyzed when relevant. There were no significant associations between SNPs in the EGF system or the DNA-repair system and RR, PFS or OS. In contrast, the VEGF+405, VEGF-460 and VEGF-2579, heterozygous patients had a higher response rate and longer PFS than homozygous patients....... Haplotype analysis of the VEGF+405 and VEGF- 460 supported our findings. These results were, however, not confirmed in the validation cohort. Although significant results regarding VEGF related SNPs, in the primary analysis, no predictive value of a broad panel of SNPs in NSCLC was found in the validation...

  6. Patient expectations predict greater pain relief with joint arthroplasty.

    Science.gov (United States)

    Gandhi, Rajiv; Davey, John Roderick; Mahomed, Nizar

    2009-08-01

    We examined the relationship between patient expectations of total joint arthroplasty and functional outcomes. We surveyed 1799 patients undergoing primary hip or knee arthroplasty for demographic data and Western Ontario McMaster University Osteoarthritis Index scores at baseline, 3 months, and 1 year of follow-up. Patient expectations were determined with 3 survey questions. The patients with the greatest expectations of surgery were younger, male, and had a lower body mass index. Linear regression modeling showed that a greater expectation of pain relief with surgery independently predicted greater reported pain relief at 1 year of follow-up, adjusted for all relevant covariates (P relief after joint arthroplasty is an important predictor of outcomes at 1 year.

  7. Predicting diabetic nephropathy in insulin-dependent patients

    DEFF Research Database (Denmark)

    Mogensen, C E; Christensen, Cramer

    1984-01-01

    We studied whether microalbuminuria (urinary albumin excretion rates of 15 to 150 micrograms per minute) would predict the development of increased proteinuria in Type I diabetes. We also studied the influence of glomerular filtration rate, renal blood flow, and blood pressure on the later...... development of proteinuria. Forty-four patients who had had Type I diabetes for at least seven years and who had albumin excretion rates below 150 micrograms per minute were studied from 1969 to 1976, and 43 were restudied in 1983. Of the 14 who initially had albumin excretion rates at or above 15 micrograms...... was not elevated in these patients. We conclude that microalbuminuria predicts the development of diabetic nephropathy and that elevated glomerular filtration rates and increased blood pressure may also contribute to this progression....

  8. CT in predicting abdominal cocoon in patients on peritoneal dialysis

    International Nuclear Information System (INIS)

    Terebus Loock, M.; Lubrano, J.; Courivaud, C.; Bresson Vautrin, C.; Kastler, B.; Delabrousse, E.

    2010-01-01

    Aim: To evaluate the computed tomography (CT) signs of encapsulating peritoneal sclerosis (EPS) in patients on peritoneal dialysis (PD) as predictive factors for the evolution to abdominal cocoon (AC). Materials and methods: Clinical features and CT signs of 90 patients on PD were retrospectively reviewed. According to the clinical features, they were divided into three groups (asymptomatic, moderate, or severe). Clinical results were correlated with previously reported CT signs of EPS, i.e., peritoneal thickening, peritoneal calcifications, loculated fluids, small bowel faeces sign, small bowel obstruction, clustered bowel loops, pseudo sac, signs of bowel ischaemia or necrosis. AC was defined at CT by the association of clustered bowel loops and a pseudo sac. Statistical analysis was performed using the Fisher's exact test and the t-test. Results: Although demonstrated in symptomatic patients (p = 0.041), the occurrence of AC was not correlated with the severity of the symptoms (p = 0.16). Among the CT signs, the presence of loculated fluids (p = 0.011), a small bowel faeces sign (p = 0.002); and small bowel obstruction (p = 0.0001) were found to be statistically correlated with the appearance of an AC. Moreover, the association of loculated fluids, small bowel faeces sign, small bowel obstruction was extremely sensitive and specific in the development of AC (sensitivity = 67%, specifity = 100%, positive predictive value = 100%, negative predictive value = 96%). Conclusion: CT should be carried out in every symptomatic patient on PD. Indeed, the association of loculated fluid, small bowel faeces sign, and small bowel obstruction enables the prediction of the development of AC, which is likely to curtail PD and require surgery.

  9. A simple stability criterion for CANDU figure-of-eight flow oscillations

    International Nuclear Information System (INIS)

    Gulshani, P.; Spinks, N.J.

    1983-01-01

    Potential flow oscillations in CANDU reactor primary heat transport system are analyzed in terms of a simple, linearized model. A simple, algebraic stability criterion is obtained. The model predictions are found to be in good agreement with those of thermohydraulic codes for high pressure natural circulation conditions. For normal operating conditions the criterion predicts the correct trend but overlooks important stabilizing effects. The model clarifies the instability mechanism; namely the response of enthalpy and, hence, pressure in the boiling region to flow change

  10. The qualitative criterion of transient angle stability

    DEFF Research Database (Denmark)

    Lyu, R.; Xue, Y.; Xue, F.

    2015-01-01

    In almost all the literatures, the qualitative assessment of transient angle stability extracts the angle information of generators based on the swing curve. As the angle (or angle difference) of concern and the threshold value rely strongly on the engineering experience, the validity and robust...... of these criterions are weak. Based on the stability mechanism from the extended equal area criterion (EEAC) theory and combining with abundant simulations of real system, this paper analyzes the criterions in most literatures and finds that the results could be too conservative or too optimistic. It is concluded...

  11. A work criterion for plastic collapse

    International Nuclear Information System (INIS)

    Muscat, Martin; Mackenzie, Donald; Hamilton, Robert

    2003-01-01

    A new criterion for evaluating limit and plastic loads in pressure vessel design by analysis is presented. The proposed criterion is based on the plastic work dissipated in the structure as loading progresses and may be used for structures subject to a single load or a combination of multiple loads. Example analyses show that limit and plastic loads given by the plastic work criterion are robust and consistent. The limit and plastic loads are determined purely by the inelastic response of the structure and are not influenced by the initial elastic response: a problem with some established plastic criteria

  12. Bone Marrow Pathology Predicts Mortality in Chronic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Cheng-Hao Weng

    2015-01-01

    Full Text Available Introduction. A bone marrow biopsy is a useful procedure for the diagnosis and staging of various hematologic and systemic diseases. The objective of this study was to investigate whether the findings of bone marrow studies can predict mortality in chronic hemodialysis patients. Methods. Seventy-eight end-stage renal disease patients on maintenance hemodialysis underwent bone marrow biopsies between 2000 and 2011, with the most common indication being unexplained anemia followed by unexplained leukocytosis and leukopenia. Results. The survivors had a higher incidence of abnormal megakaryocyte distribution P=0.001, band and segmented cells P=0.021, and lymphoid cells P=0.029 than the nonsurvivors. The overall mortality rate was 38.5% (30/78, and the most common cause of mortality was sepsis (83.3% followed by respiratory failure (10%. In multivariate Cox regression analysis, both decreased (OR 3.714, 95% CI 1.671–8.253, P=0.001 and absent (OR 9.751, 95% CI 2.030–45.115, P=0.004 megakaryocyte distribution (normal megakaryocyte distribution as the reference group, as well as myeloid/erythroid ratio (OR 1.054, CI 1.012–1.098, P=0.011, were predictive of mortality. Conclusion. The results of a bone marrow biopsy can be used to assess the pathology, and, in addition, myeloid/erythroid ratio and abnormal megakaryocyte distribution can predict mortality in chronic hemodialysis patients.

  13. Machine learning landscapes and predictions for patient outcomes

    Science.gov (United States)

    Das, Ritankar; Wales, David J.

    2017-07-01

    The theory and computational tools developed to interpret and explore energy landscapes in molecular science are applied to the landscapes defined by local minima for neural networks. These machine learning landscapes correspond to fits of training data, where the inputs are vital signs and laboratory measurements for a database of patients, and the objective is to predict a clinical outcome. In this contribution, we test the predictions obtained by fitting to single measurements, and then to combinations of between 2 and 10 different patient medical data items. The effect of including measurements over different time intervals from the 48 h period in question is analysed, and the most recent values are found to be the most important. We also compare results obtained for neural networks as a function of the number of hidden nodes, and for different values of a regularization parameter. The predictions are compared with an alternative convex fitting function, and a strong correlation is observed. The dependence of these results on the patients randomly selected for training and testing decreases systematically with the size of the database available. The machine learning landscapes defined by neural network fits in this investigation have single-funnel character, which probably explains why it is relatively straightforward to obtain the global minimum solution, or a fit that behaves similarly to this optimal parameterization.

  14. Predicting the mortality in geriatric patients with dengue fever

    Science.gov (United States)

    Huang, Hung-Sheng; Hsu, Chien-Chin; Ye, Je-Chiuan; Su, Shih-Bin; Huang, Chien-Cheng; Lin, Hung-Jung

    2017-01-01

    Abstract Geriatric patients have high mortality for dengue fever (DF); however, there is no adequate method to predict mortality in geriatric patients. Therefore, we conducted this study to develop a tool in an attempt to address this issue. We conducted a retrospective case–control study in a tertiary medical center during the DF outbreak in Taiwan in 2015. All the geriatric patients (aged ≥65 years) who visited the study hospital between September 1, 2015, and December 31, 2015, were recruited into this study. Variables included demographic data, vital signs, symptoms and signs, comorbidities, living status, laboratory data, and 30-day mortality. We investigated independent mortality predictors by univariate analysis and multivariate logistic regression analysis and then combined these predictors to predict the mortality. A total of 627 geriatric DF patients were recruited, with a mortality rate of 4.3% (27 deaths and 600 survivals). The following 4 independent mortality predictors were identified: severe coma [Glasgow Coma Scale: ≤8; adjusted odds ratio (AOR): 11.36; 95% confidence interval (CI): 1.89–68.19], bedridden (AOR: 10.46; 95% CI: 1.58–69.16), severe hepatitis (aspartate aminotransferase >1000 U/L; AOR: 96.08; 95% CI: 14.11–654.40), and renal failure (serum creatinine >2 mg/dL; AOR: 6.03; 95% CI: 1.50–24.24). When we combined the predictors, we found that the sensitivity, specificity, positive predictive value, and negative predictive value for patients with 1 or more predictors were 70.37%, 88.17%, 21.11%, and 98.51%, respectively. For patients with 2 or more predictors, the respective values were 33.33%, 99.44%, 57.14%, and 98.51%. We developed a new method to help decision making. Among geriatric patients with none of the predictors, the survival rate was 98.51%, and among those with 2 or more predictors, the mortality rate was 57.14%. This method is simple and useful, especially in an outbreak. PMID:28906367

  15. Anthropometric Indicators Predict Metabolic Syndrome Diagnosis in Maintenance Hemodialysis Patients.

    Science.gov (United States)

    Vogt, Barbara Perez; Ponce, Daniela; Caramori, Jacqueline Costa Teixeira

    2016-06-01

    Obesity has been considered the key in metabolic syndrome (MetS) development, and fat accumulation may be responsible for the occurrence of metabolic abnormalities in hemodialysis patients. The use of gold-standard methods to evaluate obesity is limited, and anthropometric measures may be the simplest methods. However, no study has investigated the association between anthropometric indexes and MetS in these patients. Therefore, the aim was to determine which anthropometric indexes had the best association and prediction for MetS in patients undergoing hemodialysis. Cross-sectional study that included patients older than 18 years, undergoing hemodialysis for at least 3 months. Patients with liver disease and cancer or those receiving corticosteroids or antiretroviral therapy were excluded. Diagnostic criteria from Harmonizing Metabolic Syndrome were used for the diagnosis of MetS. Anthropometric indexes evaluated were body mass index (BMI); percent standard of triceps skinfold thickness and of middle arm muscle circumference; waist circumference (WC); sagittal abdominal diameter; neck circumference; waist-to-hip, waist-to-thigh, and waist-to-height ratios; sagittal index; conicity index; and body fat percentage. Ninety-eight patients were included, 54.1% male, and mean age was 57.8 ± 12.9 years. The prevalence of MetS was 74.5%. Individuals with MetS had increased accumulation of abdominal fat and general obesity. Waist-to-height ratio was the variable independently associated with MetS diagnosis (odds ratio, 1.21; 95% confidence interval, 1.09-1.34; P < .01) and that better predicts MetS, followed by WC and BMI (area under the curve of 0.840, 0.836, and 0.798, respectively, P < .01). Waist-to-height ratio was the best anthropometric predictor of MetS in maintenance hemodialysis patients. © 2015 American Society for Parenteral and Enteral Nutrition.

  16. Predictive cytogenetic biomarkers for colorectal neoplasia in medium risk patients.

    Science.gov (United States)

    Ionescu, E M; Nicolaie, T; Ionescu, M A; Becheanu, G; Andrei, F; Diculescu, M; Ciocirlan, M

    2015-01-01

    DNA damage and chromosomal alterations in peripheral lymphocytes parallels DNA mutations in tumor tissues. The aim of our study was to predict the presence of neoplastic colorectal lesions by specific biomarkers in "medium risk" individuals (age 50 to 75, with no personal or family of any colorectal neoplasia). We designed a prospective cohort observational study including patients undergoing diagnostic or opportunistic screening colonoscopy. Specific biomarkers were analyzed for each patient in peripheral lymphocytes - presence of micronuclei (MN), nucleoplasmic bridges (NPB) and the Nuclear Division Index (NDI) by the cytokinesis-blocked micronucleus assay (CBMN). Of 98 patients included, 57 were "medium risk" individuals. MN frequency and NPB presence were not significantly different in patients with neoplastic lesions compared to controls. In "medium risk" individuals, mean NDI was significantly lower for patients with any neoplastic lesions (adenomas and adenocarcinomas, AUROC 0.668, p 00.5), for patients with advanced neoplasia (advanced adenoma and adenocarcinoma, AUROC 0.636 p 0.029) as well as for patients with adenocarcinoma (AUROC 0.650, p 0.048), for each comparison with the rest of the population. For a cut-off of 1.8, in "medium risk" individuals, an NDI inferior to that value may predict any neoplastic lesion with a sensitivity of 97.7%, an advanced neoplastic lesion with a sensitivity of 97% and adenocarcinoma with a sensitivity of 94.4%. NDI score may have a role as a colorectal cancer-screening test in "medium risk" individuals. DNA = deoxyribonucleic acid; CRC = colorectal cancer; EU = European Union; WHO = World Health Organization; FOBT = fecal occult blood test; CBMN = cytokinesis-blocked micronucleus assay; MN = micronuclei; NPB = nucleoplasmic bridges; NDI = Nuclear Division Index; FAP = familial adenomatous polyposis; HNPCC = hereditary non-polypoid colorectal cancer; IBD = inflammatory bowel diseases; ROC = receiver operating

  17. The stressor criterion for posttraumatic stress disorder: Does it matter?

    Science.gov (United States)

    Roberts, Andrea L.; Dohrenwend, Bruce P.; Aiello, Allison; Wright, Rosalind J.; Maercker, Andreas; Galea, Sandro; Koenen, Karestan C.

    2013-01-01

    Objective The definition of the stressor criterion for posttraumatic stress disorder (“Criterion A1”) is hotly debated with major revisions being considered for DSM-V. We examine whether symptoms, course, and consequences of PTSD vary predictably with the type of stressful event that precipitates symptoms. Method We used data from the 2009 PTSD diagnostic subsample (N=3,013) of the Nurses Health Study II. We asked respondents about exposure to stressful events qualifying under 1) DSM-III, 2) DSM-IV, or 3) not qualifying under DSM Criterion A1. Respondents selected the event they considered worst and reported subsequent PTSD symptoms. Among participants who met all other DSM-IV PTSD criteria, we compared distress, symptom severity, duration, impairment, receipt of professional help, and nine physical, behavioral, and psychiatric sequelae (e.g. physical functioning, unemployment, depression) by precipitating event group. Various assessment tools were used to determine fulfillment of PTSD Criteria B through F and to assess these 14 outcomes. Results Participants with PTSD from DSM-III events reported on average 1 more symptom (DSM-III mean=11.8 symptoms, DSM-IV=10.7, non-DSM=10.9) and more often reported symptoms lasted one year or longer compared to participants with PTSD from other groups. However, sequelae of PTSD did not vary systematically with precipitating event type. Conclusions Results indicate the stressor criterion as defined by the DSM may not be informative in characterizing PTSD symptoms and sequelae. In the context of ongoing DSM-V revision, these results suggest that Criterion A1 could be expanded in DSM-V without much consequence for our understanding of PTSD phenomenology. Events not considered qualifying stressors under the DSM produced PTSD as consequential as PTSD following DSM-III events, suggesting PTSD may be an aberrantly severe but nonspecific stress response syndrome. PMID:22401487

  18. Speed of recovery from disorientation may predict the treatment outcome of electroconvulsive therapy (ECT) in elderly patients with major depression.

    Science.gov (United States)

    Magne Bjølseth, Tor; Engedal, Knut; Šaltytė Benth, Jūratė; Bergsholm, Per; Strømnes Dybedal, Gro; Lødøen Gaarden, Torfinn; Tanum, Lars

    2016-01-15

    No study has previously investigated whether the speed of recovery from disorientation in the post-ictal period may predict the short-term treatment outcome of electroconvulsive therapy (ECT). This longitudinal cohort study included 57 elderly patients with unipolar or bipolar major depression, aged 60-85 years, treated with formula-based ECT. Treatment outcome was assessed weekly during the ECT course using the 17-item Hamilton Rating Scale for Depression (HRSD17). The post-ictal reorientation time (PRT) was assessed at the first and third treatments. Longer PRTs at the first and third treatments predicted a more rapid decline and a lower end-point in continuous HRSD17 scores (p=0.002 and 0.019, respectively). None of the patients who recovered from disorientation in less than 5 min met the remission criterion, defined as an HRSD17 score of 7 or less. A greater increment in stimulus dosage from the first to the third ECT session rendered a smaller relative decline in PRT (p<0.001). The limited number of subjects may reduce the generalizability of the findings. The speed of recovery from disorientation at the first and third sessions seems to be a predictor of the treatment outcome of formula-based ECT, at least in elderly patients with major depression. It remains to be clarified how the PRT may be utilized to guide stimulus dosing. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  19. Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records

    Science.gov (United States)

    Miotto, Riccardo; Li, Li; Kidd, Brian A.; Dudley, Joel T.

    2016-05-01

    Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name “deep patient”. We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems.

  20. We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients.

    Science.gov (United States)

    Leclerc, Jacques E; Godbout, Audrey; Arteau-Gauthier, Isabelle; Lacour, Sophie; Abel, Kati; McConnell, Elisa-Maude

    2014-02-01

    To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair. Retrospective cohort study. Charts were reviewed from cleft palate patients who underwent palatoplasty by the Von Langenbeck technique for isolated cleft palate or Bardach two-flap palatoplasty for cleft lip-palate. Seven anatomical cleft parameters were prospectively measured during the palatoplasty procedure. Three blinded speech-language pathologists retrospectively scored the clinically assessed VPI at 4 years of age. The recommendation of pharyngoplasty was also used as an indicator of VPI. From 1993 to 2008, 67 patients were enrolled in the study. The best predicting parameter was the ratio a/(30 - b1), in which a is defined as the posterior gap between the soft palate and the posterior pharyngeal wall and b1 is the width of the cleft at the hard palate level. An a/(30 - b1) ratio >0.7 to 0.8 is associated with a higher risk of developing VPI (relative risk = 2.2-5.1, sensitivity = 72%-81%, P cleft at the hard palate level and the posterior gap between the soft palate and the posterior pharyngeal wall were found to be the most significant parameters in predicting VPI. The best correlation was obtained with the ratio a/(30 - b1). 4. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Pathological stage after neoadjuvant chemoradiation and esophagectomy superiorly predicts survival in patients with esophageal squamous cell carcinoma

    International Nuclear Information System (INIS)

    Wang, Chia-Chun; Cheng, Jason Chia-Hsien; Tsai, Chiao-Ling; Lee, Jang-Ming; Huang, Pei-Ming; Lin, Chia-Chi; Hsu, Chih-Hung; Hsieh, Min-Shu; Chang, Yih-Leong; Hsu, Feng-Ming

    2015-01-01

    Background and purpose: To assess the usefulness of pathological stage according to the 7th edition of the Union for International Cancer Control–American Joint Committee on Cancer (UICC–AJCC) as a prognostic tool in patients undergoing neoadjuvant chemoradiation followed by esophagectomy (trimodality therapy, TMT) for locally advanced esophageal squamous cell carcinoma. Material and methods: One hundred twenty-five eligible patients completing TMT were enrolled for analysis. The clinical (cTNM7) and pathological (ypTNM7) stage groups of their tumors were prospectively classified, and re-grouped by the 6th edition (ypTNM6). Survival was analyzed using the Kaplan–Meier method. The Cox proportional hazard model and the Akaike information criterion (AIC) were used to compare the performance of staging systems. Results: With a median follow-up of 24.6 months, 54 patients (43.2%) died. Forty patients (32%) achieved pathological complete remission (pCR). The median survival was 31.8 months. On multivariate analysis, ypTNM7 (but not pCR or pN) was the only independent factor affecting overall survival (p < 0.001). The ypTNM7 was superior to cTNM7 or ypTNM6 in predicting both overall and recurrence-free survival after TMT based on AIC values and Cox proportional hazard model analysis. Conclusions: In patients with locally advanced esophageal squamous cell carcinoma undergoing TMT, ypTNM7 is the best predictor of survival

  2. A New Multiaxial High-Cycle Fatigue Criterion Based on the Critical Plane for Ductile and Brittle Materials

    Science.gov (United States)

    Wang, Cong; Shang, De-Guang; Wang, Xiao-Wei

    2015-02-01

    An improved high-cycle multiaxial fatigue criterion based on the critical plane was proposed in this paper. The critical plane was defined as the plane of maximum shear stress (MSS) in the proposed multiaxial fatigue criterion, which is different from the traditional critical plane based on the MSS amplitude. The proposed criterion was extended as a fatigue life prediction model that can be applicable for ductile and brittle materials. The fatigue life prediction model based on the proposed high-cycle multiaxial fatigue criterion was validated with experimental results obtained from the test of 7075-T651 aluminum alloy and some references.

  3. Generalized Majority Logic Criterion to Analyze the Statistical Strength of S-Boxes

    Science.gov (United States)

    Hussain, Iqtadar; Shah, Tariq; Gondal, Muhammad Asif; Mahmood, Hasan

    2012-05-01

    The majority logic criterion is applicable in the evaluation process of substitution boxes used in the advanced encryption standard (AES). The performance of modified or advanced substitution boxes is predicted by processing the results of statistical analysis by the majority logic criteria. In this paper, we use the majority logic criteria to analyze some popular and prevailing substitution boxes used in encryption processes. In particular, the majority logic criterion is applied to AES, affine power affine (APA), Gray, Lui J, residue prime, S8 AES, Skipjack, and Xyi substitution boxes. The majority logic criterion is further extended into a generalized majority logic criterion which has a broader spectrum of analyzing the effectiveness of substitution boxes in image encryption applications. The integral components of the statistical analyses used for the generalized majority logic criterion are derived from results of entropy analysis, contrast analysis, correlation analysis, homogeneity analysis, energy analysis, and mean of absolute deviation (MAD) analysis.

  4. Predicting Brain Metastasis in Breast Cancer Patients: Stage Versus Biology.

    Science.gov (United States)

    Azim, Hamdy A; Abdel-Malek, Raafat; Kassem, Loay

    2018-04-01

    Brain metastasis (BM) is a life-threatening event in breast cancer patients. Identifying patients at a high risk for BM can help to adopt screening programs and test preventive interventions. We tried to identify the incidence of BM in different stages and subtypes of breast cancer. We reviewed the clinical records of 2193 consecutive breast cancer patients who presented between January 1999 and December 2010. We explored the incidence of BM in relation to standard clinicopathological factors, and determined the cumulative risk of BM according to the disease stage and phenotype. Of the 2193 included women, 160 (7.3%) developed BM at a median follow-up of 5.8 years. Age younger than 60 years (P = .015), larger tumors (P = .004), lymph node (LN) positivity (P < .001), high tumor grade (P = .012), and HER2 positivity (P < .001) were associated with higher incidence of BM in the whole population. In patients who presented with locoregional disease, 3 factors independently predicted BM: large tumors (hazard ratio [HR], 3.60; 95% confidence interval [CI], 1.54-8.38; P = .003), axillary LN metastasis (HR, 4.03; 95% CI, 1.91-8.52; P < .001), and HER2 positivity (HR, 1.89; 95% CI, 1.0-3.41; P = .049). A Brain Relapse Index was formulated using those 3 factors, with 5-year cumulative incidence of BM of 19.2% in those having the 2 or 3 risk factors versus 2.5% in those with no or 1 risk factor (P < .001). In metastatic patients, 3 factors were associated with higher risk of BM: HER2 positivity (P = .007), shorter relapse-free interval (P < .001), and lung metastasis (P < .001). Disease stage and biological subtypes predict the risk for BM and subsequent treatment outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Predicting Outcome in Patients with Anti-GBM Glomerulonephritis.

    Science.gov (United States)

    van Daalen, Emma E; Jennette, J Charles; McAdoo, Stephen P; Pusey, Charles D; Alba, Marco A; Poulton, Caroline J; Wolterbeek, Ron; Nguyen, Tri Q; Goldschmeding, Roel; Alchi, Bassam; Griffiths, Meryl; de Zoysa, Janak R; Vincent, Beula; Bruijn, Jan A; Bajema, Ingeborg M

    2018-01-06

    Large studies on long-term kidney outcome in patients with anti-glomerular basement membrane (anti-GBM) GN are lacking. This study aimed to identify clinical and histopathologic parameters that predict kidney outcome in these patients. This retrospective analysis included a total of 123 patients with anti-GBM GN between 1986 and 2015 from six centers worldwide. Their kidney biopsy samples were classified according to the histopathologic classification for ANCA-associated GN. Clinical data such as details of treatment were retrieved from clinical records. The primary outcome parameter was the occurrence of ESRD. Kidney survival was analyzed using the log-rank test and Cox regression analyses. The 5-year kidney survival rate was 34%, with an improved rate observed among patients diagnosed after 2007 ( P =0.01). In patients with anti-GBM GN, histopathologic class and kidney survival were associated ( P GBM GN. Kidney outcome has improved during recent years; the success rate doubled after 2007. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_11_21_CJASNPodcast_18_1_v.mp3. Copyright © 2018 by the American Society of Nephrology.

  6. Prediction of residual metabolic activity after treatment in NSCLC patients

    International Nuclear Information System (INIS)

    Rios Velazquez, Emmanuel; Aerts, Hugo J.W.L.; Oberije, Cary; Ruysscher, Dirk De; Lambin, Philippe

    2010-01-01

    Purpose. Metabolic response assessment is often used as a surrogate of local failure and survival. Early identification of patients with residual metabolic activity is essential as this enables selection of patients who could potentially benefit from additional therapy. We report on the development of a pre-treatment prediction model for metabolic response using patient, tumor and treatment factors. Methods. One hundred and one patients with inoperable NSCLC (stage I-IV), treated with 3D conformal radical (chemo)-radiotherapy were retrospectively included in this study. All patients received a pre and post-radiotherapy fluorodeoxyglucose positron emission tomography-computed tomography FDG-PET-CT scan. The electronic medical record system and the medical patient charts were reviewed to obtain demographic, clinical, tumor and treatment data. Primary outcome measure was examined using a metabolic response assessment on a post-radiotherapy FDG-PET-CT scan. Radiotherapy was delivered in fractions of 1.8 Gy, twice a day, with a median prescribed dose of 60 Gy. Results. Overall survival was worse in patients with residual metabolic active areas compared with the patients with a complete metabolic response (p=0.0001). In univariate analysis, three variables were significantly associated with residual disease: larger primary gross tumor volume (GTVprimary, p=0.002), higher pre-treatment maximum standardized uptake value (SUV max , p=0.0005) in the primary tumor and shorter overall treatment time (OTT, p=0.046). A multivariate model including GTVprimary, SUV max , equivalent radiation dose at 2 Gy corrected for time (EQD2, T) and OTT yielded an area under the curve assessed by the leave-one-out cross validation of 0.71 (95% CI, 0.65-0.76). Conclusion. Our results confirmed the validity of metabolic response assessment as a surrogate of survival. We developed a multivariate model that is able to identify patients at risk of residual disease. These patients may benefit from

  7. Patient assessment: preparing for a predictable aesthetic outcome.

    Science.gov (United States)

    Mehta, Shamir B; Banerji, Subir; Aulakh, Raman

    2015-01-01

    The flux of patients seeking to make changes to the appearance of their smile zone appears to be on a pathway of continual increase. This is possibly due to an increase in awareness towards oral health, and perhaps social, peer and media pressures, respectively. Cohorts of dental practitioners have thus responded to the latter demands by attending a plethora of educational courses, often focusing on either restorative techniques or other disciplines, notably orthodontics and clear aligners in particular. Consequently, treatment planning and thus treatment provision may carry the risk of being biased or indeed 'outcome driven' whereby the skills and knowledge of any clinician towards a particular faculty may significantly influence the ultimate treatment plan, with the unfortunate tendency sometimes to overlook the role of the interdisciplinary approach of concomitant restorative and contemporary techniques. The role of orthodontics to facilitate the provision of such treatment, along with predictable enamel bonding, has the distinct advantage of providing an acceptable aesthetic result with minimal biological intervention. However, to achieve an optimal result in such cases requires meticulous treatment planning and patient selection to avoid pitfalls with regards to long-term stability and function. This article suggests a standardized approach to patient assessment, with an interdisciplinary perspective in mind. Clinical Relevance: With the growth of patient demand for improving the appearance of the smile, a meticulous assessment protocol is required along with effective interdisciplinary communication. This enables a comprehensive treatment plan to be developed with the correct priorities.

  8. Short Sleep Times Predict Obesity in Internal Medicine Clinic Patients

    Science.gov (United States)

    Buscemi, Dolores; Kumar, Ashwani; Nugent, Rebecca; Nugent, Kenneth

    2007-01-01

    Study Objectives: Epidemiological studies have demonstrated an association between short sleep times and obesity as defined by body mass index (BMI). We wanted to determine whether this association occurs in patients with chronic medical diagnoses since the number of confounding factors is likely higher in patients than the general population. Methods: Two hundred patients attending internal medicine clinics completed a survey regarding sleep habits, lifestyle characteristics, and medical diagnoses. An independent surveyor collected the information on the questionnaires and reviewed the medical records. Height and weight were measured by clinic personnel. Data were analyzed with multivariate logistic regression. Results: Subjects with short sleep times (< 7 hours) had an increased likelihood of obesity as defined by a BMI ≥ 30 kg/m2 when compared to the reference group of (8, 9] hours (odds ratio 2.93; 95% confidence interval, 1.06–8.09). There was a U-shaped relationship between obesity and sleep time in women but not in men. Young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea were also associated with obesity in the overall model. Conclusions: This study demonstrates an association between short sleep times and obesity in undifferentiated patients attending an internal medicine clinic using models adjusting for age, lifestyle characteristics, and some medical diagnoses. The U-shaped relationship in women suggests that sleep patterns may have gender specific associations. These observations provide the background for therapeutic trials in weight loss in patients with established medical problems. Citation: Buscemi D; Kumar A; Nugent R; Nugent K. Short sleep times predict obesity in internal medicine clinic patients. J Clin Sleep Med 2007;3(7):681–688. PMID:18198800

  9. A model to predict progression in brain-injured patients.

    Science.gov (United States)

    Tommasino, N; Forteza, D; Godino, M; Mizraji, R; Alvarez, I

    2014-11-01

    The study of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile is important to improve public health programs, organ procurement strategies, and intensive care unit (ICU) protocols. The purpose of this study was to analyze the ABI progression profile among patients admitted to ICUs with a Glasgow Coma Score (GCS) ≤8, as well as establishing a prediction model of probability of death and BD. This was a retrospective analysis of prospective data that included all brain-injured patients with GCS ≤8 admitted to a total of four public and private ICUs in Uruguay (N = 1447). The independent predictor factors of death and BD were studied using logistic regression analysis. A hierarchical model consisting of 2 nested logit regression models was then created. With these models, the probabilities of death, BD, and death by cardiorespiratory arrest were analyzed. In the first regression, we observed that as the GCS decreased and age increased, the probability of death rose. Each additional year of age increased the probability of death by 0.014. In the second model, however, BD risk decreased with each year of age. The presence of swelling, mass effect, and/or space-occupying lesion increased BD risk for the same given GCS. In the presence of injuries compatible with intracranial hypertension, age behaved as a protective factor that reduced the probability of BD. Based on the analysis of the local epidemiology, a model to predict the probability of death and BD can be developed. The organ potential donation of a country, region, or hospital can be predicted on the basis of this model, customizing it to each specific situation.

  10. The EMU debt criterion: an interpretation

    Directory of Open Access Journals (Sweden)

    R. BERNDSEN

    1997-12-01

    Full Text Available The convergence criteria specified in the Maastricht Treaty on government deficit and debt, inflation, the exchange rate and the long-term interest rate will play an important, if not decisive, role in determining which countries move on to the third stage of the Economic and Monetary Union (EMU. The aim of this work is to provide a possible interpretation of the EMU debt criterion. The author investigates the government debt criterion which, as Article 104c(2b of the Treaty shows, has a considerable scope for interpretation. Although this subject has been discussed extensively, relatively little work has been done to develop a clear interpretation of the EMU debt criterion. A flexible approach is adopted in which parts of the relevant Treaty text are characterised using two parameters.

  11. FFTBM and primary pressure acceptance criterion

    International Nuclear Information System (INIS)

    Prosek, A.

    2004-01-01

    When thermalhydraulic computer codes are used for simulation in the area of nuclear engineering the question is how to conduct an objective comparison between the code calculation and measured data. To answer this the fast Fourier transform based method (FFTBM) was developed. When the FFTBM method was developed the acceptance criteria for primary pressure and total accuracy were set. In the recent study the FFTBM method was used for accuracy quantification of RD-14M large LOCA test B9401 calculations. The blind accuracy analysis indicated good total accuracy while the primary pressure criterion was not fulfilled. The objective of the study was therefore to investigate the reasons for not fulfilling the primary pressure acceptance criterion and the applicability of the criterion to experimental facilities simulating heavy water reactor. The results of the open quantitative analysis showed that sensitivity analysis for influence parameters provide sufficient information to judge in which calculation the accuracy of primary pressure is acceptable. (author)

  12. The Role of Metformin Response in Lipid Metabolism in Patients with Recent-Onset Type 2 Diabetes: HbA1c Level as a Criterion for Designating Patients as Responders or Nonresponders to Metformin.

    Directory of Open Access Journals (Sweden)

    Zahra Kashi

    Full Text Available In this study, we investigated whether response to metformin, the most frequently drug for diabetes treatment, influences the therapeutic effects of antilipidemic medication in newly diagnosed patients with type 2 diabetes mellitus (T2DM.A total of 150 patients with T2DM were classified into two groups following 3 months of metformin therapy (1000 mg twice daily: responders (patients showing ≥1% reduction in HbA1c from baseline and nonresponders (patients showing <1% reduction in HbA1c from baseline. The patients received atorvastatin 20 mg, gemfibrozil 300 mg, or atorvastatin 20 mg and gemfibrozil 300 mg daily.HbA1c and fasting glucose levels were significantly different between baseline and 3 months among responders receiving atorvastatin; however, these differences were not statistically significant in nonresponders. Atherogenic ratios of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C; p = 0.002, total cholesterol to HDL-C (TC/HDL-C; p<0.001 and AIP (the atherogenic index of plasma; p = 0.004 decreased significantly in responders receiving atorvastatin than in nonresponders. Moreover, responders receiving atorvastatin showed a significant increase in HDL-C levels but nonresponders receiving atorvastatin did not (p = 0.007. The multivariate model identified a significant association between metformin response (as the independent variable and TG, TC, HDL-C and LDL-C (dependent variables; Wilk's λ = 0.927, p = 0.036.Metformin response affects therapeutic outcomes of atorvastatin on atherogenic lipid markers in patients newly diagnosed with T2DM. Metformin has a greater impact on BMI in responders of metformin compared to nonresponders. Adoption of better therapeutic strategies for reducing atherogenic lipid markers may be necessary for metformin nonresponders.

  13. Evaluating and Predicting Patient Safety for Medical Devices With Integral Information Technology

    Science.gov (United States)

    2005-01-01

    323 Evaluating and Predicting Patient Safety for Medical Devices with Integral Information Technology Jiajie Zhang, Vimla L. Patel, Todd R...errors are due to inappropriate designs for user interactions, rather than mechanical failures. Evaluating and predicting patient safety in medical ...the users on the identified trouble spots in the devices. We developed two methods for evaluating and predicting patient safety in medical devices

  14. General stability criterion for inviscid parallel flow

    International Nuclear Information System (INIS)

    Sun Liang

    2007-01-01

    Arnol'd's second stability theorem is approached from an elementary point of view. First, a sufficient criterion for stability is found analytically as either -μ 1 s ) s ) in the flow, where U s is the velocity at the inflection point, and μ 1 is the eigenvalue of Poincare's problem. Second, this criterion is generalized to barotropic geophysical flows in the β plane. And the connections between present criteria and Arnol'd's nonlinear criteria are also discussed. The proofs are completely elementary and so could be used to teach undergraduate students

  15. Sampling Criterion for EMC Near Field Measurements

    DEFF Research Database (Denmark)

    Franek, Ondrej; Sørensen, Morten; Ebert, Hans

    2012-01-01

    An alternative, quasi-empirical sampling criterion for EMC near field measurements intended for close coupling investigations is proposed. The criterion is based on maximum error caused by sub-optimal sampling of near fields in the vicinity of an elementary dipole, which is suggested as a worst......-case representative of a signal trace on a typical printed circuit board. It has been found that the sampling density derived in this way is in fact very similar to that given by the antenna near field sampling theorem, if an error less than 1 dB is required. The principal advantage of the proposed formulation is its...

  16. A new objective criterion for IRIS localization

    International Nuclear Information System (INIS)

    Basit, A.

    2010-01-01

    Iris localization is the most important step in iris recognition systems. For commonly used databases, exact data is not given which describe the true results of localization. To cope with this problem a new objective criterion for iris localization is proposed in this paper based on our visual system. A specific number of points are selected on pupil boundary, iris boundary, upper eyelid and lower eyelid using the original image and then distance from these points to the result of complete iris localization has been calculated. If the determined distance is below a certain threshold then iris localization is considered correct. Experimental results show that proposed criterion is very effective. (author)

  17. Are patient-reported outcomes predictive of patient satisfaction 5 years after anterior cervical spine surgery?

    Science.gov (United States)

    Schroeder, Gregory D; Coric, Dom; Kim, Han Jo; Albert, Todd J; Radcliff, Kris E

    2017-07-01

    Patient satisfaction is becoming an increasing common proxy for surgical quality; however, the correlation between patient satisfaction and surgical outcomes 2 and 5 years after anterior cervical surgery has not been evaluated. The study aimed to determine if patient satisfaction is predicted by improvement in patient-reported outcomes (PRO) 2 and 5 years after anterior cervical spine surgery. This is a retrospective analysis of prospectively collected data. The sample included patients enrolled in the Food and Drug Administration investigational device exemption clinical trial comparing total disc replacement with Mobi-C cervical artificial disc and anterior cervical discectomy and fusion. The outcome measures were visual analog scale (VAS) neck pain score, Neck Disability Index (NDI), and Short-Form 12-Item scores, as well as patient satisfaction. Receiver operating characteristic curves were used to determine if improvement in different PRO metrics can accurately identify patient satisfaction. Additionally, a logistic regression analysis was performed on the results at 24 months and 60 months to identify independent predictors of patient satisfaction. This research was supported by LDR (Zimmer Biomet) 13785 Research Boulevard - Suite 200 Austin, TX 78750. Data were available for 512 patients at 60 months. At 24 months postoperatively, NDI score improvement (area under the curve [AUC]=0.806), absolute NDI score (AUC=0.823), and absolute VAS neck pain score (AUC=0.808) were all excellent predictors of patient satisfaction. At 60 months postoperatively, NDI score improvement (AUC=0.815), absolute NDI score (AUC=0.839), VAS neck pain score improvement (AUC=0.803), and absolute VAS neck pain score (AUC=0.861) were all excellent predictors of patient satisfaction. In patients undergoing one- and two-level anterior cervical spine surgery, between 2 and 5 years postoperatively, patient satisfaction is significantly predicted by PROs, including the VAS neck score and the

  18. Nucleation of recrystallization in fine-grained materials: an extension of the Bailey-Hirsch criterion

    Science.gov (United States)

    Favre, Julien; Fabrègue, Damien; Chiba, Akihiko; Bréchet, Yves

    2013-11-01

    A new criterion for nucleation in the case of dynamic recrystallization is proposed in order to include the contribution of the grain boundary energy stored in the microstructure in the energy balance. Due to the nucleation events, the total surface area of pre-existing grain boundaries decreases, leading to a nucleus size smaller than expected by conventional nucleation criteria. The new model provides a better prediction of the nucleus size during recrystallization of pure copper compared with the conventional nucleation criterion.

  19. The particular prediction of normal MPI in diabetic patients

    International Nuclear Information System (INIS)

    Wu, Z.-F.; Li, S.-J.; Liu, H.-Y.; Liu, J.Z.; Li, X.F.; Cheng, Y.; Zhang, Y.W.; Wang, J.

    2007-01-01

    Full text: Objectives: To explore the prognostic value of normal SPECT MPI in diabetic pts. Methods: 1371 consecutively registered pts suspected with CAD were studied using rest SPECT MPI, and 1047 cases (76.37%) were followed up successfully. The mean interval of following up was 33.25±14.95(1∼56) months, and even longer than 18 months for pts with no cardiac events (CE). Results: Of 1047 pts, 172 were diabetic. During the follow up period, there are 42 cardiac events in 172 diabetic patients, and 86 in 857 non-diabetics. Diabetic pts had significantly higher rates of cardiac events (24.4% versus 9.8%; chi-square 28.5, P<0.0001). In the 567 pts with normal MPI, there are 4 cardiac events in 54 diabetic pts and 6 cases in 513 nondiabetic pts. The diabetic pts had significantly higher rates of cardiac events compared with the non-diabetic pts (7.41% versus 1.17%, Fisher's Exact Test, P=0.01). Conclusions: A normal SPECT has a high negative predictive value, but diabetic patients had significantly higher cardiac events rate compared with non-diabetic patients, what ever the MPI is normal or abnormal. (author)

  20. Factors predicting recovery from suicide in attempted suicide patients.

    Science.gov (United States)

    Sun, Fan-Ko; Lu, Chu-Yun; Tseng, Yun Shan; Chiang, Chun-Ying

    2017-12-01

    The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide. The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery. A cross-sectional design was adopted. A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis. The mean age of the participants was 40.2 years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß = -.551, p suicidal behaviour (ß = -.145, p = .008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance. Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts. The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide. © 2017 John Wiley & Sons Ltd.

  1. Predictive parameters of infectiologic complications in patients after TIPSS

    International Nuclear Information System (INIS)

    Cohnen, M.; Saleh, A.; Moedder, U.; Luethen, R.; Bode, J.; Haeussinger, D.; Daeubener, W.

    2003-01-01

    Aim To define predictive parameters of a complicated clinical course after the TIPSS procedure. Blood cultures were drawn prospectively in 41 patients from a central line and from the portal venous blood before stent placement as well as from the central line 20 min after intervention. C-reactive proteine (CRP) (mg/dl) and white blood cell count (WBC,/μl) on the day of TIPSS-procedure (d0), the first (d1) and seven (d7) days after TIPSS were compared in patients with a complicated clinical course (spontaneous bacterial peritonitis, pneumonia, sepsis; group I) to patients without clinical complications (group II) Group I showed a significant increase in CRP (d0: 1.8±1.0; d1: 3.2±1.5; d7: 4.3±3.2), and white blood cell count (d0: 7700±2600; d1: 10800±2800; d7: 7500±1800) on the first day after TIPSS-procedure in comparison to group II (CRP: d0: 1.6±0.6; d1: 1.8±1.0; d7: 1.9±0.6. WBC: d0: 6900±1500; d1: 8000±1600; d7: 7600±1400).Microbiological analysis showed in 12% skin or oral flora in the last sample. The course of CRP and WBC-count during the first week after TIPSS procedure may indicate patients with a potential risk of a complicated clinical course. (orig.) [de

  2. A pellet-clad interaction failure criterion

    International Nuclear Information System (INIS)

    Howl, D.A.; Coucill, D.N.; Marechal, A.J.C.

    1983-01-01

    A Pellet-Clad Interaction (PCI) failure criterion, enabling the number of fuel rod failures in a reactor core to be determined for a variety of normal and fault conditions, is required for safety analysis. The criterion currently being used for the safety analysis of the Pressurized Water Reactor planned for Sizewell in the UK is defined and justified in this paper. The criterion is based upon a threshold clad stress which diminishes with increasing fast neutron dose. This concept is consistent with the mechanism of clad failure being stress corrosion cracking (SCC); providing excess corrodant is always present, the dominant parameter determining the propagation of SCC defects is stress. In applying the criterion, the SLEUTH-SEER 77 fuel performance computer code is used to calculate the peak clad stress, allowing for concentrations due to pellet hourglassing and the effect of radial cracks in the fuel. The method has been validated by analysis of PCI failures in various in-reactor experiments, particularly in the well-characterised power ramp tests in the Steam Generating Heavy Water Reactor (SGHWR) at Winfrith. It is also in accord with out-of-reactor tests with iodine and irradiated Zircaloy clad, such as those carried out at Kjeller in Norway. (author)

  3. The Leadership Criterion in Technological Institute

    International Nuclear Information System (INIS)

    Carvalho, Marcelo Souza de; Cussa, Adriana Lourenco d'Avila; Suita, Julio Cezar

    2005-01-01

    This paper introduces the Direction's 'Decision Making Practice'. It has recently been reviewed with the merging of the beddings of the Leadership Criterion (CE-PNQ). These changes improved the control of institutional plans of action which are the result of the global performance critical analysis and other information associated with the Decision Making Practice. (author)

  4. Mercier criterion for high-β tokamaks

    International Nuclear Information System (INIS)

    Galvao, R.M.O.

    1984-01-01

    An expression, for the application of the Mercier criterion to numerical studies of diffuse high-β tokamaks (β approximatelly Σ,q approximatelly 1), which contains only leading order contributions in the high-β tokamak approximation is derived. (L.C.) [pt

  5. Information criterion for the categorization quality evaluation

    Directory of Open Access Journals (Sweden)

    Michail V. Svirkin

    2011-05-01

    Full Text Available The paper considers the possibility of using the variation of information function as a quality criterion for categorizing a collection of documents. The performance of the variation of information function is being examined subject to the number of categories and the sample volume of the test document collection.

  6. Selecting Items for Criterion-Referenced Tests.

    Science.gov (United States)

    Mellenbergh, Gideon J.; van der Linden, Wim J.

    1982-01-01

    Three item selection methods for criterion-referenced tests are examined: the classical theory of item difficulty and item-test correlation; the latent trait theory of item characteristic curves; and a decision-theoretic approach for optimal item selection. Item contribution to the standardized expected utility of mastery testing is discussed. (CM)

  7. A scale invariance criterion for LES parametrizations

    Directory of Open Access Journals (Sweden)

    Urs Schaefer-Rolffs

    2015-01-01

    Full Text Available Turbulent kinetic energy cascades in fluid dynamical systems are usually characterized by scale invariance. However, representations of subgrid scales in large eddy simulations do not necessarily fulfill this constraint. So far, scale invariance has been considered in the context of isotropic, incompressible, and three-dimensional turbulence. In the present paper, the theory is extended to compressible flows that obey the hydrostatic approximation, as well as to corresponding subgrid-scale parametrizations. A criterion is presented to check if the symmetries of the governing equations are correctly translated into the equations used in numerical models. By applying scaling transformations to the model equations, relations between the scaling factors are obtained by demanding that the mathematical structure of the equations does not change.The criterion is validated by recovering the breakdown of scale invariance in the classical Smagorinsky model and confirming scale invariance for the Dynamic Smagorinsky Model. The criterion also shows that the compressible continuity equation is intrinsically scale-invariant. The criterion also proves that a scale-invariant turbulent kinetic energy equation or a scale-invariant equation of motion for a passive tracer is obtained only with a dynamic mixing length. For large-scale atmospheric flows governed by the hydrostatic balance the energy cascade is due to horizontal advection and the vertical length scale exhibits a scaling behaviour that is different from that derived for horizontal length scales.

  8. Patient-rated health status predicts prognosis following percutaneous coronary intervention with drug-eluting stenting

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Versteeg, Henneke; Denollet, Johan

    2011-01-01

    In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events.......In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events....

  9. Migration Phenotype of Brain-Cancer Cells Predicts Patient Outcomes

    Directory of Open Access Journals (Sweden)

    Chris L. Smith

    2016-06-01

    Full Text Available Glioblastoma multiforme is a heterogeneous and infiltrative cancer with dismal prognosis. Studying the migratory behavior of tumor-derived cell populations can be informative, but it places a high premium on the precision of in vitro methods and the relevance of in vivo conditions. In particular, the analysis of 2D cell migration may not reflect invasion into 3D extracellular matrices in vivo. Here, we describe a method that allows time-resolved studies of primary cell migration with single-cell resolution on a fibrillar surface that closely mimics in vivo 3D migration. We used this platform to screen 14 patient-derived glioblastoma samples. We observed that the migratory phenotype of a subset of cells in response to platelet-derived growth factor was highly predictive of tumor location and recurrence in the clinic. Therefore, migratory phenotypic classifiers analyzed at the single-cell level in a patient-specific way can provide high diagnostic and prognostic value for invasive cancers.

  10. Prevalence, Predictive Factors, and Characteristics of Osteoporosis in Hyperthyroid Patients

    Directory of Open Access Journals (Sweden)

    Ayotunde O. Ale

    2018-01-01

    Full Text Available Objective. The osteoporosis in thyroid disorder has the lowest report especially in sub-Saharan Africa. This study aims to determine the prevalence, predictive factors, and characteristics of osteoporosis in hyperthyroid patients. Method. Forty (40 hyperthyroid patients and healthy controls ages 21–50 years were recruited in this study. Questionnaires were administered to capture bio- and clinical data. Biochemical tests included blood, thyroid functions, intact parathyroid hormone, corrected calcium, and 25-hydroxyvitamin D tests. Bone mineral density (BMD was also evaluated. Data were analyzed using the SPSS 21. A p value < 0.05 was regarded as significant. Results. Osteoporosis was observed in 18 (45% of study subjects, 13 (72.2% females and 5 (27.8% males, respectively. The BMD of the hyperthyroid patients had a negative correlation with free triiodothyronine, FT3 (r=−0.49, p=0.005, FT4 (r=−0.33, p=0.009, corrected calcium (r=−0.31, p=0.039, alkaline phosphatase (r=−0.53, p<0.001, and osteocalcin (r=−0.61, p<0.001. Conversely, a positive association with thyroid-stimulating hormone (TSH (r=0.54, p<0.001 was observed. Multiple regression showed osteocalcin (p<0.001 and TSH (p=0.015 as independent predictors of osteoporosis. Conclusion. Thyrotoxicosis is a risk factor for osteoporosis occurrence, and we recommend routine screening for this bone disease in persons over 20 years old with this disorder.

  11. Dynamic prediction of patient outcomes during ongoing cardiopulmonary resuscitation.

    Science.gov (United States)

    Kim, Joonghee; Kim, Kyuseok; Callaway, Clifton W; Doh, Kibbeum; Choi, Jungho; Park, Jongdae; Jo, You Hwan; Lee, Jae Hyuk

    2017-02-01

    The probability of the return of spontaneous circulation (ROSC) and subsequent favourable outcomes changes dynamically during advanced cardiac life support (ACLS). We sought to model these changes using time-to-event analysis in out-of-hospital cardiac arrest (OHCA) patients. Adult (≥18 years old), non-traumatic OHCA patients without prehospital ROSC were included. Utstein variables and initial arterial blood gas measurements were used as predictors. The incidence rate of ROSC during the first 30min of ACLS in the emergency department (ED) was modelled using spline-based parametric survival analysis. Conditional probabilities of subsequent outcomes after ROSC (1-week and 1-month survival and 6-month neurologic recovery) were modelled using multivariable logistic regression. The ROSC and conditional probability models were then combined to estimate the likelihood of achieving ROSC and subsequent outcomes by providing k additional minutes of effort. A total of 727 patients were analyzed. The incidence rate of ROSC increased rapidly until the 10th minute of ED ACLS, and it subsequently decreased. The conditional probabilities of subsequent outcomes after ROSC were also dependent on the duration of resuscitation with odds ratios for 1-week and 1-month survival and neurologic recovery of 0.93 (95% CI: 0.90-0.96, p<0.001), 0.93 (0.88-0.97, p=0.001) and 0.93 (0.87-0.99, p=0.031) per 1-min increase, respectively. Calibration testing of the combined models showed good correlation between mean predicted probability and actual prevalence. The probability of ROSC and favourable subsequent outcomes changed according to a multiphasic pattern over the first 30min of ACLS, and modelling of the dynamic changes was feasible. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Shrinkage Porosity Criterion and Its Application to A 5.5 Ton Steel Ingot

    Directory of Open Access Journals (Sweden)

    Zhang C.

    2016-06-01

    Full Text Available In order to predict the distribution of shrinkage porosity in steel ingot efficiently and accurately, a criterion R√L and a method to obtain its threshold value were proposed. The criterion R√L was derived based on the solidification characteristics of steel ingot and pressure gradient in the mushy zone, in which the physical properties, the thermal parameters, the structure of the mushy zone and the secondary dendrite arm spacing were all taken into consideration. The threshold value of the criterion R√L was obtained with combination of numerical simulation of ingot solidification and total solidification shrinkage rate. Prediction of the shrinkage porosity in a 5.5 ton ingot of 2Cr13 steel with criterion R√L>0.21 m · °C1/2 · s−3/2 agreed well with the results of experimental sectioning. Based on this criterion, optimization of the ingot was carried out by decreasing the height-to-diameter ratio and increasing the taper, which successfully eliminated the centreline porosity and further proved the applicability of this criterion.

  13. Performance of Lynch syndrome predictive models in quantifying the likelihood of germline mutations in patients with abnormal MLH1 immunoexpression.

    Science.gov (United States)

    Cabreira, Verónica; Pinto, Carla; Pinheiro, Manuela; Lopes, Paula; Peixoto, Ana; Santos, Catarina; Veiga, Isabel; Rocha, Patrícia; Pinto, Pedro; Henrique, Rui; Teixeira, Manuel R

    2017-01-01

    Lynch syndrome (LS) accounts for up to 4 % of all colorectal cancers (CRC). Detection of a pathogenic germline mutation in one of the mismatch repair genes is the definitive criterion for LS diagnosis, but it is time-consuming and expensive. Immunohistochemistry is the most sensitive prescreening test and its predictive value is very high for loss of expression of MSH2, MSH6, and (isolated) PMS2, but not for MLH1. We evaluated if LS predictive models have a role to improve the molecular testing algorithm in this specific setting by studying 38 individuals referred for molecular testing and who were subsequently shown to have loss of MLH1 immunoexpression in their tumors. For each proband we calculated a risk score, which represents the probability that the patient with CRC carries a pathogenic MLH1 germline mutation, using the PREMM 1,2,6 and MMRpro predictive models. Of the 38 individuals, 18.4 % had a pathogenic MLH1 germline mutation. MMRpro performed better for the purpose of this study, presenting a AUC of 0.83 (95 % CI 0.67-0.9; P < 0.001) compared with a AUC of 0.68 (95 % CI 0.51-0.82, P = 0.09) for PREMM 1,2,6 . Considering a threshold of 5 %, MMRpro would eliminate unnecessary germline mutation analysis in a significant proportion of cases while keeping very high sensitivity. We conclude that MMRpro is useful to correctly predict who should be screened for a germline MLH1 gene mutation and propose an algorithm to improve the cost-effectiveness of LS diagnosis.

  14. Fingerprint verification prediction model in hand dermatitis.

    Science.gov (United States)

    Lee, Chew K; Chang, Choong C; Johor, Asmah; Othman, Puwira; Baba, Roshidah

    2015-07-01

    Hand dermatitis associated fingerprint changes is a significant problem and affects fingerprint verification processes. This study was done to develop a clinically useful prediction model for fingerprint verification in patients with hand dermatitis. A case-control study involving 100 patients with hand dermatitis. All patients verified their thumbprints against their identity card. Registered fingerprints were randomized into a model derivation and model validation group. Predictive model was derived using multiple logistic regression. Validation was done using the goodness-of-fit test. The fingerprint verification prediction model consists of a major criterion (fingerprint dystrophy area of ≥ 25%) and two minor criteria (long horizontal lines and long vertical lines). The presence of the major criterion predicts it will almost always fail verification, while presence of both minor criteria and presence of one minor criterion predict high and low risk of fingerprint verification failure, respectively. When none of the criteria are met, the fingerprint almost always passes the verification. The area under the receiver operating characteristic curve was 0.937, and the goodness-of-fit test showed agreement between the observed and expected number (P = 0.26). The derived fingerprint verification failure prediction model is validated and highly discriminatory in predicting risk of fingerprint verification in patients with hand dermatitis. © 2014 The International Society of Dermatology.

  15. Applying machine learning to predict patient-specific current CD 4 ...

    African Journals Online (AJOL)

    This work shows the application of machine learning to predict current CD4 cell count of an HIV-positive patient using genome sequences, viral load and time. A regression model predicting actual CD4 cell counts and a classification model predicting if a patient's CD4 cell count is less than 200 was built using a support ...

  16. On translational superfluidity and the Landau criterion for Bose gases in the Gross-Pitaevski limit

    International Nuclear Information System (INIS)

    Wreszinski, Walter F

    2008-01-01

    The two-fluid and Landau criteria for superfluidity are compared for trapped Bose gases. While the two-fluid criterion predicts translational superfluidity, it is suggested, on the basis of the homogeneous Gross-Pitaevski limit, that a necessary part of Landau's criterion, adequate for non-translationally invariant systems, does not hold for trapped Bose gases in the GP limit. As a consequence, if the compressibility is detected to be very large (infinite by experimental standards), the two-fluid criterion is seen to be the relevant one in case the system is a translational superfluid, while the Landau criterion is the relevant one if translational superfluidity is absent. (fast track communication)

  17. Role of optimization criterion in static asymmetric analysis of lumbar spine load.

    Science.gov (United States)

    Daniel, Matej

    2011-10-01

    A common method for load estimation in biomechanics is the inverse dynamics optimization, where the muscle activation pattern is found by minimizing or maximizing the optimization criterion. It has been shown that various optimization criteria predict remarkably similar muscle activation pattern and intra-articular contact forces during leg motion. The aim of this paper is to study the effect of the choice of optimization criterion on L4/L5 loading during static asymmetric loading. Upright standing with weight in one stretched arm was taken as a representative position. Musculoskeletal model of lumbar spine model was created from CT images of Visible Human Project. Several criteria were tested based on the minimization of muscle forces, muscle stresses, and spinal load. All criteria provide the same level of lumbar spine loading (difference is below 25%), except the criterion of minimum lumbar shear force which predicts unrealistically high spinal load and should not be considered further. Estimated spinal load and predicted muscle force activation pattern are in accordance with the intradiscal pressure measurements and EMG measurements. The L4/L5 spine loads 1312 N, 1674 N, and 1993 N were predicted for mass of weight in hand 2, 5, and 8 kg, respectively using criterion of mininum muscle stress cubed. As the optimization criteria do not considerably affect the spinal load, their choice is not critical in further clinical or ergonomic studies and computationally simpler criterion can be used.

  18. A criterion for selecting renewable energy processes

    International Nuclear Information System (INIS)

    Searcy, Erin; Flynn, Peter C.

    2010-01-01

    We propose that minimum incremental cost per unit of greenhouse gas (GHG) reduction, in essence the carbon credit required to economically sustain a renewable energy plant, is the most appropriate social criterion for choosing from a myriad of alternatives. The application of this criterion is illustrated for four processing alternatives for straw/corn stover: production of power by direct combustion and biomass integrated gasification and combined cycle (BIGCC), and production of transportation fuel via lignocellulosic ethanol and Fischer Tropsch (FT) syndiesel. Ethanol requires a lower carbon credit than FT, and direct combustion a lower credit than BIGCC. For comparing processes that make a different form of end use energy, in this study ethanol vs. electrical power via direct combustion, the lowest carbon credit depends on the relative values of the two energy forms. When power is 70$ MW h -1 , ethanol production has a lower required carbon credit at oil prices greater than 600$ t -1 (80$ bbl -1 ). (author)

  19. Stability Criterion for a Finned Spinning Projectile

    OpenAIRE

    S. D. Naik

    2000-01-01

    The state-of-the-art in gun projectile technology has been used for the aerodynamic stabilisation.This approach is acceptable for guided and controlled rockets but the free-flight rockets suffer fromunacceptable dispersion. Sabot projectiles with both spin and fms developed during the last decadeneed careful analysis. In this study, the second method of Liapunov has been used to develop stability criterion for a projectile to be designed with small fins and is made to spin in the flight. This...

  20. Blind equalization with criterion with memory nonlinearity

    Science.gov (United States)

    Chen, Yuanjie; Nikias, Chrysostomos L.; Proakis, John G.

    1992-06-01

    Blind equalization methods usually combat the linear distortion caused by a nonideal channel via a transversal filter, without resorting to the a priori known training sequences. We introduce a new criterion with memory nonlinearity (CRIMNO) for the blind equalization problem. The basic idea of this criterion is to augment the Godard [or constant modulus algorithm (CMA)] cost function with additional terms that penalize the autocorrelations of the equalizer outputs. Several variations of the CRIMNO algorithms are derived, with the variations dependent on (1) whether the empirical averages or the single point estimates are used to approximate the expectations, (2) whether the recent or the delayed equalizer coefficients are used, and (3) whether the weights applied to the autocorrelation terms are fixed or are allowed to adapt. Simulation experiments show that the CRIMNO algorithm, and especially its adaptive weight version, exhibits faster convergence speed than the Godard (or CMA) algorithm. Extensions of the CRIMNO criterion to accommodate the case of correlated inputs to the channel are also presented.

  1. Predicting and explaining inflammation in Crohn's disease patients using predictive analytics methods and electronic medical record data.

    Science.gov (United States)

    Reddy, Bhargava K; Delen, Dursun; Agrawal, Rupesh K

    2018-01-01

    Crohn's disease is among the chronic inflammatory bowel diseases that impact the gastrointestinal tract. Understanding and predicting the severity of inflammation in real-time settings is critical to disease management. Extant literature has primarily focused on studies that are conducted in clinical trial settings to investigate the impact of a drug treatment on the remission status of the disease. This research proposes an analytics methodology where three different types of prediction models are developed to predict and to explain the severity of inflammation in patients diagnosed with Crohn's disease. The results show that machine-learning-based analytic methods such as gradient boosting machines can predict the inflammation severity with a very high accuracy (area under the curve = 92.82%), followed by regularized regression and logistic regression. According to the findings, a combination of baseline laboratory parameters, patient demographic characteristics, and disease location are among the strongest predictors of inflammation severity in Crohn's disease patients.

  2. 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...

  3. Can preventable adverse events be predicted among hospitalized older patients? The development and validation of a predictive model.

    NARCIS (Netherlands)

    Steeg, L. van de; Langelaan, M.; Wagner, C.

    2014-01-01

    Objective: To develop and validate a predictive model for preventable adverse events (AEs) in hospitalized older patients, using clinically important risk factors that are readily available on admission. Design: Data from two retrospective patient record review studies on AEs were used. Risk factors

  4. Sequential lineups: shift in criterion or decision strategy?

    Science.gov (United States)

    Gronlund, Scott D

    2004-04-01

    R. C. L. Lindsay and G. L. Wells (1985) argued that a sequential lineup enhanced discriminability because it elicited use of an absolute decision strategy. E. B. Ebbesen and H. D. Flowe (2002) argued that a sequential lineup led witnesses to adopt a more conservative response criterion, thereby affecting bias, not discriminability. Height was encoded as absolute (e.g., 6 ft [1.83 m] tall) or relative (e.g., taller than). If a sequential lineup elicited an absolute decision strategy, the principle of transfer-appropriate processing predicted that performance should be best when height was encoded absolutely. Conversely, if a simultaneous lineup elicited a relative decision strategy, performance should be best when height was encoded relatively. The predicted interaction was observed, providing direct evidence for the decision strategies explanation of what happens when witnesses view a sequential lineup.

  5. Rayleigh Number Criterion for Formation of A-Segregates in Steel Castings and Ingots

    DEFF Research Database (Denmark)

    Rad, M. Torabi; Kotas, Petr; Beckermann, C.

    2013-01-01

    A Rayleigh number-based criterion is developed for predicting the formation of A-segregates in steel castings and ingots. The criterion is calibrated using available experimental data for ingots involving 27 different steel compositions. The critical Rayleigh number above which A-segregates can b......, the primary reason for this over-prediction is persumed to be the presence of a central zone of equiaxed grains in the casting sections. A-segregates do not form when the grain structure is equiaxed. © The Minerals, Metals & Materials Society and ASM International 2013...

  6. Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Shazia Awan

    2017-03-01

    Full Text Available Objectives: Pulmonary embolism (PE is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG analysis and D-dimer in predicting PE in cancer patients. Methods: Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive (patients with PE and CTPA negative (PE excluded. Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs. Results: Of the total of 104 individuals who had CTPAs, 33 (31.7% were positive for PE and 71 (68.3% were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE (68.1 mmHg vs. 71 mmHg, p = 0.030. Clinical prediction rules showed good sensitivities (88−100% and negative predictive values (93−100%. An alveolar-arterial (A-a gradient > 20 had 100% sensitivity and negative predictive values. Conclusions: CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results.

  7. Factors Influencing the Predictive Power of Models for Predicting Mortality and/or Heart Failure Hospitalization in Patients With Heart Failure

    NARCIS (Netherlands)

    Ouwerkerk, Wouter; Voors, Adriaan A.; Zwinderman, Aeilko H.

    2014-01-01

    The present paper systematically reviews and compares existing prediction models in order to establish the strongest variables, models, and model characteristics in patients with heart failure predicting outcome. To improve decision making accurately predicting mortality and heart-failure

  8. Transformational leadership in primary care: Clinicians' patterned approaches to care predict patient satisfaction and health expectations.

    Science.gov (United States)

    Huynh, Ho Phi; Sweeny, Kate; Miller, Tricia

    2018-04-01

    Clinicians face the complex challenge of motivating their patients to achieve optimal health while also ensuring their satisfaction. Inspired by transformational leadership theory, we proposed that clinicians' motivational behaviors can be organized into three patient care styles (transformational, transactional, and passive-avoidant) and that these styles differentially predict patient health outcomes. In two studies using patient-reported data and observer ratings, we found that transformational patient care style positively predicted patients' satisfaction and health expectations above and beyond transactional and passive-avoidant patient care style. These findings provide initial support for the patient care style approach and suggest novel directions for the study of clinicians' motivational behaviors.

  9. Novel global robust stability criterion for neural networks with delay

    International Nuclear Information System (INIS)

    Singh, Vimal

    2009-01-01

    A novel criterion for the global robust stability of Hopfield-type interval neural networks with delay is presented. An example illustrating the improvement of the present criterion over several recently reported criteria is given.

  10. Reactor instrumentation. Definition of the single failure criterion

    International Nuclear Information System (INIS)

    1980-12-01

    The standard defines the single failure criterion which is used in other IEC publications on reactor safety systems. The purpose of the single failure criterion is the assurance of minimum redundancy. (orig./HP) [de

  11. Two novel synchronization criterions for a unified chaotic system

    International Nuclear Information System (INIS)

    Tao Chaohai; Xiong Hongxia; Hu Feng

    2006-01-01

    Two novel synchronization criterions are proposed in this paper. It includes drive-response synchronization and adaptive synchronization schemes. Moreover, these synchronization criterions can be applied to a large class of chaotic systems and are very useful for secure communication

  12. Systems interaction and single failure criterion

    International Nuclear Information System (INIS)

    1981-01-01

    This report documents the results of a six-month study to evaluate the ongoing research programs of the U.S. Nuclear Regulatory Commission (NRC) and U.S. commercial nuclear station owners which address the safety significance of systems interaction and the regulatory adequacy of the single failure criterion. The evaluation of system interactions provided is the initial phase of a more detailed study leading to the development and application of methodology for quantifying the relative safety of operating nuclear plants. (Auth.)

  13. Early Stop Criterion from the Bootstrap Ensemble

    DEFF Research Database (Denmark)

    Hansen, Lars Kai; Larsen, Jan; Fog, Torben L.

    1997-01-01

    This paper addresses the problem of generalization error estimation in neural networks. A new early stop criterion based on a Bootstrap estimate of the generalization error is suggested. The estimate does not require the network to be trained to the minimum of the cost function, as required...... by other methods based on asymptotic theory. Moreover, in contrast to methods based on cross-validation which require data left out for testing, and thus biasing the estimate, the Bootstrap technique does not have this disadvantage. The potential of the suggested technique is demonstrated on various time...

  14. Satisfying the Einstein–Podolsky–Rosen criterion with massive particles

    Science.gov (United States)

    Peise, J.; Kruse, I.; Lange, K.; Lücke, B.; Pezzè, L.; Arlt, J.; Ertmer, W.; Hammerer, K.; Santos, L.; Smerzi, A.; Klempt, C.

    2015-01-01

    In 1935, Einstein, Podolsky and Rosen (EPR) questioned the completeness of quantum mechanics by devising a quantum state of two massive particles with maximally correlated space and momentum coordinates. The EPR criterion qualifies such continuous-variable entangled states, where a measurement of one subsystem seemingly allows for a prediction of the second subsystem beyond the Heisenberg uncertainty relation. Up to now, continuous-variable EPR correlations have only been created with photons, while the demonstration of such strongly correlated states with massive particles is still outstanding. Here we report on the creation of an EPR-correlated two-mode squeezed state in an ultracold atomic ensemble. The state shows an EPR entanglement parameter of 0.18(3), which is 2.4 s.d. below the threshold 1/4 of the EPR criterion. We also present a full tomographic reconstruction of the underlying many-particle quantum state. The state presents a resource for tests of quantum nonlocality and a wide variety of applications in the field of continuous-variable quantum information and metrology. PMID:26612105

  15. Satisfying the Einstein-Podolsky-Rosen criterion with massive particles.

    Science.gov (United States)

    Peise, J; Kruse, I; Lange, K; Lücke, B; Pezzè, L; Arlt, J; Ertmer, W; Hammerer, K; Santos, L; Smerzi, A; Klempt, C

    2015-11-27

    In 1935, Einstein, Podolsky and Rosen (EPR) questioned the completeness of quantum mechanics by devising a quantum state of two massive particles with maximally correlated space and momentum coordinates. The EPR criterion qualifies such continuous-variable entangled states, where a measurement of one subsystem seemingly allows for a prediction of the second subsystem beyond the Heisenberg uncertainty relation. Up to now, continuous-variable EPR correlations have only been created with photons, while the demonstration of such strongly correlated states with massive particles is still outstanding. Here we report on the creation of an EPR-correlated two-mode squeezed state in an ultracold atomic ensemble. The state shows an EPR entanglement parameter of 0.18(3), which is 2.4 s.d. below the threshold 1/4 of the EPR criterion. We also present a full tomographic reconstruction of the underlying many-particle quantum state. The state presents a resource for tests of quantum nonlocality and a wide variety of applications in the field of continuous-variable quantum information and metrology.

  16. Generalized melting criterion for beam-induced amorphization

    International Nuclear Information System (INIS)

    Lam, N. Q.; Okamoto, Paul R.

    1993-09-01

    Recent studies have shown that the mean-square static atomic displacements provide a generic measure of the enthalpy stored in the lattice in the form of chemical and topological disorder, and that the effect of the displacements on the softening of shear elastic constants is identical to that of heating. This finding lends support to a generalized form of the Lindemann phenomenological melting criterion and leads to a natural interpretion of crystalline-to-amorphous transformations as defect-induced melting of metastable crystals driven beyond a critical state of disorder where the melting temperature falls below the glass-transition temperature. Application of the generalized Lindemann criterion to both the crystalline and amorphous phases indicates that the enthalpies of the two phases become identical when their shear moduli become equal. This thermo-elastic rule provides a basis for predicting the relative susceptibility of compounds to amorphization in terms of their elastic properties as measured by Debye temperatures. The present approach can explain many of the basic findings on beam-induced amorphization of intermetallic compounds as well as amorphous phase formation associated with ion implantation, ion-beam mixing and other solid-state processes

  17. Factors predicting walking intolerance in patients with peripheral ...

    African Journals Online (AJOL)

    Objective. To determine which physiological variables conduce to walking intolerance in patients with peripheral arterial disease (PAD). Design. The physiological response to a graded treadmill exercise test (GTT) in patients with PAD was characterised. Setting. Patients were recruited from the Department of. Vascular ...

  18. Smoking status predicts cancer patients' quality of life over time

    Directory of Open Access Journals (Sweden)

    Ursula Martinez

    2018-03-01

    These results extend previous findings showing that QOL improves in cancer patients who quit smoking. Specifically, patients who quit smoking experience a greater reduction in depression and pain levels at all time points, and the reduction increases over time. In the case of fatigue, the results suggest that patients experience the greatest improvement with longer (≥ 4 months abstinence.

  19. Prediction and assessment of depression rates in patients with ...

    African Journals Online (AJOL)

    The aim of the study is to assess, in advanced lung cancer patients, the frequency of depression and the related demographic and biomedical factors before diagnosis and after the initial treatment period. Seventy-nine patients from among 105 advanced lung cancer patients diagnosed between July 1994 and April 2003 in ...

  20. The role of socio demographic variables in predicting patients ...

    African Journals Online (AJOL)

    Background: Radiological examination remains a vital and integral aspect of health services delivery and patient satisfaction with radiological service remains beneficial both to patients and hospitals. Aim: To evaluate the influence of patient's socio demographic variables on satisfaction with radiological services. Subjects ...

  1. Multi-center MRI prediction models : Predicting sex and illness course in first episode psychosis patients

    OpenAIRE

    Nieuwenhuis, Mireille; Schnack, Hugo G.; van Haren, Neeltje E.; Kahn, René S.; Lappin, Julia; Dazzan, Paola; Morgan, Craig; Reinders, Antje A.; Gutierrez-Tordesillas, Diana; Gutierrez-Tordesillas, Diana; Roiz-Santiañez, Roberto; Crespo-Facorro, Benedicto; Schaufelberger, Maristela S.; Rosa, Pedro G.; Zanetti, Marcus V.

    2017-01-01

    Structural Magnetic Resonance Imaging (MRI) studies have attempted to use brain measures obtained at the first-episode of psychosis to predict subsequent outcome, with inconsistent results. Thus, there is a real need to validate the utility of brain measures in the prediction of outcome using large datasets, from independent samples, obtained with different protocols and from different MRI scanners. This study had three main aims: 1) to investigate whether structural MRI data from multiple ce...

  2. Abdominal aortic calcifications predict survival in peritoneal dialysis patients

    DEFF Research Database (Denmark)

    Mäkelä, Satu M; Asola, Markku; Hadimeri, Henrik

    2018-01-01

    BACKGROUND: Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal...... dialysis (PD) patients using methods easily available in everyday clinical practice. METHODS: We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar.......9) in 17%, and high (> 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS ≥ 7 (p

  3. Positive predictive value of infective endocarditis in the Danish National Patient Registry: a validation study.

    Science.gov (United States)

    Østergaard, Lauge; Adelborg, Kasper; Sundbøll, Jens; Pedersen, Lars; Loldrup Fosbøl, Emil; Schmidt, Morten

    2018-05-30

    The positive predictive value of an infective endocarditis diagnosis is approximately 80% in the Danish National Patient Registry. However, since infective endocarditis is a heterogeneous disease implying long-term intravenous treatment, we hypothesiszed that the positive predictive value varies by length of hospital stay. A total of 100 patients with first-time infective endocarditis in the Danish National Patient Registry were identified from January 2010 - December 2012 at the University hospital of Aarhus and regional hospitals of Herning and Randers. Medical records were reviewed. We calculated the positive predictive value according to admission length, and separately for patients with a cardiac implantable electronic device and a prosthetic heart valve using the Wilson score method. Among the 92 medical records available for review, the majority of the patients had admission length ⩾2 weeks. The positive predictive value increased with length of admission. In patients with admission length value was 65% while it was 90% for admission length ⩾2 weeks. The positive predictive value was 81% for patients with a cardiac implantable electronic device and 87% for patients with a prosthetic valve. The positive predictive value of the infective endocarditis diagnosis in the Danish National Patient Registry is high for patients with admission length ⩾2 weeks. Using this algorithm, the Danish National Patient Registry provides a valid source for identifying infective endocarditis for research.

  4. Goldberger-Treiman constraint criterion for hyperon coupling constants

    International Nuclear Information System (INIS)

    General, Ignacio J.; Cotanch, Stephen R.

    2004-01-01

    The generalized Goldberger-Treiman relation is combined with the Dashen-Weinstein sum rule to provide a constraint equation between the g KΣN and g KΛN coupling constants. A comprehensive examination of the published phenomenological and theoretical hyperon couplings has yielded a much smaller set of values, spanning the intervals 0.80≤g KΣN /√(4π)≤2.72 and -3.90≤g KΛN /√(4π)≤-1.84, consistent with this criterion. The broken SU F (3) and Goldberger-Treiman hyperon couplings satisfy the constraint along with predictions from a Taylor series extrapolation using the same momentum variation as exhibited by g πNN

  5. Reviewing Employee Turnover: Focusing on Proximal Withdrawal States and an Expanded Criterion

    Science.gov (United States)

    Hom, Peter W.; Mitchell, Terence R.; Lee, Thomas W.; Griffeth, Rodger W.

    2012-01-01

    We reconceptualize employee turnover to promote researchers' understanding and prediction of why employees quit or stay in employing institutions. A literature review identifies shortcomings with prevailing turnover dimensions. In response, we expand the conceptual domain of the turnover criterion to include multiple types of turnover (notably,…

  6. Discriminant Validity Assessment: Use of Fornell & Larcker criterion versus HTMT Criterion

    Science.gov (United States)

    Hamid, M. R. Ab; Sami, W.; Mohmad Sidek, M. H.

    2017-09-01

    Assessment of discriminant validity is a must in any research that involves latent variables for the prevention of multicollinearity issues. Fornell and Larcker criterion is the most widely used method for this purpose. However, a new method has emerged for establishing the discriminant validity assessment through heterotrait-monotrait (HTMT) ratio of correlations method. Therefore, this article presents the results of discriminant validity assessment using these methods. Data from previous study was used that involved 429 respondents for empirical validation of value-based excellence model in higher education institutions (HEI) in Malaysia. From the analysis, the convergent, divergent and discriminant validity were established and admissible using Fornell and Larcker criterion. However, the discriminant validity is an issue when employing the HTMT criterion. This shows that the latent variables under study faced the issue of multicollinearity and should be looked into for further details. This also implied that the HTMT criterion is a stringent measure that could detect the possible indiscriminant among the latent variables. In conclusion, the instrument which consisted of six latent variables was still lacking in terms of discriminant validity and should be explored further.

  7. PET image reconstruction: mean, variance, and optimal minimax criterion

    International Nuclear Information System (INIS)

    Liu, Huafeng; Guo, Min; Gao, Fei; Shi, Pengcheng; Xue, Liying; Nie, Jing

    2015-01-01

    Given the noise nature of positron emission tomography (PET) measurements, it is critical to know the image quality and reliability as well as expected radioactivity map (mean image) for both qualitative interpretation and quantitative analysis. While existing efforts have often been devoted to providing only the reconstructed mean image, we present a unified framework for joint estimation of the mean and corresponding variance of the radioactivity map based on an efficient optimal min–max criterion. The proposed framework formulates the PET image reconstruction problem to be a transformation from system uncertainties to estimation errors, where the minimax criterion is adopted to minimize the estimation errors with possibly maximized system uncertainties. The estimation errors, in the form of a covariance matrix, express the measurement uncertainties in a complete way. The framework is then optimized by ∞-norm optimization and solved with the corresponding H ∞ filter. Unlike conventional statistical reconstruction algorithms, that rely on the statistical modeling methods of the measurement data or noise, the proposed joint estimation stands from the point of view of signal energies and can handle from imperfect statistical assumptions to even no a priori statistical assumptions. The performance and accuracy of reconstructed mean and variance images are validated using Monte Carlo simulations. Experiments on phantom scans with a small animal PET scanner and real patient scans are also conducted for assessment of clinical potential. (paper)

  8. Transthyretin Concentrations in Acute Stroke Patients Predict Convalescent Rehabilitation.

    Science.gov (United States)

    Isono, Naofumi; Imamura, Yuki; Ohmura, Keiko; Ueda, Norihide; Kawabata, Shinji; Furuse, Motomasa; Kuroiwa, Toshihiko

    2017-06-01

    For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation. We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure. In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes. A minimal transthyretin concentration (stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Extended equal areas criterion: foundations and applications

    Energy Technology Data Exchange (ETDEWEB)

    Yusheng, Xue [Nanjim Automation Research Institute, Nanjim (China)

    1994-12-31

    The extended equal area criterion (EEAC) provides analytical expressions for ultra fast transient stability assessment, flexible sensitivity analysis, and means to preventive and emergency controls. Its outstanding performances have been demonstrated by thousands upon thousands simulations on more than 50 real power systems and by on-line operation records in an EMS environment of Northeast China Power System since September 1992. However, the researchers have mainly based on heuristics and simulations. This paper lays a theoretical foundation of EEAC and brings to light the mechanism of transient stability. It proves true that the dynamic EEAC furnishes a necessary and sufficient condition for stability of multi machine systems with any detailed models, in the sense of the integration accuracy. This establishes a new platform for further advancing EEAC and better understanding of problems. An overview of EEAC applications in China is also given in this paper. (author) 30 refs.

  10. An ER activity profile including ER, PR, Bcl-2 and IGF-IR may have potential as selection criterion for letrozole or tamoxifen treatment of patients with advanced breast cancer

    DEFF Research Database (Denmark)

    Henriksen, Katrine L; Rasmussen, Birgitte B; Lykkesfeldt, Anne E

    2009-01-01

    microarrays from formalin fixed paraffin embedded primary tumor material from a subgroup of patients (9.4%), who have participated in the international, randomized, phase III clinical trial PO25 comparing letrozole with tamoxifen in 907 patients with advanced breast cancer. The expression levels of ER...

  11. Application of the single failure criterion

    International Nuclear Information System (INIS)

    1990-01-01

    In order to present further details on the application and interpretation and on the limitations of individual concepts in the NUSS Codes and Safety Guides, a series of Safety Practice publications have been initiated. It is hoped that many Member States will be able to benefit from the experience presented in these books. The present publication will be useful not only to regulators but also to designers and could be particularly helpful in the interpretation of cases which fall on the borderline between the two areas. It should assist in clarifying, by way of examples, many of the concepts and implementation methods. It also describes some of the limitations involved. The book addresses a specialized topic and it is recommended that it be used together with the other books in the Safety Series. During the development of this publication the actual practices of all countries with major reactor programmes has been taken into account. An interpretation of the relevant text of the Design Code is given in the light of these national practices. The criterion is put into perspective with the general reliability requirements in which it is also embedded in the Design Code. Its relation to common cause and other multiple failure cases and also to the temporary disengagement of components in systems important to safety is clarified. Its use and its limitations are thus explained in the context of reliability targets for systems performance. The guidance provided applies to all reactor systems and would be applicable even to systems not in nuclear power plants. But since this publication was developed to give an interpretation of a specific requirement of the Design Code, the broader applicability is not explicitly claimed. The Design Code lists three cases for which compliance with the criterion may not be justified. The present publication assists in the more precise and practical identification of those cases. 9 figs, 1 tab

  12. Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups

    OpenAIRE

    Marschollek, Michael; Gövercin, Mehmet; Rust, Stefan; Gietzelt, Matthias; Schulze, Mareike; Wolf, Klaus-Hendrik; Steinhagen-Thiessen, Elisabeth

    2012-01-01

    Abstract Background Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1), and to identify high-risk subgroups from the data (aim#2). Methods A ...

  13. Patient Characteristics Predicting Readmission Among Individuals Hospitalized for Heart Failure

    Science.gov (United States)

    O'Connor, Melissa; Murtaugh, Christopher M.; Shah, Shivani; Barrón-Vaya, Yolanda; Bowles, Kathryn H.; Peng, Timothy R.; Zhu, Carolyn W.; Feldman, Penny H.

    2015-01-01

    Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates. Database searches yielded 950 potential articles, of which 34 studies met inclusion criteria. Patient characteristics generally have a very modest effect on all-cause or heart failure–related readmission within 7 to 180 days of index hospital discharge. A range of cardiac diseases and other comorbidities only minimally increase readmission rates. No single patient characteristic stands out as a key contributor across multiple studies underscoring the challenge of developing successful interventions to reduce readmissions. Interventions may need to be general in design with the specific intervention depending on each patient's unique clinical profile. PMID:26180045

  14. Patient Characteristics Predicting Readmission Among Individuals Hospitalized for Heart Failure.

    Science.gov (United States)

    O'Connor, Melissa; Murtaugh, Christopher M; Shah, Shivani; Barrón-Vaya, Yolanda; Bowles, Kathryn H; Peng, Timothy R; Zhu, Carolyn W; Feldman, Penny H

    2016-02-01

    Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates. Database searches yielded 950 potential articles, of which 34 studies met inclusion criteria. Patient characteristics generally have a very modest effect on all-cause or heart failure-related readmission within 7 to 180 days of index hospital discharge. A range of cardiac diseases and other comorbidities only minimally increase readmission rates. No single patient characteristic stands out as a key contributor across multiple studies underscoring the challenge of developing successful interventions to reduce readmissions. Interventions may need to be general in design with the specific intervention depending on each patient's unique clinical profile. © The Author(s) 2015.

  15. Early warning score predicts acute mortality in stroke patients

    DEFF Research Database (Denmark)

    Liljehult, J; Christensen, Thomas

    2016-01-01

    OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study wa...... tool for identifying patients at risk of dying after acute stroke. Readily available physiological parameters are converted to a single score, which can guide both nurses and physicians in clinical decision making and resource allocation.......OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study...

  16. Using recurrent neural networks to predict colorectal cancer among patients

    NARCIS (Netherlands)

    Amirkhan, Ryan; Hoogendoorn, Mark; Numans, Mattijs E.; Moons, Leon

    2018-01-01

    Development of predictive models from Electronic Medical Records (EMRs) is a far from trivial task. Especially the temporal nature of health records is an aspect that is often ignored yet of utmost importance. Additionally, data is extremely sparse. Previous research has shown that the

  17. Factors predicting mortality in elderly patients admitted to a ...

    African Journals Online (AJOL)

    The median age was 70 years (interquartile range 67 - 75 years). The overall ICU mortality was 44.7%, and 64% of deaths occurred within 5 days of admission. On univariate analysis, the factors predicting mortality were alcohol misuse (p=0.09), pneumonia (p.0.001), shock (p=0.001), dehydration (p=0.007), urine output ...

  18. Prediction model to predict critical weight loss in patients with head and neck cancer during (chemo)radiotherapy.

    Science.gov (United States)

    Langius, Jacqueline A E; Twisk, Jos; Kampman, Martine; Doornaert, Patricia; Kramer, Mark H H; Weijs, Peter J M; Leemans, C René

    2016-01-01

    Patients with head and neck cancer (HNC) frequently encounter weight loss with multiple negative outcomes as a consequence. Adequate treatment is best achieved by early identification of patients at risk for critical weight loss. The objective of this study was to detect predictive factors for critical weight loss in patients with HNC receiving (chemo)radiotherapy ((C)RT). In this cohort study, 910 patients with HNC were included receiving RT (±surgery/concurrent chemotherapy) with curative intent. Body weight was measured at the start and end of (C)RT. Logistic regression and classification and regression tree (CART) analyses were used to analyse predictive factors for critical weight loss (defined as >5%) during (C)RT. Possible predictors included gender, age, WHO performance status, tumour location, TNM classification, treatment modality, RT technique (three-dimensional conformal RT (3D-RT) vs intensity-modulated RT (IMRT)), total dose on the primary tumour and RT on the elective or macroscopic lymph nodes. At the end of (C)RT, mean weight loss was 5.1±4.9%. Fifty percent of patients had critical weight loss during (C)RT. The main predictors for critical weight loss during (C)RT by both logistic and CART analyses were RT on the lymph nodes, higher RT dose on the primary tumour, receiving 3D-RT instead of IMRT, and younger age. Critical weight loss during (C)RT was prevalent in half of HNC patients. To predict critical weight loss, a practical prediction tree for adequate nutritional advice was developed, including the risk factors RT to the neck, higher RT dose, 3D-RT, and younger age. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. 18F-FDG PET predicts survival after pretargeted radioimmunotherapy in patients with progressive metastatic medullary thyroid carcinoma

    International Nuclear Information System (INIS)

    Salaun, Pierre-Yves; Robin, Philippe; Campion, Loic; Ansquer, Catherine; Mathieu, Cedric; Frampas, Eric; Bournaud, Claire; Vuillez, Jean-Philippe; Taieb, David; Rousseau, Caroline; Drui, Delphine; Mirallie, Eric; Borson-Chazot, Francoise; Goldenberg, David M.; Chatal, Jean-Francois; Barbet, Jacques; Kraeber-Bodere, Francoise

    2014-01-01

    PET is a powerful tool for assessing targeted therapy. Since 18 F-FDG shows a potential prognostic value in medullary thyroid carcinoma (MTC), this study evaluated 18 F-FDG PET alone and combined with morphological and biomarker evaluations as a surrogate marker of overall survival (OS) in patients with progressive metastatic MTC treated with pretargeted anti-CEA radioimmunotherapy (pRAIT) in a phase II clinical trial. Patients underwent PET associated with morphological imaging (CT and MRI) and biomarker evaluations, before and 3 and 6 months, and then every 6 months, after pRAIT for 36 months. A combined evaluation was performed using anatomic, metabolic and biomarker methods. The prognostic value of the PET response was compared with demographic parameters at inclusion including age, sex, RET mutation, time from initial diagnosis, calcitonin and CEA concentrations and doubling times (DT), SUV max , location of disease and bone marrow involvement, and with response using RECIST, biomarker concentration variation, impact on DT, and combined methods. Enrolled in the study were 25 men and 17 women with disease progression. The median OS from pRAIT was 3.7 years (0.2 to 6.5 years) and from MTC diagnosis 10.9 years (1.7 to 31.5 years). After pRAIT, PET/CT showed 1 patient with a complete response, 4 with a partial response and 24 with disease stabilization. The combined evaluation showed 20 responses. For OS from pRAIT, univariate analysis showed the prognostic value of biomarker DT (P = 0.011) and SUV max (P = 0.038) calculated before pRAIT and impact on DT (P = 0.034), RECIST (P = 0.009), PET (P = 0.009), and combined response (P = 0.004) measured after pRAIT. PET had the highest predictive value with the lowest Akaike information criterion (AIC 74.26) as compared to RECIST (AIC 78.06), biomarker variation (AIC 81.94) and impact on DT (AIC 79.22). No benefit was obtained by combining the methods (AIC 78.75). This result was confirmed by the analysis of OS from MTC

  20. {sup 18}F-FDG PET predicts survival after pretargeted radioimmunotherapy in patients with progressive metastatic medullary thyroid carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Salaun, Pierre-Yves; Robin, Philippe [University Hospital, Nuclear Medicine Department, Brest (France); Campion, Loic [ICO-Gauducheau Cancer Institute, Statistical Department, Nantes (France); Ansquer, Catherine; Mathieu, Cedric [University Hospital, Nuclear Medicine Department, Nantes (France); Frampas, Eric [University Hospital, Radiology Department, Nantes (France); Universite de Nantes, Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Nantes (France); Bournaud, Claire [University Hospital, Nuclear Medicine Department, Lyon (France); Vuillez, Jean-Philippe [University Hospital, Nuclear Medicine Department, Grenoble (France); Taieb, David [University Hospital, Nuclear Medicine Department, Marseille (France); Rousseau, Caroline [Universite de Nantes, Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Nantes (France); ICO-Rene Gauducheau, Nuclear Medicine Department, Nantes (France); Drui, Delphine [University Hospital, Endocrinology Department, Nantes (France); Mirallie, Eric [University Hospital, Surgery Department, Nantes (France); Borson-Chazot, Francoise [University Hospital, Endocrinology Department, Lyon (France); Goldenberg, David M. [IBC Pharmaceuticals, Inc., and Immunomedics, Inc., Morris Plains, NJ (United States); Center for Molecular Medicine and Immunology, Garden State Cancer Center, Morris Plains, NJ (United States); Chatal, Jean-Francois [GIP ARRONAX, Saint-Herblain (France); Barbet, Jacques [Universite de Nantes, Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Nantes (France); GIP ARRONAX, Saint-Herblain (France); Kraeber-Bodere, Francoise [University Hospital, Nuclear Medicine Department, Nantes (France); Universite de Nantes, Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Nantes (France); ICO-Rene Gauducheau, Nuclear Medicine Department, Nantes (France); Hotel Dieu University Hospital, Nuclear Medicine Department, Nantes (France)

    2014-08-15

    PET is a powerful tool for assessing targeted therapy. Since {sup 18}F-FDG shows a potential prognostic value in medullary thyroid carcinoma (MTC), this study evaluated {sup 18}F-FDG PET alone and combined with morphological and biomarker evaluations as a surrogate marker of overall survival (OS) in patients with progressive metastatic MTC treated with pretargeted anti-CEA radioimmunotherapy (pRAIT) in a phase II clinical trial. Patients underwent PET associated with morphological imaging (CT and MRI) and biomarker evaluations, before and 3 and 6 months, and then every 6 months, after pRAIT for 36 months. A combined evaluation was performed using anatomic, metabolic and biomarker methods. The prognostic value of the PET response was compared with demographic parameters at inclusion including age, sex, RET mutation, time from initial diagnosis, calcitonin and CEA concentrations and doubling times (DT), SUV{sub max}, location of disease and bone marrow involvement, and with response using RECIST, biomarker concentration variation, impact on DT, and combined methods. Enrolled in the study were 25 men and 17 women with disease progression. The median OS from pRAIT was 3.7 years (0.2 to 6.5 years) and from MTC diagnosis 10.9 years (1.7 to 31.5 years). After pRAIT, PET/CT showed 1 patient with a complete response, 4 with a partial response and 24 with disease stabilization. The combined evaluation showed 20 responses. For OS from pRAIT, univariate analysis showed the prognostic value of biomarker DT (P = 0.011) and SUV{sub max} (P = 0.038) calculated before pRAIT and impact on DT (P = 0.034), RECIST (P = 0.009), PET (P = 0.009), and combined response (P = 0.004) measured after pRAIT. PET had the highest predictive value with the lowest Akaike information criterion (AIC 74.26) as compared to RECIST (AIC 78.06), biomarker variation (AIC 81.94) and impact on DT (AIC 79.22). No benefit was obtained by combining the methods (AIC 78.75). This result was confirmed by the

  1. Avascular necrosis in sickle cell (homozygous S) patients: Predictive ...

    African Journals Online (AJOL)

    2013-04-24

    Apr 24, 2013 ... Results: The prevalence of AVN in sickle cell patients was ... Key words: Avascular necrosis, homozygous S, platelet count, sickle cell anemia, white cell count .... frequency of vaso‑occlusive crisis, platelet, and white cell.

  2. Factors predicting hyperkalemia in patients with cirrhosis receiving spironolactone

    International Nuclear Information System (INIS)

    Abbas, Z.; Mumtaz, K.; Salam, A.; Jafri, W.

    2003-01-01

    Objective: To evaluate the factors leading to hyperkalemia in patients with cirrhosis receiving spironolactone. Results: Patients with hyperkalemia (K>5 mmol/l) had higher blood urea nitrogen, serum creatinine and bilirubin levels (p=0.004, 0.001 and 0.044 respectively). Their serum sodium and albumin levels were lower (p=0.000 and 0.017 respectively). They had advanced cirrhosis with high Pugh score (p=0.003). These patients were on higher dose of spironolactone (p=0.001). Multivariate analysis showed that dose of spironolactone > 100 mg/day, serum creatinine >1.3 mg/dl, persistence of ascites and edema, and female gender were important predictors of development of hyperkalemia. Conclusion: Patients with cirrhosis receiving high dose of the diuretic, having edema, ascites and high serum creatinine are at the greater risk of developing hyperkalemia during spironolactone therapy. (author)

  3. Cardiovascular risk prediction in chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Santiago Cedeño Mora

    2017-05-01

    Conclusion: The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013] can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events.

  4. SKread predicts handwriting performance in patients with low vision.

    Science.gov (United States)

    Downes, Ken; Walker, Laura L; Fletcher, Donald C

    2015-06-01

    To assess whether performance on the Smith-Kettlewell Reading (SKread) test is a reliable predictor of handwriting performance in patients with low vision. Cross-sectional study. Sixty-six patients at their initial low-vision rehabilitation evaluation. The patients completed all components of a routine low-vision appointment including logMAR acuity, performed the SKread test, and performed a handwriting task. Patients were timed while performing each task and their accuracy was recorded. The handwriting task was performed by having patients write 5 5-letter words into sets of boxes where each letter is separated by a box. The boxes were 15 × 15 mm, and accuracy was scored with 50 points possible from 25 letters: 1 point for each letter within the confines of a box and 1 point if the letter was legible. Correlation analysis was then performed. Median age of participants was 84 (range 54-97) years. Fifty-seven patients (86%) had age-related macular degeneration or some other maculopathy, whereas 9 patients (14%) had visual impairment from media opacity or neurologic impairment. Median Early Treatment Diabetic Retinopathy Study acuity was 20/133 (range 20/22 to 20/1000), and median logMAR acuity was 0.82 (range 0.04-1.70). SKread errors per block correlated with logMAR acuity (r = 0.6), and SKread time per block correlated with logMAR acuity (r = 0.51). SKread errors per block correlated with handwriting task time/accuracy ratio (r = 0.61). SKread time per block correlated with handwriting task time/accuracy ratio (r = 0.7). LogMAR acuity score correlated with handwriting task time/accuracy ratio (r = 0.42). All p values were handwriting performance in patients with low vision better than logMAR acuity. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  5. Immune phenotypes predict survival in patients with glioblastoma multiforme

    Directory of Open Access Journals (Sweden)

    Haouraa Mostafa

    2016-09-01

    Full Text Available Abstract Background Glioblastoma multiforme (GBM, a common primary malignant brain tumor, rarely disseminates beyond the central nervous system and has a very bad prognosis. The current study aimed at the analysis of immunological control in individual patients with GBM. Methods Immune phenotypes and plasma biomarkers of GBM patients were determined at the time of diagnosis using flow cytometry and ELISA, respectively. Results Using descriptive statistics, we found that immune anomalies were distinct in individual patients. Defined marker profiles proved highly relevant for survival. A remarkable relation between activated NK cells and improved survival in GBM patients was in contrast to increased CD39 and IL-10 in patients with a detrimental course and very short survival. Recursive partitioning analysis (RPA and Cox proportional hazards models substantiated the relevance of absolute numbers of CD8 cells and low numbers of CD39 cells for better survival. Conclusions Defined alterations of the immune system may guide the course of disease in patients with GBM and may be prognostically valuable for longitudinal studies or can be applied for immune intervention.

  6. Serum albumin predicts survival in patients with hilar cholangiocarcinoma.

    Science.gov (United States)

    Waghray, Abhijeet; Sobotka, Anastasia; Marrero, Carlos Romero; Estfan, Bassam; Aucejo, Federico; Narayanan Menon, K V

    2017-02-01

    Hilar cholangiocarcinoma is a devastating malignancy with incidence varying by geography and other risk factors. Rapid progression of disease and delays in diagnosis restrict the number of patients eligible for curative therapy. The objective of this study was to determine prognostic factors of overall survival in all patients presenting with hilar cholangiocarcinoma. All adult patients with histologically confirmed hilar cholangiocarcinoma from 2003 to 2013 were evaluated for predictors of survival using demographic factors, laboratory data, symptoms and radiological characteristics at presentation. A total of 116 patients were identified to have pathological diagnosis of hilar cholangiocarcinoma and were included in the analysis. Patients with a serum albumin level >3.0 g/dL (P 3.0 g/dL was identified as an independent predictor of overall survival (hazard ratio 0.31; 95% confidence interval 0.14-0.70) with a survival benefit of 44 weeks. This study was the largest analysis to date of prognostic factors in patients with hilar cholangiocarcinoma. A serum albumin level >3.0 g/dL conferred an independent survival advantage with a significantly greater length of survival. © The Author(s) 2016. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University.

  7. Hypoalbuminaemia predicts outcome in adult patients with congenital heart disease

    Science.gov (United States)

    Kempny, Aleksander; Diller, Gerhard-Paul; Alonso-Gonzalez, Rafael; Uebing, Anselm; Rafiq, Isma; Li, Wei; Swan, Lorna; Hooper, James; Donovan, Jackie; Wort, Stephen J; Gatzoulis, Michael A; Dimopoulos, Konstantinos

    2015-01-01

    Background In patients with acquired heart failure, hypoalbuminaemia is associated with increased risk of death. The prevalence of hypoproteinaemia and hypoalbuminaemia and their relation to outcome in adult patients with congenital heart disease (ACHD) remains, however, unknown. Methods Data on patients with ACHD who underwent blood testing in our centre within the last 14 years were collected. The relation between laboratory, clinical or demographic parameters at baseline and mortality was assessed using Cox proportional hazards regression analysis. Results A total of 2886 patients with ACHD were included. Mean age was 33.3 years (23.6–44.7) and 50.1% patients were men. Median plasma albumin concentration was 41.0 g/L (38.0–44.0), whereas hypoalbuminaemia (disease complexity, hypoalbuminaemia remained a significant predictor of death. Conclusions Hypoalbuminaemia is common in patients with ACHD and is associated with a threefold increased risk of risk of death. Hypoalbuminaemia, therefore, should be included in risk-stratification algorithms as it may assist management decisions and timing of interventions in the growing ACHD population. PMID:25736048

  8. Personalized mortality prediction driven by electronic medical data and a patient similarity metric.

    Directory of Open Access Journals (Sweden)

    Joon Lee

    Full Text Available Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1 to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2 to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made.We deployed a cosine-similarity-based patient similarity metric (PSM to an intensive care unit (ICU database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care.The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR systems, our novel medical data analytics

  9. Personalized Mortality Prediction Driven by Electronic Medical Data and a Patient Similarity Metric

    Science.gov (United States)

    Lee, Joon; Maslove, David M.; Dubin, Joel A.

    2015-01-01

    Background Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1) to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2) to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made. Methods and Findings We deployed a cosine-similarity-based patient similarity metric (PSM) to an intensive care unit (ICU) database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care. Conclusions The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR) systems, our

  10. Personalized mortality prediction driven by electronic medical data and a patient similarity metric.

    Science.gov (United States)

    Lee, Joon; Maslove, David M; Dubin, Joel A

    2015-01-01

    Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1) to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2) to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made. We deployed a cosine-similarity-based patient similarity metric (PSM) to an intensive care unit (ICU) database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care. The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR) systems, our novel medical data analytics contributes to

  11. Accuracy of a selection criterion for glass forming ability in the Ni–Nb–Zr system

    International Nuclear Information System (INIS)

    Déo, L.P.; Oliveira, M.F. de

    2014-01-01

    Highlights: • We applied a selection in the Ni–Nb–Zr system to find alloys with high GFA. • We used the thermal parameter γ m to evaluate the GFA of alloys. • The correlation between the γ m parameter and R c in the studied system is poor. • The effect of oxygen impurity reduced dramatically the GFA of alloys. • Unknown intermetallic compounds reduced the accuracy of the criterion. - Abstract: Several theories have been developed and applied in metallic systems in order to find the best stoichiometries with high glass forming ability; however there is no universal theory to predict the glass forming ability in metallic systems. Recently a selection criterion was applied in the Zr–Ni–Cu system and it was found some correlation between experimental and theoretical data. This criterion correlates critical cooling rate for glass formation with topological instability of stable crystalline structures; average work function difference and average electron density difference among the constituent elements of the alloy. In the present work, this criterion was applied in the Ni–Nb–Zr system. It was investigated the influence of factors not considered in the calculation and on the accuracy of the criterion, such as unknown intermetallic compounds and oxygen contamination. Bulk amorphous specimens were produced by injection casting. The amorphous nature was analyzed by X-ray diffraction and differential scanning calorimetry; oxygen contamination was quantified by the inert gas fusion method

  12. 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.

  13. Predictive value of specific radiographic findings of disability in patients with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Kaye, J.J.; Nance, E.P. Jr.; Callahan, L.F.; Pincus, T.

    1986-01-01

    This study was carried out to determine whether and to what extend radiographic erosion, joint space narrowing, and malalignment are predictive of clinical disability in patients with rheumatoid arthristis (RA). Radiographs of the hands and wrists of 224 patients with RA were scored for these radiographic parameters. To determine which of these findings best explained variation in clinical measures of disability, a series of regression analyses was performed. Malalignment scores were the best predictor of joint deformity and limitation of motion. Erosion scores were most predictive of variation in functional tests. The author concludes that specific radiographic findings of malalignment and erosion are significantly predictive of disability in patients with RA

  14. A Path-Independent Forming Limit Criterion for Stamping Simulations

    International Nuclear Information System (INIS)

    Zhu Xinhai; Chappuis, Laurent; Xia, Z. Cedric

    2005-01-01

    Forming Limit Diagram (FLD) has been proved to be a powerful tool for assessing necking failures in sheet metal forming analysis for majority of stamping operations over the last three decades. However, experimental evidence and theoretical analysis suggest that its applications are limited to linear or almost linear strain paths during its deformation history. Abrupt changes or even gradual deviations from linear strain-paths will shift forming limit curves from their original values, a situation that occurs in vast majority of sequential stamping operations such as where the drawing process is followed by flanging and re-strike processes. Various forming limit models have been put forward recently to provide remedies for the problem, noticeably stress-based and strain gradient-based forming limit criteria. This study presents an alternative path-independent forming limit criterion. Instead of traditional Forming Limit Diagrams (FLD) which are constructed in terms of major - minor principal strains throughout deformation history, the new criterion defines a critical effective strain ε-bar* as the limit strain for necking, and it is shown that ε-bar* can be expressed as a function of current strain rate state and material work hardening properties, without the need of explicitly considering strain-path effects. It is given by ε-bar* = f(β, k, n) where β = (dε 2 /dε 1 ) at current deformation state, and k and n are material strain hardening parameters if a power law is assumed. The analysis is built upon previous work by Storen and Rice [1975] and Zhu et al [2002] with the incorporation of anisotropic yield models such as Hill'48 for quadratic orthotropic yield and Hill'79 for non-quadratic orthotropic yield. Effects of anisotropic parameters such as R-values and exponent n-values on necking are investigated in detail for a variety of strain paths. Results predicted according to current analysis are compared against experimental data gathered from literature

  15. Direct numerical simulations of non-premixed ethylene-air flames: Local flame extinction criterion

    KAUST Repository

    Lecoustre, Vivien R.

    2014-11-01

    Direct Numerical Simulations (DNS) of ethylene/air diffusion flame extinctions in decaying two-dimensional turbulence were performed. A Damköhler-number-based flame extinction criterion as provided by classical large activation energy asymptotic (AEA) theory is assessed for its validity in predicting flame extinction and compared to one based on Chemical Explosive Mode Analysis (CEMA) of the detailed chemistry. The DNS code solves compressible flow conservation equations using high order finite difference and explicit time integration schemes. The ethylene/air chemistry is simulated with a reduced mechanism that is generated based on the directed relation graph (DRG) based methods along with stiffness removal. The numerical configuration is an ethylene fuel strip embedded in ambient air and exposed to a prescribed decaying turbulent flow field. The emphasis of this study is on the several flame extinction events observed in contrived parametric simulations. A modified viscosity and changing pressure (MVCP) scheme was adopted in order to artificially manipulate the probability of flame extinction. Using MVCP, pressure was changed from the baseline case of 1 atm to 0.1 and 10 atm. In the high pressure MVCP case, the simulated flame is extinction-free, whereas in the low pressure MVCP case, the simulated flame features frequent extinction events and is close to global extinction. Results show that, despite its relative simplicity and provided that the global flame activation temperature is correctly calibrated, the AEA-based flame extinction criterion can accurately predict the simulated flame extinction events. It is also found that the AEA-based criterion provides predictions of flame extinction that are consistent with those provided by a CEMA-based criterion. This study supports the validity of a simple Damköhler-number-based criterion to predict flame extinction in engineering-level CFD models. © 2014 The Combustion Institute.

  16. Unitary Evolution as a Uniqueness Criterion

    Science.gov (United States)

    Cortez, J.; Mena Marugán, G. A.; Olmedo, J.; Velhinho, J. M.

    2015-01-01

    It is well known that the process of quantizing field theories is plagued with ambiguities. First, there is ambiguity in the choice of basic variables describing the system. Second, once a choice of field variables has been made, there is ambiguity concerning the selection of a quantum representation of the corresponding canonical commutation relations. The natural strategy to remove these ambiguities is to demand positivity of energy and to invoke symmetries, namely by requiring that classical symmetries become unitarily implemented in the quantum realm. The success of this strategy depends, however, on the existence of a sufficiently large group of symmetries, usually including time-translation invariance. These criteria are therefore generally insufficient in non-stationary situations, as is typical for free fields in curved spacetimes. Recently, the criterion of unitary implementation of the dynamics has been proposed in order to select a unique quantization in the context of manifestly non-stationary systems. Specifically, the unitarity criterion, together with the requirement of invariance under spatial symmetries, has been successfully employed to remove the ambiguities in the quantization of linearly polarized Gowdy models as well as in the quantization of a scalar field with time varying mass, propagating in a static background whose spatial topology is either of a d-sphere (with d = 1, 2, 3) or a three torus. Following Ref. 3, we will see here that the symmetry and unitarity criteria allows for a complete removal of the ambiguities in the quantization of scalar fields propagating in static spacetimes with compact spatial sections, obeying field equations with an explicitly time-dependent mass, of the form ddot φ - Δ φ + s(t)φ = 0 . These results apply in particular to free fields in spacetimes which, like e.g. in the closed FRW models, are conformal to a static spacetime, by means of an exclusively time-dependent conformal factor. In fact, in such

  17. Predictive factors for relapse in patients on buprenorphine maintenance.

    Science.gov (United States)

    Ferri, Michael; Finlayson, Alistair J Reid; Wang, Li; Martin, Peter R

    2014-01-01

    Despite the dramatic increase in the use of buprenorphine for the treatment of opioid dependence, clinical outcomes of this treatment approach continue to need evaluation. This study examines factors associated with relapse and retention during buprenorphine treatment in a sample of opioid dependent outpatients. In a retrospective chart review of 62 patients with opioid dependence, relapse was determined by self-report, urine toxicology screens, and by checking the state controlled substance monitoring database. Data was analyzed using two-way tests of association and logistic regression. Patients with comorbid anxiety disorders, active benzodiazepine use (contrary to clinic policy), or active alcohol abuse, were significantly more likely to relapse. Patients who relapsed were also more likely to be on a higher buprenorphine maintenance dose. This study identifies relapse risk factors during buprenorphine treatment for opioid dependence. Future research is needed to determine whether modifying these factors may lead to improved treatment outcomes. © American Academy of Addiction Psychiatry.

  18. Classification and regression tree (CART) model to predict pulmonary tuberculosis in hospitalized patients.

    Science.gov (United States)

    Aguiar, Fabio S; Almeida, Luciana L; Ruffino-Netto, Antonio; Kritski, Afranio Lineu; Mello, Fernanda Cq; Werneck, Guilherme L

    2012-08-07

    Tuberculosis (TB) remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART) model was generated and validated. The area under the ROC curve (AUC), sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear) and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with clinical suspicion of TB in tertiary health facilities in

  19. Coupling of EIT with computational lung modeling for predicting patient-specific ventilatory responses.

    Science.gov (United States)

    Roth, Christian J; Becher, Tobias; Frerichs, Inéz; Weiler, Norbert; Wall, Wolfgang A

    2017-04-01

    Providing optimal personalized mechanical ventilation for patients with acute or chronic respiratory failure is still a challenge within a clinical setting for each case anew. In this article, we integrate electrical impedance tomography (EIT) monitoring into a powerful patient-specific computational lung model to create an approach for personalizing protective ventilatory treatment. The underlying computational lung model is based on a single computed tomography scan and able to predict global airflow quantities, as well as local tissue aeration and strains for any ventilation maneuver. For validation, a novel "virtual EIT" module is added to our computational lung model, allowing to simulate EIT images based on the patient's thorax geometry and the results of our numerically predicted tissue aeration. Clinically measured EIT images are not used to calibrate the computational model. Thus they provide an independent method to validate the computational predictions at high temporal resolution. The performance of this coupling approach has been tested in an example patient with acute respiratory distress syndrome. The method shows good agreement between computationally predicted and clinically measured airflow data and EIT images. These results imply that the proposed framework can be used for numerical prediction of patient-specific responses to certain therapeutic measures before applying them to an actual patient. In the long run, definition of patient-specific optimal ventilation protocols might be assisted by computational modeling. NEW & NOTEWORTHY In this work, we present a patient-specific computational lung model that is able to predict global and local ventilatory quantities for a given patient and any selected ventilation protocol. For the first time, such a predictive lung model is equipped with a virtual electrical impedance tomography module allowing real-time validation of the computed results with the patient measurements. First promising results

  20. Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center.

    Science.gov (United States)

    Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc

    2015-02-01

    Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

  1. Patient Similarity in Prediction Models Based on Health Data: A Scoping Review

    Science.gov (United States)

    Sharafoddini, Anis; Dubin, Joel A

    2017-01-01

    Background Physicians and health policy makers are required to make predictions during their decision making in various medical problems. Many advances have been made in predictive modeling toward outcome prediction, but these innovations target an average patient and are insufficiently adjustable for individual patients. One developing idea in this field is individualized predictive analytics based on patient similarity. The goal of this approach is to identify patients who are similar to an index patient and derive insights from the records of similar patients to provide personalized predictions.. Objective The aim is to summarize and review published studies describing computer-based approaches for predicting patients’ future health status based on health data and patient similarity, identify gaps, and provide a starting point for related future research. Methods The method involved (1) conducting the review by performing automated searches in Scopus, PubMed, and ISI Web of Science, selecting relevant studies by first screening titles and abstracts then analyzing full-texts, and (2) documenting by extracting publication details and information on context, predictors, missing data, modeling algorithm, outcome, and evaluation methods into a matrix table, synthesizing data, and reporting results. Results After duplicate removal, 1339 articles were screened in abstracts and titles and 67 were selected for full-text review. In total, 22 articles met the inclusion criteria. Within included articles, hospitals were the main source of data (n=10). Cardiovascular disease (n=7) and diabetes (n=4) were the dominant patient diseases. Most studies (n=18) used neighborhood-based approaches in devising prediction models. Two studies showed that patient similarity-based modeling outperformed population-based predictive methods. Conclusions Interest in patient similarity-based predictive modeling for diagnosis and prognosis has been growing. In addition to raw/coded health

  2. EEG arousal prediction via hypoxemia indicator in patients with ...

    African Journals Online (AJOL)

    Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder characterized by recurrent airflow obstruction caused by a total or partial collapse of the upper airway. OSAS is a common affliction suffered by millions. The arousal index (ArI) is the best predictor of daytime somnolence for patients with OSAS, ...

  3. Obesity-Related Adipokines Predict Patient-Reported Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Rajiv Gandhi

    2013-12-01

    Full Text Available Background/Aims: Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. Methods: 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire and pain (Short Form McGill Pain Questionnaire measures. Synovial fluid (SF samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. Results: 54% of the cohort was female (n = 27. The mean age (SD of the sample was 62.9 (9.9 years and the mean BMI (SD was 28.1 (5.4 kg/m2. From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p Conclusions: The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets.

  4. Obesity-related adipokines predict patient-reported shoulder pain.

    Science.gov (United States)

    Gandhi, Rajiv; Perruccio, Anthony V; Rizek, Randy; Dessouki, Omar; Evans, Heather M K; Mahomed, Nizar N

    2013-01-01

    Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire) and pain (Short Form McGill Pain Questionnaire) measures. Synovial fluid (SF) samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. 54% of the cohort was female (n = 27). The mean age (SD) of the sample was 62.9 (9.9) years and the mean BMI (SD) was 28.1 (5.4) kg/m(2). From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p < 0.05). Adipokine levels were not associated with functional outcome scores. The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets. © 2013 S. Karger GmbH, Freiburg.

  5. Avascular necrosis in sickle cell (homozygous S) patients: Predictive ...

    African Journals Online (AJOL)

    ... with the development of AVN. Conclusion: In conclusion, patients with a raised steady state platelet count may have a higher tendency to develop AVN and may require closer orthopedic review and prophylactic intervention. Key words: Avascular necrosis, homozygous S, platelet count, sickle cell anemia, white cell count ...

  6. Risk Prediction of New Adjacent Vertebral Fractures After PVP for Patients with Vertebral Compression Fractures: Development of a Prediction Model

    International Nuclear Information System (INIS)

    Zhong, Bin-Yan; He, Shi-Cheng; Zhu, Hai-Dong; Wu, Chun-Gen; Fang, Wen; Chen, Li; Guo, Jin-He; Deng, Gang; Zhu, Guang-Yu; Teng, Gao-Jun

    2017-01-01

    PurposeWe aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition.Materials and MethodsPatients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic.Results421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors.ConclusionsThe PNAV score is an objective and easy approach to predict the risk of new AVCFs.

  7. Risk Prediction of New Adjacent Vertebral Fractures After PVP for Patients with Vertebral Compression Fractures: Development of a Prediction Model

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Bin-Yan; He, Shi-Cheng; Zhu, Hai-Dong [Southeast University, Department of Radiology, Medical School, Zhongda Hospital (China); Wu, Chun-Gen [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China); Fang, Wen; Chen, Li; Guo, Jin-He; Deng, Gang; Zhu, Guang-Yu; Teng, Gao-Jun, E-mail: gjteng@vip.sina.com [Southeast University, Department of Radiology, Medical School, Zhongda Hospital (China)

    2017-02-15

    PurposeWe aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition.Materials and MethodsPatients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic.Results421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors.ConclusionsThe PNAV score is an objective and easy approach to predict the risk of new AVCFs.

  8. Patient characteristics do not predict poor glycaemic control in type 2 diabetes patients treated in primary care

    NARCIS (Netherlands)

    Goudswaard, AN; Stolk, RP; Zuithoff, P; Rutten, GEHM

    Many diabetic patients in general practice do not achieve good glycaemic control. The aim of this study was to assess which characteristics of type 2 diabetes patients treated in primary care predict poor glycaemic control (HbA(1c) greater than or equal to7%). Data were collected from the medical

  9. A criterion for heated pipe design by linear electric resistances

    International Nuclear Information System (INIS)

    Bloch, M.; Cruz, J.R.B.

    1984-01-01

    A criterion for linear eletrical elements instalation on horizontal tubes is obtainned in this work. This criterion is based upon the calculation of the thermal stresses caused by the non uniform temperature distribution in the tube cross section. The finite difference method and the SAP IV computer code are both used in the calculations. The criterion is applied to the thermal circuits of the IEN which has tube diameter varying from φ 1/2 in till φ 8 in. (author) [pt

  10. One- and 2-Year Mortality Prediction for Patients Starting Chronic Dialysis

    Directory of Open Access Journals (Sweden)

    Mikko Haapio

    2017-11-01

    Discussion: Mortality prediction algorithms could be more widely implemented into management of ESRD patients. The presented models are practical with only a limited number of variables and fairly good performance.

  11. Characterization and Predictive Value of Segmental Curve Flexibility in Adolescent Idiopathic Scoliosis Patients

    DEFF Research Database (Denmark)

    Yao, Guanfeng; Cheung, Jason P Y; Shigematsu, Hideki

    2017-01-01

    STUDY DESIGN: A prospective radiographic analysis of adolescent idiopathic scoliosis (AIS) patients managed with alternate-level pedicle screw fixation was performed. OBJECTIVE: The objective of this study was to characterize segmental curve flexibility and to determine its predictive value...

  12. Low serum leptin predicts mortality in patients with chronic kidney disease stage 5

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Rattensperger, Dirk; Zidek, Walter

    2007-01-01

    Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy....

  13. Using acute kidney injury severity and scoring systems to predict outcome in patients with burn injury

    Directory of Open Access Journals (Sweden)

    George Kuo

    2016-12-01

    Conclusion: Our results revealed that AKI stage has considerable discriminative power for predicting mortality. Compared with other prognostic models, AKI stage is easier to use to assess outcome in patients with severe burn injury.

  14. Use of molecular markers for predicting therapy response in cancer patients.

    LENUS (Irish Health Repository)

    Duffy, Michael J

    2012-02-01

    Predictive markers are factors that are associated with upfront response or resistance to a particular therapy. Predictive markers are important in oncology as tumors of the same tissue of origin vary widely in their response to most available systemic therapies. Currently recommended oncological predictive markers include both estrogen and progesterone receptors for identifying patients with breast cancers likely to benefit from hormone therapy, HER-2 for the identification of breast cancer patients likely to benefit from trastuzumab, specific K-RAS mutations for the identification of patients with advanced colorectal cancer unlikely to benefit from either cetuximab or panitumumab and specific EGFR mutations for selecting patients with advanced non-small-cell lung cancer for treatment with tyrosine kinase inhibitors such as gefitinib and erlotinib. The availability of predictive markers should increase drug efficacy and decrease toxicity, thus leading to a more personalized approach to cancer treatment.

  15. A new self-report inventory of dyslexia for students: criterion and construct validity.

    Science.gov (United States)

    Tamboer, Peter; Vorst, Harrie C M

    2015-02-01

    The validity of a Dutch self-report inventory of dyslexia was ascertained in two samples of students. Six biographical questions, 20 general language statements and 56 specific language statements were based on dyslexia as a multi-dimensional deficit. Dyslexia and non-dyslexia were assessed with two criteria: identification with test results (Sample 1) and classification using biographical information (both samples). Using discriminant analyses, these criteria were predicted with various groups of statements. All together, 11 discriminant functions were used to estimate classification accuracy of the inventory. In Sample 1, 15 statements predicted the test criterion with classification accuracy of 98%, and 18 statements predicted the biographical criterion with classification accuracy of 97%. In Sample 2, 16 statements predicted the biographical criterion with classification accuracy of 94%. Estimations of positive and negative predictive value were 89% and 99%. Items of various discriminant functions were factor analysed to find characteristic difficulties of students with dyslexia, resulting in a five-factor structure in Sample 1 and a four-factor structure in Sample 2. Answer bias was investigated with measures of internal consistency reliability. Less than 20 self-report items are sufficient to accurately classify students with and without dyslexia. This supports the usefulness of self-assessment of dyslexia as a valid alternative to diagnostic test batteries. Copyright © 2015 John Wiley & Sons, Ltd.

  16. An integrated biochemical prediction model of all-cause mortality in patients undergoing lower extremity bypass surgery for advanced peripheral artery disease.

    Science.gov (United States)

    Owens, Christopher D; Kim, Ji Min; Hevelone, Nathanael D; Gasper, Warren J; Belkin, Michael; Creager, Mark A; Conte, Michael S

    2012-09-01

    Patients with advanced peripheral artery disease (PAD) have a high prevalence of cardiovascular (CV) risk factors and shortened life expectancy. However, CV risk factors poorly predict midterm (model was used to assess the main outcome of all-cause mortality. A clinical model was constructed with known CV risk factors, and the incremental value of the addition of clinical chemistry, lipid assessment, and a panel of 11 inflammatory parameters was investigated using the C statistic, the integrated discrimination improvement index, and Akaike information criterion. The study monitored 225 patients for a median of 893 days (interquartile range, 539-1315 days). In this study, 50 patients (22.22%) died during the follow-up period. By life-table analysis (expressed as percent surviving ± standard error), survival at 1, 2, 3, 4, and 5 years, respectively, was 90.5% ± 1.9%, 83.4% ± 2.5%, 77.5% ± 3.1%, 71.0% ± 3.8%, and 65.3% ± 6.5%. Compared with survivors, decedents were older, diabetic, had extant coronary artery disease, and were more likely to present with critical limb ischemia as their indication for bypass surgery (P model and produced a final C statistic of 0.82. A risk prediction model including traditional risk factors and parameters of inflammation, renal function, and nutrition had excellent discriminatory ability in predicting all-cause mortality in patients with clinically advanced PAD undergoing bypass surgery. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  17. Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy.

    Science.gov (United States)

    Takagi, Kosei; Yoshida, Ryuichi; Yagi, Takahito; Umeda, Yuzo; Nobuoka, Daisuke; Kuise, Takashi; Fujiwara, Toshiyoshi

    2017-05-26

    Recently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative outcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes following pancreaticoduodenectomy (PD). We performed a retrospective study of consecutive patients (n = 219) who underwent PD at our institution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed tomography. We evaluated postoperative outcomes and the influence of sarcopenia on short-term outcomes, especially infectious complications. Subsequently, multivariate analysis was used to assess the impact of prognostic factors (including sarcopenia) on postoperative infections. The mortality, major complication, and infectious complication rates for all patients were 1.4%, 16.4%, and 47.0%, respectively. Fifty-five patients met the criteria for sarcopenia. Sarcopenia was significantly associated with a higher incidence of in-hospital mortality (P = 0.004) and infectious complications (P sarcopenia (odds ratio = 3.43; P Sarcopenia is an independent preoperative predictor of infectious complications after PD. Clinical assessment combined with sarcopenia may be helpful for understanding the risk of postoperative outcomes and determining perioperative management strategies.

  18. Aortic stiffness and diameter predict progressive aortic dilatation in patients with Marfan syndrome

    NARCIS (Netherlands)

    Nollen, Gijs J.; Groenink, Maarten; Tijssen, Jan G. P.; van der Wall, Ernst E.; Mulder, Barbara J. M.

    2004-01-01

    Aim Patients with Marfan syndrome may develop dissection due to progressive dilatation in the entire aorta, which is not always predictable by mere anatomic assessment of the aortic diameter, especially of the descending aorta. The aim of this study was to identify the predictive value of aortic

  19. Transient elastography for predicting liver-related events in cirrhotic HIV-infected patients

    OpenAIRE

    Montes-Ramírez, M. L.; Berenguer, Juan; Miró, J. M.; Quereda, Carmen; Hernando Jeréz, María Asunción; Sanz, J.; Ortega, E.; Tural, Cristina; Wichmann, M. A.; Zamora, F. X.; González García, J. J.

    2017-01-01

    We assessed liver stiffness measurement (LSM) for the prediction of mortality and decompensation in HIVinfected patients with compensated liver cirrhosis. A prospective cohort study of HIV-infected patients with confirmed liver cirrhosis from 9 hospitals in Spain. LSM was undertaken for each patient; clinical events were collected prospectively after the baseline visit, and patients were followed until death or the censoring date. We used univariate/multivariate Cox proportional haz...

  20. Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study

    OpenAIRE

    Ubbink, Dirk T; Lindeboom, Robert; Eskes, Anne M; Brull, Huub; Legemate, Dink A; Vermeulen, Hester

    2015-01-01

    It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We developed a model to detect which factors can predict (prolonged) healing of complex acute wounds in patients treated in a large wound expertise centre (WEC). Using Cox and linear regression analyses, we ...

  1. Predictive factors for moderate or severe exacerbations in asthma patients receiving outpatient care

    OpenAIRE

    Guti?rrez, Francisco Javier ?lvarez; Galv?n, Marta Ferrer; Gallardo, Juan Francisco Medina; Mancera, Marta Barrera; Romero, Beatriz Romero; Falc?n, Auxiliadora Romero

    2017-01-01

    Background Asthma exacerbations are important events that affect disease control, but predictive factors for severe or moderate exacerbations are not known. The objective was to study the predictive factors for moderate (ME) and severe (SE) exacerbations in asthma patients receiving outpatient care. Methods Patients aged?>?12?years with asthma were included in the study and followed-up at 4-monthly intervals over a 12-month period. Clinical (severity, level of control, asthma control test [AC...

  2. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia

    OpenAIRE

    Fang, Wen-Feng; Yang, Kuang-Yao; Wu, Chieh-Liang; Yu, Chong-Jen; Chen, Chang-Wen; Tu, Chih-Yen; Lin, Meng-Chih

    2011-01-01

    Introduction Healthcare-associated pneumonia (HCAP) is a relatively new category of pneumonia. It refers to infections that occur prior to hospital admission in patients with specific risk factors following contact or exposure to a healthcare environment. There is currently no scoring index to predict the outcomes of HCAP patients. We applied and compared different community acquired pneumonia (CAP) scoring indices to predict 30-day mortality and 3-day and 14-day intensive care unit (ICU) adm...

  3. Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction.

    Science.gov (United States)

    Martin, Lisa; Watanabe, Sharon; Fainsinger, Robin; Lau, Francis; Ghosh, Sunita; Quan, Hue; Atkins, Marlis; Fassbender, Konrad; Downing, G Michael; Baracos, Vickie

    2010-10-01

    To determine whether elements of a standard nutritional screening assessment are independently prognostic of survival in patients with advanced cancer. A prospective nested cohort of patients with metastatic cancer were accrued from different units of a Regional Palliative Care Program. Patients completed a nutritional screen on admission. Data included age, sex, cancer site, height, weight history, dietary intake, 13 nutrition impact symptoms, and patient- and physician-reported performance status (PS). Univariate and multivariate survival analyses were conducted. Concordance statistics (c-statistics) were used to test the predictive accuracy of models based on training and validation sets; a c-statistic of 0.5 indicates the model predicts the outcome as well as chance; perfect prediction has a c-statistic of 1.0. A training set of patients in palliative home care (n = 1,164) was used to identify prognostic variables. Primary disease site, PS, short-term weight change (either gain or loss), dietary intake, and dysphagia predicted survival in multivariate analysis (P statistics between predicted and observed responses for survival in the training set (0.90) and validation set (0.88; n = 603). The addition of weight change, dietary intake, and dysphagia did not further improve the c-statistic of the model. The c-statistic was also not altered by substituting physician-rated palliative PS for patient-reported PS. We demonstrate a high probability of concordance between predicted and observed survival for patients in distinct palliative care settings (home care, tertiary inpatient, ambulatory outpatient) based on patient-reported information.

  4. LSSVM-Based Rock Failure Criterion and Its Application in Numerical Simulation

    Directory of Open Access Journals (Sweden)

    Changxing Zhu

    2015-01-01

    Full Text Available A rock failure criterion is very important for the prediction of the failure of rocks or rock masses in rock mechanics and engineering. Least squares support vector machines (LSSVM are a powerful tool for addressing complex nonlinear problems. This paper describes a LSSVM-based rock failure criterion for analyzing the deformation of a circular tunnel under different in situ stresses without assuming a function form. First, LSSVM was used to represent the nonlinear relationship between the mechanical properties of rock and the failure behavior of the rock in order to construct a rock failure criterion based on experimental data. Then, this was used in a hypothetical numerical analysis of a circular tunnel to analyze the mechanical behavior of the rock mass surrounding the tunnel. The Mohr-Coulomb and Hoek-Brown failure criteria were also used to analyze the same case, and the results were compared; these clearly indicate that LSSVM can be used to establish a rock failure criterion and to predict the failure of a rock mass during excavation of a circular tunnel.

  5. MTR-18 Predictive Biomarkers Of Bevacizumab Response In Recurrent Glioblastoma Patients

    DEFF Research Database (Denmark)

    Urup, Thomas; Michaelsen, Signe Regner; Olsen, Lars Rønn

    2015-01-01

    Bevacizumab (BEV) plus chemotherapy has shown activity in recurrent glioblastoma (GBM). However, the prognosis varies and only one third of patients have a durable clinical response to BEV combination therapy. Recent findings from a randomized phase-3 study (AVAglio) indicate that patients...... with the proneural GBM subtype have a survival benefit when treated with BEV in combination with standard treatment. However, no validated biomarkers able to predict BEV response have been identified and the biology reflecting a clinical BEV response is poorly understood. The primary objective of this study...... was to evaluate the predictive and prognostic value of GBM subtypes in recurrent GBM patients treated with BEV therapy. The secondary objective was to identify biomarkers able to predict response to BEV therapy in recurrent GBM patients. METHODS: A total of 90 recurrent GBM patients treated with BEV combination...

  6. Clinical models are inaccurate in predicting bile duct stones in situ for patients with gallbladder.

    Science.gov (United States)

    Topal, B; Fieuws, S; Tomczyk, K; Aerts, R; Van Steenbergen, W; Verslype, C; Penninckx, F

    2009-01-01

    The probability that a patient has common bile duct stones (CBDS) is a key factor in determining diagnostic and treatment strategies. This prospective cohort study evaluated the accuracy of clinical models in predicting CBDS for patients who will undergo cholecystectomy for lithiasis. From October 2005 until September 2006, 335 consecutive patients with symptoms of gallstone disease underwent cholecystectomy. Statistical analysis was performed on prospective patient data obtained at the time of first presentation to the hospital. Demonstrable CBDS at the time of endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography (IOC) was considered the gold standard for the presence of CBDS. Common bile duct stones were demonstrated in 53 patients. For 35 patients, ERCP was performed, with successful stone clearance in 24 of 30 patients who had proven CBDS. In 29 patients, IOC showed CBDS, which were managed successfully via laparoscopic common bile duct exploration, with stone extraction at the time of cholecystectomy. Prospective validation of the existing model for CBDS resulted in a predictive accuracy rate of 73%. The new model showed a predictive accuracy rate of 79%. Clinical models are inaccurate in predicting CBDS in patients with cholelithiasis. Management strategies should be based on the local availability of therapeutic expertise.

  7. Prediction of survival in patients with Stage IV kidney cancer

    Directory of Open Access Journals (Sweden)

    L. V. Mirilenko

    2015-01-01

    Full Text Available The efficiency of treatment was evaluated and the predictors of adjusted survival (AS were identified in patients with disseminated kidney cancer treated at the Republican Research and Practical Center for Oncology and Medical Radiology in 1999 to 2011 (A.E. Okeanov, P.I. Moiseev, L.F. Levin. Malignant tumors in Belarus, 2001–2012. Edited by O.G. Sukonko. Seven factors (regional lymph node metastases; distant bone metastases; a high-grade tumor; sarcomatous tumor differentiation; hemoglobin levels of < 125 g/l in women and < 150 g/l in men; an erythrocyte sedimentation rate of 40 mm/h; palliative surgery were found to have an independent, unfavorable impact on AS. A multidimensional model was built to define what risk group low (no more than 2 poor factors, moderate (3–4 poor factors, and high (more than 4 poor factors the patients with Stage IV kidney cancer belonged to. In these groups, the median survival was 34.7, 17.2, and 4.0 months and 3-year AS rates were 48.6, 24.6, and 3.2 %, respectively. 

  8. Suboptimal Criterion Learning in Static and Dynamic Environments.

    Directory of Open Access Journals (Sweden)

    Elyse H Norton

    2017-01-01

    Full Text Available Humans often make decisions based on uncertain sensory information. Signal detection theory (SDT describes detection and discrimination decisions as a comparison of stimulus "strength" to a fixed decision criterion. However, recent research suggests that current responses depend on the recent history of stimuli and previous responses, suggesting that the decision criterion is updated trial-by-trial. The mechanisms underpinning criterion setting remain unknown. Here, we examine how observers learn to set a decision criterion in an orientation-discrimination task under both static and dynamic conditions. To investigate mechanisms underlying trial-by-trial criterion placement, we introduce a novel task in which participants explicitly set the criterion, and compare it to a more traditional discrimination task, allowing us to model this explicit indication of criterion dynamics. In each task, stimuli were ellipses with principal orientations drawn from two categories: Gaussian distributions with different means and equal variance. In the covert-criterion task, observers categorized a displayed ellipse. In the overt-criterion task, observers adjusted the orientation of a line that served as the discrimination criterion for a subsequently presented ellipse. We compared performance to the ideal Bayesian learner and several suboptimal models that varied in both computational and memory demands. Under static and dynamic conditions, we found that, in both tasks, observers used suboptimal learning rules. In most conditions, a model in which the recent history of past samples determines a belief about category means fit the data best for most observers and on average. Our results reveal dynamic adjustment of discrimination criterion, even after prolonged training, and indicate how decision criteria are updated over time.

  9. A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis.

    Science.gov (United States)

    Xu, Duo; Zhao, Ruo-Chi; Gao, Wen-Hui; Cui, Han-Bin

    2017-04-05

    Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model. A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model. The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = -7.34 + 2.99 × [Ccr model demonstrated that a Ccr prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with

  10. Predictive Factors of Anxiety and Depression in Patients with Acute Coronary Syndrome.

    Science.gov (United States)

    Altino, Denise Meira; Nogueira-Martins, Luiz Antônio; de Barros, Alba Lucia Bottura Leite; Lopes, Juliana de Lima

    2017-12-01

    To identify the predictive factors of anxiety and depression in patients with acute coronary syndrome. Cross-sectional and retrospective study conducted with 120 patients hospitalized with acute coronary syndrome. Factors interfering with anxiety and depression were assessed. Anxiety was related to sex, stress, years of education, and depression, while depression was related to sex, diabetes mellitus, obesity, years of education, and trait-anxiety. Obesity and anxiety were considered predictive factors for depression, while depression and fewer years of education were considered predictive factors for anxiety. Copyright © 2017. Published by Elsevier Inc.

  11. A priori Prediction of Neoadjuvant Chemotherapy Response and Survival in Breast Cancer Patients using Quantitative Ultrasound.

    Science.gov (United States)

    Tadayyon, Hadi; Sannachi, Lakshmanan; Gangeh, Mehrdad J; Kim, Christina; Ghandi, Sonal; Trudeau, Maureen; Pritchard, Kathleen; Tran, William T; Slodkowska, Elzbieta; Sadeghi-Naini, Ali; Czarnota, Gregory J

    2017-04-12

    Quantitative ultrasound (QUS) can probe tissue structure and analyze tumour characteristics. Using a 6-MHz ultrasound system, radiofrequency data were acquired from 56 locally advanced breast cancer patients prior to their neoadjuvant chemotherapy (NAC) and QUS texture features were computed from regions of interest in tumour cores and their margins as potential predictive and prognostic indicators. Breast tumour molecular features were also collected and used for analysis. A multiparametric QUS model was constructed, which demonstrated a response prediction accuracy of 88% and ability to predict patient 5-year survival rates (p = 0.01). QUS features demonstrated superior performance in comparison to molecular markers and the combination of QUS and molecular markers did not improve response prediction. This study demonstrates, for the first time, that non-invasive QUS features in the core and margin of breast tumours can indicate breast cancer response to neoadjuvant chemotherapy (NAC) and predict five-year recurrence-free survival.

  12. Prediction and observation of post-admission hematoma expansion in patients with intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Ovesen, Christian; Havsteen, Inger; Rosenbaum, Sverre

    2014-01-01

    within the hematoma along with the hematoma-size is reported to be predictive of hematoma expansion and outcome. Because patients tend to arrive earlier to the hospital, a larger fraction of acute ICH-patients must be expected to undergo hematoma expansion. This renders observation and radiological......Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review...... radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24 h after symptom onset, but predominantly occurs in the early hours. Thus capturing markers of on-going bleeding on imaging techniques could predict hematoma expansion...

  13. The Concept of Performance Levels in Criterion-Referenced Assessment.

    Science.gov (United States)

    Hewitson, Mal

    The concept of performance levels in criterion-referenced assessment is explored by applying the idea to different types of tests commonly used in schools, mastery tests (including diagnostic tests) and achievement tests. In mastery tests, a threshold performance standard must be established for each criterion. Attainment of this threshold…

  14. Re-Evaluation of Acid-Base Prediction Rules in Patients with Chronic Respiratory Acidosis

    Directory of Open Access Journals (Sweden)

    Tereza Martinu

    2003-01-01

    Full Text Available RATIONALE: The prediction rules for the evaluation of the acid-base status in patients with chronic respiratory acidosis, derived primarily from an experimental canine model, suggest that complete compensation should not occur. This appears to contradict frequent observations of normal or near-normal pH levels in patients with chronic hypercapnia.

  15. Correlation between predicted and actual consequences of capsule endoscopy on patient management

    NARCIS (Netherlands)

    Westerhof, J.; Weersma, R. K.; Thijs, W. J.; Limburg, A. J.; Koornstra, J. J.; de Graaf, A.P.

    Background. Capsule endoscopy (CE) is a relatively new diagnostic modality in the evaluation of patients with suspected small bowel pathology. It is unclear to what extent physicians are able to predict the clinical consequences of CE on patient management. Methods. In this prospective study, 180

  16. Prognostic and predictive value of cathepsin X in serum from colorectal cancer patients

    DEFF Research Database (Denmark)

    Vižin, Tjaša; Christensen, Ib Jarle; Wilhelmsen, Michael

    2014-01-01

    , but for patients in stages I-III with local resectable disease. The significant association of cathepsin X with survival in a group of patients who received no chemotherapy and the absence of this association in the group who received chemotherapy, suggest the possible predictive value for response to chemotherapy...

  17. Prediction of BRCA1 status in patients with breast cancer using estrogen receptor and basal phenotype

    NARCIS (Netherlands)

    Lakhani, Sunil R.; Reis-Filho, Jorge S.; Fulford, Laura; Penault-Llorca, Frederique; van der Vijver, Marc; Parry, Suzanne; Bishop, Timothy; Benitez, Javier; Rivas, Carmen; Bignon, Yves-Jean; Chang-Claude, Jenny; Hamann, Ute; Cornelisse, Cees J.; Devilee, Peter; Beckmann, Matthias W.; Nestle-Krämling, Carolin; Daly, Peter A.; Haites, Neva; Varley, Jenny; Lalloo, Fiona; Evans, Gareth; Maugard, Christine; Meijers-Heijboer, Hanne; Klijn, Jan G. M.; Olah, Edith; Gusterson, Barry A.; Pilotti, Silvana; Radice, Paolo; Scherneck, Siegfried; Sobol, Hagay; Jacquemier, Jocelyne; Wagner, Teresa; Peto, Julian; Stratton, Michael R.; McGuffog, Lesley; Easton, Douglas F.

    2005-01-01

    To investigate the proportion of breast cancers arising in patients with germ line BRCA1 and BRCA2 mutations expressing basal markers and developing predictive tests for identification of high-risk patients. Histopathologic material from 182 tumors in BRCA1 mutation carriers, 63 BRCA2 carriers, and

  18. Can the outcome of pelvic-floor rehabilitation in patients with fecal incontinence be predicted?

    NARCIS (Netherlands)

    M.P. Terra (Maaike); M. Deutekom (Marije); A.C. Dobben (Annette); C.G.M.I. Baeten; L.W.M. Janssen (Lucas); G.E. Boeckxstaens (Guy); A.F. Engel (Alexander); R.J.F. Felt-Bersma; J.F.W. Slors; M.F. Gerhards (Michael); A.B. Bijnen (Bart); E. Everhardt; W.R. Schouten (Ruud); B. Berghmans; P.M.M. Bossuyt (Patrick); J. Stoker (Jacob)

    2008-01-01

    textabstractPurpose: Pelvic-floor rehabilitation does not provide the same degree of relief in all fecal incontinent patients. We aimed at studying prospectively the ability of tests to predict the outcome of pelvic-floor rehabilitation in patients with fecal incontinence. Materials and methods: Two

  19. Myeloperoxidase levels predicts angiographic severity of coronary artery disease in patients with chronic stable angina

    Directory of Open Access Journals (Sweden)

    Mehdi Baseri

    2014-01-01

    Conclusions: Our findings indicated that the plasma MPO levels increase in patients with stable CAD and hence that, it can be used as adiagnostic factor to predict the coronary artery atherosclerosis severity in stable CAD patients; However, it needs further widespread investigations to achieve an accurate cut point.

  20. Predictive validity of proposed remission criteria in first-episode schizophrenic patients responding to antipsychotics

    NARCIS (Netherlands)

    Wunderink, Lex; Nienhuis, Fokko J.; Sytema, Sjoerd; Wiersma, Durk

    The objective of this study was to examine the predictive validity of the remission criteria proposed by Andreasen et all in first-episode patients responding to antipsychotics. Antipsychotic responsive patients with first-episode schizophrenia showing symptom remission (n = 60) were compared with

  1. SOX9 Expression Predicts Relapse of Stage II Colon Cancer Patients

    DEFF Research Database (Denmark)

    Espersen, Maiken Lise Marcker; Linnemann, Dorte; Christensen, Ib Jarle

    2016-01-01

    The aim of this study was to investigate if the protein expression of Sex-determining region y-box 9 (SOX9) in primary tumors could predict relapse of stage II colon cancer patients.144 patients with stage II primary colon cancer were retrospectively enrolledin the study. SOX9 expression...

  2. Development of a Decision Support System to Predict Physicians' Rehabilitation Protocols for Patients with Knee Osteoarthritis

    Science.gov (United States)

    Hawamdeh, Ziad M.; Alshraideh, Mohammad A.; Al-Ajlouni, Jihad M.; Salah, Imad K.; Holm, Margo B.; Otom, Ali H.

    2012-01-01

    To design a medical decision support system (MDSS) that would accurately predict the rehabilitation protocols prescribed by the physicians for patients with knee osteoarthritis (OA) using only their demographic and clinical characteristics. The demographic and clinical variables for 170 patients receiving one of three treatment protocols for knee…

  3. Can Predictive Modeling Identify Head and Neck Oncology Patients at Risk for Readmission?

    Science.gov (United States)

    Manning, Amy M; Casper, Keith A; Peter, Kay St; Wilson, Keith M; Mark, Jonathan R; Collar, Ryan M

    2018-05-01

    Objective Unplanned readmission within 30 days is a contributor to health care costs in the United States. The use of predictive modeling during hospitalization to identify patients at risk for readmission offers a novel approach to quality improvement and cost reduction. Study Design Two-phase study including retrospective analysis of prospectively collected data followed by prospective longitudinal study. Setting Tertiary academic medical center. Subjects and Methods Prospectively collected data for patients undergoing surgical treatment for head and neck cancer from January 2013 to January 2015 were used to build predictive models for readmission within 30 days of discharge using logistic regression, classification and regression tree (CART) analysis, and random forests. One model (logistic regression) was then placed prospectively into the discharge workflow from March 2016 to May 2016 to determine the model's ability to predict which patients would be readmitted within 30 days. Results In total, 174 admissions had descriptive data. Thirty-two were excluded due to incomplete data. Logistic regression, CART, and random forest predictive models were constructed using the remaining 142 admissions. When applied to 106 consecutive prospective head and neck oncology patients at the time of discharge, the logistic regression model predicted readmissions with a specificity of 94%, a sensitivity of 47%, a negative predictive value of 90%, and a positive predictive value of 62% (odds ratio, 14.9; 95% confidence interval, 4.02-55.45). Conclusion Prospectively collected head and neck cancer databases can be used to develop predictive models that can accurately predict which patients will be readmitted. This offers valuable support for quality improvement initiatives and readmission-related cost reduction in head and neck cancer care.

  4. Predicted risks of radiogenic cardiac toxicity in two pediatric patients undergoing photon or proton radiotherapy

    International Nuclear Information System (INIS)

    Zhang, Rui; Howell, Rebecca M; Homann, Kenneth; Giebeler, Annelise; Taddei, Phillip J; Mahajan, Anita; Newhauser, Wayne D

    2013-01-01

    Hodgkin disease (HD) and medulloblastoma (MB) are common malignancies found in children and young adults, and radiotherapy is part of the standard treatment. It was reported that these patients who received radiation therapy have an increased risk of cardiovascular late effects. We compared the predicted risk of developing radiogenic cardiac toxicity after photon versus proton radiotherapies for a pediatric patient with HD and a pediatric patient with MB. In the treatment plans, each patient’s heart was contoured in fine detail, including substructures of the pericardium and myocardium. Risk calculations took into account both therapeutic and stray radiation doses. We calculated the relative risk (RR) of cardiac toxicity using a linear risk model and the normal tissue complication probability (NTCP) values using relative seriality and Lyman models. Uncertainty analyses were also performed. The RR values of cardiac toxicity for the HD patient were 7.27 (proton) and 8.37 (photon), respectively; the RR values for the MB patient were 1.28 (proton) and 8.39 (photon), respectively. The predicted NTCP values for the HD patient were 2.17% (proton) and 2.67% (photon) for the myocardium, and were 2.11% (proton) and 1.92% (photon) for the whole heart. The predicted ratios of NTCP values (proton/photon) for the MB patient were much less than unity. Uncertainty analyses revealed that the predicted ratio of risk between proton and photon therapies was sensitive to uncertainties in the NTCP model parameters and the mean radiation weighting factor for neutrons, but was not sensitive to heart structure contours. The qualitative findings of the study were not sensitive to uncertainties in these factors. We conclude that proton and photon radiotherapies confer similar predicted risks of cardiac toxicity for the HD patient in this study, and that proton therapy reduced the predicted risk for the MB patient in this study

  5. Emotional exhaustion and workload predict clinician-rated and objective patient safety

    Science.gov (United States)

    Welp, Annalena; Meier, Laurenz L.; Manser, Tanja

    2015-01-01

    Aims: To investigate the role of clinician burnout, demographic, and organizational characteristics in predicting subjective and objective indicators of patient safety. Background: Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables, and objective patient safety indicators is poorly understood. The present study addresses this gap. Method: Participants were 1425 physicians and nurses working in intensive care. Regression analysis (multilevel) was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience) and organizational (e.g., workload, predictability) characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. Results: Clinician-rated patient safety was associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios. Conclusion: At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables and support to the development of managerial guidelines to ensure clinicians’ psychological health and patients’ safety. PMID:25657627

  6. Prediction of morbidity and mortality in patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Brian J. Wells

    2013-06-01

    Full Text Available Introduction. The objective of this study was to create a tool that accurately predicts the risk of morbidity and mortality in patients with type 2 diabetes according to an oral hypoglycemic agent.Materials and Methods. The model was based on a cohort of 33,067 patients with type 2 diabetes who were prescribed a single oral hypoglycemic agent at the Cleveland Clinic between 1998 and 2006. Competing risk regression models were created for coronary heart disease (CHD, heart failure, and stroke, while a Cox regression model was created for mortality. Propensity scores were used to account for possible treatment bias. A prediction tool was created and internally validated using tenfold cross-validation. The results were compared to a Framingham model and a model based on the United Kingdom Prospective Diabetes Study (UKPDS for CHD and stroke, respectively.Results and Discussion. Median follow-up for the mortality outcome was 769 days. The numbers of patients experiencing events were as follows: CHD (3062, heart failure (1408, stroke (1451, and mortality (3661. The prediction tools demonstrated the following concordance indices (c-statistics for the specific outcomes: CHD (0.730, heart failure (0.753, stroke (0.688, and mortality (0.719. The prediction tool was superior to the Framingham model at predicting CHD and was at least as accurate as the UKPDS model at predicting stroke.Conclusions. We created an accurate tool for predicting the risk of stroke, coronary heart disease, heart failure, and death in patients with type 2 diabetes. The calculator is available online at http://rcalc.ccf.org under the heading “Type 2 Diabetes” and entitled, “Predicting 5-Year Morbidity and Mortality.” This may be a valuable tool to aid the clinician’s choice of an oral hypoglycemic, to better inform patients, and to motivate dialogue between physician and patient.

  7. Emotional Exhaustion and Workload Predict Clinician-Rated and Objective Patient Safety

    Directory of Open Access Journals (Sweden)

    Annalena eWelp

    2015-01-01

    Full Text Available Aims: To investigate the role of clinician burnout, demographic and organizational characteristics in predicting subjective and objective indicators of patient safety. Background: Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables and objective patient safety indicators is poorly understood. The present study addresses this gap. Method: Participants were 1425 physicians and nurses working in intensive care. (Multilevel regression analysis was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience and organizational (e.g., workload, predictability characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. Results: Clinician-rated patient safety were associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios.Conclusion: At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables or and support the development of managerial guidelines to ensure clinicians’ psychological health and patients’ safety.

  8. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

    Science.gov (United States)

    Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

    2015-01-01

    Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

  9. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

    Science.gov (United States)

    Hung, Man; Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

    2015-01-01

    Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

  10. Black Hole Sign: Novel Imaging Marker That Predicts Hematoma Growth in Patients With Intracerebral Hemorrhage.

    Science.gov (United States)

    Li, Qi; Zhang, Gang; Xiong, Xin; Wang, Xing-Chen; Yang, Wen-Song; Li, Ke-Wei; Wei, Xiao; Xie, Peng

    2016-07-01

    Early hematoma growth is a devastating neurological complication after intracerebral hemorrhage. We aim to report and evaluate the usefulness of computed tomography (CT) black hole sign in predicting hematoma growth in patients with intracerebral hemorrhage. Patients with intracerebral hemorrhage were screened for the presence of CT black hole sign on admission head CT performed within 6 hours after onset of symptoms. The black hole sign was defined as hypoattenuatting area encapsulated within the hyperattenuating hematoma with a clearly defined border. The sensitivity, specificity, and positive and negative predictive values of CT black hole sign in predicting hematoma expansion were calculated. Logistic regression analyses were used to assess the presence of the black hole sign and early hematoma growth. A total of 206 patients were enrolled. Black hole sign was found in 30 (14.6%) of 206 patients on the baseline CT scan. The black hole sign was more common in patients with hematoma growth (31.9%) than those without hematoma growth (5.8%; Phole sign in predicting early hematoma growth were 31.9%, 94.1%, 73.3%, and 73.2%, respectively. The time-to-admission CT scan, baseline hematoma volume, and the presence of black hole sign on admission CT independently predict hematoma growth in multivariate model. The CT black hole sign could be used as a simple and easy-to-use predictor for early hematoma growth in patients with intracerebral hemorrhage. © 2016 American Heart Association, Inc.

  11. Modified Schur-Cohn Criterion for Stability of Delayed Systems

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Mulero-Martínez

    2015-01-01

    Full Text Available A modified Schur-Cohn criterion for time-delay linear time-invariant systems is derived. The classical Schur-Cohn criterion has two main drawbacks; namely, (i the dimension of the Schur-Cohn matrix generates some round-off errors eventually resulting in a polynomial of s with erroneous coefficients and (ii imaginary roots are very hard to detect when numerical errors creep in. In contrast to the classical Schur-Cohn criterion an alternative approach is proposed in this paper which is based on the application of triangular matrices over a polynomial ring in a similar way as in the Jury test of stability for discrete systems. The advantages of the proposed approach are that it halves the dimension of the polynomial and it only requires seeking real roots, making this modified criterion comparable to the Rekasius substitution criterion.

  12. A nomogram for predicting survival in patients with breast cancer brain metastasis.

    Science.gov (United States)

    Huang, Zhou; Sun, Bing; Wu, Shikai; Meng, Xiangying; Cong, Yang; Shen, Ge; Song, Santai

    2018-05-01

    Brain metastasis (BM) is common in patients with breast cancer. Predicting patient survival is critical for the clinical management of breast cancer brain metastasis (BCBM). The present study was designed to develop and evaluate a prognostic model for patients with newly diagnosed BCBM. Based on the clinical data of patients with BCBM treated in the Affiliated Hospital of Academy of Military Medical Sciences (Beijing, China) between 2002 and 2014, a nomogram was developed to predict survival using proportional hazards regression analysis. The model was validated internally by bootstrapping, and the concordance index (c-index) was calculated. A calibration curve and c-index were used to evaluate discriminatory and predictive ability, in order to compare the nomogram with widely used models, including recursive partitioning analysis (RPA), graded prognostic assessment (GPA) and breast-graded prognostic assessment (Breast-GPA). A total of 411 patients with BCBM were included in the development of this predictive model. The median overall survival time was 14.1 months. Statistically significant predictors for patient survival included biological subtype, Karnofsky performance score, leptomeningeal metastasis, extracranial metastasis, the number of brain metastases and disease-free survival. A nomogram for predicting 1- and 2-year overall survival rates was constructed, which exhibited good accuracy in predicting overall survival with a concordance index of 0.735. This model outperformed RPA, GPA and Breast-GPA, based on the comparisons of the c-indexes. The nomogram constructed based on a multiple factor analysis was able to more accurately predict the individual survival probability of patients with BCBM, compared with existing models.

  13. Predictive factors for malignancy in incidental pulmonary nodules detected in breast cancer patients at baseline CT

    Energy Technology Data Exchange (ETDEWEB)

    Hammer, Mark M.; Mortani Barbosa, Eduardo J. [University of Pennsylvania, Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, Philadelphia, PA (United States)

    2017-07-15

    Pulmonary nodules are commonly encountered at staging CTs in patients with extrathoracic malignancies, but their significance on a per-patient basis remains uncertain. We undertook a retrospective analysis of pulmonary nodules identified in patients with a diagnosis of breast cancer from 2010 - 2015, evaluating nodules present at a baseline CT (i.e. prevalent nodules). We reviewed 211 patients with 248 individual nodules. The rate of malignancy in prevalent nodules is low, approximately 13 %. Variables associated with metastasis include pleural studding, hilar lymphadenopathy and the presence of extrapulmonary metastasis, as well as number of nodules, nodule size and nodule shape. Using a combination of these factors, we have developed an evidence-based multivariate decision tree to predict which nodules are malignant in these patients, which is 91 % accurate and 100 % sensitive for metastasis. We propose a simplified clinical prediction algorithm to guide radiologists and oncologists in managing patients with breast cancer and incidental pulmonary nodules. (orig.)

  14. Integration of Multi-Modal Biomedical Data to Predict Cancer Grade and Patient Survival.

    Science.gov (United States)

    Phan, John H; Hoffman, Ryan; Kothari, Sonal; Wu, Po-Yen; Wang, May D

    2016-02-01

    The Big Data era in Biomedical research has resulted in large-cohort data repositories such as The Cancer Genome Atlas (TCGA). These repositories routinely contain hundreds of matched patient samples for genomic, proteomic, imaging, and clinical data modalities, enabling holistic and multi-modal integrative analysis of human disease. Using TCGA renal and ovarian cancer data, we conducted a novel investigation of multi-modal data integration by combining histopathological image and RNA-seq data. We compared the performances of two integrative prediction methods: majority vote and stacked generalization. Results indicate that integration of multiple data modalities improves prediction of cancer grade and outcome. Specifically, stacked generalization, a method that integrates multiple data modalities to produce a single prediction result, outperforms both single-data-modality prediction and majority vote. Moreover, stacked generalization reveals the contribution of each data modality (and specific features within each data modality) to the final prediction result and may provide biological insights to explain prediction performance.

  15. What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties.

    Science.gov (United States)

    Matsen, Frederick A; Russ, Stacy M; Vu, Phuong T; Hsu, Jason E; Lucas, Robert M; Comstock, Bryan A

    2016-11-01

    Although shoulder arthroplasties generally are effective in improving patients' comfort and function, the results are variable for reasons that are not well understood. We posed two questions: (1) What factors are associated with better 2-year outcomes after shoulder arthroplasty? (2) What are the sensitivities, specificities, and positive and negative predictive values of a multivariate predictive model for better outcome? Three hundred thirty-nine patients having a shoulder arthroplasty (hemiarthroplasty, arthroplasty for cuff tear arthropathy, ream and run arthroplasty, total shoulder or reverse total shoulder arthroplasty) between August 24, 2010 and December 31, 2012 consented to participate in this prospective study. Two patients were excluded because they were missing baseline variables. Forty-three patients were missing 2-year data. Univariate and multivariate analyses determined the relationship of baseline patient, shoulder, and surgical characteristics to a "better" outcome, defined as an improvement of at least 30% of the maximal possible improvement in the Simple Shoulder Test. The results were used to develop a predictive model, the accuracy of which was tested using a 10-fold cross-validation. After controlling for potentially relevant confounding variables, the multivariate analysis showed that the factors significantly associated with better outcomes were American Society of Anesthesiologists Class I (odds ratio [OR], 1.94; 95% CI, 1.03-3.65; p = 0.041), shoulder problem not related to work (OR, 5.36; 95% CI, 2.15-13.37; p factors listed above. The area under the receiver operating characteristic curve generated from the cross-validated enhanced predictive model was 0.79 (generally values of 0.7 to 0.8 are considered fair and values of 0.8 to 0.9 are considered good). The false-positive fraction and the true-positive fraction depended on the cutoff probability selected (ie, the selected probability above which the prediction would be classified as

  16. Poor caregiver mental health predicts mortality of patients with neurodegenerative disease.

    Science.gov (United States)

    Lwi, Sandy J; Ford, Brett Q; Casey, James J; Miller, Bruce L; Levenson, Robert W

    2017-07-11

    Dementia and other neurodegenerative diseases cause profound declines in functioning; thus, many patients require caregivers for assistance with daily living. Patients differ greatly in how long they live after disease onset, with the nature and severity of the disease playing an important role. Caregiving can also be extremely stressful, and many caregivers experience declines in mental health. In this study, we investigated the role that caregiver mental health plays in patient mortality. In 176 patient-caregiver dyads, we found that worse caregiver mental health predicted greater patient mortality even when accounting for key risk factors in patients (i.e., diagnosis, age, sex, dementia severity, and patient mental health). These findings highlight the importance of caring for caregivers as well as patients when attempting to improve patients' lives.

  17. Demographic Factors and Hospital Size Predict Patient Satisfaction Variance- Implications for Hospital Value-Based Purchasing

    Science.gov (United States)

    McFarland, Daniel C.; Ornstein, Katherine; Holcombe, Randall F.

    2016-01-01

    Background Hospital Value-Based Purchasing (HVBP) incentivizes quality performance based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population dense areas and could bias CMS reimbursement. Objective Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Design Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized four highly predictive variables and hospitals were re-ranked accordingly. Setting 3,907 HVBP-participating hospitals. Patients 934,800 patient surveys, by most conservative estimate. Measurements 3,144 county demographics (U.S. Census), and HCAHPS. Results Hospital size and primary language (‘non-English speaking’) most strongly predicted unfavorable HCAHPS scores while education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals’ locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Conclusions Demographic and structural factors (e.g., hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. PMID:25940305

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

    Science.gov (United States)

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

    2015-01-01

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

  19. [GSH fermentation process modeling using entropy-criterion based RBF neural network model].

    Science.gov (United States)

    Tan, Zuoping; Wang, Shitong; Deng, Zhaohong; Du, Guocheng

    2008-05-01

    The prediction accuracy and generalization of GSH fermentation process modeling are often deteriorated by noise existing in the corresponding experimental data. In order to avoid this problem, we present a novel RBF neural network modeling approach based on entropy criterion. It considers the whole distribution structure of the training data set in the parameter learning process compared with the traditional MSE-criterion based parameter learning, and thus effectively avoids the weak generalization and over-learning. Then the proposed approach is applied to the GSH fermentation process modeling. Our results demonstrate that this proposed method has better prediction accuracy, generalization and robustness such that it offers a potential application merit for the GSH fermentation process modeling.

  20. Hepatic Venous Pressure Gradient Predicts Long-Term Mortality in Patients with Decompensated Cirrhosis

    Science.gov (United States)

    Kim, Tae Yeob; Lee, Jae Gon; Kim, Ji Yeoun; Kim, Sun Min; Kim, Jinoo; Jeong, Woo Kyoung

    2016-01-01

    Purpose The present study aimed to investigate the role of hepatic venous pressure gradient (HVPG) for prediction of long-term mortality in patients with decompensated cirrhosis. Materials and Methods Clinical data from 97 non-critically-ill cirrhotic patients with HVPG measurements were retrospectively and consecutively collected between 2009 and 2012. Patients were classified according to clinical stages and presence of ascites. The prognostic accuracy of HVPG for death, survival curves, and hazard ratios were analyzed. Results During a median follow-up of 24 (interquartile range, 13-36) months, 22 patients (22.7%) died. The area under the receiver operating characteristics curves of HVPG for predicting 1-year, 2-year, and overall mortality were 0.801, 0.737, and 0.687, respectively (all p17 mm Hg, respectively (p=0.015). In the ascites group, the mortality rates at 1 and 2 years were 3.9% and 17.6% with HVPG ≤17 mm Hg and 17.5% and 35.2% with HVPG >17 mm Hg, respectively (p=0.044). Regarding the risk factors for mortality, both HVPG and model for end-stage liver disease were positively related with long-term mortality in all patients. Particularly, for the patients with ascites, both prothrombin time and HVPG were independent risk factors for predicting poor outcomes. Conclusion HVPG is useful for predicting the long-term mortality in patients with decompensated cirrhosis, especially in the presence of ascites. PMID:26632394

  1. Capnography for assessing nocturnal hypoventilation and predicting compliance with subsequent noninvasive ventilation in patients with ALS.

    Directory of Open Access Journals (Sweden)

    Sung-Min Kim

    Full Text Available BACKGROUND: Patients with amyotrophic lateral sclerosis (ALS suffer from hypoventilation, which can easily worsen during sleep. This study evaluated the efficacy of capnography monitoring in patients with ALS for assessing nocturnal hypoventilation and predicting good compliance with subsequent noninvasive ventilation (NIV treatment. METHODS: Nocturnal monitoring and brief wake screening by capnography/pulse oximetry, functional scores, and other respiratory signs were assessed in 26 patients with ALS. Twenty-one of these patients were treated with NIV and had their treatment compliance evaluated. RESULTS: Nocturnal capnography values were reliable and strongly correlated with the patients' respiratory symptoms (R(2 = 0.211-0.305, p = 0.004-0.021. The duration of nocturnal hypercapnea obtained by capnography exhibited a significant predictive power for good compliance with subsequent NIV treatment, with an area-under-the-curve value of 0.846 (p = 0.018. In contrast, no significant predictive values for nocturnal pulse oximetry or functional scores for nocturnal hypoventilation were found. Brief waking supine capnography was also useful as a screening tool before routine nocturnal capnography monitoring. CONCLUSION: Capnography is an efficient tool for assessing nocturnal hypoventilation and predicting good compliance with subsequent NIV treatment of ALS patients, and may prove useful as an adjunctive tool for assessing the need for NIV treatment in these patients.

  2. Early hospital mortality prediction of intensive care unit patients using an ensemble learning approach.

    Science.gov (United States)

    Awad, Aya; Bader-El-Den, Mohamed; McNicholas, James; Briggs, Jim

    2017-12-01

    Mortality prediction of hospitalized patients is an important problem. Over the past few decades, several severity scoring systems and machine learning mortality prediction models have been developed for predicting hospital mortality. By contrast, early mortality prediction for intensive care unit patients remains an open challenge. Most research has focused on severity of illness scoring systems or data mining (DM) models designed for risk estimation at least 24 or 48h after ICU admission. This study highlights the main data challenges in early mortality prediction in ICU patients and introduces a new machine learning based framework for Early Mortality Prediction for Intensive Care Unit patients (EMPICU). The proposed method is evaluated on the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database. Mortality prediction models are developed for patients at the age of 16 or above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU). We employ the ensemble learning Random Forest (RF), the predictive Decision Trees (DT), the probabilistic Naive Bayes (NB) and the rule-based Projective Adaptive Resonance Theory (PART) models. The primary outcome was hospital mortality. The explanatory variables included demographic, physiological, vital signs and laboratory test variables. Performance measures were calculated using cross-validated area under the receiver operating characteristic curve (AUROC) to minimize bias. 11,722 patients with single ICU stays are considered. Only patients at the age of 16 years old and above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU) are considered in this study. The proposed EMPICU framework outperformed standard scoring systems (SOFA, SAPS-I, APACHE-II, NEWS and qSOFA) in terms of AUROC and time (i.e. at 6h compared to 48h or more after admission). The results show that although there are many values missing in the first few hour of ICU admission

  3. Predictive value of stroke discharge diagnoses in the Danish National Patient Register.

    Science.gov (United States)

    Lühdorf, Pernille; Overvad, Kim; Schmidt, Erik B; Johnsen, Søren P; Bach, Flemming W

    2017-08-01

    To determine the positive predictive values for stroke discharge diagnoses, including subarachnoidal haemorrhage, intracerebral haemorrhage and cerebral infarction in the Danish National Patient Register. Participants in the Danish cohort study Diet, Cancer and Health with a stroke discharge diagnosis in the National Patient Register between 1993 and 2009 were identified and their medical records were retrieved for validation of the diagnoses. A total of 3326 records of possible cases of stroke were reviewed. The overall positive predictive value for stroke was 69.3% (95% confidence interval (CI) 67.8-70.9%). The predictive values differed according to hospital characteristics, with the highest predictive value of 87.8% (95% CI 85.5-90.1%) found in departments of neurology and the lowest predictive value of 43.0% (95% CI 37.6-48.5%) found in outpatient clinics. The overall stroke diagnosis in the Danish National Patient Register had a limited predictive value. We therefore recommend the critical use of non-validated register data for research on stroke. The possibility of optimising the predictive values based on more advanced algorithms should be considered.

  4. Multiparametric analysis of magnetic resonance images for glioma grading and patient survival time prediction

    International Nuclear Information System (INIS)

    Garzon, Benjamin; Emblem, Kyrre E.; Mouridsen, Kim; Nedregaard, Baard; Due-Toennessen, Paulina; Nome, Terje; Hald, John K.; Bjoernerud, Atle; Haaberg, Asta K.; Kvinnsland, Yngve

    2011-01-01

    Background. A systematic comparison of magnetic resonance imaging (MRI) options for glioma diagnosis is lacking. Purpose. To investigate multiple MR-derived image features with respect to diagnostic accuracy in tumor grading and survival prediction in glioma patients. Material and Methods. T1 pre- and post-contrast, T2 and dynamic susceptibility contrast scans of 74 glioma patients with histologically confirmed grade were acquired. For each patient, a set of statistical features was obtained from the parametric maps derived from the original images, in a region-of-interest encompassing the tumor volume. A forward stepwise selection procedure was used to find the best combinations of features for grade prediction with a cross-validated logistic model and survival time prediction with a cox proportional-hazards regression. Results. Presence/absence of enhancement paired with kurtosis of the FM (first moment of the first-pass curve) was the feature combination that best predicted tumor grade (grade II vs. grade III-IV; median AUC 0.96), with the main contribution being due to the first of the features. A lower predictive value (median AUC = 0.82) was obtained when grade IV tumors were excluded. Presence/absence of enhancement alone was the best predictor for survival time, and the regression was significant (P < 0.0001). Conclusion. Presence/absence of enhancement, reflecting transendothelial leakage, was the feature with highest predictive value for grade and survival time in glioma patients

  5. Multiparametric analysis of magnetic resonance images for glioma grading and patient survival time prediction

    Energy Technology Data Exchange (ETDEWEB)

    Garzon, Benjamin (Dept. of Circulation and Medical Imaging, NTNU, Trondheim (Norway)), email: benjamin.garzon@ntnu.no; Emblem, Kyrre E. (The Interventional Center, Rikshospitalet, Oslo Univ. Hospital, Oslo (Norway); Dept. of Radiology, MGH-HST AA Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston (United States)); Mouridsen, Kim (Center of Functionally Integrative Neuroscience, Aarhus Univ., Aarhus (Denmark)); Nedregaard, Baard; Due-Toennessen, Paulina; Nome, Terje; Hald, John K. (Dept. of Radiology and Nuclear Medicine, Rikshospitalet, Oslo Univ. Hospital, Oslo (Norway)); Bjoernerud, Atle (The Interventional Center, Rikshospitalet, Oslo Univ. Hospital, Oslo (Norway)); Haaberg, Asta K. (Dept. of Circulation and Medical Imaging, NTNU, Trondheim (Norway); Dept. of Medical Imaging, St Olav' s Hospital, Trondheim (Norway)); Kvinnsland, Yngve (NordicImagingLab, Bergen (Norway))

    2011-11-15

    Background. A systematic comparison of magnetic resonance imaging (MRI) options for glioma diagnosis is lacking. Purpose. To investigate multiple MR-derived image features with respect to diagnostic accuracy in tumor grading and survival prediction in glioma patients. Material and Methods. T1 pre- and post-contrast, T2 and dynamic susceptibility contrast scans of 74 glioma patients with histologically confirmed grade were acquired. For each patient, a set of statistical features was obtained from the parametric maps derived from the original images, in a region-of-interest encompassing the tumor volume. A forward stepwise selection procedure was used to find the best combinations of features for grade prediction with a cross-validated logistic model and survival time prediction with a cox proportional-hazards regression. Results. Presence/absence of enhancement paired with kurtosis of the FM (first moment of the first-pass curve) was the feature combination that best predicted tumor grade (grade II vs. grade III-IV; median AUC 0.96), with the main contribution being due to the first of the features. A lower predictive value (median AUC = 0.82) was obtained when grade IV tumors were excluded. Presence/absence of enhancement alone was the best predictor for survival time, and the regression was significant (P < 0.0001). Conclusion. Presence/absence of enhancement, reflecting transendothelial leakage, was the feature with highest predictive value for grade and survival time in glioma patients

  6. Predicting Outcome in Comatose Patients: The Role of EEG Reactivity to Quantifiable Electrical Stimuli

    Directory of Open Access Journals (Sweden)

    Gang Liu

    2016-01-01

    Full Text Available Objective. To test the value of quantifiable electrical stimuli as a reliable method to assess electroencephalogram reactivity (EEG-R for the early prognostication of outcome in comatose patients. Methods. EEG was recorded in consecutive adults in coma after cardiopulmonary resuscitation (CPR or stroke. EEG-R to standard electrical stimuli was tested. Each patient received a 3-month follow-up by the Glasgow-Pittsburgh cerebral performance categories (CPC or modified Rankin scale (mRS score. Results. Twenty-two patients met the inclusion criteria. In the CPR group, 6 of 7 patients with EEG-R had good outcomes (positive predictive value (PPV, 85.7% and 4 of 5 patients without EEG-R had poor outcomes (negative predictive value (NPV, 80%. The sensitivity and specificity were 85.7% and 80%, respectively. In the stroke group, 6 of 7 patients with EEG-R had good outcomes (PPV, 85.7%; all of the 3 patients without EEG-R had poor outcomes (NPV, 100%. The sensitivity and specificity were 100% and 75%, respectively. Of all patients, the presence of EEG-R showed 92.3% sensitivity, 77.7% specificity, 85.7% PPV, and 87.5% NPV. Conclusion. EEG-R to quantifiable electrical stimuli might be a good positive predictive factor for the prognosis of outcome in comatose patients after CPR or stroke.

  7. Development of Multivariable Models to Predict and Benchmark Transfusion in Elective Surgery Supporting Patient Blood Management.

    Science.gov (United States)

    Hayn, Dieter; Kreiner, Karl; Ebner, Hubert; Kastner, Peter; Breznik, Nada; Rzepka, Angelika; Hofmann, Axel; Gombotz, Hans; Schreier, Günter

    2017-06-14

    Blood transfusion is a highly prevalent procedure in hospitalized patients and in some clinical scenarios it has lifesaving potential. However, in most cases transfusion is administered to hemodynamically stable patients with no benefit, but increased odds of adverse patient outcomes and substantial direct and indirect cost. Therefore, the concept of Patient Blood Management has increasingly gained importance to pre-empt and reduce transfusion and to identify the optimal transfusion volume for an individual patient when transfusion is indicated. It was our aim to describe, how predictive modeling and machine learning tools applied on pre-operative data can be used to predict the amount of red blood cells to be transfused during surgery and to prospectively optimize blood ordering schedules. In addition, the data derived from the predictive models should be used to benchmark different hospitals concerning their blood transfusion patterns. 6,530 case records obtained for elective surgeries from 16 centers taking part in two studies conducted in 2004-2005 and 2009-2010 were analyzed. Transfused red blood cell volume was predicted using random forests. Separate models were trained for overall data, for each center and for each of the two studies. Important characteristics of different models were compared with one another. Our results indicate that predictive modeling applied prior surgery can predict the transfused volume of red blood cells more accurately (correlation coefficient cc = 0.61) than state of the art algorithms (cc = 0.39). We found significantly different patterns of feature importance a) in different hospitals and b) between study 1 and study 2. We conclude that predictive modeling can be used to benchmark the importance of different features on the models derived with data from different hospitals. This might help to optimize crucial processes in a specific hospital, even in other scenarios beyond Patient Blood Management.

  8. Methodological Challenges in Examining the Impact of Healthcare Predictive Analytics on Nursing-Sensitive Patient Outcomes.

    Science.gov (United States)

    Jeffery, Alvin D

    2015-06-01

    The expansion of real-time analytic abilities within current electronic health records has led to innovations in predictive modeling and clinical decision support systems. However, the ability of these systems to influence patient outcomes is currently unknown. Even though nurses are the largest profession within the healthcare workforce, little research has been performed to explore the impact of clinical decision support on their decisions and the patient outcomes associated with them. A scoping literature review explored the impact clinical decision support systems containing healthcare predictive analytics have on four nursing-sensitive patient outcomes (pressure ulcers, failure to rescue, falls, and infections). While many articles discussed variable selection and predictive model development/validation, only four articles examined the impact on patient outcomes. The novelty of predictive analytics and the inherent methodological challenges in studying clinical decision support impact are likely responsible for this paucity of literature. Major methodological challenges include (1) multilevel nature of intervention, (2) treatment fidelity, and (3) adequacy of clinicians' subsequent behavior. There is currently insufficient evidence to demonstrate efficacy of healthcare predictive analytics-enhanced clinical decision support systems on nursing-sensitive patient outcomes. Innovative research methods and a greater emphasis on studying this phenomenon are needed.

  9. Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

    Science.gov (United States)

    Ovesen, Christian; Havsteen, Inger; Rosenbaum, Sverre; Christensen, Hanne

    2014-01-01

    Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24 h after symptom onset, but predominantly occurs in the early hours. Thus capturing markers of on-going bleeding on imaging techniques could predict hematoma expansion. The spot sign observed on computed tomography angiography is believed to represent on-going bleeding and is to date the most well investigated and reliable radiological predictor of hematoma expansion as well as functional outcome and mortality. On non-contrast CT, the presence of foci of hypoattenuation within the hematoma along with the hematoma-size is reported to be predictive of hematoma expansion and outcome. Because patients tend to arrive earlier to the hospital, a larger fraction of acute ICH-patients must be expected to undergo hematoma expansion. This renders observation and radiological follow-up investigations increasingly relevant. Transcranial duplex sonography has in recent years proven to be able to estimate hematoma volume with good precision and could be a valuable tool in bedside serial observation of acute ICH-patients. Future studies will elucidate, if better prediction and observation of post-admission hematoma expansion can help select patients, who will benefit from hemostatic treatment. PMID:25324825

  10. Predicting early cognitive decline in newly-diagnosed Parkinson's patients: A practical model.

    Science.gov (United States)

    Hogue, Olivia; Fernandez, Hubert H; Floden, Darlene P

    2018-06-19

    To create a multivariable model to predict early cognitive decline among de novo patients with Parkinson's disease, using brief, inexpensive assessments that are easily incorporated into clinical flow. Data for 351 drug-naïve patients diagnosed with idiopathic Parkinson's disease were obtained from the Parkinson's Progression Markers Initiative. Baseline demographic, disease history, motor, and non-motor features were considered as candidate predictors. Best subsets selection was used to determine the multivariable baseline symptom profile that most accurately predicted individual cognitive decline within three years. Eleven per cent of the sample experienced cognitive decline. The final logistic regression model predicting decline included five baseline variables: verbal memory retention, right-sided bradykinesia, years of education, subjective report of cognitive impairment, and REM behavior disorder. Model discrimination was good (optimism-adjusted concordance index = .749). The associated nomogram provides a tool to determine individual patient risk of meaningful cognitive change in the early stages of the disease. Through the consideration of easily-implemented or routinely-gathered assessments, we have identified a multidimensional baseline profile and created a convenient, inexpensive tool to predict cognitive decline in the earliest stages of Parkinson's disease. The use of this tool would generate prediction at the individual level, allowing clinicians to tailor medical management for each patient and identify at-risk patients for clinical trials aimed at disease modifying therapies. Copyright © 2018. Published by Elsevier Ltd.

  11. Factors Predicting Treatment Failure in Patients Treated with Iodine-131 for Graves’ Disease

    International Nuclear Information System (INIS)

    Manohar, Kuruva; Mittal, Bhagwant Rai; Bhoil, Amit; Bhattacharya, Anish; Dutta, Pinaki; Bhansali, Anil

    2013-01-01

    Treatment of Graves' disease with iodine-131 ( 131 I) is well-known; however, all patients do not respond to a single dose of 131 I and may require higher and repeated doses. This study was carried out to identify the factors, which can predict treatment failure to a single dose of 131 I treatment in these patients. Data of 150 patients with Graves' disease treated with 259-370 MBq of 131 I followed-up for at least 1-year were retrospectively analyzed. Logistic regression analysis was used to predict factors which can predict treatment failure, such as age, sex, duration of disease, grade of goiter, duration of treatment with anti-thyroid drugs, mean dosage of anti-thyroid drugs used, 99m Tc-pertechnetate ( 99m TcO 4 - ) uptake at 20 min, dose of 131 I administered, total triiodothyronine and thyroxine levels. Of the 150 patients, 25 patients required retreatment within 1 year of initial treatment with 131 I. Logistic regression analysis revealed that male sex and 99m TcO 4 - uptake were associated with treatment failure. On receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) was significant for 99m TcO 4 - uptake predicting treatment failure (AUC = 0.623; P = 0.039). Optimum cutoff for 99m TcO 4 - uptake was 17.75 with a sensitivity of 68% and specificity of 66% to predict treatment failure. Patients with >17.75% 99m TcO 4 - uptake had odds ratio of 3.14 (P = 0.014) for treatment failure and male patients had odds ratio of 1.783 for treatment failure. Our results suggest that male patients and patients with high pre-treatment 99m TcO 4 - uptake are more likely to require repeated doses of 131 I to achieve complete remission

  12. Western Validation of a Novel Gastric Cancer Prognosis Prediction Model in US Gastric Cancer Patients.

    Science.gov (United States)

    Woo, Yanghee; Goldner, Bryan; Son, Taeil; Song, Kijun; Noh, Sung Hoon; Fong, Yuman; Hyung, Woo Jin

    2018-03-01

    A novel prediction model for accurate determination of 5-year overall survival of gastric cancer patients was developed by an international collaborative group (G6+). This prediction model was created using a single institution's database of 11,851 Korean patients and included readily available and clinically relevant factors. Already validated using external East Asian cohorts, its applicability in the American population was yet to be determined. Using the Surveillance, Epidemiology, and End Results (SEER) dataset, 2014 release, all patients diagnosed with gastric adenocarcinoma who underwent surgical resection between 2002 and 2012, were selected. Characteristics for analysis included: age, sex, depth of tumor invasion, number of positive lymph nodes, total lymph nodes retrieved, presence of distant metastasis, extent of resection, and histology. Concordance index (C-statistic) was assessed using the novel prediction model and compared with the prognostic index, the seventh edition of the TNM staging system. Of the 26,019 gastric cancer patients identified from the SEER database, 15,483 had complete datasets. Validation of the novel prediction tool revealed a C-statistic of 0.762 (95% CI 0.754 to 0.769) compared with the seventh TNM staging model, C-statistic 0.683 (95% CI 0.677 to 0.689), (p prediction model for gastric cancer in the American patient population. Its superior prediction of the 5-year survival of gastric cancer patients in a large Western cohort strongly supports its global applicability. Importantly, this model allows for accurate prognosis for an increasing number of gastric cancer patients worldwide, including those who received inadequate lymphadenectomy or underwent a noncurative resection. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Failure Criterion for Brick Masonry: A Micro-Mechanics Approach

    Directory of Open Access Journals (Sweden)

    Kawa Marek

    2015-02-01

    Full Text Available The paper deals with the formulation of failure criterion for an in-plane loaded masonry. Using micro-mechanics approach the strength estimation for masonry microstructure with constituents obeying the Drucker-Prager criterion is determined numerically. The procedure invokes lower bound analysis: for assumed stress fields constructed within masonry periodic cell critical load is obtained as a solution of constrained optimization problem. The analysis is carried out for many different loading conditions at different orientations of bed joints. The performance of the approach is verified against solutions obtained for corresponding layered and block microstructures, which provides the upper and lower strength bounds for masonry microstructure, respectively. Subsequently, a phenomenological anisotropic strength criterion for masonry microstructure is proposed. The criterion has a form of conjunction of Jaeger critical plane condition and Tsai-Wu criterion. The model proposed is identified based on the fitting of numerical results obtained from the microstructural analysis. Identified criterion is then verified against results obtained for different loading orientations. It appears that strength of masonry microstructure can be satisfactorily described by the criterion proposed.

  14. Stigma Predicts Treatment Preferences and Care Engagement among Veterans Affairs Primary Care Patients with Depression

    Science.gov (United States)

    Campbell, Duncan G.; Bonner, Laura M.; Bolkan, Cory R.; Lanto, Andrew B.; Zivin, Kara; Waltz, Thomas J.; Klap, Ruth; Rubenstein, Lisa V.; Chaney, Edmund F.

    2016-01-01

    Background Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. Purpose To test whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. Methods We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. Results Relative to low stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. Conclusions High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement. PMID:26935310

  15. Classification and regression tree (CART model to predict pulmonary tuberculosis in hospitalized patients

    Directory of Open Access Journals (Sweden)

    Aguiar Fabio S

    2012-08-01

    Full Text Available Abstract Background Tuberculosis (TB remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Methods Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART model was generated and validated. The area under the ROC curve (AUC, sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. Results We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. Conclusions The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with

  16. Differentiation between Superficial and Deep Lobe Parotid Tumors by Magnetic Resonance Imaging: Usefulness of the Parotid Duct Criterion

    International Nuclear Information System (INIS)

    Imaizumi, A.; Kuribayashi, A.; Okochi, K.; Yoshino, N.; Kurabayashi, T.; Ishii, J.; Sumi, Y.

    2009-01-01

    Background: The location of a parotid tumor affects the choice of surgery, and there is a risk of damaging the facial nerve during surgery. Thus, differentiation between superficial and deep lobe parotid tumors is important for appropriate surgical planning. Purpose: To evaluate the usefulness of using the parotid duct, in addition to the retromandibular vein, for differentiating between superficial and deep lobe parotid tumors on MR images. Material and Methods: Magnetic resonance images of 42 parotid tumors in 40 patients were reviewed to determine whether the tumor was located in the superficial or deep lobe. In each case, the retromandibular vein and the parotid duct were used to locate the tumor. The parotid duct was only used in cases where the tumor and the duct were visualized on the same image. Results: Using the retromandibular vein criterion, 71% of deep lobe and 86% of superficial lobe tumors were correctly diagnosed, providing an accuracy of 81%. However, the accuracy achieved when using the parotid duct criterion was 100%, although it could be applied to only 28 of the 42 cases. Based on these results, we defined the following diagnostic method: the parotid duct criterion is first applied, and for cases in which it cannot be applied, the retromandibular vein criterion is used. The accuracy of this method was 88%, which was better than that achieved using the retromandibular vein criterion alone. Conclusion: The parotid duct criterion is useful for determining the location of parotid tumors. Combining the parotid duct criterion with the retromandibular vein criterion might improve the diagnostic accuracy of parotid tumor location compared to using the latter criterion alone

  17. Differentiation between Superficial and Deep Lobe Parotid Tumors by Magnetic Resonance Imaging: Usefulness of the Parotid Duct Criterion

    Energy Technology Data Exchange (ETDEWEB)

    Imaizumi, A.; Kuribayashi, A.; Okochi, K.; Yoshino, N.; Kurabayashi, T. (Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental Univ., Tokyo (Japan)); Ishii, J. (Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental Univ., Tokyo (Japan)); Sumi, Y. (Division of Oral and Dental Surgery, Dept. of Advanced Medicine, National Center for Geriatrics and Gerontology, Aichi (Japan))

    2009-08-15

    Background: The location of a parotid tumor affects the choice of surgery, and there is a risk of damaging the facial nerve during surgery. Thus, differentiation between superficial and deep lobe parotid tumors is important for appropriate surgical planning. Purpose: To evaluate the usefulness of using the parotid duct, in addition to the retromandibular vein, for differentiating between superficial and deep lobe parotid tumors on MR images. Material and Methods: Magnetic resonance images of 42 parotid tumors in 40 patients were reviewed to determine whether the tumor was located in the superficial or deep lobe. In each case, the retromandibular vein and the parotid duct were used to locate the tumor. The parotid duct was only used in cases where the tumor and the duct were visualized on the same image. Results: Using the retromandibular vein criterion, 71% of deep lobe and 86% of superficial lobe tumors were correctly diagnosed, providing an accuracy of 81%. However, the accuracy achieved when using the parotid duct criterion was 100%, although it could be applied to only 28 of the 42 cases. Based on these results, we defined the following diagnostic method: the parotid duct criterion is first applied, and for cases in which it cannot be applied, the retromandibular vein criterion is used. The accuracy of this method was 88%, which was better than that achieved using the retromandibular vein criterion alone. Conclusion: The parotid duct criterion is useful for determining the location of parotid tumors. Combining the parotid duct criterion with the retromandibular vein criterion might improve the diagnostic accuracy of parotid tumor location compared to using the latter criterion alone

  18. Cerebral Oximetry for the Prediction of Neurological Dysfunction in Cardiosurgical Patients

    Directory of Open Access Journals (Sweden)

    A. N. Shepelyuk

    2011-01-01

    Full Text Available Objective: to study the efficiency of intraoperative transeosophageal echocardiography in the detection of indications for and contraindications to early activation in the operating room after myocardial revascularization under extracorporeal circulation. Subject and methods. One hundred and eighty-six patients aged 55.0±0.6 years were examined. A Sonos Agilent 5500 apparatus and a multipurpose Omni-2 transducer were used for ultrasound study. Left ventricular ejection fraction was determined in the four-chamber (Simpson and transgastric views (visualization of the left ventricle in cross-section at the level of the papillary muscles. To identify impaired myocardial contractility hindering immediate activation, the authors analyzed the data of examining 142 patients who might undergo tracheal extubation in the operating room. A decreased left ventricular ejection fraction of less than 50% in the transgastric view was considered to be a contraindication to activation. The sensitivity of echocardiography in the differential diagnosis of acute myocardial infarction _ was studied in 44 patients with echocardiographic signs of acute myocardial ischemic lesion. Results. A left ventricular ejection fraction of less than 50% (41.5±2.2% in the transgastric view was a refusal criterion for immediate patient activation. This group of patients, as compared with those having a left ventricular ejection fraction of 60.1±1.7%, had a longer duration of inotropic therapy (45.2±2.1 and 13±1.1 hrs; p<0.05 and a more prolonged length of postoperative intensive care unit stay (36.2±1.7 and 18.8±0.75 hrs; p<0.05. The correlation coefficient between the left ventricular ejection fraction at the end of surgery and the duration of inotropic therapy was 0.51 (p<0.0001 and that with an intensive care unit stay was 0.48 (p=0.00018. Among the patients with electrocardiographic signs of acute myocardial ischemic lesion, ultrasound study did not confirm the diagnosis

  19. Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder?

    Directory of Open Access Journals (Sweden)

    Jörg Wiltink

    Full Text Available Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT. No study has addressed which patient variables predict outcome of PDT for social anxiety disorder.In the largest multicenter trial on psychotherapy of social anxiety (SA to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems and outcome was analysed using logistic and linear regressions.Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems with a limited proportion of incremental variance (5.5 to 10 percent, while, e.g., shame, self-esteem or harm avoidance did not.We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research.Controlled-trials.com/ISRCTN53517394.

  20. FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients

    Energy Technology Data Exchange (ETDEWEB)

    Brenner, Winfried; Eary, Janet F. [Division of Nuclear Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356113, WA 98195-6113, Seattle (United States); Conrad, Ernest U. [Department of Orthopaedics, University of Washington Medical Center, Seattle, WA (United States)

    2004-02-01

    The aims of this study were to assess the potential of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) for tumor grading in chondrosarcoma patients and to evaluate the role of standardized uptake value (SUV) as a parameter for prediction of patient outcome. FDG PET imaging was performed in 31 patients with chondrosarcoma prior to therapy. SUV was calculated for each tumor and correlated to tumor grade and size, and to patient outcome in terms of local relapse or metastatic disease with a mean follow-up period of 48 months. Chondrosarcomas were detectable in all patients. Tumor SUV was 3.38{+-}1.61 for grade I (n=15), 5.44{+-}3.06 for grade II (n=13), and 7.10{+-}2.61 for grade III (n=3). Significant differences were found between patients with and without disease progression: SUV was 6.42{+-}2.70 (n=10) in patients developing recurrent or metastatic disease compared with 3.74{+-}2.22 in patients without relapse (P=0.015). Using a cut-off of 4 for SUV, sensitivity, specificity, and positive and negative predictive values for a relapse were 90%, 76%, 64%, and 94%, respectively. Combining tumor grade and SUV, these parameters improved to 90%, 95%, 90%, and 95%, respectively. Pretherapeutic tumor SUV obtained by FDG PET imaging was a useful parameter for tumor grading and prediction of outcome in chondrosarcoma patients. The combination of SUV and histopathologic tumor grade further improved prediction of outcome substantially, allowing identification of patients at high risk for local relapse or metastatic disease. (orig.)

  1. Development and validation of a prediction model for loss of physical function in elderly hemodialysis patients.

    Science.gov (United States)

    Fukuma, Shingo; Shimizu, Sayaka; Shintani, Ayumi; Kamitani, Tsukasa; Akizawa, Tadao; Fukuhara, Shunichi

    2017-09-05

    Among aging hemodialysis patients, loss of physical function has become a major issue. We developed and validated a model of predicting loss of physical function among elderly hemodialysis patients. We conducted a cohort study involving maintenance hemodialysis patients  ≥65 years of age from the Dialysis Outcomes and Practice Pattern Study in Japan. The derivation cohort included 593 early phase (1996-2004) patients and the temporal validation cohort included 447 late-phase (2005-12) patients. The main outcome was the incidence of loss of physical function, defined as the 12-item Short Form Health Survey physical function score decreasing to 0 within a year. Using backward stepwise logistic regression by Akaike's Information Criteria, six predictors (age, gender, dementia, mental health, moderate activity and ascending stairs) were selected for the final model. Points were assigned based on the regression coefficients and the total score was calculated by summing the points for each predictor. In total, 65 (11.0%) and 53 (11.9%) hemodialysis patients lost their physical function within 1 year in the derivation and validation cohorts, respectively. This model has good predictive performance quantified by both discrimination and calibration. The proportion of the loss of physical function increased sequentially through low-, middle-, and high-score categories based on the model (2.5%, 11.7% and 22.3% in the validation cohort, respectively). The loss of physical function was strongly associated with 1-year mortality [adjusted odds ratio 2.48 (95% confidence interval 1.26-4.91)]. We developed and validated a risk prediction model with good predictive performance for loss of physical function in elderly hemodialysis patients. Our simple prediction model may help physicians and patients make more informed decisions for healthy longevity. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.

  2. Criterion for testing multiparticle negative-partial-transpose entanglement

    International Nuclear Information System (INIS)

    Zeng, B.; Zhou, D.L.; Zhang, P.; Xu, Z.; You, L.

    2003-01-01

    We revisit the criterion of multiparticle entanglement based on the overlaps of a given quantum state ρ with maximally entangled states. For a system of m particles, each with N distinct states, we prove that ρ is m-particle negative partial transpose entangled, if there exists a maximally entangled state vertical bar MES>, such that >1/N. While this sufficiency condition is weaker than the Peres-Horodecki criterion in all cases, it applies to multi-particle systems, and becomes especially useful when the number of particles (m) is large. We also consider the converse of this criterion and illustrate its invalidity with counter examples

  3. Industry Software Trustworthiness Criterion Research Based on Business Trustworthiness

    Science.gov (United States)

    Zhang, Jin; Liu, Jun-fei; Jiao, Hai-xing; Shen, Yi; Liu, Shu-yuan

    To industry software Trustworthiness problem, an idea aiming to business to construct industry software trustworthiness criterion is proposed. Based on the triangle model of "trustworthy grade definition-trustworthy evidence model-trustworthy evaluating", the idea of business trustworthiness is incarnated from different aspects of trustworthy triangle model for special industry software, power producing management system (PPMS). Business trustworthiness is the center in the constructed industry trustworthy software criterion. Fusing the international standard and industry rules, the constructed trustworthy criterion strengthens the maneuverability and reliability. Quantitive evaluating method makes the evaluating results be intuitionistic and comparable.

  4. Criterion of damage beginning: experimental identification for laminate composite

    International Nuclear Information System (INIS)

    Thiebaud, F.; Perreux, D.; Varchon, D.; Lebras, J.

    1996-01-01

    The aim of this study is to propose a criterion of damage beginning for laminate composite. The materials is a glass-epoxy laminate [+55 deg.,-55 deg.[ n performed by winding filament process. First of all a description of the damage is performed and allows to define a damage variable. Thanks to the potential of free energy, an associated variable is defined. The damage criterion is written by using this last one. The parameter of the criterion is identified using mechanical and acoustical methods. The result is compared and exhibit a good agreement. (authors). 13 refs., 5 figs

  5. Femoral artery pressure measurement to predict the outcome of arterial surgery in patients with multilevel disease

    DEFF Research Database (Denmark)

    Faris, I; Tønnesen, K H; Agerskov, K

    1982-01-01

    Direct measurement of the femoral artery pressure before operation has been used to predict the postoperative change in ankle and toe pressure in 102 limbs (83 patients) that underwent aortoiliac surgery for the treatment of atherosclerotic occlusion or stenosis affecting both the aortoiliac...... and femoral artery segments. Rest pain or gangrene was present in 74 limbs. In 26 other limbs simultaneous aortoiliac and femoral artery reconstructions were performed. The changes in both toe and ankle pressures could be confidently predicted from the preoperative data. A predicted toe pressure of lower than...... 25 mm Hg was associated with a high probability that amputation would be required. The chances of an amputation were less than 3% if a toe pressure higher than 40 mm Hg was predicted. If the predicted ankle pressure index was lower than 0.56, there was a 90% chance that intermittent claudication...

  6. Predicting short term mood developments among depressed patients using adherence and ecological momentary assessment data

    Directory of Open Access Journals (Sweden)

    Adam Mikus

    2018-06-01

    Full Text Available Technology driven interventions provide us with an increasing amount of fine-grained data about the patient. This data includes regular ecological momentary assessments (EMA but also response times to EMA questions by a user. When observing this data, we see a huge variation between the patterns exhibited by different patients. Some are more stable while others vary a lot over time. This poses a challenging problem for the domain of artificial intelligence and makes on wondering whether it is possible to predict the future mental state of a patient using the data that is available. In the end, these predictions could potentially contribute to interventions that tailor the feedback to the user on a daily basis, for example by warning a user that a fall-back might be expected during the next days, or by applying a strategy to prevent the fall-back from occurring in the first place.In this work, we focus on short term mood prediction by considering the adherence and usage data as an additional predictor. We apply recurrent neural networks to handle the temporal aspects best and try to explore whether individual, group level, or one single predictive model provides the highest predictive performance (measured using the root mean squared error (RMSE. We use data collected from patients from five countries who used the ICT4Depression/MoodBuster platform in the context of the EU E-COMPARED project. In total, we used the data from 143 patients (with between 9 and 425days of EMA data who were diagnosed with a major depressive disorder according to DSM-IV.Results show that we can make predictions of short term mood change quite accurate (ranging between 0.065 and 0.11. The past EMA mood ratings proved to be the most influential while adherence and usage data did not improve prediction accuracy. In general, group level predictions proved to be the most promising, however differences were not significant.Short term mood prediction remains a difficult task

  7. [Value of sepsis single-disease manage system in predicting mortality in patients with sepsis].

    Science.gov (United States)

    Chen, J; Wang, L H; Ouyang, B; Chen, M Y; Wu, J F; Liu, Y J; Liu, Z M; Guan, X D

    2018-04-03

    Objective: To observe the effect of sepsis single-disease manage system on the improvement of sepsis treatment and the value in predicting mortality in patients with sepsis. Methods: A retrospective study was conducted. Patients with sepsis admitted to the Department of Surgical Intensive Care Unit of Sun Yat-Sen University First Affiliated Hospital from September 22, 2013 to May 5, 2015 were enrolled in this study. Sepsis single-disease manage system (Rui Xin clinical data manage system, China data, China) was used to monitor 25 clinical quality parameters, consisting of timeliness, normalization and outcome parameters. Based on whether these quality parameters could be completed or not, the clinical practice was evaluated by the system. The unachieved quality parameter was defined as suspicious parameters, and these suspicious parameters were used to predict mortality of patients with receiver operating characteristic curve (ROC). Results: A total of 1 220 patients with sepsis were enrolled, included 805 males and 415 females. The mean age was (59±17) years, and acute physiology and chronic health evaluation (APACHE Ⅱ) scores was 19±8. The area under ROC curve of total suspicious numbers for predicting 28-day mortality was 0.70; when the suspicious parameters number was more than 6, the sensitivity was 68.0% and the specificity was 61.0% for predicting 28-day mortality. In addition, the area under ROC curve of outcome suspicious number for predicting 28-day mortality was 0.89; when the suspicious outcome parameters numbers was more than 1, the sensitivity was 88.0% and the specificity was 78.0% for predicting 28-day mortality. Moreover, the area under ROC curve of total suspicious number for predicting 90-day mortality was 0.73; when the total suspicious parameters number was more than 7, the sensitivity was 60.0% and the specificity was 74.0% for predicting 90-day mortality. Finally, the area under ROC curve of outcome suspicious numbers for predicting 90

  8. Predicting the efficacy of radiotherapy in individual glioblastoma patients in vivo: a mathematical modeling approach

    International Nuclear Information System (INIS)

    Rockne, R; Alvord, E C Jr; Swanson, K R; Rockhill, J K; Kalet, I; Hendrickson, K; Mrugala, M; Spence, A M; Lai, A; Cloughesy, T

    2010-01-01

    Glioblastoma multiforme (GBM) is the most malignant form of primary brain tumors known as gliomas. They proliferate and invade extensively and yield short life expectancies despite aggressive treatment. Response to treatment is usually measured in terms of the survival of groups of patients treated similarly, but this statistical approach misses the subgroups that may have responded to or may have been injured by treatment. Such statistics offer scant reassurance to individual patients who have suffered through these treatments. Furthermore, current imaging-based treatment response metrics in individual patients ignore patient-specific differences in tumor growth kinetics, which have been shown to vary widely across patients even within the same histological diagnosis and, unfortunately, these metrics have shown only minimal success in predicting patient outcome. We consider nine newly diagnosed GBM patients receiving diagnostic biopsy followed by standard-of-care external beam radiation therapy (XRT). We present and apply a patient-specific, biologically based mathematical model for glioma growth that quantifies response to XRT in individual patients in vivo. The mathematical model uses net rates of proliferation and migration of malignant tumor cells to characterize the tumor's growth and invasion along with the linear-quadratic model for the response to radiation therapy. Using only routinely available pre-treatment MRIs to inform the patient-specific bio-mathematical model simulations, we find that radiation response in these patients, quantified by both clinical and model-generated measures, could have been predicted prior to treatment with high accuracy. Specifically, we find that the net proliferation rate is correlated with the radiation response parameter (r = 0.89, p = 0.0007), resulting in a predictive relationship that is tested with a leave-one-out cross-validation technique. This relationship predicts the tumor size post-therapy to within inter

  9. Prediction of esophageal varices and variceal hemorrhage in patients with acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Rockey, Don C; Elliott, Alan; Lyles, Thomas

    2016-03-01

    In patients with upper gastrointestinal bleeding (UGIB), identifying those with esophageal variceal hemorrhage prior to endoscopy would be clinically useful. This retrospective study of a large cohort of patients with UGIB used logistic regression analyses to evaluate the platelet count, aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) and Lok index (all non-invasive blood markers) as predictors of variceal bleeding in (1) all patients with UGIB and (2) patients with cirrhosis and UGIB. 2233 patients admitted for UGIB were identified; 1034 patients had cirrhosis (46%) and of these, 555 patients (54%) had acute UGIB due to esophageal varices. In all patients with UGIB, the platelet count (cut-off 122,000/mm(3)), APRI (cut-off 5.1), AAR (cut-off 2.8) and Lok index (cut-off 0.9) had area under the curve (AUC)s of 0.80 0.82, 0.64, and 0.80, respectively, for predicting the presence of varices prior to endoscopy. To predict varices as the culprit of bleeding, the platelet count (cut-off 69,000), APRI (cut-off 2.6), AAR (cut-off 2.5) and Lok Index (0.90) had AUCs of 0.76, 0.77, 0.57 and 0.73, respectively. Finally, in patients with cirrhosis and UGIB, logistic regression was unable to identify optimal cut-off values useful for predicting varices as the culprit bleeding lesion for any of the non-invasive markers studied. For all patients with UGIB, non-invasive markers appear to differentiate patients with varices from those without varices and to identify those with a variceal culprit lesion. However, these markers could not distinguish between a variceal culprit and other lesions in patients with cirrhosis. Copyright © 2016 American Federation for Medical Research.

  10. Artificial neural networks to predict presence of significant pathology in patients presenting to routine colorectal clinics.

    Science.gov (United States)

    Maslekar, S; Gardiner, A B; Monson, J R T; Duthie, G S

    2010-12-01

    Artificial neural networks (ANNs) are computer programs used to identify complex relations within data. Routine predictions of presence of colorectal pathology based on population statistics have little meaning for individual patient. This results in large number of unnecessary lower gastrointestinal endoscopies (LGEs - colonoscopies and flexible sigmoidoscopies). We aimed to develop a neural network algorithm that can accurately predict presence of significant pathology in patients attending routine outpatient clinics for gastrointestinal symptoms. Ethics approval was obtained and the study was monitored according to International Committee on Harmonisation - Good Clinical Practice (ICH-GCP) standards. Three-hundred patients undergoing LGE prospectively completed a specifically developed questionnaire, which included 40 variables based on clinical symptoms, signs, past- and family history. Complete data sets of 100 patients were used to train the ANN; the remaining data was used for internal validation. The primary output used was positive finding on LGE, including polyps, cancer, diverticular disease or colitis. For external validation, the ANN was applied to data from 50 patients in primary care and also compared with the predictions of four clinicians. Clear correlation between actual data value and ANN predictions were found (r = 0.931; P = 0.0001). The predictive accuracy of ANN was 95% in training group and 90% (95% CI 84-96) in the internal validation set and this was significantly higher than the clinical accuracy (75%). ANN also showed high accuracy in the external validation group (89%). Artificial neural networks offer the possibility of personal prediction of outcome for individual patients presenting in clinics with colorectal symptoms, making it possible to make more appropriate requests for lower gastrointestinal endoscopy. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.

  11. Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study.

    Science.gov (United States)

    Ubbink, Dirk T; Lindeboom, Robert; Eskes, Anne M; Brull, Huub; Legemate, Dink A; Vermeulen, Hester

    2015-10-01

    It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We developed a model to detect which factors can predict (prolonged) healing of complex acute wounds in patients treated in a large wound expertise centre (WEC). Using Cox and linear regression analyses, we determined which patient- and wound-related characteristics best predict time to complete wound healing and derived a prediction formula to estimate how long this may take. We selected 563 patients with acute wounds, documented in the WEC registry between 2007 and 2012. Wounds had existed for a median of 19 days (range 6-46 days). The majority of these were located on the leg (52%). Five significant independent predictors of prolonged wound healing were identified: wound location on the trunk [hazard ratio (HR) 0·565, 95% confidence interval (CI) 0·405-0·788; P = 0·001], wound infection (HR 0·728, 95% CI 0·534-0·991; P = 0·044), wound size (HR 0·993, 95% CI 0·988-0·997; P = 0·001), wound duration (HR 0·998, 95% CI 0·996-0·999; P = 0·005) and patient's age (HR 1·009, 95% CI 1·001-1·018; P = 0·020), but not diabetes. Awareness of the five factors predicting the healing of complex acute wounds, particularly wound infection and location on the trunk, may help caregivers to predict wound healing time and to detect, refer and focus on patients who need additional attention. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  12. Patient feature based dosimetric Pareto front prediction in esophageal cancer radiotherapy.

    Science.gov (United States)

    Wang, Jiazhou; Jin, Xiance; Zhao, Kuaike; Peng, Jiayuan; Xie, Jiang; Chen, Junchao; Zhang, Zhen; Studenski, Matthew; Hu, Weigang

    2015-02-01

    To investigate the feasibility of the dosimetric Pareto front (PF) prediction based on patient's anatomic and dosimetric parameters for esophageal cancer patients. Eighty esophagus patients in the authors' institution were enrolled in this study. A total of 2928 intensity-modulated radiotherapy plans were obtained and used to generate PF for each patient. On average, each patient had 36.6 plans. The anatomic and dosimetric features were extracted from these plans. The mean lung dose (MLD), mean heart dose (MHD), spinal cord max dose, and PTV homogeneity index were recorded for each plan. Principal component analysis was used to extract overlap volume histogram (OVH) features between PTV and other organs at risk. The full dataset was separated into two parts; a training dataset and a validation dataset. The prediction outcomes were the MHD and MLD. The spearman's rank correlation coefficient was used to evaluate the correlation between the anatomical features and dosimetric features. The stepwise multiple regression method was used to fit the PF. The cross validation method was used to evaluate the model. With 1000 repetitions, the mean prediction error of the MHD was 469 cGy. The most correlated factor was the first principal components of the OVH between heart and PTV and the overlap between heart and PTV in Z-axis. The mean prediction error of the MLD was 284 cGy. The most correlated factors were the first principal components of the OVH between heart and PTV and the overlap between lung and PTV in Z-axis. It is feasible to use patients' anatomic and dosimetric features to generate a predicted Pareto front. Additional samples and further studies are required improve the prediction model.

  13. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach

    NARCIS (Netherlands)

    Broer, S.L.; Disseldorp, J. van; Broeze, K.A.; Dolleman, M.; Opmeer, B.C.; Bossuyt, P.; Eijkemans, M.J.; Mol, B.W.; Broekmans, F.J.; Anderson, R.A.; Ashrafi, M.; Bancsi, L.F.; Caroppo, E.; Copperman, A.; Ebner, T.; Eldar Geva, M.; Erdem, M.; Greenblatt, E.M.; Jayaprakasan, K.; Fenning, R.; Klinkert, E.R.; Kwee, J.; Lambalk, C.B.; La Marca, A.; McIlveen, M.; Merce, L.T.; Muttukrishna, S.; Nelson, S.M.; Ng, H.Y.; Popovic-Todorovic, B.; Smeenk, J.M.J.; Tomas, C.; Linden, P.J. van der; Rooij, I.A. van; et al.,

    2013-01-01

    BACKGROUND Although ovarian reserve tests (ORTs) are frequently used prior to IVF treatment for outcome prediction, their added predictive value is unclear. We assessed the added value of ORTs to patient characteristics in the prediction of IVF outcome. METHODS An individual patient data (IPD)

  14. Low serum albumin may predict the need for gastric resection in patients with perforated peptic ulcer.

    Science.gov (United States)

    Seow, J G; Lim, Y R; Shelat, V G

    2017-06-01

    Perforated peptic ulcer (PPU) is a common surgical emergency and treatment involves omental patch repair (PR). Gastric resection (GR) is reserved for difficult pathologies. We audit the outcomes of GR at our institution and evaluate the pre-operative factors predicting the need for GR. This is a single-institution, retrospective study of patients with PPU who underwent surgery from 2004 to 2012. Demographics, clinical presentation and intra-operative findings were studied to identify factors predicting the need for GR in PPU. An audit of clinical outcomes and mortality for all patients with GR is reported. 537 (89.6 %) patients underwent PR and 62 (10.4 %) patients GR. Old age (p peptic ulcer disease (PUD) (p = 0.0159), low hemoglobin (p ulcer size (p < 0.0001) predict the need for GR. On multivariate analysis only low serum albumin (OR 5.57, 95 % CI 1.56-19.84, p = 0.008) predicted the need for GR. The presence of Helicobacter pylori infection was protective against GR (OR 0.25, 95 %CI 0.14-0.44, p < 0.0001). Morbidity and mortality of GR was 27.7 and 24.2 %, respectively. GR is needed in one in ten cases of PPU. Low serum albumin predicted the need for GR on multivariate analysis. Morbidity and mortality of GR remains high.

  15. A new method for predicting functional recovery of stroke patients with hemiplegia: logarithmic modelling.

    Science.gov (United States)

    Koyama, Tetsuo; Matsumoto, Kenji; Okuno, Taiji; Domen, Kazuhisa

    2005-10-01

    To examine the validity and applicability of logarithmic modelling for predicting functional recovery of stroke patients with hemiplegia. Longitudinal postal survey. Stroke patients with hemiplegia staying in a long-term rehabilitation facility, who had been referred from acute medical service 30-60 days after onset. Functional Independence Measure (FIM) scores were periodically assessed during hospitalization. For each individual, a logarithmic formula that was scaled by an interval increase in FIM scores during the initial 2-6 weeks was used for predicting functional recovery. For the study, we recruited 18 patients who showed a wide variety of disability levels on admission (FIM scores 25-107). For each patient, the predicted FIM scores derived from the logarithmic formula matched the actual change in FIM scores. The changes predicted the recovery of motor rather than cognitive functions. Regression analysis showed a close fit between logarithmic modelling and actual FIM scores (across-subject R2 = 0.945). Provided with two initial time-point samplings, logarithmic modelling allows accurate prediction of functional recovery for individuals. Because the modelling is mathematically simple, it can be widely applied in daily clinical practice.

  16. Preoperative Electrocardiogram Score for Predicting New-Onset Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Gu, Jiwei; Andreasen, Jan J; Melgaard, Jacob; Lundbye-Christensen, Søren; Hansen, John; Schmidt, Erik B; Thorsteinsson, Kristinn; Graff, Claus

    2017-02-01

    To investigate if electrocardiogram (ECG) markers from routine preoperative ECGs can be used in combination with clinical data to predict new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Retrospective observational case-control study. Single-center university hospital. One hundred consecutive adult patients (50 POAF, 50 without POAF) who underwent coronary artery bypass grafting, valve surgery, or combinations. Retrospective review of medical records and registration of POAF. Clinical data and demographics were retrieved from the Western Denmark Heart Registry and patient records. Paper tracings of preoperative ECGs were collected from patient records, and ECG measurements were read by two independent readers blinded to outcome. A subset of four clinical variables (age, gender, body mass index, and type of surgery) were selected to form a multivariate clinical prediction model for POAF and five ECG variables (QRS duration, PR interval, P-wave duration, left atrial enlargement, and left ventricular hypertrophy) were used in a multivariate ECG model. Adding ECG variables to the clinical prediction model significantly improved the area under the receiver operating characteristic curve from 0.54 to 0.67 (with cross-validation). The best predictive model for POAF was a combined clinical and ECG model with the following four variables: age, PR-interval, QRS duration, and left atrial enlargement. ECG markers obtained from a routine preoperative ECG may be helpful in predicting new-onset POAF in patients undergoing cardiac surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Predicting the lung compliance of mechanically ventilated patients via statistical modeling

    International Nuclear Information System (INIS)

    Ganzert, Steven; Kramer, Stefan; Guttmann, Josef

    2012-01-01

    To avoid ventilator associated lung injury (VALI) during mechanical ventilation, the ventilator is adjusted with reference to the volume distensibility or ‘compliance’ of the lung. For lung-protective ventilation, the lung should be inflated at its maximum compliance, i.e. when during inspiration a maximal intrapulmonary volume change is achieved by a minimal change of pressure. To accomplish this, one of the main parameters is the adjusted positive end-expiratory pressure (PEEP). As changing the ventilator settings usually produces an effect on patient's lung mechanics with a considerable time delay, the prediction of the compliance change associated with a planned change of PEEP could assist the physician at the bedside. This study introduces a machine learning approach to predict the nonlinear lung compliance for the individual patient by Gaussian processes, a probabilistic modeling technique. Experiments are based on time series data obtained from patients suffering from acute respiratory distress syndrome (ARDS). With a high hit ratio of up to 93%, the learned models could predict whether an increase/decrease of PEEP would lead to an increase/decrease of the compliance. However, the prediction of the complete pressure–volume relation for an individual patient has to be improved. We conclude that the approach is well suitable for the given problem domain but that an individualized feature selection should be applied for a precise prediction of individual pressure–volume curves. (paper)

  18. Predicting objective function weights from patient anatomy in prostate IMRT treatment planning

    International Nuclear Information System (INIS)

    Lee, Taewoo; Hammad, Muhannad; Chan, Timothy C. Y.; Craig, Tim; Sharpe, Michael B.

    2013-01-01

    Purpose: Intensity-modulated radiation therapy (IMRT) treatment planning typically combines multiple criteria into a single objective function by taking a weighted sum. The authors propose a statistical model that predicts objective function weights from patient anatomy for prostate IMRT treatment planning. This study provides a proof of concept for geometry-driven weight determination. Methods: A previously developed inverse optimization method (IOM) was used to generate optimal objective function weights for 24 patients using their historical treatment plans (i.e., dose distributions). These IOM weights were around 1% for each of the femoral heads, while bladder and rectum weights varied greatly between patients. A regression model was developed to predict a patient's rectum weight using the ratio of the overlap volume of the rectum and bladder with the planning target volume at a 1 cm expansion as the independent variable. The femoral head weights were fixed to 1% each and the bladder weight was calculated as one minus the rectum and femoral head weights. The model was validated using leave-one-out cross validation. Objective values and dose distributions generated through inverse planning using the predicted weights were compared to those generated using the original IOM weights, as well as an average of the IOM weights across all patients. Results: The IOM weight vectors were on average six times closer to the predicted weight vectors than to the average weight vector, usingl 2 distance. Likewise, the bladder and rectum objective values achieved by the predicted weights were more similar to the objective values achieved by the IOM weights. The difference in objective value performance between the predicted and average weights was statistically significant according to a one-sided sign test. For all patients, the difference in rectum V54.3 Gy, rectum V70.0 Gy, bladder V54.3 Gy, and bladder V70.0 Gy values between the dose distributions generated by the

  19. ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism

    DEFF Research Database (Denmark)

    Borgwardt, Henrik Gutte; Mortensen, Jann; Jensen, Claus V

    2010-01-01

    The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE).......The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE)....

  20. Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, H. [Sungkyunkwan Univ., Seoul (Korea, Republic of). Dept. of Health Sciences and Technology; Oh, D.; Park, H.C.; Han, Y.; Lim, D.H. [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Kang, S.W. [Korea Univ., Seoul (Korea, Republic of). Dept. of Radiologic Science; Paik, S.W. [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of). Dept. of Medicine

    2013-07-15

    Purpose: The aim of this work was to determine predictive factors for gastroduodenal (GD) toxicity in hepatocellular carcinoma (HCC) patients who were treated with radiotherapy (RT). Patients and methods: A total of 90 HCC patients who underwent esophagogastroduodenoscopy (EGD) before and after RT were enrolled. RT was delivered as 30-50 Gy (median 37.5 Gy) in 2-5 Gy (median 3.5 Gy) per fraction. All endoscopic findings were reviewed and GD toxicities related to RT were graded by the Common Toxicity Criteria for Adverse Events, version 3.0. The predictive factors for the {>=} grade 2 GD toxicity were investigated. Results: Endoscopic findings showed erosive gastritis in 14 patients (16 %), gastric ulcers in 8 patients (9 %), erosive duodenitis in 15 patients (17 %), and duodenal ulcers in 14 patients (16 %). Grade 2 toxicity developed in 19 patients (21 %) and grade 3 toxicity developed in 8 patients (9 %). V{sub 25} for stomach and V{sub 35} for duodenum (volume receiving a RT dose of more than x Gy) were the most predictive factors for {>=} grade 2 toxicity. The gastric toxicity rate at 6 months was 2.9 % for V{sub 25} {<=} 6.3 % and 57.1 % for V{sub 25} > 6.3 %. The duodenal toxicity rate at 6 months was 9.4 % for V{sub 35} > 5.4 % and 45.9 % for V{sub 35} > 5.4 %. By multivariate analysis including the clinical factors, V{sub 25} for stomach and V{sub 35} for duodenum were the significant factors. Conclusion: EGD revealed that GD toxicity is common following RT for HCC. V{sub 25} for the stomach and V{sub 35} for the duodenum were the significant factors to predict {>=} grade 2 GD toxicity. (orig.)

  1. Predicting Appropriate Admission of Bronchiolitis Patients in the Emergency Department: Rationale and Methods.

    Science.gov (United States)

    Luo, Gang; Stone, Bryan L; Johnson, Michael D; Nkoy, Flory L

    2016-03-07

    In young children, bronchiolitis is the most common illness resulting in hospitalization. For children less than age 2, bronchiolitis incurs an annual total inpatient cost of $1.73 billion. Each year in the United States, 287,000 emergency department (ED) visits occur because of bronchiolitis, with a hospital admission rate of 32%-40%. Due to a lack of evidence and objective criteria for managing bronchiolitis, ED disposition decisions (hospital admission or discharge to home) are often made subjectively, resulting in significant practice variation. Studies reviewing admission need suggest that up to 29% of admissions from the ED are unnecessary. About 6% of ED discharges for bronchiolitis result in ED returns with admission. These inappropriate dispositions waste limited health care resources, increase patient and parental distress, expose patients to iatrogenic risks, and worsen outcomes. Existing clinical guidelines for bronchiolitis offer limited improvement in patient outcomes. Methodological shortcomings include that the guidelines provide no specific thresholds for ED decisions to admit or to discharge, have an insufficient level of detail, and do not account for differences in patient and illness characteristics including co-morbidities. Predictive models are frequently used to complement clinical guidelines, reduce practice variation, and improve clinicians' decision making. Used in real time, predictive models can present objective criteria supported by historical data for an individualized disease management plan and guide admission decisions. However, existing predictive models for ED patients with bronchiolitis have limitations, including low accuracy and the assumption that the actual ED disposition decision was appropriate. To date, no operational definition of appropriate admission exists. No model has been built based on appropriate admissions, which include both actual admissions that were necessary and actual ED discharges that were unsafe. The

  2. A Novel Risk prediction Model for Patients with Combined Hepatocellular-Cholangiocarcinoma.

    Science.gov (United States)

    Tian, Meng-Xin; He, Wen-Jun; Liu, Wei-Ren; Yin, Jia-Cheng; Jin, Lei; Tang, Zheng; Jiang, Xi-Fei; Wang, Han; Zhou, Pei-Yun; Tao, Chen-Yang; Ding, Zhen-Bin; Peng, Yuan-Fei; Dai, Zhi; Qiu, Shuang-Jian; Zhou, Jian; Fan, Jia; Shi, Ying-Hong

    2018-01-01

    Backgrounds: Regarding the difficulty of CHC diagnosis and potential adverse outcomes or misuse of clinical therapies, an increasing number of patients have undergone liver transplantation, transcatheter arterial chemoembolization (TACE) or other treatments. Objective: To construct a convenient and reliable risk prediction model for identifying high-risk individuals with combined hepatocellular-cholangiocarcinoma (CHC). Methods: 3369 patients who underwent surgical resection for liver cancer at Zhongshan Hospital were enrolled in this study. The epidemiological and clinical characteristics of the patients were collected at the time of tumor diagnosis. Variables ( P model discrimination. Calibration was performed using the Hosmer-Lemeshow test and a calibration curve. Internal validation was performed using a bootstrapping approach. Results: Among the entire study population, 250 patients (7.42%) were pathologically defined with CHC. Age, HBcAb, red blood cells (RBC), blood urea nitrogen (BUN), AFP, CEA and portal vein tumor thrombus (PVTT) were included in the final risk prediction model (area under the curve, 0.69; 95% confidence interval, 0.51-0.77). Bootstrapping validation presented negligible optimism. When the risk threshold of the prediction model was set at 20%, 2.73% of the patients diagnosed with liver cancer would be diagnosed definitely, which could identify CHC patients with 12.40% sensitivity, 98.04% specificity, and a positive predictive value of 33.70%. Conclusions: Herein, the study established a risk prediction model which incorporates the clinical risk predictors and CT/MRI-presented PVTT status that could be adopted to facilitate the diagnosis of CHC patients preoperatively.

  3. Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients.

    Science.gov (United States)

    Schroll, Rebecca; Swift, David; Tatum, Danielle; Couch, Stuart; Heaney, Jiselle B; Llado-Farrulla, Monica; Zucker, Shana; Gill, Frances; Brown, Griffin; Buffin, Nicholas; Duchesne, Juan

    2018-01-01

    Various scoring systems have been developed to predict need for massive transfusion in traumatically injured patients. Assessments of Blood Consumption (ABC) score and Shock Index (SI) have been shown to be reliable predictors for Massive Transfusion Protocol (MTP) activation. However, no study has directly compared these two scoring systems to determine which is a better predictor for MTP activation. The primary objective was to determine whether ABC or SI better predicted the need for MTP in adult trauma patients with severe hemorrhage. This was a retrospective cohort study which included all injured patients who were trauma activations between January 1, 2009 and December 31, 2013 at an urban Level I trauma center. Patients ABC and SI were calculated for each patient. MTP was defined as need for >10 units PRBC transfusion within 24h of emergency department arrival. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were used to evaluate scoring systems' ability to predict effective MTP utilization. A total of 645 patients had complete data for analysis. Shock Index ≥1 had sensitivity of 67.7% (95% CI 49.5%-82.6%) and specificity of 81.3% (95% CI 78.0%-84.3%) for predicting MTP, and ABC score ≥2 had sensitivity of 47.0% (95% CI 29.8%-64.9%) and specificity of 89.8% (95% CI 87.2%-92.1%). AUROC analyses showed SI to be the strongest predictor followed by ABC score with AUROC values of 0.83 and 0.74, respectively. SI had a significantly greater sensitivity (P=0.035), but a significantly weaker specificity (PABC score. ABC score and Shock Index can both be used to predict need for massive transfusion in trauma patients, however SI is more sensitive and requires less technical skill than ABC score. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Predictive Factors of Clinical Response of Infliximab Therapy in Active Nonradiographic Axial Spondyloarthritis Patients

    Directory of Open Access Journals (Sweden)

    Zhiming Lin

    2015-01-01

    Full Text Available Objectives. To evaluate the efficiency and the predictive factors of clinical response of infliximab in active nonradiographic axial spondyloarthritis patients. Methods. Active nonradiographic patients fulfilling ESSG criteria for SpA but not fulfilling modified New York criteria were included. All patients received infliximab treatment for 24 weeks. The primary endpoint was ASAS20 response at weeks 12 and 24. The abilities of baseline parameters and response at week 2 to predict ASAS20 response at weeks 12 and 24 were assessed using ROC curve and logistic regression analysis, respectively. Results. Of 70 axial SpA patients included, the proportions of patients achieving an ASAS20 response at weeks 2, 6, 12, and 24 were 85.7%, 88.6%, 87.1%, and 84.3%, respectively. Baseline MRI sacroiliitis score (AUC = 0.791; P=0.005, CRP (AUC = 0.75; P=0.017, and ASDAS (AUC = 0.778, P=0.007 significantly predicted ASAS20 response at week 12. However, only ASDAS (AUC = 0.696, P=0.040 significantly predicted ASAS20 response at week 24. Achievement of ASAS20 response after the first infliximab infusion was a significant predictor of subsequent ASAS20 response at weeks 12 and 24 (wald χ2=6.87, P=0.009, and wald χ2=5.171, P=0.023. Conclusions. Infliximab shows efficiency in active nonradiographic axial spondyloarthritis patients. ASDAS score and first-dose response could help predicting clinical efficacy of infliximab therapy in these patients.

  5. Predicting survival time in noncurative patients with advanced cancer: a prospective study in China.

    Science.gov (United States)

    Cui, Jing; Zhou, Lingjun; Wee, B; Shen, Fengping; Ma, Xiuqiang; Zhao, Jijun

    2014-05-01

    Accurate prediction of prognosis for cancer patients is important for good clinical decision making in therapeutic and care strategies. The application of prognostic tools and indicators could improve prediction accuracy. This study aimed to develop a new prognostic scale to predict survival time of advanced cancer patients in China. We prospectively collected items that we anticipated might influence survival time of advanced cancer patients. Participants were recruited from 12 hospitals in Shanghai, China. We collected data including demographic information, clinical symptoms and signs, and biochemical test results. Log-rank tests, Cox regression, and linear regression were performed to develop a prognostic scale. Three hundred twenty patients with advanced cancer were recruited. Fourteen prognostic factors were included in the prognostic scale: Karnofsky Performance Scale (KPS) score, pain, ascites, hydrothorax, edema, delirium, cachexia, white blood cell (WBC) count, hemoglobin, sodium, total bilirubin, direct bilirubin, aspartate aminotransferase (AST), and alkaline phosphatase (ALP) values. The score was calculated by summing the partial scores, ranging from 0 to 30. When using the cutoff points of 7-day, 30-day, 90-day, and 180-day survival time, the scores were calculated as 12, 10, 8, and 6, respectively. We propose a new prognostic scale including KPS, pain, ascites, hydrothorax, edema, delirium, cachexia, WBC count, hemoglobin, sodium, total bilirubin, direct bilirubin, AST, and ALP values, which may help guide physicians in predicting the likely survival time of cancer patients more accurately. More studies are needed to validate this scale in the future.

  6. Patient-ventilator asynchrony affects pulse pressure variation prediction of fluid responsiveness.

    Science.gov (United States)

    Messina, Antonio; Colombo, Davide; Cammarota, Gianmaria; De Lucia, Marta; Cecconi, Maurizio; Antonelli, Massimo; Corte, Francesco Della; Navalesi, Paolo

    2015-10-01

    During partial ventilatory support, pulse pressure variation (PPV) fails to adequately predict fluid responsiveness. This prospective study aims to investigate whether patient-ventilator asynchrony affects PPV prediction of fluid responsiveness during pressure support ventilation (PSV). This is an observational physiological study evaluating the response to a 500-mL fluid challenge in 54 patients receiving PSV, 27 without (Synch) and 27 with asynchronies (Asynch), as assessed by visual inspection of ventilator waveforms by 2 skilled blinded physicians. The area under the curve was 0.71 (confidence interval, 0.57-0.83) for the overall population, 0.86 (confidence interval, 0.68-0.96) in the Synch group, and 0.53 (confidence interval, 0.33-0.73) in the Asynch group (P = .018). Sensitivity and specificity of PPV were 78% and 89% in the Synch group and 36% and 46% in the Asynch group. Logistic regression showed that the PPV prediction was influenced by patient-ventilator asynchrony (odds ratio, 8.8 [2.0-38.0]; P < .003). Of the 27 patients without asynchronies, 12 had a tidal volume greater than or equal to 8 mL/kg; in this subgroup, the rate of correct classification was 100%. Patient-ventilator asynchrony affects PPV performance during partial ventilatory support influencing its efficacy in predicting fluid responsiveness. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Users' experiences of an emergency department patient admission predictive tool: A qualitative evaluation.

    Science.gov (United States)

    Jessup, Melanie; Crilly, Julia; Boyle, Justin; Wallis, Marianne; Lind, James; Green, David; Fitzgerald, Gerard

    2016-09-01

    Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool's accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally. © The Author(s) 2015.

  8. A Predictive Model for Readmissions Among Medicare Patients in a California Hospital.

    Science.gov (United States)

    Duncan, Ian; Huynh, Nhan

    2017-11-17

    Predictive models for hospital readmission rates are in high demand because of the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). The LACE index is one of the most popular predictive tools among hospitals in the United States. The LACE index is a simple tool with 4 parameters: Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the previous 6 months. The authors applied logistic regression to develop a predictive model for a medium-sized not-for-profit community hospital in California using patient-level data with more specific patient information (including 13 explanatory variables). Specifically, the logistic regression is applied to 2 populations: a general population including all patients and the specific group of patients targeted by the CMS penalty (characterized as ages 65 or older with select conditions). The 2 resulting logistic regression models have a higher sensitivity rate compared to the sensitivity of the LACE index. The C statistic values of the model applied to both populations demonstrate moderate levels of predictive power. The authors also build an economic model to demonstrate the potential financial impact of the use of the model for targeting high-risk patients in a sample hospital and demonstrate that, on balance, whether the hospital gains or loses from reducing readmissions depends on its margin and the extent of its readmission penalties.

  9. A study on the instability criterion for the stratified flow in horizontal pipe at cocurrent flow conditions

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Chang Kyung [Korea Electric Power Research Institute, Taejon (Korea, Republic of)

    1997-12-31

    This paper presents a theoretical approach of the instability criterion from stratified to nonstratified flow in horizontal pipe at cocurrent flow conditions. The new theoretical instability criterion for the stratified and nonstratified flow transition in horizontal pipe has been developed by hyperbolic equations in two-phase flow. Critical flow condition criterion and onset of slugging at cocurrent flow condition correspond to zero and imaginary characteristics which occur when the hyperbolicity of a stratified two-phase flow is broken, respectively. Through comparison between results predicted by the present flow is broken, respectively. Through comparison between results predicted by the present theory and the Kukita et al. [1] experimental data of pipes, it is shown that they are in good agreement with data. 4 refs., 2 figs. (Author)

  10. A study on the instability criterion for the stratified flow in horizontal pipe at cocurrent flow conditions

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Chang Kyung [Korea Electric Power Research Institute, Taejon (Korea, Republic of)

    1998-12-31

    This paper presents a theoretical approach of the instability criterion from stratified to nonstratified flow in horizontal pipe at cocurrent flow conditions. The new theoretical instability criterion for the stratified and nonstratified flow transition in horizontal pipe has been developed by hyperbolic equations in two-phase flow. Critical flow condition criterion and onset of slugging at cocurrent flow condition correspond to zero and imaginary characteristics which occur when the hyperbolicity of a stratified two-phase flow is broken, respectively. Through comparison between results predicted by the present flow is broken, respectively. Through comparison between results predicted by the present theory and the Kukita et al. [1] experimental data of pipes, it is shown that they are in good agreement with data. 4 refs., 2 figs. (Author)

  11. Current psychiatric disorders in patients with epilepsy are predicted by maltreatment experiences during childhood.

    Science.gov (United States)

    Labudda, Kirsten; Illies, Dominik; Herzig, Cornelia; Schröder, Katharina; Bien, Christian G; Neuner, Frank

    2017-09-01

    Childhood maltreatment has been shown to be a risk factor for the development of psychiatric disorders. Although the prevalence of psychiatric disorders is high in epilepsy patients, it is unknown if childhood maltreatment experiences are elevated compared to the normal population and if early maltreatment is a risk factor for current psychiatric comorbidities in epilepsy patients. This is the main purpose of this study. Structured interviews were used to assess current Axis I diagnoses in 120 epilepsy patients from a tertiary Epilepsy Center (34 TLE patients, 86 non-TLE patients). Childhood maltreatment in the family and peer victimization were assessed with validated questionnaires. Patients' maltreatment scores were compared with those of a representative matched control group. Logistic regression analysis was conducted to assess the potential impact of childhood maltreatment on current psychiatric comorbidity in epilepsy patients. Compared to a matched control group, epilepsy patients had higher emotional and sexual maltreatment scores. Patients with a current psychiatric diagnosis reported more family and peer maltreatment than patients without a psychiatric disorder. Family maltreatment scores predicted the likelihood of a current psychiatric disorder. TLE patients did not differ from non-TLE patients according to maltreatment experiences and rates of current psychiatric disorders. Our findings suggest that in epilepsy patients emotional and sexual childhood maltreatment is experienced more often than in the normal population and that early maltreatment is a general risk factor for psychiatric comorbidities in this group. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Inability of Physicians and Nurses to Predict Patient Satisfaction in the Emergency Department

    Science.gov (United States)

    DeLaney, Matthew C.; Page, David B.; Kunstadt, Ethan B.; Ragan, Matt; Rodgers, Joel; Wang, Henry E.

    2015-01-01

    Introduction Patient satisfaction is a commonly assessed dimension of emergency department (ED) care quality. The ability of ED clinicians to estimate patient satisfaction is unknown. We sought to evaluate the ability of emergency medicine resident physicians and nurses to predict patient-reported satisfaction with physician and nursing care, pain levels, and understanding of discharge instructions. Methods We studied a convenience sample of 100 patients treated at an urban academic ED. Patients rated satisfaction with nursing care, physician care, pain level at time of disposition and understanding of discharge instructions. Resident physicians and nurses estimated responses for each patient. We compared patient, physician and nursing responses using Cohen’s kappa, weighting the estimates to account for the ordinal responses. Results Overall, patients had a high degree of satisfaction with care provided by the nurses and physicians, although this was underestimated by providers. There was poor agreement between physician estimation of patient satisfaction (weighted κ=0.23, standard error: 0.078) and nursing estimates of patient satisfaction (weighted κ=0.11, standard error: 0.043); physician estimation of patient pain (weighted κ=0.43, standard error: 0.082) and nursing estimates (weighted κ=0.39, standard error: 0.081); physician estimates of patient comprehension of discharge instruction (weighted κ=0.19, standard error: 0.082) and nursing estimates (weighted κ=0.13, standard error: 0.078). Providers underestimated pain and patient comprehension of discharge instructions. Conclusion ED providers were not able to predict patient satisfaction with nurse or physician care, pain level, or understanding of discharge instructions. PMID:26759661

  13. Robust Deep Network with Maximum Correntropy Criterion for Seizure Detection

    Directory of Open Access Journals (Sweden)

    Yu Qi

    2014-01-01

    Full Text Available Effective seizure detection from long-term EEG is highly important for seizure diagnosis. Existing methods usually design the feature and classifier individually, while little work has been done for the simultaneous optimization of the two parts. This work proposes a deep network to jointly learn a feature and a classifier so that they could help each other to make the whole system optimal. To deal with the challenge of the impulsive noises and outliers caused by EMG artifacts in EEG signals, we formulate a robust stacked autoencoder (R-SAE as a part of the network to learn an effective feature. In R-SAE, the maximum correntropy criterion (MCC is proposed to reduce the effect of noise/outliers. Unlike the mean square error (MSE, the output of the new kernel MCC increases more slowly than that of MSE when the input goes away from the center. Thus, the effect of those noises/outliers positioned far away from the center can be suppressed. The proposed method is evaluated on six patients of 33.6 hours of scalp EEG data. Our method achieves a sensitivity of 100% and a specificity of 99%, which is promising for clinical applications.

  14. Importance biasing quality criterion based on contribution response theory

    International Nuclear Information System (INIS)

    Borisov, N.M.; Panin, M.P.

    2001-01-01

    The report proposes a visual criterion of importance biasing both of forward and adjoint simulation. The similarity of contribution Monte Carlo and importance biasing random collision event distribution is proved. The conservation of total number of random trajectory crossings of surfaces, which separate the source and the detector is proposed as importance biasing quality criterion. The use of this criterion is demonstrated on the example of forward vs. adjoint importance biasing in gamma ray deep penetration problem. The larger amount of published data on forward field characteristics than on adjoint leads to the more accurate approximation of adjoint importance function in comparison to forward, for it adjoint importance simulation is more effective than forward. The proposed criterion indicates it visually, showing the most uniform distribution of random trajectory crossing events for the most effective importance biasing parameters and pointing to the direction of tuning importance biasing parameters. (orig.)

  15. A multipole acceptability criterion for electronic structure theory

    International Nuclear Information System (INIS)

    Schwegler, E.; Challacombe, M.; Head-Gordon, M.

    1998-01-01

    Accurate and computationally inexpensive estimates of multipole expansion errors are crucial to the success of several fast electronic structure methods. In this paper, a new nonempirical multipole acceptability criterion is described that is directly applicable to expansions of high order moments. Several model calculations typical of electronic structure theory are presented to demonstrate its performance. For cases involving small translation distances, accuracies are increased by up to five orders of magnitude over an empirical criterion. The new multipole acceptance criterion is on average within an order of magnitude of the exact expansion error. Use of the multipole acceptance criterion in hierarchical multipole based methods as well as in traditional electronic structure methods is discussed. copyright 1998 American Institute of Physics

  16. Bayesian Information Criterion as an Alternative way of Statistical Inference

    Directory of Open Access Journals (Sweden)

    Nadejda Yu. Gubanova

    2012-05-01

    Full Text Available The article treats Bayesian information criterion as an alternative to traditional methods of statistical inference, based on NHST. The comparison of ANOVA and BIC results for psychological experiment is discussed.

  17. Angular criterion for distinguishing between Fraunhofer and Fresnel diffraction

    International Nuclear Information System (INIS)

    Medina, Francisco F.; Garcia-Sucerquia, Jorge; Castaneda, Roman; Matteucci, Giorgio

    2003-03-01

    The distinction between Fresnel and Fraunhofer diffraction is a crucial condition for the accurate analysis of diffracting structures. In this paper we propose a criterion based on the angle subtended by the first zero of the diffraction pattern from the center of the diffracting aperture. The determination of the zero of the diffraction pattern is the crucial point for assuring the precision of the criterion. It mainly depends on the dynamical range of the detector. Therefore, the applicability of adequate thresholds for different detector types is discussed. The criterion is also generalized by expressing it in terms of the number of Fresnel zones delimited by the aperture. Simulations are reported for illustrating the feasibility of the criterion. (author)

  18. Prospective prediction of resistance to neoadjuvant therapy in patients with locoregional esophageal adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Rosen DG

    2015-02-01

    Full Text Available Daniel G Rosen,1 Weiwei Shan,2 Natalie Lassen,2 Clare Johnson,2 Kristen Oelschlager,2 Yaeli Bierman-Harrar,1 Kenneth A Kesler,3 Derek Maetzold,2 Sunil Badve,3 Robert W Cook,2 Romil Saxena3 1Baylor College of Medicine, Houston TX, USA; 2Castle Biosciences, Incorporated, Friendswood, TX, USA; 3Indiana University, Indianapolis, IN, USA Background: To clinically validate a multianalyte algorithmic immunohistochemistry (IHC assay that has been previously shown to accurately identify patients with locoregional esophageal adenocarcinoma (EC who will exhibit extreme resistance to neoadjuvant chemoradiotherapy. Methods: Archived biopsy specimens of EC were subject to IHC examination of compartmentalized immunoreactivity of nuclear factor kappa B (NF-κB, Sonic Hedgehog (SHH, and GLI family zinc finger 1 (Gli-1, and a labeling index score was assigned to each biomarker. Test prediction was generated by logistic regression predictive modeling, using the labeling index scores for all three analytes from each sample, referring to a validated training set of 167 EC patients. Accuracy of the test was determined by comparing the predicted outcomes with pathologically determined College of American Pathologists tumor response grade. Analytical validity of the test was measured by comparing validation set prediction results obtained in two independent Clinical Laboratory Improvement Amendment-certified laboratories, and by measuring concordance between two trained labeling index readers. Results: Specimens from 64 patients that met specific criteria were collected. No technical failure was encountered during the IHC labeling procedures. The logistic regression algorithm generated an area under the curve of 0.96 and 0.85 for the 64 sample cohort in two independent clinical laboratories, respectively, comparing predictive results with the established training set. Positive predictive values of 88% and 82% were also achieved in each laboratory, respectively. A

  19. Fear of cancer recurrence and its predictive factors among Iranian cancer patients

    Directory of Open Access Journals (Sweden)

    Alireza Mohajjel Aghdam

    2014-01-01

    Full Text Available Context: Fear of cancer recurrence (FOCR is one of the most important psychological problems among cancer patients. In extensive review of related literature there were no articles on FOCR among Iranian cancer patients. Aim: The aim of present study was to investigation FOCR and its predictive factors among Iranian cancer patients. Materials and Methods: In this descriptive-correlational study 129 cancer patients participated. For data collection, the demographic checklist and short form of fear of progression questionnaire was used. Logistic regression was used to determine predictive factors of FOCR. Result: Mean score of FOCR among participants was 44.8 and about 50% of them had high level of FOCR. The most important worries of participants were about their family and the future of their children and their lesser worries were about the physical symptoms and fear of physical damage because of cancer treatments. Also, women, breast cancer patient, and patients with lower level of education have more FOCR. Discussion: There is immediate need for supportive care program designed for Iranian cancer patients aimed at decreasing their FOCR. Especially, breast cancer patients and the patient with low educational level need more attention.

  20. Thalamic functional connectivity predicts seizure laterality in individual TLE patients: Application of a biomarker development strategy

    Directory of Open Access Journals (Sweden)

    Daniel S. Barron

    2015-01-01

    No significant differences in functional connection strength in patient and control groups were observed with Mann-Whitney Tests (corrected for multiple comparisons. Notwithstanding the lack of group differences, individual patient difference scores (from control mean connection strength successfully predicted seizure onset zone as shown in ROC curves: discriminant analysis (two-dimensional predicted seizure onset zone with 85% sensitivity and 91% specificity; logistic regression (four-dimensional achieved 86% sensitivity and 100% specificity. The strongest markers in both analyses were left thalamo-hippocampal and right thalamo-entorhinal cortex functional connection strength. Thus, this study shows that thalamic functional connections are sensitive and specific markers of seizure onset laterality in individual temporal lobe epilepsy patients. This study also advances an overall strategy for the programmatic development of neuroimaging biomarkers in clinical and genetic populations: a disease model informed by coordinate-based meta-analysis was used to anatomically constrain individual patient analyses.

  1. Role of alexithymia in predicting psychological symptoms in patients with breast and prostate cancer

    Directory of Open Access Journals (Sweden)

    M. Mowlaie

    2015-12-01

    Full Text Available Background: Identifying the psychological factors involved in psychological problems of patients with cancer is very important. Objective: The aim of this study was to determine the role of alexithymia in predicting psychological symptoms in patients with cancer. Methods: This cross sectional study was conducted in 102 patients with cancer selected by convenience sampling method in Ardabil during 2014. The measurement tools were the Persian version of Toronto Alexithymia Scale (TAS-20 and the Hopkins Symptom Checklist-25 (SCL-25. Data were analyzed using Pearson's correlation coefficient and regression analysis. Findings: There was significantly positive correlation between alexithymia and all psychological symptoms. In regression analysis, alexithymia was predictor of all psychological symptoms. Conclusion: With regards to the results, it seems that alexithymia is able to predict psychological symptoms. Therefore, paying more attention to psychological determinants in patients with cancer and providing appropriate treatment strategies can be effective to alleviate the mental suffering.

  2. Angiotensinogen and HLA class II predict bevacizumab response in recurrent glioblastoma patients

    DEFF Research Database (Denmark)

    Urup, Thomas; Michaelsen, Signe Regner; Olsen, Lars Rønn

    2016-01-01

    Background: Bevacizumab combination therapy is among the most frequently used treatments in recurrent glioblastoma and patients who achieve response to bevacizumab have improved survival as well as quality of life. Accordingly, the aim of this study was to identify predictive biomarkers for bevac......Background: Bevacizumab combination therapy is among the most frequently used treatments in recurrent glioblastoma and patients who achieve response to bevacizumab have improved survival as well as quality of life. Accordingly, the aim of this study was to identify predictive biomarkers...... for bevacizumab response in recurrent glioblastoma patients. Methods: The study included a total of 82 recurrent glioblastoma patients treated with bevacizumab combination therapy whom were both response and biomarker evaluable. Gene expression of tumor tissue was analyzed by using a customized Nano...

  3. Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy.

    Science.gov (United States)

    Sima, Camelia S; Jarnagin, William R; Fong, Yuman; Elkin, Elena; Fischer, Mary; Wuest, David; D'Angelica, Michael; DeMatteo, Ronald P; Blumgart, Leslie H; Gönen, Mithat

    2009-12-01

    To develop 2 instruments that predict the probability of perioperative red blood cell transfusion in patients undergoing elective liver resection for primary and secondary tumors. Hepatic resection is the most effective treatment for several benign and malign conditions, but may be accompanied by substantial blood loss and the need for perioperative transfusions. While blood conservation strategies such as autologous blood donation, acute normovolemic hemodilution, or cell saver systems are available, they are economically efficient only if directed toward patients with a high risk of transfusion. Using preoperative data from 1204 consecutive patients who underwent liver resection between 1995 and 2000 at Memorial Sloan- Kettering Cancer Center, we modeled the probability of perioperative red blood cell transfusion. We used the resulting model, validated on an independent dataset (n = 555 patients), to develop 2 prediction instruments, a nomogram and a transfusion score, which can be easily implemented into clinical practice. The planned number of liver segments resected, concomitant extrahepatic organ resection, a diagnosis of primary liver malignancy, as well as preoperative hemoglobin and platelets levels predicted the probability of perioperative red blood cell transfusion. The predictions of the model appeared accurate and with good discriminatory abilities, generating an area under the receiver operating characteristic curve of 0.71. Preoperative factors can be combined into risk profiles to predict the likelihood of transfusion during or after elective liver resection. These predictions, easy to calculate in the frame of a nomogram or of a transfusion score, can be used to identify patients who are at high risk for red cell transfusions and therefore most likely to benefit from blood conservation techniques.

  4. Stochastic Learning and the Intuitive Criterion in Simple Signaling Games

    DEFF Research Database (Denmark)

    Sloth, Birgitte; Whitta-Jacobsen, Hans Jørgen

    A stochastic learning process for signaling games with two types, two signals, and two responses gives rise to equilibrium selection which is in remarkable accordance with the selection obtained by the intuitive criterion......A stochastic learning process for signaling games with two types, two signals, and two responses gives rise to equilibrium selection which is in remarkable accordance with the selection obtained by the intuitive criterion...

  5. A Criterion to Identify Maximally Entangled Four-Qubit State

    International Nuclear Information System (INIS)

    Zha Xinwei; Song Haiyang; Feng Feng

    2011-01-01

    Paolo Facchi, et al. [Phys. Rev. A 77 (2008) 060304(R)] presented a maximally multipartite entangled state (MMES). Here, we give a criterion for the identification of maximally entangled four-qubit states. Using this criterion, we not only identify some existing maximally entangled four-qubit states in the literature, but also find several new maximally entangled four-qubit states as well. (general)

  6. Self-Adjointness Criterion for Operators in Fock Spaces

    International Nuclear Information System (INIS)

    Falconi, Marco

    2015-01-01

    In this paper we provide a criterion of essential self-adjointness for operators in the tensor product of a separable Hilbert space and a Fock space. The class of operators we consider may contain a self-adjoint part, a part that preserves the number of Fock space particles and a non-diagonal part that is at most quadratic with respect to the creation and annihilation operators. The hypotheses of the criterion are satisfied in several interesting applications

  7. Decision criterion dynamics in animals performing an auditory detection task.

    Directory of Open Access Journals (Sweden)

    Robert W Mill

    Full Text Available Classical signal detection theory attributes bias in perceptual decisions to a threshold criterion, against which sensory excitation is compared. The optimal criterion setting depends on the signal level, which may vary over time, and about which the subject is naïve. Consequently, the subject must optimise its threshold by responding appropriately to feedback. Here a series of experiments was conducted, and a computational model applied, to determine how the decision bias of the ferret in an auditory signal detection task tracks changes in the stimulus level. The time scales of criterion dynamics were investigated by means of a yes-no signal-in-noise detection task, in which trials were grouped into blocks that alternately contained easy- and hard-to-detect signals. The responses of the ferrets implied both long- and short-term criterion dynamics. The animals exhibited a bias in favour of responding "yes" during blocks of harder trials, and vice versa. Moreover, the outcome of each single trial had a strong influence on the decision at the next trial. We demonstrate that the single-trial and block-level changes in bias are a manifestation of the same criterion update policy by fitting a model, in which the criterion is shifted by fixed amounts according to the outcome of the previous trial and decays strongly towards a resting value. The apparent block-level stabilisation of bias arises as the probabilities of outcomes and shifts on single trials mutually interact to establish equilibrium. To gain an intuition into how stable criterion distributions arise from specific parameter sets we develop a Markov model which accounts for the dynamic effects of criterion shifts. Our approach provides a framework for investigating the dynamics of decisions at different timescales in other species (e.g., humans and in other psychological domains (e.g., vision, memory.

  8. Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage.

    Science.gov (United States)

    Li, Qi; Yang, Wen-Song; Chen, Sheng-Li; Lv, Fu-Rong; Lv, Fa-Jin; Hu, Xi; Zhu, Dan; Cao, Du; Wang, Xing-Chen; Li, Rui; Yuan, Liang; Qin, Xin-Yue; Xie, Peng

    2018-01-01

    In spontaneous intracerebral hemorrhage (ICH), black hole sign has been proposed as a promising imaging marker that predicts hematoma expansion in patients with ICH. The aim of our study was to investigate whether admission CT black hole sign predicts hematoma growth in patients with ICH. From July 2011 till February 2016, patients with spontaneous ICH who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. The presence of black hole sign on admission non-enhanced CT was independently assessed by 2 readers. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Univariate and multivariable logistic regression analyses were performed to assess the association between the presence of the black hole sign and functional outcome. A total of 225 patients (67.6% male, mean age 60.3 years) were included in our study. Black hole sign was identified in 32 of 225 (14.2%) patients on admission CT scan. The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, baseline ICH volume, admission Glasgow Coma Scale score, and presence of black hole sign on baseline CT independently predict poor functional outcome at 90 days. There are significantly more patients with a poor functional outcome (defined as mRS ≥4) among patients with black hole sign than those without (84.4 vs. 32.1%, p black hole sign independently predicts poor outcome in patients with ICH. Early identification of black hole sign is useful in prognostic stratification and may serve as a potential therapeutic target for anti-expansion clinical trials. © 2018 S. Karger AG, Basel.

  9. Predictive model of portal venous system thrombosis in cirrhotic portal hypertensive patients after splenectomy

    OpenAIRE

    He, Shasha; He, Fangping

    2015-01-01

    Objective: This study is to investigate the risk factors of portal venous system thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy and to establish a Logistic regression prediction model. Methods: A total of 119 patients with cirrhotic portal hypertension were enrolled. Their clinical data was retrospectively analyzed. They were divided into PVT group (n = 18) and non-PVT group (n = 101). One-way analysis and multivariate Logistic regression analysis were perfo...

  10. Early Prediction and Outcome of Septic Encephalopathy in Acute Stroke Patients With Nosocomial Coma

    OpenAIRE

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui

    2015-01-01

    Background Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). Methods A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with...

  11. Contribution of temporal data to predictive performance in 30-day readmission of morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Petra Povalej Brzan

    2017-04-01

    Full Text Available Background Reduction of readmissions after discharge represents an important challenge for many hospitals and has attracted the interest of many researchers in the past few years. Most of the studies in this field focus on building cross-sectional predictive models that aim to predict the occurrence of readmission within 30-days based on information from the current hospitalization. The aim of this study is demonstration of predictive performance gain obtained by inclusion of information from historical hospitalization records among morbidly obese patients. Methods The California Statewide inpatient database was used to build regularized logistic regression models for prediction of readmission in morbidly obese patients (n = 18,881. Temporal features were extracted from historical patient hospitalization records in a one-year timeframe. Five different datasets of patients were prepared based on the number of available hospitalizations per patient. Sample size of the five datasets ranged from 4,787 patients with more than five hospitalizations to 20,521 patients with at least two hospitalization records in one year. A 10-fold cross validation was repeted 100 times to assess the variability of the results. Additionally, random forest and extreme gradient boosting were used to confirm the results. Results Area under the ROC curve increased significantly when including information from up to three historical records on all datasets. The inclusion of more than three historical records was not efficient. Similar results can be observed for Brier score and PPV value. The number of selected predictors corresponded to the complexity of the dataset ranging from an average of 29.50 selected features on the smallest dataset to 184.96 on the largest dataset based on 100 repetitions of 10-fold cross-validation. Discussion The results show positive influence of adding information from historical hospitalization records on predictive performance using all

  12. Development and validation of multivariable predictive model for thromboembolic events in lymphoma patients.

    Science.gov (United States)

    Antic, Darko; Milic, Natasa; Nikolovski, Srdjan; Todorovic, Milena; Bila, Jelena; Djurdjevic, Predrag; Andjelic, Bosko; Djurasinovic, Vladislava; Sretenovic, Aleksandra; Vukovic, Vojin; Jelicic, Jelena; Hayman, Suzanne; Mihaljevic, Biljana

    2016-10-01

    Lymphoma patients are at increased risk of thromboembolic events but thromboprophylaxis in these patients is largely underused. We sought to develop and validate a simple model, based on individual clinical and laboratory patient characteristics that would designate lymphoma patients at risk for thromboembolic event. The study population included 1,820 lymphoma patients who were treated in the Lymphoma Departments at the Clinics of Hematology, Clinical Center of Serbia and Clinical Center Kragujevac. The model was developed using data from a derivation cohort (n = 1,236), and further assessed in the validation cohort (n = 584). Sixty-five patients (5.3%) in the derivation cohort and 34 (5.8%) patients in the validation cohort developed thromboembolic events. The variables independently associated with risk for thromboembolism were: previous venous and/or arterial events, mediastinal involvement, BMI>30 kg/m(2) , reduced mobility, extranodal localization, development of neutropenia and hemoglobin level 3). For patients classified at risk (intermediate and high-risk scores), the model produced negative predictive value of 98.5%, positive predictive value of 25.1%, sensitivity of 75.4%, and specificity of 87.5%. A high-risk score had positive predictive value of 65.2%. The diagnostic performance measures retained similar values in the validation cohort. Developed prognostic Thrombosis Lymphoma - ThroLy score is more specific for lymphoma patients than any other available score targeting thrombosis in cancer patients. Am. J. Hematol. 91:1014-1019, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  13. Clinical Decision Support Model to Predict Occlusal Force in Bruxism Patients.

    Science.gov (United States)

    Thanathornwong, Bhornsawan; Suebnukarn, Siriwan

    2017-10-01

    The aim of this study was to develop a decision support model for the prediction of occlusal force from the size and color of articulating paper markings in bruxism patients. We used the information from the datasets of 30 bruxism patients in which digital measurements of the size and color of articulating paper markings (12-µm Hanel; Coltene/Whaledent GmbH, Langenau, Germany) on canine protected hard stabilization splints were measured in pixels (P) and in red (R), green (G), and blue (B) values using Adobe Photoshop software (Adobe Systems, San Jose, CA, USA). The occlusal force (F) was measured using T-Scan III (Tekscan Inc., South Boston, MA, USA). The multiple regression equation was applied to predict F from the P and RGB. Model evaluation was performed using the datasets from 10 new patients. The patient's occlusal force measured by T-Scan III was used as a 'gold standard' to compare with the occlusal force predicted by the multiple regression model. The results demonstrate that the correlation between the occlusal force and the pixels and RGB of the articulating paper markings was positive (F = 1.62×P + 0.07×R -0.08×G + 0.08×B + 4.74; R 2 = 0.34). There was a high degree of agreement between the occlusal force of the patient measured using T-Scan III and the occlusal force predicted by the model (kappa value = 0.82). The results obtained demonstrate that the multiple regression model can predict the occlusal force using the digital values for the size and color of the articulating paper markings in bruxism patients.

  14. Clinical Decision Support Model to Predict Occlusal Force in Bruxism Patients

    Science.gov (United States)

    Thanathornwong, Bhornsawan

    2017-01-01

    Objectives The aim of this study was to develop a decision support model for the prediction of occlusal force from the size and color of articulating paper markings in bruxism patients. Methods We used the information from the datasets of 30 bruxism patients in which digital measurements of the size and color of articulating paper markings (12-µm Hanel; Coltene/Whaledent GmbH, Langenau, Germany) on canine protected hard stabilization splints were measured in pixels (P) and in red (R), green (G), and blue (B) values using Adobe Photoshop software (Adobe Systems, San Jose, CA, USA). The occlusal force (F) was measured using T-Scan III (Tekscan Inc., South Boston, MA, USA). The multiple regression equation was applied to predict F from the P and RGB. Model evaluation was performed using the datasets from 10 new patients. The patient's occlusal force measured by T-Scan III was used as a ‘gold standard’ to compare with the occlusal force predicted by the multiple regression model. Results The results demonstrate that the correlation between the occlusal force and the pixels and RGB of the articulating paper markings was positive (F = 1.62×P + 0.07×R –0.08×G + 0.08×B + 4.74; R2 = 0.34). There was a high degree of agreement between the occlusal force of the patient measured using T-Scan III and the occlusal force predicted by the model (kappa value = 0.82). Conclusions The results obtained demonstrate that the multiple regression model can predict the occlusal force using the digital values for the size and color of the articulating paper markings in bruxism patients. PMID:29181234

  15. Predictive Score Card in Lumbar Disc Herniation: Is It Reflective of Patient Surgical Success after Discectomy?

    Directory of Open Access Journals (Sweden)

    Parisa Azimi

    Full Text Available Does the Finneson-Cooper score reflect the true value of predicting surgical success before discectomy? The aim of this study was to identify reliable predictors for surgical success two year after surgery for patients with LDH. Prospective analysis of 154 patients with LDH who underwent single-level lumbar discectomy was performed. Pre- and post-surgical success was assessed by the Oswestry Disability Index (ODI over a 2-year period. The Finneson-Cooper score also was used for evaluation of the clinical results. Using the ODI, surgical success was defined as a 30% (or more improvement on the ODI score from the baseline. The ODI was considered the gold standard in this study. Finally, the sensitivity, specificity, and positive and negative predictive power of the Finneson-Cooper score in predicting surgical success were calculated. The mean age of the patients was 49.6 (SD = 9.3 years and 47.4% were male. Significant improvement from the pre- to post-operative ODI scores was observed (P < 0.001. Post-surgical success was 76.0% (n = 117. The patients' rating on surgical success assessments by the ODI discriminated well between sub-groups of patients who differed with respect to the Finneson-Cooper score. Regarding patients' surgical success, the sensitivity, specificity, and accuracy of the Finneson-Cooper ratings correlated with success rate. The findings indicated that the Finneson-Cooper score was reflective of surgical success before discectomy.

  16. Application of a prediction model for the progression of rheumatoid arthritis in patients with undifferentiated arthritis.

    Science.gov (United States)

    Arana-Guajardo, Ana; Pérez-Barbosa, Lorena; Vega-Morales, David; Riega-Torres, Janett; Esquivel-Valerio, Jorge; Garza-Elizondo, Mario

    2014-01-01

    Different prediction rules have been applied to patients with undifferentiated arthritis (UA) to identify those that progress to rheumatoid arthritis (RA). The Leiden Prediction Rule (LPR) has proven useful in different UA cohorts. To apply the LPR to a cohort of patients with UA of northeastern Mexico. We included 47 patients with UA, LPR was applied at baseline. They were evaluated and then classified after one year of follow-up into two groups: those who progressed to RA (according to ACR 1987) and those who did not. 43% of the AI patients developed RA. In the RA group, 56% of patients obtained a score ≤ 6 and only 15% ≥ 8. 70% who did not progress to RA had a score between 6 and ≤ 8. There was no difference in median score of LPR between groups, p=0.940. Most patients who progressed to RA scored less than 6 points in the LPR. Unlike what was observed in other cohorts, the model in our population did not allow us to predict the progression of the disease. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  17. The importance of different frequency bands in predicting subcutaneous glucose concentration in type 1 diabetic patients.

    Science.gov (United States)

    Lu, Yinghui; Gribok, Andrei V; Ward, W Kenneth; Reifman, Jaques

    2010-08-01

    We investigated the relative importance and predictive power of different frequency bands of subcutaneous glucose signals for the short-term (0-50 min) forecasting of glucose concentrations in type 1 diabetic patients with data-driven autoregressive (AR) models. The study data consisted of minute-by-minute glucose signals collected from nine deidentified patients over a five-day period using continuous glucose monitoring devices. AR models were developed using single and pairwise combinations of frequency bands of the glucose signal and compared with a reference model including all bands. The results suggest that: for open-loop applications, there is no need to explicitly represent exogenous inputs, such as meals and insulin intake, in AR models; models based on a single-frequency band, with periods between 60-120 min and 150-500 min, yield good predictive power (error bands produce predictions that are indistinguishable from those of the reference model as long as the 60-120 min period band is included; and AR models can be developed on signals of short length (approximately 300 min), i.e., ignoring long circadian rhythms, without any detriment in prediction accuracy. Together, these findings provide insights into efficient development of more effective and parsimonious data-driven models for short-term prediction of glucose concentrations in diabetic patients.

  18. A stepwise composite echocardiographic score predicts severe pulmonary hypertension in patients with interstitial lung disease.

    Science.gov (United States)

    Bax, Simon; Bredy, Charlene; Kempny, Aleksander; Dimopoulos, Konstantinos; Devaraj, Anand; Walsh, Simon; Jacob, Joseph; Nair, Arjun; Kokosi, Maria; Keir, Gregory; Kouranos, Vasileios; George, Peter M; McCabe, Colm; Wilde, Michael; Wells, Athol; Li, Wei; Wort, Stephen John; Price, Laura C

    2018-04-01

    European Respiratory Society (ERS) guidelines recommend the assessment of patients with interstitial lung disease (ILD) and severe pulmonary hypertension (PH), as defined by a mean pulmonary artery pressure (mPAP) ≥35 mmHg at right heart catheterisation (RHC). We developed and validated a stepwise echocardiographic score to detect severe PH using the tricuspid regurgitant velocity and right atrial pressure (right ventricular systolic pressure (RVSP)) and additional echocardiographic signs. Consecutive ILD patients with suspected PH underwent RHC between 2005 and 2015. Receiver operating curve analysis tested the ability of components of the score to predict mPAP ≥35 mmHg, and a score devised using a stepwise approach. The score was tested in a contemporaneous validation cohort. The score used "additional PH signs" where RVSP was unavailable, using a bootstrapping technique. Within the derivation cohort (n=210), a score ≥7 predicted severe PH with 89% sensitivity, 71% specificity, positive predictive value 68% and negative predictive value 90%, with similar performance in the validation cohort (n=61) (area under the curve (AUC) 84.8% versus 83.1%, p=0.8). Although RVSP could be estimated in 92% of studies, reducing this to 60% maintained a fair accuracy (AUC 74.4%). This simple stepwise echocardiographic PH score can predict severe PH in patients with ILD.

  19. Structural MRI-Based Predictions in Patients with Treatment-Refractory Depression (TRD.

    Directory of Open Access Journals (Sweden)

    Blair A Johnston

    Full Text Available The application of machine learning techniques to psychiatric neuroimaging offers the possibility to identify robust, reliable and objective disease biomarkers both within and between contemporary syndromal diagnoses that could guide routine clinical practice. The use of quantitative methods to identify psychiatric biomarkers is consequently important, particularly with a view to making predictions relevant to individual patients, rather than at a group-level. Here, we describe predictions of treatment-refractory depression (TRD diagnosis using structural T1-weighted brain scans obtained from twenty adult participants with TRD and 21 never depressed controls. We report 85% accuracy of individual subject diagnostic prediction. Using an automated feature selection method, the major brain regions supporting this significant classification were in the caudate, insula, habenula and periventricular grey matter. It was not, however, possible to predict the degree of 'treatment resistance' in individual patients, at least as quantified by the Massachusetts General Hospital (MGH-S clinical staging method; but the insula was again identified as a region of interest. Structural brain imaging data alone can be used to predict diagnostic status, but not MGH-S staging, with a high degree of accuracy in patients with TRD.

  20. Application of the PredictAD Software Tool to Predict Progression in Patients with Mild Cognitive Impairment

    DEFF Research Database (Denmark)

    Simonsen, Anja H; Mattila, Jussi; Hejl, Anne-Mette

    2012-01-01

    of incremental data presentation using the software tool. A 5th phase was done with all available patient data presented on paper charts. Classifications by the clinical raters were compared to the clinical diagnoses made by the Alzheimer's Disease Neuroimaging Initiative investigators. Results: A statistical...... significant trend (p classification accuracy (from 62.6 to 70.0%) was found when using the PredictAD tool during the stepwise procedure. When the same data were presented on paper, classification accuracy of the raters dropped significantly from 70.0 to 63.2%. Conclusion: Best...... classification accuracy was achieved by the clinical raters when using the tool for decision support, suggesting that the tool can add value in diagnostic classification when large amounts of heterogeneous data are presented....

  1. Functional network architecture predicts psychologically mediated analgesia related to treatment in chronic knee pain patients.

    Science.gov (United States)

    Hashmi, Javeria Ali; Kong, Jian; Spaeth, Rosa; Khan, Sheraz; Kaptchuk, Ted J; Gollub, Randy L

    2014-03-12

    Placebo analgesia is an indicator of how efficiently the brain translates psychological signals conveyed by a treatment procedure into pain relief. It has been demonstrated that functional connectivity between distributed brain regions predicts placebo analgesia in chronic back pain patients. Greater network efficiency in baseline brain networks may allow better information transfer and facilitate adaptive physiological responses to psychological aspects of treatment. Here, we theorized that topological network alignments in resting state scans predict psychologically conditioned analgesic responses to acupuncture treatment in chronic knee osteoarthritis pain patients (n = 45). Analgesia was induced by building positive expectations toward acupuncture treatment with verbal suggestion and heat pain conditioning on a test site of the arm. This procedure induced significantly more analgesia after sham or real acupuncture on the test site than in a control site. The psychologically conditioned analgesia was invariant to sham versus real treatment. Efficiency of information transfer within local networks calculated with graph-theoretic measures (local efficiency and clustering coefficients) significantly predicted conditioned analgesia. Clustering coefficients in regions associated with memory, motivation, and pain modulation were closely involved in predicting analgesia. Moreover, women showed higher clustering coefficients and marginally greater pain reduction than men. Overall, analgesic response to placebo cues can be predicted from a priori resting state data by observing local network topology. Such low-cost synchronizations may represent preparatory resources that facilitate subsequent performance of brain circuits in responding to adaptive environmental cues. This suggests a potential utility of network measures in predicting placebo response for clinical use.

  2. Optimal design of constant-stress accelerated degradation tests using the M-optimality criterion

    International Nuclear Information System (INIS)

    Wang, Han; Zhao, Yu; Ma, Xiaobing; Wang, Hongyu

    2017-01-01

    In this paper, we propose the M-optimality criterion for designing constant-stress accelerated degradation tests (ADTs). The newly proposed criterion concentrates on the degradation mechanism equivalence rather than evaluation precision or prediction accuracy which is usually considered in traditional optimization criteria. Subject to the constraints of total sample number, test termination time as well as the stress region, an optimum constant-stress ADT plan is derived by determining the combination of stress levels and the number of samples allocated to each stress level, when the degradation path comes from inverse Gaussian (IG) process model with covariates and random effects. A numerical example is presented to verify the robustness of our proposed optimum plan and compare its efficiency with other test plans. Results show that, with a slightly relaxed requirement of evaluation precision and prediction accuracy, our proposed optimum plan reduces the dispersion of the estimated acceleration factor between the usage stress level and a higher accelerated stress level, which makes an important contribution to reliability demonstration and assessment tests. - Highlights: • We establish the necessary conditions for degradation mechanism equivalence of ADTs. • We propose the M-optimality criterion for designing constant-stress ADT plans. • The M-optimality plan reduces the dispersion of the estimated accelerated factors. • An electrical connector with its stress relaxation data is used for illustration.

  3. Frequency of reporting and predictive factors for anxiety and depression in patients with advanced cancer.

    Science.gov (United States)

    Salvo, N; Zeng, L; Zhang, L; Leung, M; Khan, L; Presutti, R; Nguyen, J; Holden, L; Culleton, S; Chow, E

    2012-03-01

    The prevalence of anxiety and depression in patients with advanced cancer has been reported to be on average 25% and to significantly affect patients' quality of life. Despite high prevalence rates, these disorders remain underdiagnosed and undertreated. The purpose of our study was to examine the self-report rates of anxiety and depression with the Edmonton Symptom Assessment System (ESAS) and to assess the predictive factors for these reports in cancer patients with metastatic disease. Consecutive patients who attended the Rapid Response Radiotherapy Program (RRRP) completed the ESAS as well as baseline demographic information. Ordinal logistic regression analysis was used to determine factors that significantly predicted anxiety and/or depression. Pearson χ(2) was used to test goodness-of-fit for categorical variables and established whether or not an observed frequency distribution differed from a predicted frequency distribution. A univariate analysis was conducted first and those variables with a P valueanalysis. A score test was used to test the proportional odds assumption. In total, 1439 patients seen in the RRRP between January 1999 and October 2009 completed ESAS questionnaires. Fifty-five per cent of patients reported at least mild symptoms of depression and 65% reported at least mild anxiety. In the univariate analysis, patients who were female, who had a lower performance status score, or primary lung cancer were more likely to report depressed and anxious feelings. Primary prostate cancer patients were significantly less likely to report depression and anxiety. Patients referred for spinal cord compression were significantly less depressed. The multivariate models showed that younger patients were significantly more anxious than older patients and females reported more anxiety than males. Patients who reported higher feelings of nausea, tiredness, drowsiness, dyspnoea, and worse appetite and overall well-being on the ESAS tool were more likely to

  4. Neutron shielding calculations in a proton therapy facility based on Monte Carlo simulations and analytical models: Criterion for selecting the method of choice

    International Nuclear Information System (INIS)

    Titt, U.; Newhauser, W. D.

    2005-01-01

    Proton therapy facilities are shielded to limit the amount of secondary radiation to which patients, occupational workers and members of the general public are exposed. The most commonly applied shielding design methods for proton therapy facilities comprise semi-empirical and analytical methods to estimate the neutron dose equivalent. This study compares the results of these methods with a detailed simulation of a proton therapy facility by using the Monte Carlo technique. A comparison of neutron dose equivalent values predicted by the various methods reveals the superior accuracy of the Monte Carlo predictions in locations where the calculations converge. However, the reliability of the overall shielding design increases if simulation results, for which solutions have not converged, e.g. owing to too few particle histories, can be excluded, and deterministic models are being used at these locations. Criteria to accept or reject Monte Carlo calculations in such complex structures are not well understood. An optimum rejection criterion would allow all converging solutions of Monte Carlo simulation to be taken into account, and reject all solutions with uncertainties larger than the design safety margins. In this study, the optimum rejection criterion of 10% was found. The mean ratio was 26, 62% of all receptor locations showed a ratio between 0.9 and 10, and 92% were between 1 and 100. (authors)

  5. Predictive value of early near-infrared spectroscopy monitoring of patients with traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Alina Vilkė

    2014-01-01

    Conclusions: NIRS plays an important role in the clinical care of TBI patients. Regional brain saturation monitoring provides accurate predictive data, which can improve the allocation of scarce medical resources, set the treatment goals and alleviate the early communication with patients’ relatives.

  6. Surgical outcome prediction in patients with advanced ovarian cancer using computed tomography scans and intraoperative findings

    Directory of Open Access Journals (Sweden)

    Ha-Jeong Kim

    2014-09-01

    Conclusion: The combination of omental extension to the stomach or spleen and involvement of inguinal or pelvic lymph nodes in preoperative CT scans is considered predictive of suboptimal cytoreduction. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction.

  7. Subjective evaluation of the accuracy of video imaging prediction following orthognathic surgery in Chinese patients

    NARCIS (Netherlands)

    Chew, Ming Tak; Koh, Chay Hui; Sandham, John; Wong, Hwee Bee

    Purpose: The aims of this retrospective study were to assess the subjective accuracy of predictions generated by a computer imaging software in Chinese patients who had undergone orthognathic surgery and to determine the influence of initial dysgnathia and complexity of the surgical procedure on

  8. Predicting Resilience via Social Support and Illness Perceptions Among Patients Undergoing Hemodialysis

    Directory of Open Access Journals (Sweden)

    Reihane Hajmohammadi

    2017-07-01

    Full Text Available Background and Objectives Chronic renal disease is a threatening condition for the health, economic, and social status of the affected person and his/her family. Patients undergoing hemodialysis encounter mental and health problems; the current study aimed at predicting resilience via social support and illness perceptions among patients undergoing hemodialysis. Methods The current descriptive-correlational study had a statistical population including 308 patients undergoing hemodialysis in Kerman, Iran, in 2017. Based on the Krejcie-Morgan table, the minimum required sample size was 169. The sample was selected using a convenience sampling method. Data collection tools were the Connor-Davidson resilience scale, the medical outcome study (MOS social support survey developed by Sherbourne and Stewart, and the brief illness perception questionnaire developed by Broadbent et al. Data were analyzed using a Pearson correlation coefficient and a stepwise regression analysis via SPSS version 19. Results Results indicated that resilience was significantly and positively related to social support (r = 0.318, P < 0.05 and illness perceptions (r = 0.165, P < 0.05. Among the subscales of social support, emotional support, tangible support, and social interaction could predict resilience, and among the subscales of illness perceptions, only cognitive representation could predict resilience. Conclusions The obtained results demonstrated that resilience was significantly and positively related to social support and illness perceptions. Additionally, the subscales of social support and illness perceptions could predict resilience among the patients undergoing hemodialysis.

  9. Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study

    NARCIS (Netherlands)

    Ubbink, Dirk T.; Lindeboom, Robert; Eskes, Anne M.; Brull, Huub; Legemate, Dink A.; Vermeulen, Hester

    2015-01-01

    It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We

  10. Predicting complex acute wound healing in patients from a wound expertise centre registry : a prognostic study

    NARCIS (Netherlands)

    Ubbink, Dirk T; Lindeboom, Robert; Eskes, Anne M; Brull, Huub; Legemate, Dink A; Vermeulen, Hester

    2015-01-01

    It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We

  11. Predictive factors of unfavorable prostate cancer in patients who underwent prostatectomy but eligible for active surveillance

    Directory of Open Access Journals (Sweden)

    Seol Ho Choo

    2014-06-01

    Conclusions: A significant proportion of patients who were candidates for active surveillance had unfavorable prostate cancer. Age, PSA density, and two positive cores were independent significant predictive factors for unfavorable prostate cancer. These factors should be considered when performing active surveillance.

  12. A model for predicting skin dose received by patients from an x-ray ...

    African Journals Online (AJOL)

    We have done this by modifying a model for predicting skin dose derived by Edmonds for a triple-phase generator. Results for 100 patients based on the triple-phase generator output show a reasonable average agreement (»1%) between our present model and the Edmonds's model. Although our earlier estimated ...

  13. Nomograms for predicting survival and recurrence in patients with adenoid cystic carcinoma. An international collaborative study

    DEFF Research Database (Denmark)

    Ganly, Ian; Amit, Moran; Kou, Lei

    2015-01-01

    BACKGROUND: Due to the rarity of adenoid cystic carcinoma (ACC), information on outcome is based upon small retrospective case series. The aim of our study was to create a large multiinstitutional international dataset of patients with ACC in order to design predictive nomograms for outcome. METH...

  14. Serum YKL-40 predicts long-term mortality in patients with stable coronary disease

    DEFF Research Database (Denmark)

    Harutyunyan, Marina; Gøtze, Jens P; Winkel, Per

    2013-01-01

    We investigated whether the inflammatory biomarker YKL-40 could improve the long-term prediction of death made by common risk factors plus high-sensitivity C-reactive protein (hs-CRP) and N-terminal-pro-B natriuretic peptide (NT-proBNP) in patients with stable coronary artery disease (CAD)....

  15. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption.

    Science.gov (United States)

    Wang, Liangcheng; Matsunaga, Shigetaka; Mikami, Yukiko; Takai, Yasushi; Terui, Katsuo; Seki, Hiroyuki

    2016-07-01

    Placental abruption is a severe obstetric complication of pregnancy that can cause disseminated intravascular coagulation and progress to massive post-partum hemorrhage. Coagulation disorder due to extreme consumption of fibrinogen is considered the main pathogenesis of disseminated intravascular coagulation in patients with placental abruption. The present study sought to determine if the pre-delivery fibrinogen level could predict adverse maternal or neonatal outcomes in patients with placental abruption. This retrospective medical chart review was conducted in a center for maternal, fetal, and neonatal medicine in Japan with 61 patients with placental abruption. Fibrinogen levels prior to delivery were collected and evaluated for the prediction of maternal and neonatal outcomes. The main outcome measures for maternal outcomes were disseminated intravascular coagulation and hemorrhage, and the main outcome measures for neonatal outcomes were Apgar score at 5 min, umbilical artery pH, and stillbirth. The receiver-operator curve and multivariate logistic regression analyses indicated that fibrinogen significantly predicted overt disseminated intravascular coagulation and the requirement of ≥6 red blood cell units, ≥10 fresh frozen plasma units, and ≥20 fresh frozen plasma units for transfusion. Moderate hemorrhage occurred in 71.5% of patients with a decrease in fibrinogen levels to 155 mg/dL. Fibrinogen could also predict neonatal outcomes. Umbilical artery pH neonatal outcomes with placental abruption. © 2016 Japan Society of Obstetrics and Gynecology. © 2016 Japan Society of Obstetrics and Gynecology.

  16. Satisfaction of psychotic patients with care and its value to predict outcomes

    NARCIS (Netherlands)

    Vermeulen, J. M.; Schirmbeck, N. F.; Van Tricht, M. J.; de Haan, L.

    2018-01-01

    Background: A key indicator of quality of treatment from the patient's perspective is expressed by satisfaction with care. Our aim was to (i) explore satisfaction and its relation to clinical outcome measures; and (ii) explore the predictive value of satisfaction for the course of outcomes over

  17. Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

    NARCIS (Netherlands)

    Groot, N.; Oijen, M.G. van; Kessels, K.; Hemmink, M.; Weusten, B.; Timmer, R.; Hazen, W.; Lelyveld, N. van; Vermeijden, J.R.; Curvers, W.; Baak, L.; Verburg, R.; Bosman, J.; Wijkerslooth, L. de; Rooij, J van; Venneman, N.; Pennings, M.C.P.; Hee, K. van; Scheffer, R.; Eijk, R. van; Meiland, R.; Siersema, P.D.; Bredenoord, A.

    2014-01-01

    INTRODUCTION: Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added

  18. Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

    NARCIS (Netherlands)

    de Groot, N. L.; van Oijen, M. G. H.; Kessels, K.; Hemmink, M.; Weusten, B. L. A. M.; Timmer, R.; Hazen, W. L.; van Lelyveld, N.; Vermeijden, J. R.; Curvers, W. L.; Baak, L. C.; Verburg, R.; Bosman, J. H.; de Wijkerslooth, L. R. H.; de Rooij, J.; Venneman, N. G.; Pennings, M.; van Hee, K.; Scheffer, R. C. H.; van Eijk, R. L.; Meiland, R.; Siersema, P. D.; Bredenoord, A. J.

    2014-01-01

    Introduction: Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added

  19. Development and validation of multivariable models to predict mortality and hospitalization in patients with heart failure

    NARCIS (Netherlands)

    Voors, Adriaan A.; Ouwerkerk, Wouter; Zannad, Faiez; van Veldhuisen, Dirk J.; Samani, Nilesh J.; Ponikowski, Piotr; Ng, Leong L.; Metra, Marco; ter Maaten, Jozine M.; Lang, Chim C.; Hillege, Hans L.; van der Harst, Pim; Filippatos, Gerasimos; Dickstein, Kenneth; Cleland, John G.; Anker, Stefan D.; Zwinderman, Aeilko H.

    Introduction From a prospective multicentre multicountry clinical trial, we developed and validated risk models to predict prospective all-cause mortality and hospitalizations because of heart failure (HF) in patients with HF. Methods and results BIOSTAT-CHF is a research programme designed to

  20. Development and validation of multivariable models to predict mortality and hospitalization in patients with heart failure

    NARCIS (Netherlands)

    Voors, Adriaan A.; Ouwerkerk, Wouter; Zannad, Faiez; van Veldhuisen, Dirk J.; Samani, Nilesh J.; Ponikowski, Piotr; Ng, Leong L.; Metra, Marco; ter Maaten, Jozine M.; Lang, Chim C.; Hillege, Hans L.; van der Harst, Pim; Filippatos, Gerasimos; Dickstein, Kenneth; Cleland, John G.; Anker, Stefan D.; Zwinderman, Aeilko H.

    2017-01-01

    Introduction From a prospective multicentre multicountry clinical trial, we developed and validated risk models to predict prospective all-cause mortality and hospitalizations because of heart failure (HF) in patients with HF. Methods and results BIOSTAT-CHF is a research programme designed to

  1. Inflammation biomarkers and mortality prediction in patients with type 2 diabetes (ZODIAC-27)

    NARCIS (Netherlands)

    Landman, Gijs W. D.; Kleefstra, Nanne; Groenier, Klaas H.; Bakker, Stephan J. L.; Groeneveld, Geert H.; Bilo, Henk J. G.; van Hateren, Kornelis J. J.

    Background: C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (MR-proADM) are inflammation markers associated with long-term mortality risk. We compared the associations and predictive capacities of CRP, PCT and MR-proADM with cardiovascular and all-cause mortality in patients

  2. Predictive factors of cessation of ambulation in patients with Duchenne muscular dystrophy

    NARCIS (Netherlands)

    Bakker, Jan P. J.; de Groot, Imelda J. M.; Beelen, Anita; Lankhorst, Gustaaf J.

    2002-01-01

    To identify baseline patient and treatment characteristics that can predict wheelchair dependency within 2 yr. This prospective cohort study included 44 subjects who met study inclusion criteria. The same investigator examined them at 6-mo intervals. Ambulatory status, anthropometric data, muscle

  3. Tumor Necrosis Factor Inhibitor Primary Failure Predicts Decreased Ustekinumab Efficacy in Psoriasis Patients.

    Science.gov (United States)

    Sorensen, Eric P; Fanucci, Kristina A; Saraiya, Ami; Volf, Eva; Au, Shiu-chung; Argobi, Yahya; Mansfield, Ryan; Gottlieb, Alice B

    2015-08-01

    Additional studies are needed to examine the efficacy of ustekinumab in psoriasis patients who have previously been exposed to tumor necrosis factor inhibitors (TNFi). To examine the predictive effect of TNFi primary failure and the number of TNFi exposures on the efficacy of ustekinumab in psoriasis treatment. This retrospective study examined 44 psoriasis patients treated at the Tufts Medical Center Department of Dermatology between January 2008 and July 2014. Patients were selected if they were treated with ustekinumab and had ≥ 1 previous TNFi exposure. The following subgroups were compared: patients with vs without a previous TNFi primary failure, and patients with one vs multiple previous TNFi exposures. The efficacy measure used was the previously validated Simple Measure for Assessing Psoriasis Activity (S-MAPA), which is calculated by the product of the body surface area and physician global assessment. The primary outcome was the percentage improvement S-MAPA from course baseline at week 12 of ustekinumab treatment. Secondary outcomes were the psoriasis clearance, primary failure, and secondary failure rates with ustekinumab treatment. Patients with a previous TNFi primary failure had a significantly lower percentage improvement in S-MAPA score at week 12 of ustekinumab treatment compared with patients without TNFi primary failure (36.2% vs 61.1%, P=.027). Multivariate analysis demonstrated that this relationship was independent of patient demographics and medical comorbidities. Patients with multiple TNFi exposures had a non-statistically significant lower percentage S-MAPA improvement at week 12 (40.5% vs 52.9%, P=.294) of ustekinumab treatment compared with patients with a single TNFi exposure. Among psoriasis patients previously exposed to TNFi, a history of a previous TNFi primary failure predicts a decreased response to ustekinumab independent of patient demographics and medical comorbidities.

  4. Predictive Factors and Treatment Outcomes of Tuberculous Pleural Effusion in Patients With Cancer and Pleural Effusion.

    Science.gov (United States)

    Lee, Jaehee; Lee, Yong Dae; Lim, Jae Kwang; Lee, Deok Heon; Yoo, Seung Soo; Lee, Shin Yup; Cha, Seung Ick; Park, Jae Yong; Kim, Chang Ho

    2017-08-01

    Patients with cancer are at an increased risk of tuberculosis. As pleural effusion has great clinical significance in patients with cancer, the differential diagnosis between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) is important. However, the predictive factors and treatment outcomes of TPE in patients with cancer have rarely been studied. Confirmed TPE cases identified at cancer diagnosis and during anticancer management from 2008-2015 were retrospectively investigated. Patients in the study included coexisting TPE and cancer (n = 20), MPE (n = 40) and TPE without cancer (n = 40). Control groups were patients with MPE, and patients with TPE without cancer. Clinical, laboratory and pleural fluid characteristics were compared among groups. Treatment outcomes were compared between patients with TPE with and without cancer. In the final analysis, serum C-reactive protein (S-CRP) ≥3.0mg/dL and pleural fluid adenosine deaminase (ADA) ≥40U/L were independent predictors for identifying TPE in patients with cancer having pleural effusion. The combination of S-CRP with pleural fluid ADA using an "or" rule achieved a sensitivity of 100%, whereas both parameters combined in an "and" rule had a specificity of 98%. Treatment outcomes were not different between the TPE groups with and without cancer. S-CRP and pleural fluid ADA levels may be helpful for predicting TPE in patients with cancer with pleural effusion. The combination of these biomarkers provides better information for distinguishing between TPE and MPE in these patients. Treatment outcomes of TPE in patients with cancer are comparable to those in patients without cancer. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  5. Predictive score of sarcopenia occurrence one year after bariatric surgery in severely obese patients.

    Science.gov (United States)

    Voican, Cosmin Sebastian; Lebrun, Amandine; Maitre, Sophie; Lainas, Panagiotis; Lamouri, Karima; Njike-Nakseu, Micheline; Gaillard, Martin; Tranchart, Hadrien; Balian, Axel; Dagher, Ibrahim; Perlemuter, Gabriel; Naveau, Sylvie

    2018-01-01

    Sarcopenic obesity is a risk factor of morbidity and mortality. The aim of this study was to generate a predictive score of sarcopenia occurrence one year after bariatric surgery. We conducted an observational prospective cohort study on a total of 184 severely obese patients admitted to our institution to undergo sleeve gastrectomy. Skeletal muscle cross-sectional area at the third lumbar vertebrae (SMA, cm2) was measured from the routinely performed computed tomography. The skeletal muscle index (SMI) was calculated as follows: SMA/height2 (cm2/m2). Sarcopenia was defined as an SMI predictive sarcopenia occurrence scores were constructed using SMA and gender (SS1 score) or SMI and gender (SS2 score). The area under receiver operating characteristic (AUROC) curve of the SS2 score was significantly greater than that of the SS1 score for the diagnosis of postoperative sarcopenia occurrence (0.95±0.02 versus 0.90±0.02; ppredictive value of 83%, and a negative predictive value of 95%. In the group of patients without baseline sarcopenia, the SS2 score had still an excellent AUROC of 0.92±0.02. A cut-off of 0.55 predicted development of sarcopenia one year after sleeve gastrectomy in these patients with a sensitivity of 87%, a specificity of 88%, and negative predictive value of 95%. The SS2 score has excellent predictive value for the occurrence of sarcopenia one year after sleeve gastrectomy. This score can be used to target early intensification of nutritional and dietetic follow-up to the predicted high-risk population.

  6. Accuracy of circulating histones in predicting persistent organ failure and mortality in patients with acute pancreatitis.

    Science.gov (United States)

    Liu, T; Huang, W; Szatmary, P; Abrams, S T; Alhamdi, Y; Lin, Z; Greenhalf, W; Wang, G; Sutton, R; Toh, C H

    2017-08-01

    Early prediction of acute pancreatitis severity remains a challenge. Circulating levels of histones are raised early in mouse models and correlate with disease severity. It was hypothesized that circulating histones predict persistent organ failure in patients with acute pancreatitis. Consecutive patients with acute pancreatitis fulfilling inclusion criteria admitted to Royal Liverpool University Hospital were enrolled prospectively between June 2010 and March 2014. Blood samples were obtained within 48 h of abdominal pain onset and relevant clinical data during the hospital stay were collected. Healthy volunteers were enrolled as controls. The primary endpoint was occurrence of persistent organ failure. The predictive values of circulating histones, clinical scores and other biomarkers were determined. Among 236 patients with acute pancreatitis, there were 156 (66·1 per cent), 57 (24·2 per cent) and 23 (9·7 per cent) with mild, moderate and severe disease respectively, according to the revised Atlanta classification. Forty-seven healthy volunteers were included. The area under the receiver operating characteristic (ROC) curve (AUC) for circulating histones in predicting persistent organ failure and mortality was 0·92 (95 per cent c.i. 0·85 to 0·99) and 0·96 (0·92 to 1·00) respectively; histones were at least as accurate as clinical scores or biochemical markers. For infected pancreatic necrosis and/or sepsis, the AUC was 0·78 (0·62 to 0·94). Histones did not predict or correlate with local pancreatic complications, but correlated negatively with leucocyte cell viability (r = -0·511, P = 0·001). Quantitative assessment of circulating histones in plasma within 48 h of abdominal pain onset can predict persistent organ failure and mortality in patients with acute pancreatitis. Early death of immune cells may contribute to raised circulating histone levels in acute pancreatitis. © 2017 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS

  7. Radiotherapy on the neck nodes predicts severe weight loss in patients with early stage laryngeal cancer

    International Nuclear Information System (INIS)

    Langius, Jacqueline A.E.; Doornaert, Patricia; Spreeuwenberg, Marieke D.; Langendijk, Johannes A.; Leemans, C. Rene; Schueren, Marian A.E. van Bokhorst-de van der

    2010-01-01

    Background and purpose: Although patients with early stage (T1/T2) laryngeal cancer (LC) are thought to have a low incidence of malnutrition, severe weight loss is observed in a subgroup of these patients during radiotherapy (RT). The objective of this study was to evaluate weight loss and nutrition-related symptoms in patients with T1/T2 LC during RT and to select predictive factors for early identification of malnourished patients. Methods: Of all patients with T1/T2 LC, who received primary RT between 1999 and 2007, the following characteristics were recorded: sex, age, TNM classification, tumour location, radiation schedule, performance status, quality of life, weight loss, and nutrition-related symptoms. The association between baseline characteristics and malnutrition (>5% weight loss during RT) was investigated by Cox regression analysis. Results: The study population consisted of 238 patients. During RT, 44% of patients developed malnutrition. Tumour location, TNM classification, RT on the neck nodes, RT dose, nausea/vomiting, pain, swallowing, senses problems, trouble with social eating, dry mouth and the use of painkillers were all significantly associated with malnutrition. In the multivariate analysis, RTs on both the neck nodes (HR 4.16, 95% CI 2.62-6.60) and dry mouth (HR 1.72, 95% CI 1.14-2.60) remained predictive. Nevertheless, RT on the neck nodes alone resulted in the best predictive model for malnutrition scores. Conclusions: Patients with early stage laryngeal cancer are at risk of malnutrition during radiotherapy. Radiotherapy on the neck nodes is the best predictor of malnutrition during radiotherapy. Therefore, we suggest to offer nutritional counselling to all the patients who receive nodal irradiation.

  8. Wavelength selection in injection-driven Hele-Shaw flows: A maximum amplitude criterion

    Science.gov (United States)

    Dias, Eduardo; Miranda, Jose

    2013-11-01

    As in most interfacial flow problems, the standard theoretical procedure to establish wavelength selection in the viscous fingering instability is to maximize the linear growth rate. However, there are important discrepancies between previous theoretical predictions and existing experimental data. In this work we perform a linear stability analysis of the radial Hele-Shaw flow system that takes into account the combined action of viscous normal stresses and wetting effects. Most importantly, we introduce an alternative selection criterion for which the selected wavelength is determined by the maximum of the interfacial perturbation amplitude. The effectiveness of such a criterion is substantiated by the significantly improved agreement between theory and experiments. We thank CNPq (Brazilian Sponsor) for financial support.

  9. Application of a new criterion for assessing the susceptibility to internal erosion

    Energy Technology Data Exchange (ETDEWEB)

    Li, M.; Garner, S.J. [BC Hydro, Burnaby, BC (Canada); Fannin, R.J. [British Columbia Univ., Vancouver, BC (Canada)

    2009-07-01

    Occasionally, internal erosion can occur in internally unstable soils that are subject to seepage flow. This paper presented a modification to the Kenney-Lau criterion for assessing susceptibility to internal erosion in widely-graded cohesionless soils. The original Kenney-Lau criterion and the newly-proposed Li-Fannin criteria were both used to evaluate the grading stability of filter and core materials from two zoned earthfill dams in British Columbia. Using a statistical approach, the criteria were applied to construction data to account for the many gradation curves available within the specification envelope for materials used in construction. The paper discussed the implications of the findings within the context of laboratory permeameter tests on the same soils, and also based on a sinkhole incident at one of the dams. It was concluded that the Kenney-Lau method appears to be less conservative for predicting the internal instability of widely graded materials. 16 refs., 5 figs.

  10. Criterion for vortex breakdown on shock wave and streamwise vortex interactions.

    Science.gov (United States)

    Hiejima, Toshihiko

    2014-05-01

    The interactions between supersonic streamwise vortices and oblique shock waves are theoretically and numerically investigated by three-dimensional (3D) Navier-Stokes equations. Based on the two inequalities, a criterion for shock-induced breakdown of the streamwise vortex is proposed. The simple breakdown condition depends on the Mach number, the swirl number, the velocity deficit, and the shock angle. According to the proposed criterion, the breakdown region expands as the Mach number increases. In numerical simulations, vortex breakdown appeared under conditions of multiple pressure increases and the helicity disappeared behind the oblique shock wave along the line of the vortex center. The numerical results are consistent with the predicted breakdown condition at Mach numbers 2.0 and 3.0. This study also found that the axial velocity deficit is important for classifying the breakdown configuration.

  11. Ethical leadership: meta-analytic evidence of criterion-related and incremental validity.

    Science.gov (United States)

    Ng, Thomas W H; Feldman, Daniel C

    2015-05-01

    This study examines the criterion-related and incremental validity of ethical leadership (EL) with meta-analytic data. Across 101 samples published over the last 15 years (N = 29,620), we observed that EL demonstrated acceptable criterion-related validity with variables that tap followers' job attitudes, job performance, and evaluations of their leaders. Further, followers' trust in the leader mediated the relationships of EL with job attitudes and performance. In terms of incremental validity, we found that EL significantly, albeit weakly in some cases, predicted task performance, citizenship behavior, and counterproductive work behavior-even after controlling for the effects of such variables as transformational leadership, use of contingent rewards, management by exception, interactional fairness, and destructive leadership. The article concludes with a discussion of ways to strengthen the incremental validity of EL. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  12. A criterion for the onset of slugging in horizontal stratified air-water countercurrent flow

    International Nuclear Information System (INIS)

    Chun, Moon-Hyun; Lee, Byung-Ryung; Kim, Yang-Seok

    1995-01-01

    This paper presents an experimental and theoretical investigation of wave height and transition criterion from wavy to slug flow in horizontal air-water countercurrent stratified flow conditions. A theoretical formula for the wave height in a stratified wavy flow regime has been developed using the concept of total energy balance over a wave crest to consider the shear stress acting on the interface of two fluids. From the limiting condition of the formula for the wave height, a necessary criterion for transition from a stratified wavy flow to a slug flow has been derived. A series of experiments have been conducted changing the non-dimensional water depth and the flow rates of air in a horizontal pipe and a duct. Comparisons between the measured data and the predictions of the present theory show that the agreement is within ±8%

  13. A criterion for the onset of slugging in horizontal stratified air-water countercurrent flow

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Moon-Hyun; Lee, Byung-Ryung; Kim, Yang-Seok [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)] [and others

    1995-09-01

    This paper presents an experimental and theoretical investigation of wave height and transition criterion from wavy to slug flow in horizontal air-water countercurrent stratified flow conditions. A theoretical formula for the wave height in a stratified wavy flow regime has been developed using the concept of total energy balance over a wave crest to consider the shear stress acting on the interface of two fluids. From the limiting condition of the formula for the wave height, a necessary criterion for transition from a stratified wavy flow to a slug flow has been derived. A series of experiments have been conducted changing the non-dimensional water depth and the flow rates of air in a horizontal pipe and a duct. Comparisons between the measured data and the predictions of the present theory show that the agreement is within {plus_minus}8%.

  14. Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

    Science.gov (United States)

    Stonelake, Stephen; Thomson, Peter; Suggett, Nigel

    2015-09-01

    National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the 'high risk' patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk. Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien-Dindo classification. The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien-Dindo grade 2-3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4-5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01). Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively. In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the 'high-risk' patient.

  15. Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting.

    Science.gov (United States)

    Rydman, Eric; Ponzer, Sari; Ottosson, Carin; Järnbert-Pettersson, Hans

    2017-04-01

    To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting. Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument's ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set). The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %. Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.

  16. Patients in palliative care-Development of a predictive model for anxiety using routine data.

    Science.gov (United States)

    Hofmann, Sonja; Hess, Stephanie; Klein, Carsten; Lindena, Gabriele; Radbruch, Lukas; Ostgathe, Christoph

    2017-01-01

    Anxiety is one of the most common psychological symptoms in patients in a palliative care situation. This study aims to develop a predictive model for anxiety using data from the standard documentation routine. Data sets of palliative care patients collected by the German quality management benchmarking system called Hospice and Palliative Care Evaluation (HOPE) from 2007 to 2011 were randomly divided into a training set containing two-thirds of the data and a test set with the remaining one-third. We dichotomized anxiety levels, proxy rated by medical staff using the validated HOPE Symptom and Problem Checklist, into two groups with no or mild anxiety versus moderate or severe anxiety. Using the training set, a multivariable logistic regression model was developed by backward stepwise selection. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC) based on the test set. An analysis of 9924 data sets suggests a predictive model for anxiety in patients receiving palliative care which contains gender, age, ECOG, living situation, pain, nausea, dyspnea, loss of appetite, tiredness, need for assistance with activities of daily living, problems with organization of care, medication with sedatives/anxiolytics, antidepressants, antihypertensive drugs, laxatives, and antibiotics. It results in a fair predictive value (AUC = 0.72). Routinely collected data providing individual-, disease- and therapy-related information contain valuable information that is useful for the prediction of anxiety risks in patients receiving palliative care. These findings could thus be advantageous for providing appropriate support for patients in palliative care settings and should receive special attention in future research.

  17. Predicting the Occurrence of Oxygenation Impairment in Patients with Type-B Acute Aortic Dissection

    Science.gov (United States)

    Tomita, Kazunori; Hata, Noritake; Kobayashi, Nobuaki; Shinada, Takuro; Shirakabe, Akihiro

    2014-01-01

    Complicated respiratory failure requiring mechanical ventilation in patients with type-B acute aortic dissection (AAD) has been previously reported, and inflammatory reactions have been found to be associated with the occurrence of oxygenation impairment (OI). However, the possibility of predicting the occurrence of OI in patients with type-B AAD has not yet been evaluated. This study was performed to investigate the possibility of predicting the occurrence of OI in type-B AAD. In this study, 79 type-B AAD patients were enrolled to investigate the possibility of predicting the occurrence of OI. OI was defined as Po 2/Fio 2 ≤ 200. Patient characteristics, type of AAD, vital signs on admission, and the presence of inflammatory reactions obtained on admission day were evaluated. OI occurred in 39 patients (49%) on hospital day 2.5 ± 1.4 on average. Younger age, male gender, nonslender frame (body mass index ≥ 22 kg/m2), a relatively high maximum body temperature on the admission day (≥ 36.5°C), DeBakey IIIb type, patent false lumen, and lower Po 2/Fio 2 on admission were found to be associated with the occurrence of OI. Multivariate analysis revealed that nonslender frame, relatively high body temperature on the admission day, and lower Po 2/Fio 2 on admission were reliable for predicting the occurrence of oxygen impairment. The occurrence of OI in type-B AAD can be predicted in the clinical setting. PMID:24627618

  18. A NEW METHOD FOR PREDICTING SURVIVAL AND ESTIMATING UNCERTAINTY IN TRAUMA PATIENTS

    Directory of Open Access Journals (Sweden)

    V. G. Schetinin

    2017-01-01

    Full Text Available The Trauma and Injury Severity Score (TRISS is the current “gold” standard of screening patient’s condition for purposes of predicting survival probability. More than 40 years of TRISS practice revealed a number of problems, particularly, 1 unexplained fluctuation of predicted values caused by aggregation of screening tests, and 2 low accuracy of uncertainty intervals estimations. We developed a new method made it available for practitioners as a web calculator to reduce negative effect of factors given above. The method involves Bayesian methodology of statistical inference which, being computationally expensive, in theory provides most accurate predictions. We implemented and tested this approach on a data set including 571,148 patients registered in the US National Trauma Data Bank (NTDB with 1–20 injuries. These patients were distributed over the following categories: (1 174,647 with 1 injury, (2 381,137 with 2–10 injuries, and (3 15,364 with 11–20 injuries. Survival rates in each category were 0.977, 0.953, and 0.831, respectively. The proposed method has improved prediction accuracy by 0.04%, 0.36%, and 3.64% (p-value <0.05 in the categories 1, 2, and 3, respectively. Hosmer-Lemeshow statistics showed a significant improvement of the new model calibration. The uncertainty 2σ intervals were reduced from 0.628 to 0.569 for patients of the second category and from 1.227 to 0.930 for patients of the third category, both with p-value <0.005. The new method shows the statistically significant improvement (p-value <0.05 in accuracy of predicting survival and estimating the uncertainty intervals. The largest improvement has been achieved for patients with 11–20 injuries. The method is available for practitioners as a web calculator http://www.traumacalc.org.

  19. Distance saturation product predicts health-related quality of life among sarcoidosis patients.

    Science.gov (United States)

    Bourbonnais, Julie M; Malaisamy, Subramanian; Dalal, Bhavinkumar D; Samarakoon, Priyan C; Parikh, Swapna R; Samavati, Lobelia

    2012-06-13

    Sarcoidosis is a chronic disease with different phenotypic manifestations. Health-related quality of life is an important aspect in sarcoidosis, yet difficult to measure. The objective of this study was to identify clinical markers predictive of poor quality of life in sarcoidosis patients that can be followed over time and targeted for intervention. We assessed the quality of life of 162 patients with confirmed sarcoidosis in a prospective, cross-sectional study using the Sarcoidosis Health Questionnaire (SHQ) and Short Form-36 Health Survey (SF-36). We evaluated the validity of these questionnaires and sought to identify variables that would best explain the performance scores of the patients. On multivariate regression analyses, the very best composite model to predict total scores from both surveys was a model containing the distance-saturation product and Borg Dyspnea Scale score at the end of a 6-min walk test. This model could better predict SF-36 scores (R² = 0.33) than SHQ scores (R² = 0.24). Substitution of distanced walked in 6 min for the distance-saturation product in this model resulted in a lesser ability to predict both scores (R² = 0.26 for SF-36; R² = 0.22 for SHQ). Both the SHQ and SF-36 surveys are valuable tools in the assessment of health-related quality of life in sarcoidosis patients. The best model to predict quality of life among these patients, as determined by regression analyses, included the distance-saturation product and Borg score after the 6-min walk test. Both variables represent easily obtainable clinical parameters that can be followed over time and targeted for intervention.

  20. Ductile failure analysis of API X65 pipes with notch-type defects using a local fracture criterion

    International Nuclear Information System (INIS)

    Oh, Chang-Kyun; Kim, Yun-Jae; Baek, Jong-Hyun; Kim, Young-Pyo; Kim, Woo-Sik

    2007-01-01

    A local failure criterion for API X65 steel is applied to predict ductile failure of full-scale API X65 pipes with simulated corrosion and gouge defects under internal pressure. The local failure criterion is the stress-modified fracture strain as a function of the stress triaxiality (defined by the ratio of the hydrostatic stress to the effective stress). Based on detailed finite element (FE) analyses with the proposed local failure criterion, burst pressures of defective pipes are estimated and compared with experimental data. For pipes with simulated corrosion defects, FE analysis with the proposed local fracture criterion indicates that predicted failure takes place after the defective pipes attain maximum loads for all cases, possibly due to the fact that the material has sufficient ductility. For pipes with simulated gouge defects, on the other hand, it is found that predicted failure takes place before global instability, and the predicted burst pressures are in good agreement with experimental data, providing confidence in the present approach

  1. High serum uric acid concentration predicts poor survival in patients with breast cancer.

    Science.gov (United States)

    Yue, Cai-Feng; Feng, Pin-Ning; Yao, Zhen-Rong; Yu, Xue-Gao; Lin, Wen-Bin; Qian, Yuan-Min; Guo, Yun-Miao; Li, Lai-Sheng; Liu, Min

    2017-10-01

    Uric acid is a product of purine metabolism. Recently, uric acid has gained much attraction in cancer. In this study, we aim to investigate the clinicopathological and prognostic significance of serum uric acid concentration in breast cancer patients. A total of 443 female patients with histopathologically diagnosed breast cancer were included. After a mean follow-up time of 56months, survival was analysed using the Kaplan-Meier method. To further evaluate the prognostic significance of uric acid concentrations, univariate and multivariate Cox regression analyses were applied. Of the clinicopathological parameters, uric acid concentration was associated with age, body mass index, ER status and PR status. Univariate analysis identified that patients with increased uric acid concentration had a significantly inferior overall survival (HR 2.13, 95% CI 1.15-3.94, p=0.016). In multivariate analysis, we found that high uric acid concentration is an independent prognostic factor predicting death, but insufficient to predict local relapse or distant metastasis. Kaplan-Meier analysis indicated that high uric acid concentration is related to the poor overall survival (p=0.013). High uric acid concentration predicts poor survival in patients with breast cancer, and might serve as a potential marker for appropriate management of breast cancer patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Predicting readmission risk of patients with diabetes hospitalized for cardiovascular disease: a retrospective cohort study.

    Science.gov (United States)

    Rubin, Daniel J; Golden, Sherita Hill; McDonnell, Marie E; Zhao, Huaqing

    2017-08-01

    To develop and validate a tool that predicts 30d readmission risk of patients with diabetes hospitalized for cardiovascular disease (CVD), the Diabetes Early Readmission Risk Indicator-CVD (DERRI-CVD™). A cohort of 8189 discharges was retrospectively selected from electronic records of adult patients with diabetes hospitalized for CVD. Discharges of 60% of the patients (n=4950) were randomly selected as a training sample and the remaining 40% (n=3219) were the validation sample. Statistically significant predictors of all-cause 30d readmission risk were identified by multivariable logistic regression modeling: education level, employment status, living within 5miles of the hospital, pre-admission diabetes therapy, macrovascular complications, admission serum creatinine and albumin levels, having a hospital discharge within 90days pre-admission, and a psychiatric diagnosis. Model discrimination and calibration were good (C-statistic 0.71). Performance in the validation sample was comparable. Predicted 30d readmission risk was similar in the training and validation samples (38.6% and 35.1% in the highest quintiles). The DERRI-CVD™ may be a valid tool to predict all-cause 30d readmission risk of patients with diabetes hospitalized for CVD. Identifying high-risk patients may encourage the use of interventions targeting those at greatest risk, potentially leading to better outcomes and lower healthcare costs. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Predictive value of digital subtraction angiography in patients with tuberculous meningitis

    International Nuclear Information System (INIS)

    Rojas-Echeverri, L.A.; Soto-Hernandez, J.L.; Garza, S.; Martinez-Zubieta, R.; Miranda, L.I.; Garcia-Ramos, G.; Zenteno, M.

    1996-01-01

    Digital subtraction angiography (DSA) was performed in 24 adults with tuberculous meningitis (TBM) and results were correlated with 24 admission and 16 follow-up CT examinations. 19 MRI studies and clinical outcome at a mean follow-up of 44 weeks. DSA was abnormal in 11 patients. Abnormal DSA was associated with advenced clinical stages of the Medical Research Council classification, admission CT with hydrocephalus or gyral cortical enhancement. MRI disclosed brain infarcts not seen on initial CT in 8 cases. Of seven patients who died, 4 had abnormal and 3 normal DSA. Among patients who survived, those with normal DSA had a better functional outcome by Karnofsky scores. During follow-up infarcts were evident in 16 patients. Abnormal DSA in relation to brain infarcts had a sensitivity of 0.56, specificity 0.75, positive predictive value 0.82 and negative predictive value 0.46. A single arteriogram does not predict the outcome in patients with TBM and its value is limited in the assessment of vascular complications of TBM. Angiography in TBM is justified only in specific clinical trials to assess new therapeutic modalities against infarcts. (orig.)

  4. Identifying a predictive model for response to atypical antipsychotic monotherapy treatment in south Indian schizophrenia patients.

    Science.gov (United States)

    Gupta, Meenal; Moily, Nagaraj S; Kaur, Harpreet; Jajodia, Ajay; Jain, Sanjeev; Kukreti, Ritushree

    2013-08-01

    Atypical antipsychotic (AAP) drugs are the preferred choice of treatment for schizophrenia patients. Patients who do not show favorable response to AAP monotherapy are subjected to random prolonged therapeutic treatment with AAP multitherapy, typical antipsychotics or a combination of both. Therefore, prior identification of patients' response to drugs can be an important step in providing efficacious and safe therapeutic treatment. We thus attempted to elucidate a genetic signature which could predict patients' response to AAP monotherapy. Our logistic regression analyses indicated the probability that 76% patients carrying combination of four SNPs will not show favorable response to AAP therapy. The robustness of this prediction model was assessed using repeated 10-fold cross validation method, and the results across n-fold cross-validations (mean accuracy=71.91%; 95%CI=71.47-72.35) suggest high accuracy and reliability of the prediction model. Further validations of these results in large sample sets are likely to establish their clinical applicability. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. [Clinical value of angiogenin in predicting the prognosis of patients with idiopathic pulmonary fibrosis].

    Science.gov (United States)

    Bai, Yanling; Zhu, Haiyan; Sun, Qiyu; Gu, Guozhong; Zhang, Lingyu; Li, Ying; Yang, Baofeng

    2017-09-01

    To explore the relationship between angiogenin-1/2 (Ang-1/2) and clinical parameters of idiopathic pulmonary fibrosis (IPF), and to assess the value of Ang-1/2 in predicting the prognosis of patients with IPF. A retrospective analysis was conducted. Ninety-one patients diagnosed as IPF by high resolution CT (HRCT) and lung biopsy admitted to Daqing Oil Field General Hospital from March 2014 to January 2015 were enrolled. The general data, serum parameters and pulmonary function parameters of all patients were collected. After treatment, all of the 91 patients were followed-up to 2 years. The patients were divided into favorable prognosis group and unfavorable prognosis group according to follow-up results. The differences in all parameters between the two groups were compared. The relationship between Ang-1, Ang-2 and lung function parameters was analyzed by Pearson correlation analysis. Cox proportional hazard regression model was used to evaluate the effect of clinical parameters on the prognosis of patients with IPF. The effect of Ang-2 in predicting prognosis of patients with IPF was analyzed by receiver operating characteristic (ROC) curve. During the 2-year follow-up period, 30 of 91 patients showed a favorable prognosis, and 55 showed an unfavorable prognosis with a poor prognosis rate of 64.71%, and 6 patients withdrew from the study due to loss of follow-up and death. Compared with the favorable prognosis group, Ang-2 level in the unfavorable prognosis group was significantly increased (μg/L: 2.88±1.63 vs. 1.89±1.22, t = 2.909, P = 0.005), but Ang-1 only showed a slight increase (μg/L: 28.70±14.26 vs. 25.62±11.95, t = 1.005, P = 0.318). The results of Pearson correlation analysis showed that Ang-2 level was negatively correlated with forced expiratory volume in 1 second (FVC1) and the percentage of carbon monoxide diffusing capacity accounting for the expected value (DLCO%: r value was -0.227 and -0.206, and P value was 0.147 and 0.253, respectively

  6. The use of patient factors to improve the prediction of operative duration using laparoscopic cholecystectomy.

    Science.gov (United States)

    Thiels, Cornelius A; Yu, Denny; Abdelrahman, Amro M; Habermann, Elizabeth B; Hallbeck, Susan; Pasupathy, Kalyan S; Bingener, Juliane

    2017-01-01

    Reliable prediction of operative duration is essential for improving patient and care team satisfaction, optimizing resource utilization and reducing cost. Current operative scheduling systems are unreliable and contribute to costly over- and underestimation of operative time. We hypothesized that the inclusion of patient-specific factors would improve the accuracy in predicting operative duration. We reviewed all elective laparoscopic cholecystectomies performed at a single institution between 01/2007 and 06/2013. Concurrent procedures were excluded. Univariate analysis evaluated the effect of age, gender, BMI, ASA, laboratory values, smoking, and comorbidities on operative duration. Multivariable linear regression models were constructed using the significant factors (p historical surgeon-specific and procedure-specific operative duration. External validation was done using the ACS-NSQIP database (n = 11,842). A total of 1801 laparoscopic cholecystectomy patients met inclusion criteria. Female sex was associated with reduced operative duration (-7.5 min, p < 0.001 vs. male sex) while increasing BMI (+5.1 min BMI 25-29.9, +6.9 min BMI 30-34.9, +10.4 min BMI 35-39.9, +17.0 min BMI 40 + , all p < 0.05 vs. normal BMI), increasing ASA (+7.4 min ASA III, +38.3 min ASA IV, all p < 0.01 vs. ASA I), and elevated liver function tests (+7.9 min, p < 0.01 vs. normal) were predictive of increased operative duration on univariate analysis. A model was then constructed using these predictive factors. The traditional surgical scheduling system was poorly predictive of actual operative duration (R 2  = 0.001) compared to the patient factors model (R 2  = 0.08). The model remained predictive on external validation (R 2  = 0.14).The addition of surgeon as a variable in the institutional model further improved predictive ability of the model (R 2  = 0.18). The use of routinely available pre-operative patient factors improves the prediction of operative

  7. Prognostic and predictive value of liver volume on colorectal cancer patients with unresectable liver metastases

    International Nuclear Information System (INIS)

    Park, Jun Su; Park, Hee Chul; Choi, Doo Ho; Park, Won; Yu, Jeong Il; Park, Young Suk; Kang, Won Ki; Park, Joon Oh

    2014-01-01

    To determine the prognostic and predictive value of liver volume in colorectal cancer patients with unresectable liver metastases. Sixteen patients received whole liver radiotherapy (WLRT) between January 1997 and June 2013. A total dose of 21 Gy was delivered in 7 fractions. The median survival time after WLRT was 9 weeks. In univariate analysis, performance status, serum albumin and total bilirubin level, liver volume and extrahepatic metastases were associated with survival. The mean liver volume was significantly different between subgroups with and without pain relief (3,097 and 4,739 mL, respectively; p = 0.002). A larger liver volume is a poor prognostic factor for survival and also a negative predictive factor for response to WLRT. If patients who are referred for WLRT have large liver volume, they should be informed of the poor prognosis and should be closely observed during and after WLRT.

  8. Prognostic and predictive value of liver volume on colorectal cancer patients with unresectable liver metastases

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jun Su; Park, Hee Chul; Choi, Doo Ho; Park, Won; Yu, Jeong Il; Park, Young Suk; Kang, Won Ki; Park, Joon Oh [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2014-06-15

    To determine the prognostic and predictive value of liver volume in colorectal cancer patients with unresectable liver metastases. Sixteen patients received whole liver radiotherapy (WLRT) between January 1997 and June 2013. A total dose of 21 Gy was delivered in 7 fractions. The median survival time after WLRT was 9 weeks. In univariate analysis, performance status, serum albumin and total bilirubin level, liver volume and extrahepatic metastases were associated with survival. The mean liver volume was significantly different between subgroups with and without pain relief (3,097 and 4,739 mL, respectively; p = 0.002). A larger liver volume is a poor prognostic factor for survival and also a negative predictive factor for response to WLRT. If patients who are referred for WLRT have large liver volume, they should be informed of the poor prognosis and should be closely observed during and after WLRT.

  9. Prediction of Excessive Weight Gain in Insulin Treated Patients with Type 2 Diabetes

    DEFF Research Database (Denmark)

    Cichosz, Simon Lebech; Lundby-Christensen, Louise; Johansen, Mette D

    2017-01-01

    of this study was to identify predictors of weight gain in insulin treated patients with Type 2 diabetes mellitus. METHODS: A total of 412 individuals with Type 2 diabetes mellitus were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analogue......AIMS: Weight gain is an ongoing challenge when initiating insulin therapy in patients with Type 2 diabetes mellitus. However, if prediction of insulin associated weight gain was possible on an individualized level, targeted initiatives could be implemented to reduce weight gain. The objective...... treatment regimens. Participants with excessive weight gain were defined as the group with weight gain in the 4(th) quartile. We developed a pattern classification method to predict individuals prone to excessive weight gain. RESULTS: The median weight gain among all patients (n = 412) was 2.4 (95...

  10. Prediction of Splint Therapy Efficacy Using Bone Scan in Patients with Unilateral Temporomandibular Disorder

    International Nuclear Information System (INIS)

    Lee, Sang Mi; Lee, Won Woo; Yun, Pil Young; Kim, Young Kyun; Kim, Sang Eun

    2009-01-01

    It is not known whether bone scan is useful for the prediction of the prognosis of patients with temporomandibular disorders (TMD). The aim of the present study was to identify useful prognostic markers on bone scan for the pre-therapeutic assessment of patients with unilateral TMD. Between January 2005 and July 2007, 55 patients (M:F=9:46; mean age, 34.7±14.1 y) with unilateral TMD that underwent a pre-therapeutic bone scan were enrolled. Uptake of Tc-99m HDP in each temporomandibular joint (TMJ) was quantitated using a 13X13 pixel-square region-of-interest over TMJ and parietal skull area as background. TMJ uptake ratios and asymmetric indices were calculated. TMD patients were classified as improved or not improved and the bone scan findings associated with each group were investigated. Forty-six patients were improved, whereas 9 patients were not improved. There was no significant difference between the two groups of patients regarding the TMJ uptake ratio of the involved joint, the TMJ uptake ratio of the non-involved joint, and the asymmetric index (p>0.05). However, in a subgroup analysis, the patients with an increased uptake of Tc-99m HDP at the disease-involved TMJ, by visual assessment, could be easily identified by the asymmetric index; the patients that improved had a higher asymmetric index than the patients that did not improve (1.32±0.35 vs. 1.08±0.04, p=0.023), The Tc-99m HDP bone scan may help predict the prognosis of patients with unilateral TMD after splint therapy when the TMD-involved joint reveals increased uptake by visual assessment

  11. Prediction of Splint Therapy Efficacy Using Bone Scan in Patients with Unilateral Temporomandibular Disorder

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Mi; Lee, Won Woo; Yun, Pil Young; Kim, Young Kyun; Kim, Sang Eun [Seoul National University Bundang Hospital, Seoul (Korea, Republic of)

    2009-04-15

    It is not known whether bone scan is useful for the prediction of the prognosis of patients with temporomandibular disorders (TMD). The aim of the present study was to identify useful prognostic markers on bone scan for the pre-therapeutic assessment of patients with unilateral TMD. Between January 2005 and July 2007, 55 patients (M:F=9:46; mean age, 34.7{+-}14.1 y) with unilateral TMD that underwent a pre-therapeutic bone scan were enrolled. Uptake of Tc-99m HDP in each temporomandibular joint (TMJ) was quantitated using a 13X13 pixel-square region-of-interest over TMJ and parietal skull area as background. TMJ uptake ratios and asymmetric indices were calculated. TMD patients were classified as improved or not improved and the bone scan findings associated with each group were investigated. Forty-six patients were improved, whereas 9 patients were not improved. There was no significant difference between the two groups of patients regarding the TMJ uptake ratio of the involved joint, the TMJ uptake ratio of the non-involved joint, and the asymmetric index (p>0.05). However, in a subgroup analysis, the patients with an increased uptake of Tc-99m HDP at the disease-involved TMJ, by visual assessment, could be easily identified by the asymmetric index; the patients that improved had a higher asymmetric index than the patients that did not improve (1.32{+-}0.35 vs. 1.08{+-}0.04, p=0.023), The Tc-99m HDP bone scan may help predict the prognosis of patients with unilateral TMD after splint therapy when the TMD-involved joint reveals increased uptake by visual assessment.

  12. Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey

    Science.gov (United States)

    2014-01-01

    Background The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients. Methods A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions Understanding use and factors predicting use can increase adoption and utilization of social media for health care–related purposes among underserved patients in community health centers. PMID:25427823

  13. Do patient characteristics predict outcome in the outpatient treatment of chronic tinnitus?

    Science.gov (United States)

    Kröner-Herwig, Birgit; Zachriat, Claudia; Weigand, Doreen

    2006-12-06

    Various patient characteristics were assessed before offering a treatment to reduce tinnitus related distress to 57 individuals suffering from chronic idiopathic tinnitus. Patients were randomly assigned to a cognitive-behavioral tinnitus coping training (TCT) and a habituation-based training (HT) modelled after Tinnitus Retraining Therapy (TRT) as conceived by Jastreboff. Both trainings were conducted in groups. It was hypothesized that comorbidity regarding mental disorders or psychopathological symptoms (DSM-IV diagnoses, SCL-90R score) and a high level of dysfunctional cognitions relating to tinnitus would have a negative effect on therapy outcome while both trainings proved to be highly efficacious for the average patient. Also further patient features (assessed at baseline) were explored as potential predictors of outcome. None of the hypotheses was corroborated by the data. On the contrary, a higher number of diagnoses was associated with better outcome (statistical trend) and a higher extent of annoyance and interference led to a larger positive change in patients if treated by TCT. No predictor could be identified for long-term success (follow-up ≥18 months) except regarding education. The higher the educational level, the larger was the improvement in HT patients. It is concluded that therapy outcome of TCT and HT can not reliably be predicted by patient characteristics and that early variables of the therapeutic process should be analysed as potentially predicting subsequent therapeutic outcome.

  14. Patient nostril microbial flora: individual-dependency and diversity precluding prediction of Staphylococcus aureus acquisition.

    Science.gov (United States)

    Alvarez, A S; Remy, L; Allix-Béguec, C; Ligier, C; Dupont, C; Leminor, O; Lawrence, C; Supply, P; Guillemot, D; Gaillard, J L; Salomon, J; Herrmann, J-L

    2014-01-01

    The potential role of a patient's resident microbial flora in the risk of acquiring multiresistant bacteria (MRB) during hospitalization is unclear. We investigated this role by cross-sectional study of 103 patients at risk of acquisition of Staphylococcus aureus (SA), resistant (MRSA) or not (MSSA) to methicillin, recruited in four French hospitals. The flora was analysed by an exhaustive culture-based approach combined with molecular and/or mass-spectrometry-based identification, and SA strain typing. Forty-three of the 53 SA-negative patients at entry were followed for up to 52 weeks: 19 (44.2%) remained negative for SA and 24 (55.8%) became positive, including 19 (79%) who acquired an MSSA, four (17%) who acquired an MRSA and one who acquired both (4%). Fifty-one different species were identified among the 103 patients, of which two, Corynebacterium accolens and Staphylococcus haemolyticus (p = 0.02-0.01), were more prevalent in the absence of SA. However, the same number of patients carrying or not these two species acquired an MSSA/MRSA during follow-up, regardless of antibiotic treatment received. Clustering analysis showed that the microbial flora was highly specific to each patient, and not predictive for acquisition of MSSA/MRSA or not. Patient-specific microbial resident flora is not predictive of SA acquisition. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  15. Immunologic prediction of relapse in patients with pemphigus vulgaris (PV) in clinical remission.

    Science.gov (United States)

    Daneshpazhooh, Maryam; Zafarmand Sedigh, Vahid; Balighi, Kamran; Hosseini, S Hamed; Ramezani, Ali; Kalantari, Mohammad-Sadegh; Ghandi, Narges; Ghiasi, Maryam; Nikoo, Azita; Chams-Davatchi, Cheyda

    2016-06-01

    Pemphigus vulgaris (PV) is characterized by multiple relapses, occurring especially in patients on minimal therapy or off therapy. To identify immunologic predictors (anti-desmoglein [Dsg] 1 and 3 antibodies; direct immunofluorescence [DIF]) for relapse in PV patients. Eighty-nine patients in complete clinical remission for at least 6 months and receiving less than or equal to 10 mg prednisolone daily and no immunosuppressive drugs were evaluated using DIF (n=89) and Dsg ELISA (n=46). They were followed until relapse or for at least 18 months. DIF was positive in 44 of 89 patients (49.5%); anti-Dsg 3 antibodies were detected in 18 of 46 patients (39.1%) and anti-Dsg 1 antibodies were detected in 4 of 46 patients (8.7%). Relapse occurred in 38 patients (42.7%). Mean relapse-free time was significantly shorter in anti-Dsg 3-positive patients compared to anti-Dsg 3- negative patients (P = .015) and in DIF-positive patients compared to DIF-negative patients (P = .047), but not in anti-Dsg 1- positive patients compared to anti-Dsg 1-negative patients (P = .501). Sensitivity and predictive values of neither of these tests were high. Small number of anti-Dsg 1-positive patients and use of conventional ELISA. Positive anti-Dsg 3 ELISA and, to a lesser degree, positive DIF are predictors of relapse in PV patients in clinical remission. Decision on discontinuing treatment should be based on the results of these tests as well as on clinical findings. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Predicting return to work for lower back pain patients receiving worker's compensation.

    Science.gov (United States)

    Lancourt, J; Kettelhut, M

    1992-06-01

    The results of a prospective study of 134 patients with lower back pain suggest that nonorganic factors are better predictors of return to work than organic findings. Patients who returned to work had fewer job, personal, or family related problems. There were no significant differences between patients who returned to work and those who did not when comparing myelograms, computed tomographic scans, or roentgenographs. The only significant difference in physical organic findings was for muscle atrophy. Patients who did not return to work had a statistically higher incidence rate of muscle atrophy. Length of time off from work was significantly related to outcome, but when patients were categorized according to time off the job, different factors predicted failure to return for patients off work for less than 6 months and patients off for more than 6 months. For patients off for less than 6 months, important predictors were a high Oswestry score, history of leg pain, family relocation, short tenure on the job, verbal magnification of pain, reports of moderate to severe pain on superficial palpation, and positive reaction to a "sham" sciatic tension test. None of these was a significant predictor for the group off for more than 6 months. For the group off work for more than 6 months, previous injuries, and stability of family living arrangements were among the significant predictors not significant for the group off less than 6 months. Using 21 factors selected from a larger group of 92 factors, three statistically significant (P less than or equal to 0.001) predictive measures were developed. These measures predicted return to work for the total sample, and for the two subgroups (off more than, or less than 6 months) more accurately than did the total set of 92 factors.

  17. Cardiac Troponin Elevation Predicts Mortality in Patients Undergoing Orthotopic Liver Transplantation

    Directory of Open Access Journals (Sweden)

    David Snipelisky

    2013-01-01

    Full Text Available Introduction. While patients undergoing orthotopic liver transplantation (OLT have high cardiovascular event rates, preoperative risk stratification may not necessarily predict those susceptible patients. Troponin T (TnT may help predict patients at risk for cardiovascular complications. Methods. Consecutive patients undergoing OLT at Mayo Clinic in Florida between 1998 and 2010 who had TnT obtained within 10 days following surgery were included. Three groups were compared based on TnT level: (1 normal (TnT ≤0.01 ng/mL, (2 intermediate (TnT 0.02–0.11 ng/mL, and (3 elevated (TnT >0.11 ng/mL. Overall and cardiovascular mortality was assessed. Results. Of the 78 patients included, there was no difference in age, gender, severity of liver disease, and echocardiographic findings. Patients in the normal and intermediate TnT groups had a lower overall mortality rate (14.3% and 0%, resp. when compared with those with elevated TnT (50%; P=0.001. Patients in the elevated TnT group had a cardiovascular mortality rate of 37.5% compared with 1.4% in the other groups combined (P<0.01. The elevated TnT group had a much higher mortality rate when compared with those in the intermediate group (P<0.0001. Conclusion. TnT may accurately help risk stratify patients in the early postoperative setting to better predict cardiovascular complications.

  18. Prediction model of critical weight loss in cancer patients during particle therapy.

    Science.gov (United States)

    Zhang, Zhihong; Zhu, Yu; Zhang, Lijuan; Wang, Ziying; Wan, Hongwei

    2018-01-01

    The objective of this study is to investigate the predictors of critical weight loss in cancer patients receiving particle therapy, and build a prediction model based on its predictive factors. Patients receiving particle therapy were enroled between June 2015 and June 2016. Body weight was measured at the start and end of particle therapy. Association between critical weight loss (defined as >5%) during particle therapy and patients' demographic, clinical characteristic, pre-therapeutic nutrition risk screening (NRS 2002) and BMI were evaluated by logistic regression and decision tree analysis. Finally, 375 cancer patients receiving particle therapy were included. Mean weight loss was 0.55 kg, and 11.5% of patients experienced critical weight loss during particle therapy. The main predictors of critical weight loss during particle therapy were head and neck tumour location, total radiation dose ≥70 Gy on the primary tumour, and without post-surgery, as indicated by both logistic regression and decision tree analysis. Prediction model that includes tumour locations, total radiation dose and post-surgery had a good predictive ability, with the area under receiver operating characteristic curve 0.79 (95% CI: 0.71-0.88) and 0.78 (95% CI: 0.69-0.86) for decision tree and logistic regression model, respectively. Cancer patients with head and neck tumour location, total radiation dose ≥70 Gy and without post-surgery were at higher risk of critical weight loss during particle therapy, and early intensive nutrition counselling or intervention should be target at this population. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Predictive properties of plasma amino acid profile for cardiovascular disease in patients with type 2 diabetes.

    Directory of Open Access Journals (Sweden)

    Shinji Kume

    Full Text Available Prevention of cardiovascular disease (CVD is an important therapeutic object of diabetes care. This study assessed whether an index based on plasma free amino acid (PFAA profiles could predict the onset of CVD in diabetic patients. The baseline concentrations of 31 PFAAs were measured with high-performance liquid chromatography-electrospray ionization-mass spectrometry in 385 Japanese patients with type 2 diabetes registered in 2001 for our prospective observational follow-up study. During 10 years of follow-up, 63 patients developed cardiovascular composite endpoints (myocardial infarction, angina pectoris, worsening of heart failure and stroke. Using the PFAA profiles and clinical information, an index (CVD-AI consisting of six amino acids to predict the onset of any endpoints was retrospectively constructed. CVD-AI levels were significantly higher in patients who did than did not develop CVD. The area under the receiver-operator characteristic curve of CVD-AI (0.72 [95% confidence interval (CI: 0.64-0.79] showed equal or slightly better discriminatory capacity than urinary albumin excretion rate (0.69 [95% CI: 0.62-0.77] on predicting endpoints. A multivariate Cox proportional hazards regression analysis showed that the high level of CVD-AI was identified as an independent risk factor for CVD (adjusted hazard ratio: 2.86 [95% CI: 1.57-5.19]. This predictive effect of CVD-AI was observed even in patients with normoalbuminuria, as well as those with albuminuria. In conclusion, these results suggest that CVD-AI based on PFAA profiles is useful for identifying diabetic patients at risk for CVD regardless of the degree of albuminuria, or for improving the discriminative capability by combining it with albuminuria.

  20. Hypotension, bedridden, leukocytosis, thrombocytopenia and elevated serum creatinine predict mortality in geriatric patients with fever.

    Science.gov (United States)

    Chung, Min-Hsien; Chu, Feng-Yuan; Yang, Tzu-Meng; Lin, Hung-Jung; Chen, Jiann-Hwa; Guo, How-Ran; Vong, Si-Chon; Su, Shih-Bin; Huang, Chien-Cheng; Hsu, Chien-Chin

    2015-07-01

    The geriatric population (aged ≥65 years) accounts for 12-24% of all emergency department (ED) visits. Of them, 10% have a fever, 70-90% will be admitted and 7-10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality. We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point. A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine >2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were. The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever. © 2014 Japan Geriatrics Society.

  1. Predictive Properties of Plasma Amino Acid Profile for Cardiovascular Disease in Patients with Type 2 Diabetes

    Science.gov (United States)

    Kume, Shinji; Araki, Shin-ichi; Ono, Nobukazu; Shinhara, Atsuko; Muramatsu, Takahiko; Araki, Hisazumi; Isshiki, Keiji; Nakamura, Kazuki; Miyano, Hiroshi; Koya, Daisuke; Haneda, Masakazu; Ugi, Satoshi; Kawai, Hiromichi; Kashiwagi, Atsunori; Uzu, Takashi; Maegawa, Hiroshi

    2014-01-01

    Prevention of cardiovascular disease (CVD) is an important therapeutic object of diabetes care. This study assessed whether an index based on plasma free amino acid (PFAA) profiles could predict the onset of CVD in diabetic patients. The baseline concentrations of 31 PFAAs were measured with high-performance liquid chromatography-electrospray ionization-mass spectrometry in 385 Japanese patients with type 2 diabetes registered in 2001 for our prospective observational follow-up study. During 10 years of follow-up, 63 patients developed cardiovascular composite endpoints (myocardial infarction, angina pectoris, worsening of heart failure and stroke). Using the PFAA profiles and clinical information, an index (CVD-AI) consisting of six amino acids to predict the onset of any endpoints was retrospectively constructed. CVD-AI levels were significantly higher in patients who did than did not develop CVD. The area under the receiver-operator characteristic curve of CVD-AI (0.72 [95% confidence interval (CI): 0.64–0.79]) showed equal or slightly better discriminatory capacity than urinary albumin excretion rate (0.69 [95% CI: 0.62–0.77]) on predicting endpoints. A multivariate Cox proportional hazards regression analysis showed that the high level of CVD-AI was identified as an independent risk factor for CVD (adjusted hazard ratio: 2.86 [95% CI: 1.57–5.19]). This predictive effect of CVD-AI was observed even in patients with normoalbuminuria, as well as those with albuminuria. In conclusion, these results suggest that CVD-AI based on PFAA profiles is useful for identifying diabetic patients at risk for CVD regardless of the degree of albuminuria, or for improving the discriminative capability by combining it with albuminuria. PMID:24971671

  2. Identifying the bleeding trauma patient: predictive factors for massive transfusion in an Australasian trauma population.

    Science.gov (United States)

    Hsu, Jeremy Ming; Hitos, Kerry; Fletcher, John P

    2013-09-01

    Military and civilian data would suggest that hemostatic resuscitation results in improved outcomes for exsanguinating patients. However, identification of those patients who are at risk of significant hemorrhage is not clearly defined. We attempted to identify factors that would predict the need for massive transfusion (MT) in an Australasian trauma population, by comparing those trauma patients who did receive massive transfusion with those who did not. Between 1985 and 2010, 1,686 trauma patients receiving at least 1 U of packed red blood cells were identified from our prospectively maintained trauma registry. Demographic, physiologic, laboratory, injury, and outcome variables were reviewed. Univariate analysis determined significant factors between those who received MT and those who did not. A predictive multivariate logistic regression model with backward conditional stepwise elimination was used for MT risk. Statistical analysis was performed using SPSS PASW. MT patients had a higher pulse rate, lower Glasgow Coma Scale (GCS) score, lower systolic blood pressure, lower hemoglobin level, higher Injury Severity Score (ISS), higher international normalized ratio (INR), and longer stay. Initial logistic regression identified base deficit (BD), INR, and hemoperitoneum at laparotomy as independent predictive variables. After assigning cutoff points of BD being greater than 5 and an INR of 1.5 or greater, a further model was created. A BD greater than 5 and either INR of 1.5 or greater or hemoperitoneum was associated with 51 times increase in MT risk (odds ratio, 51.6; 95% confidence interval, 24.9-95.8). The area under the receiver operating characteristic curve for the model was 0.859. From this study, a combination of BD, INR, and hemoperitoneum has demonstrated good predictability for MT. This tool may assist in the determination of those patients who might benefit from hemostatic resuscitation. Prognostic study, level III.

  3. An Easy Tool to Predict Survival in Patients Receiving Radiation Therapy for Painful Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Westhoff, Paulien G., E-mail: p.g.westhoff@umcutrecht.nl [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Graeff, Alexander de [Department of Medical Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Bollen, Laurens; Dijkstra, Sander P. [Department of Orthopedic Surgery, Leiden University Medical Center (Netherlands); Steen-Banasik, Elzbieta M. van der [ARTI Institute for Radiation Oncology Arnhem, Arnhem (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Leer, Jan Willem H. [Department of Radiotherapy, University Medical Center Nijmegen, Nijmegen (Netherlands); Marijnen, Corrie A.; Linden, Yvette M. van der [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands)

    2014-11-15

    Purpose: Patients with bone metastases have a widely varying survival. A reliable estimation of survival is needed for appropriate treatment strategies. Our goal was to assess the value of simple prognostic factors, namely, patient and tumor characteristics, Karnofsky performance status (KPS), and patient-reported scores of pain and quality of life, to predict survival in patients with painful bone metastases. Methods and Materials: In the Dutch Bone Metastasis Study, 1157 patients were treated with radiation therapy for painful bone metastases. At randomization, physicians determined the KPS; patients rated general health on a visual analogue scale (VAS-gh), valuation of life on a verbal rating scale (VRS-vl) and pain intensity. To assess the predictive value of the variables, we used multivariate Cox proportional hazard analyses and C-statistics for discriminative value. Of the final model, calibration was assessed. External validation was performed on a dataset of 934 patients who were treated with radiation therapy for vertebral metastases. Results: Patients had mainly breast (39%), prostate (23%), or lung cancer (25%). After a maximum of 142 weeks' follow-up, 74% of patients had died. The best predictive model included sex, primary tumor, visceral metastases, KPS, VAS-gh, and VRS-vl (C-statistic = 0.72, 95% CI = 0.70-0.74). A reduced model, with only KPS and primary tumor, showed comparable discriminative capacity (C-statistic = 0.71, 95% CI = 0.69-0.72). External validation showed a C-statistic of 0.72 (95% CI = 0.70-0.73). Calibration of the derivation and the validation dataset showed underestimation of survival. Conclusion: In predicting survival in patients with painful bone metastases, KPS combined with primary tumor was comparable to a more complex model. Considering the amount of variables in complex models and the additional burden on patients, the simple model is preferred for daily use. In addition, a risk table for survival is

  4. Mass gathering medicine: a predictive model for patient presentation and transport rates.

    Science.gov (United States)

    Arbon, P; Bridgewater, F H; Smith, C

    2001-01-01

    This paper reports on research into the influence of environmental factors (including crowd size, temperature, humidity, and venue type) on the number of patients and the patient problems presenting to first-aid services at large, public events in Australia. Regression models were developed to predict rates of patient presentation and of transportation-to-a-hospital for future mass gatherings. To develop a data set and predictive model that can be applied across venues and types of mass gathering events that is not venue or event specific. Data collected will allow informed event planning for future mass gatherings for which health care services are required. Mass gatherings were defined as public events attended by in excess of 25,000 people. Over a period of 12 months, 201 mass gatherings attended by a combined audience in excess of 12 million people were surveyed throughout Australia. The survey was undertaken by St. John Ambulance Australia personnel. The researchers collected data on the incidence and type of patients presenting for treatment and on the environmental factors that may influence these presentations. A standard reporting format and definition of event geography was employed to overcome the event-specific nature of many previous surveys. There are 11,956 patients in the sample. The patient presentation rate across all event types was 0.992/1,000 attendees, and the transportation-to-hospital rate was 0.027/1,000 persons in attendance. The rates of patient presentations declined slightly as crowd sizes increased. The weather (particularly the relative humidity) was related positively to an increase in the rates of presentations. Other factors that influenced the number and type of patients presenting were the mobility of the crowd, the availability of alcohol, the event being enclosed by a boundary, and the number of patient-care personnel on duty. Three regression models were developed to predict presentation rates at future events. Several

  5. Predictive value of radioculography in patients with lumbago-sciatica. A prospective study (part 2)

    Energy Technology Data Exchange (ETDEWEB)

    Espersen, J.O.; Kosteljanetz, M. (University Hospital, Aarhus (Denmark). Dept. of Neurosurgery); Halaburt, H.; Miletic, T. (University Hospital, Aarhus (Denmark). Dept. of Neuroradiology)

    1984-01-01

    One hundred patients with symptoms of lumbo-sacral root compression were prospectively and consecutively assigned to operation based alone on clinical findings. A preoperative myelogram was performed in all patients and described without a knowledge of the clinical features. All patients were explored for the clinically and myelographically relevant disc. When the myelogram was normal (16 patients) both lower lumbar interspaces were exposed. In 58 patients a herniated disc was revealed at surgery. Only 'myelographic herniation' with indentation of the contrast column was accompanied by a high frequency of disc herniation at surgery (73-87%). In cases with normal myelograms only 5% had a disc herniation. The severity of the myelographic finding was clearly correlated to the frequency of positive surgical findings and good outcomes. The preoperative radiculogram gives a high degree of certainty in the preoperative evaluation whether a surgical lesion is present or not and reveals a precise prediction of the outcome of surgery.

  6. Tumor-stroma ratio predicts recurrence in patients with colon cancer treated with neoadjuvant chemotherapy

    DEFF Research Database (Denmark)

    Hansen, Torben Frøstrup; Kjær-Frifeldt, Sanne; Lindebjerg, Jan

    2017-01-01

    BACKGROUND: Neoadjuvant chemotherapy represents a new treatment approach to locally advanced colon cancer. The aim of this study was to analyze the ability of tumor-stroma ratio (TSR) to predict disease recurrence in patients with locally advanced colon cancer treated with neoadjuvant chemotherapy....... MATERIAL AND METHODS: This study included 65 patients with colon cancer treated with neoadjuvant chemotherapy in a phase II trial. All patients were planned for three cycles of capecitabine and oxaliplatin before surgery. Hematoxylin and eosin stained tissue sections from surgically resected primary tumors...... was 55%, compared to 94% in the group of patients with a high TSR. CONCLUSIONS: TSR assessed in the surgically resected primary tumor from patients with locally advanced colon cancer treated with neoadjuvant chemotherapy provides prognostic value and may serve as a relevant parameter in selecting...

  7. Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica.

    Science.gov (United States)

    Verwoerd, A J H; Luijsterburg, P A J; Lin, C W C; Jacobs, W C H; Koes, B W; Verhagen, A P

    2013-09-01

    Identification of prognostic factors for surgery in patients with sciatica is important to be able to predict surgery in an early stage. Identification of prognostic factors predicting persistent pain, disability and recovery are important for better understanding of the clinical course, to inform patient and physician and support decision making. Consequently, we aimed to systematically review prognostic factors predicting outcome in non-surgically treated patients with sciatica. A search of Medline, Embase, Web of Science and Cinahl, up to March 2012 was performed for prospective cohort studies on prognostic factors for non-surgically treated sciatica. Two reviewers independently selected studies for inclusion and assessed the risk of bias. Outcomes were pain, disability, recovery and surgery. A best evidence synthesis was carried out in order to assess and summarize the data. The initial search yielded 4392 articles of which 23 articles reporting on 14 original cohorts met the inclusion criteria. High clinical, methodological and statistical heterogeneity among studies was found. Reported evidence regarding prognostic factors predicting the outcome in sciatica is limited. The majority of factors that have been evaluated, e.g., age, body mass index, smoking and sensory disturbance, showed no association with outcome. The only positive association with strong evidence was found for leg pain intensity at baseline as prognostic factor for subsequent surgery. © 2013 European Federation of International Association for the Study of Pain Chapters.

  8. Risk score prediction model for dementia in patients with type 2 diabetes.

    Science.gov (United States)

    Li, Chia-Ing; Li, Tsai-Chung; Liu, Chiu-Shong; Liao, Li-Na; Lin, Wen-Yuan; Lin, Chih-Hsueh; Yang, Sing-Yu; Chiang, Jen-Huai; Lin, Cheng-Chieh

    2018-03-30

    No study established a prediction dementia model in the Asian populations. This study aims to develop a prediction model for dementia in Chinese type 2 diabetes patients. This retrospective cohort study included 27,540 Chinese type 2 diabetes patients (aged 50-94 years) enrolled in Taiwan National Diabetes Care Management Program. Participants were randomly allocated into derivation and validation sets at 2:1 ratio. Cox proportional hazards regression models were used to identify risk factors for dementia in the derivation set. Steps proposed by Framingham Heart Study were used to establish a prediction model with a scoring system. The average follow-up was 8.09 years, with a total of 853 incident dementia cases in derivation set. Dementia risk score summed up the individual scores (from 0 to 20). The areas under curve of 3-, 5-, and 10-year dementia risks were 0.82, 0.79, and 0.76 in derivation set and 0.84, 0.80, and 0.75 in validation set, respectively. The proposed score system is the first dementia risk prediction model for Chinese type 2 diabetes patients in Taiwan. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  9. Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients.

    Science.gov (United States)

    Martinez, Bruno Prata; Gomes, Isabela Barboza; Oliveira, Carolina Santana de; Ramos, Isis Resende; Rocha, Mônica Diniz Marques; Forgiarini Júnior, Luiz Alberto; Camelier, Fernanda Warken Rosa; Camelier, Aquiles Assunção

    2015-05-01

    The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. This cross-sectional study analyzed 68 elderly patients (≥60 years of age) in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test). After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated. In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7%) of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%) and abdominal disorders (10.2%). The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002). The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients.

  10. Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk.

    Science.gov (United States)

    Yarnitsky, David; Crispel, Yonathan; Eisenberg, Elon; Granovsky, Yelena; Ben-Nun, Alon; Sprecher, Elliot; Best, Lael-Anson; Granot, Michal

    2008-08-15

    Surgical and medical procedures, mainly those associated with nerve injuries, may lead to chronic persistent pain. Currently, one cannot predict which patients undergoing such procedures are 'at risk' to develop chronic pain. We hypothesized that the endogenous analgesia system is key to determining the pattern of handling noxious events, and therefore testing diffuse noxious inhibitory control (DNIC) will predict susceptibility to develop chronic post-thoracotomy pain (CPTP). Pre-operative psychophysical tests, including DNIC assessment (pain reduction during exposure to another noxious stimulus at remote body area), were conducted in 62 patients, who were followed 29.0+/-16.9 weeks after thoracotomy. Logistic regression revealed that pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP. Efficient DNIC predicted lower risk of CPTP, with OR 0.52 (0.33-0.77 95% CI, p=0.0024), i.e., a 10-point numerical pain scale (NPS) reduction halves the chance to develop chronic pain. Higher acute pain intensity indicated OR of 1.80 (1.28-2.77, p=0.0024) predicting nearly a double chance to develop chronic pain for each 10-point increase. The other psychophysical measures, pain thresholds and supra-threshold pain magnitudes, did not predict CPTP. For prediction of acute post-operative pain intensity, DNIC efficiency was not found significant. Effectiveness of the endogenous analgesia system obtained at a pain-free state, therefore, seems to reflect the individual's ability to tackle noxious events, identifying patients 'at risk' to develop post-intervention chronic pain. Applying this diagnostic approach before procedures that might generate pain may allow individually tailored pain prevention and management, which may substantially reduce suffering.

  11. In silico modeling predicts drug sensitivity of patient-derived cancer cells.

    Science.gov (United States)

    Pingle, Sandeep C; Sultana, Zeba; Pastorino, Sandra; Jiang, Pengfei; Mukthavaram, Rajesh; Chao, Ying; Bharati, Ila Sri; Nomura, Natsuko; Makale, Milan; Abbasi, Taher; Kapoor, Shweta; Kumar, Ansu; Usmani, Shahabuddin; Agrawal, Ashish; Vali, Shireen; Kesari, Santosh

    2014-05-21

    Glioblastoma (GBM) is an aggressive disease associated with poor survival. It is essential to account for the complexity of GBM biology to improve diagnostic and therapeutic strategies. This complexity is best represented by the increasing amounts of profiling ("omics") data available due to advances in biotechnology. The challenge of integrating these vast genomic and proteomic data can be addressed by a comprehensive systems modeling approach. Here, we present an in silico model, where we simulate GBM tumor cells using genomic profiling data. We use this in silico tumor model to predict responses of cancer cells to targeted drugs. Initially, we probed the results from a recent hypothesis-independent, empirical study by Garnett and co-workers that analyzed the sensitivity of hundreds of profiled cancer cell lines to 130 different anticancer agents. We then used the tumor model to predict sensitivity of patient-derived GBM cell lines to different targeted therapeutic agents. Among the drug-mutation associations reported in the Garnett study, our in silico model accurately predicted ~85% of the associations. While testing the model in a prospective manner using simulations of patient-derived GBM cell lines, we compared our simulation predictions with experimental data using the same cells in vitro. This analysis yielded a ~75% agreement of in silico drug sensitivity with in vitro experimental findings. These results demonstrate a strong predictability of our simulation approach using the in silico tumor model presented here. Our ultimate goal is to use this model to stratify patients for clinical trials. By accurately predicting responses of cancer cells to targeted agents a priori, this in silico tumor model provides an innovative approach to personalizing therapy and promises to improve clinical management of cancer.

  12. Predictive role of stress echocardiography before carotid endarterectomy in patients with coronary artery disease.

    Science.gov (United States)

    Galyfos, George; Tsioufis, Constantinos; Theodorou, Dimitris; Katsaragakis, Stilianos; Zografos, Georgios; Filis, Konstantinos

    2015-07-01

    Our aim was to examine the predictive value of preoperative stress echocardiography regarding early myocardial ischemia and late cardiac events after carotid endarterectomy (CEA). Patients with coronary artery disease undergoing CEA were prospectively included in this study. All patients (n = 162) were classified into low, medium, and high cardiac risk group, according to preoperative stress echocardiography. Classification was based on the criteria of the American Society of Echocardiography. For all patients, cTnI was measured before surgery and on postoperative days 1, 3, and 7. Postoperative cTnI values ranging from 0.05 to 0.5 ng/mL were classified as myocardial ischemia; values >0.5 ng/mL were classified as myocardial infarction. Cardiac damage was defined as either myocardial ischemia or infarction. No deaths, strokes, or symptomatic coronary events were observed during the early postoperative period. There were 112 low cardiac risk patients, 42 medium-risk patients, and 8 high-risk patients, according to stress echocardiography findings. Overall, there were 22 patients (14%) that increased their cTnI values postoperatively (12 of low cardiac risk and 10 of medium cardiac risk), and all of them were asymptomatic. None of the high-risk patients showed any troponin increase. Late cardiac events were associated with cTnI increase, although no high-risk patients showed any late event. Preoperative stress echocardiography does not seem to independently recognize patients in high risk for asymptomatic cardiac damage after CEA. Postoperative troponin elevation seems to be more predictive for late adverse cardiac events than preoperative stress echocardiography. © 2014, Wiley Periodicals, Inc.

  13. Gene network inherent in genomic big data improves the accuracy of prognostic prediction for cancer patients.

    Science.gov (United States)

    Kim, Yun Hak; Jeong, Dae Cheon; Pak, Kyoungjune; Goh, Tae Sik; Lee, Chi-Seung; Han, Myoung-Eun; Kim, Ji-Young; Liangwen, Liu; Kim, Chi Dae; Jang, Jeon Yeob; Cha, Wonjae; Oh, Sae-Ock

    2017-09-29

    Accurate prediction of prognosis is critical for therapeutic decisions regarding cancer patients. Many previously developed prognostic scoring systems have limitations in reflecting recent progress in the field of cancer biology such as microarray, next-generation sequencing, and signaling pathways. To develop a new prognostic scoring system for cancer patients, we used mRNA expression and clinical data in various independent breast cancer cohorts (n=1214) from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) and Gene Expression Omnibus (GEO). A new prognostic score that reflects gene network inherent in genomic big data was calculated using Network-Regularized high-dimensional Cox-regression (Net-score). We compared its discriminatory power with those of two previously used statistical methods: stepwise variable selection via univariate Cox regression (Uni-score) and Cox regression via Elastic net (Enet-score). The Net scoring system showed better discriminatory power in prediction of disease-specific survival (DSS) than other statistical methods (p=0 in METABRIC training cohort, p=0.000331, 4.58e-06 in two METABRIC validation cohorts) when accuracy was examined by log-rank test. Notably, comparison of C-index and AUC values in receiver operating characteristic analysis at 5 years showed fewer differences between training and validation cohorts with the Net scoring system than other statistical methods, suggesting minimal overfitting. The Net-based scoring system also successfully predicted prognosis in various independent GEO cohorts with high discriminatory power. In conclusion, the Net-based scoring system showed better discriminative power than previous statistical methods in prognostic prediction for breast cancer patients. This new system will mark a new era in prognosis prediction for cancer patients.

  14. Lactate Parameters Predict Clinical Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Lee, Seung Hoon; Min, Yang Won; Bae, Joohwan; Lee, Hyuk; Min, Byung Hoon; Lee, Jun Haeng; Rhee, Poong Lyul; Kim, Jae J

    2017-11-01

    The predictive role of lactate in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) has been suggested. This study evaluated several lactate parameters in terms of predicting outcomes of bleeding patients and sought to establish a new scoring model by combining lactate parameters and the AIMS65 score. A total of 114 patients with NVUGIB who underwent serum lactate level testing at least twice and endoscopic hemostasis within 24 hours after admission were retrospectively analyzed. The associations between five lactate parameters and clinical outcomes were evaluated and the predictive power of lactate parameter combined AIMS65s (L-AIMS65s) and AIMS56 scoring was compared. The most common cause of bleeding was gastric ulcer (48.2%). Lactate clearance rate (LCR) was associated with 30-day rebleeding (odds ratio [OR], 0.931; 95% confidence interval [CI], 0.872-0.994; P = 0.033). Initial lactate (OR, 1.313; 95% CI, 1.050-1.643; P = 0.017), maximal lactate (OR, 1.277; 95% CI, 1.037-1.573; P = 0.021), and average lactate (OR, 1.535; 95% CI, 1.137-2.072; P = 0.005) levels were associated with 30-day mortality. Initial lactate (OR, 1.213; 95% CI, 1.027-1.432; P = 0.023), maximal lactate (OR, 1.271; 95% CI, 1.074-1.504; P = 0.005), and average lactate (OR, 1.501; 95% CI, 1.150-1.959; P = 0.003) levels were associated with admission over 7 days. Although L-AIMS65s showed the highest area under the curve for prediction of each outcome, differences between L-AIMS65s and AIMS65 did not reach statistical significance. In conclusion, lactate parameters have a prognostic role in patients with NVUGIB. However, they do not increase the predictive power of AIMS65 when combined. © 2017 The Korean Academy of Medical Sciences.

  15. Mood color choice helps to predict response to hypnotherapy in patients with irritable bowel syndrome

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    Tarrier Nicholas

    2010-12-01

    Full Text Available Abstract Background Approximately two thirds of patients with irritable bowel syndrome (IBS respond well to hypnotherapy. However, it is time consuming as well as expensive to provide and therefore a way of predicting outcome would be extremely useful. The use of imagery and color form an integral part of the hypnotherapeutic process and we have hypothesised that investigating color and how it relates to mood might help to predict response to treatment. In order to undertake this study we have previously developed and validated a method of presenting colors to individuals for research purposes called the Manchester Color Wheel (MCW. Using this instrument we have been able to classify colors into positive, neutral and negative shades and this study aimed to assess their predictive role in hypnotherapy. Methods 156 consecutive IBS patients (aged 14-74, mean 42.0 years, 127 (81% females, 29 (19% males were studied. Before treatment, each patient was asked to relate their mood to a color on the MCW as well as completing the IBS Symptom Severity Score, the Hospital Anxiety and Depression (HAD Scale, the Non-colonic Symptom Scale, the Quality of Life Scale and the Tellegen Absorption Scale (TAS which is a measure of hypnotisability. Following hypnotherapy all these measures were repeated with the exception of the TAS. Results For patients with a positive mood color the odds of responding to hypnotherapy were nine times higher than that of those choosing either a neutral or negative color or no color at all (odds ratio: 8.889; p = 0.042. Furthermore, a high TAS score and the presence of HAD anxiety also had good predictive value (odds ratio: 4.024; p = 0.092, 3.917; p Conclusion A positive mood color, especially when combined with HAD anxiety and a high TAS score, predict a good response to hypnotherapy.

  16. Predictive value of the transtheoretical model to smoking cessation in hospitalized patients with cardiovascular disease.

    Science.gov (United States)

    Chouinard, Maud-Christine; Robichaud-Ekstrand, Sylvie

    2007-02-01

    Several authors have questioned the transtheoretical model. Determining the predictive value of each cognitive-behavioural element within this model could explain the multiple successes reported in smoking cessation programmes. The purpose of this study was to predict point-prevalent smoking abstinence at 2 and 6 months, using the constructs of the transtheoretical model, when applied to a pooled sample of individuals who were hospitalized for a cardiovascular event. The study follows a predictive correlation design. Recently hospitalized patients (n=168) with cardiovascular disease were pooled from a randomized, controlled trial. Independent variables of the predictive transtheoretical model comprise stages and processes of change, pros and cons to quit smoking (decisional balance), self-efficacy, and social support. These were evaluated at baseline, 2 and 6 months. Compared to smokers, individuals who abstained from smoking at 2 and 6 months were more confident at baseline to remain non-smokers, perceived less pros and cons to continue smoking, utilized less consciousness raising and self-re-evaluation experiential processes of change, and received more positive reinforcement from their social network with regard to their smoke-free behaviour. Self-efficacy and stages of change at baseline were predictive of smoking abstinence after 6 months. Other variables found to be predictive of smoking abstinence at 6 months were an increase in self-efficacy; an increase in positive social support behaviour and a decrease of the pros within the decisional balance. The results partially support the predictive value of the transtheoretical model constructs in smoking cessation for cardiovascular disease patients.

  17. Prediction of Clinical Deterioration in Hospitalized Adult Patients with Hematologic Malignancies Using a Neural Network Model.

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    Scott B Hu

    Full Text Available Clinical deterioration (ICU transfer and cardiac arrest occurs during approximately 5-10% of hospital admissions. Existing prediction models have a high false positive rate, leading to multiple false alarms and alarm fatigue. We used routine vital signs and laboratory values obtained from the electronic medical record (EMR along with a machine learning algorithm called a neural network to develop a prediction model that would increase the predictive accuracy and decrease false alarm rates.Retrospective cohort study.The hematologic malignancy unit in an academic medical center in the United States.Adult patients admitted to the hematologic malignancy unit from 2009 to 2010.None.Vital signs and laboratory values were obtained from the electronic medical record system and then used as predictors (features. A neural network was used to build a model to predict clinical deterioration events (ICU transfer and cardiac arrest. The performance of the neural network model was compared to the VitalPac Early Warning Score (ViEWS. Five hundred sixty five consecutive total admissions were available with 43 admissions resulting in clinical deterioration. Using simulation, the neural network outperformed the ViEWS model with a positive predictive value of 82% compared to 24%, respectively.We developed and tested a neural network-based prediction model for clinical deterioration in patients hospitalized in the hematologic malignancy unit. Our neural network model outperformed an existing model, substantially increasing the positive predictive value, allowing the clinician to be confident in the alarm raised. This system can be readily implemented in a real-time fashion in existing EMR systems.

  18. Circulating cell death products predict clinical outcome of colorectal cancer patients

    International Nuclear Information System (INIS)

    Koelink, Pim J; Lamers, Cornelis BHW; Hommes, Daan W; Verspaget, Hein W

    2009-01-01

    Tumor cell death generates products that can be measured in the circulation of cancer patients. CK18-Asp396 (M30 antigen) is a caspase-degraded product of cytokeratin 18 (CK18), produced by apoptotic epithelial cells, and is elevated in breast and lung cancer patients. We determined the CK18-Asp396 and total CK18 levels in plasma of 49 colorectal cancer patients, before and after surgical resection of the tumor, by ELISA. Correlations with patient and tumor characteristics were determined by Kruskal-Wallis H and Mann-Whitney U tests. Disease-free survival was determined using Kaplan-Meier methodology with Log Rank tests, and univariate and multivariate Cox proportional hazard analysis. Plasma CK18-Asp396 and total CK18 levels in colorectal cancer patients were related to disease stage and tumor diameter, and were predictive of disease-free survival, independent of disease-stage, with hazard ratios (HR) of patients with high levels (> median) compared to those with low levels (≤ median) of 3.58 (95% CI: 1.17–11.02) and 3.58 (95% CI: 0.97–7.71), respectively. The CK18-Asp396/CK18 ratio, which decreased with tumor progression, was also predictive of disease-free survival, with a low ratio (≤ median) associated with worse disease-free survival: HR 2.78 (95% CI: 1.06–7.19). Remarkably, the plasma CK18-Asp396 and total CK18 levels after surgical removal of the tumor were also predictive of disease-free survival, with patients with high levels having a HR of 3.78 (95% CI: 0.77–18.50) and 4.12 (95% CI: 0.84–20.34), respectively, indicating that these parameters can be used also to monitor patients after surgery. CK18-Asp396 and total CK18 levels in the circulation of colorectal cancer patients are predictive of tumor progression and prognosis and might be helpful for treatment selection and monitoring of these patients

  19. Evaluation of renal resistive index in cirrhotic patients for predicting the hepatirenal syndrome

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    Baek, Seung Yon; Kim, Hyae young; Yi, Sun Young [Ewha WoMans Univ. Mokdong Hospital, Seoul (Korea, Republic of)

    1996-04-01

    To evaluate the usefulness of renal resistive index(RI) in patients with liver cirrhosis as an indicator for predicting hepatorenal syndrome. Renal RIs of thirty cirrhotic patients were analyzed using the gray-scale and Doppler ultrasonograms. As a control group, eight normal subjects were included. Renal RIs were measured at three sites of interlobar or arcuate arteries of both kidneys. The patients were divided into three groups (A, B, or C) according to the Child-Turcotte-Pugh classification and their serum BUN and creatinine levels were compared. We determined whether RIs of normal controls differed from those of cirrhotic patients or whether RIs of cirrhotic patients correlated with the Child-Turcotte-Pugh classification or BUN and creatinine levels. Mean RIs(0.63 {+-}0.33) of normal subjects were statistically different from those(0.67 {+-} 0.05) of cirrhotic patients(P=0.009). RIs of group A(n=6), B(n=9) and C(n=15) were 0.65 {+-} 0.03, 0.65 {+-} 0.04 and 0.70 {+-} 0.04, respectively. The ANOVA test revealed statistically significant differences between the three groups(F ratio=4.472, P=0.021). RIs did not correlate with BUN or creatinine levels. RI could be used as an index for predicting hepatorenal syndrome before the renal function becomes impaired.

  20. Evaluation of renal resistive index in cirrhotic patients for predicting the hepatirenal syndrome

    International Nuclear Information System (INIS)

    Baek, Seung Yon; Kim, Hyae young; Yi, Sun Young

    1996-01-01

    To evaluate the usefulness of renal resistive index(RI) in patients with liver cirrhosis as an indicator for predicting hepatorenal syndrome. Renal RIs of thirty cirrhotic patients were analyzed using the gray-scale and Doppler ultrasonograms. As a control group, eight normal subjects were included. Renal RIs were measured at three sites of interlobar or arcuate arteries of both kidneys. The patients were divided into three groups (A, B, or C) according to the Child-Turcotte-Pugh classification and their serum BUN and creatinine levels were compared. We determined whether RIs of normal controls differed from those of cirrhotic patients or whether RIs of cirrhotic patients correlated with the Child-Turcotte-Pugh classification or BUN and creatinine levels. Mean RIs(0.63 ±0.33) of normal subjects were statistically different from those(0.67 ± 0.05) of cirrhotic patients(P=0.009). RIs of group A(n=6), B(n=9) and C(n=15) were 0.65 ± 0.03, 0.65 ± 0.04 and 0.70 ± 0.04, respectively. The ANOVA test revealed statistically significant differences between the three groups(F ratio=4.472, P=0.021). RIs did not correlate with BUN or creatinine levels. RI could be used as an index for predicting hepatorenal syndrome before the renal function becomes impaired

  1. Vestibular asymmetry predicts falls among elderly patients with multi-sensory dizziness.

    Science.gov (United States)

    Ekvall Hansson, Eva; Magnusson, Måns

    2013-07-22

    Dizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. While BPPV is the most common cause of dizziness among elderly, multisensory deficits is the second, with visual, vestibular and proprioceptive reduced function. Asymmetric vestibular function is overrepresented in elderly persons with hip fractures and wrist fractures and can be accessed for screening. In this prospective study with one year observation period, 55 patients (41 women, 14 men), 65 to 90 years old (median 80, interquartile range 11) with multisensory dizziness were included. Headshake test were pathologic in 24 patients, which substantially increased the risk of falls (OR 3.4). Thirteen of the 21 patients who had fallen (p = 0.03), and all 6 patients who sustained three falls or more (p = 0.04), had vestibular asymmetry. No other measure could predict the risk of falls (OR 0.55-1.71). Signs of vestibular asymmetry among elderly with multisensory dizziness could predict falls. Hence, it seems important to address fall-prevention programs to such a group of patients. Simple bedside tests of vestibular asymmetry might be a possibility to screen for one risk factor for falls among elderly.

  2. Factors predicting survival in amyotrophic lateral sclerosis patients on non-invasive ventilation.

    Science.gov (United States)

    Gonzalez Calzada, Nuria; Prats Soro, Enric; Mateu Gomez, Lluis; Giro Bulta, Esther; Cordoba Izquierdo, Ana; Povedano Panades, Monica; Dorca Sargatal, Jordi; Farrero Muñoz, Eva

    2016-01-01

    Non invasive ventilation (NIV) improves quality of life and extends survival in amyotrophic lateral sclerosis (ALS) patients. However, few data exist about the factors related to survival. We intended to assess the predictive factors that influence survival in patients after NIV initiation. Patients who started NIV from 2000 to 2014 and were tolerant (compliance ≥ 4 hours) were included; demographic, disease related and respiratory variables at NIV initiation were analysed. Statistical analysis was performed using the Kaplan-Meier test and Cox proportional hazard models. 213 patients were included with median survival from NIV initiation of 13.5 months. In univariate analysis, the identified risk factors for mortality were severity of bulbar involvement (HR 2), Forced Vital Capacity (FVC) % (HR 0.99) and ALSFRS-R (HR 0.97). Multivariate analysis showed that bulbar involvement (HR 1.92) and ALSFRS-R (HR 0.97) were independent predictive factors of survival in patients on NIV. In our study, the two prognostic factors in ALS patients following NIV were the severity of bulbar involvement and ALSFRS-R at the time on NIV initiation. A better assessment of bulbar involvement, including evaluation of the upper airway, and a careful titration on NIV are necessary to optimize treatment efficacy.

  3. Predictive and Prognostic Value of sPRR in Patients with Primary Epithelial Ovarian Cancer

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    Katrin Kreienbring

    2016-01-01

    Full Text Available Aim. The purpose of the present study was to analyze the predictive and prognostic role of soluble (prorenin receptor (sPRR as a biomarker for clinicopathological outcome in patients with primary epithelial ovarian cancer (EOC. As part of the renin-angiotensin system (RAS whose activity is known to increase in ovarian cancer patients, the relation of sPRR and ovarian cancer should be further investigated. Patients and Methods. In this study 197 patients with primary EOC in our institution from 2000 to 2011 were included. sPRR was determined by enzyme-linked immunosorbent assay (ELISA in preoperative taken blood sera. Associations with clinicopathological outcome were analyzed and serum levels of sPRR in patients have been compared to those in healthy specimen. Kaplan-Meier and logistic/Cox regression assessed the impact of the markers on progression-free survival (PFS and overall survival (OS. Results. There have been no correlations proved of sPRR levels with neither clinicopathological factors nor prognostic data. Also the distribution of sPRR in patients and controls was normal. Conclusion. sPRR seems to have no predictive, prognostic, or diagnostic value in EOC. As several factors of the RAS which might indicate cancer events have been shown, sPRR seems not to be affected.

  4. The Predictive Value of Scores Used in Intensive Care Unit for Burn Patients Prognostic.

    Science.gov (United States)

    Novac, M; Dragoescu, Alice; Stanculescu, Andreea; Duca, Lucica; Cernea, Daniela

    2014-01-01

    Statistical evaluation of the prognosis of burned patients based on the analysis of prognostic scores as quickly and easily obtainable that track the evolution of burned patient in ICU. Material / Methods: The prospective study included 92 patients were performed with severe burns on 35-67% body surface large area, aiming to establish a cut-off score for each studied and statistically significant prognostic parameter for assessing the risk of mortality. The control group was represented by 20 patients with burns on the body surface of 0.05) sex (male / female), but we had p cut-off. Quantification of variables by calculating the area under the ROC curve (AUC), sensitivity and sensitivity, positive predictive value (PPV) and negative predictive value (NPV), allowed a better appreciation of these prognostic scores. These systems applicable to the burned patient scores, making a cut-off of each index / mortality probability score, he can manifest usefulness in medical decision making process and strategy to reduce the risk of death in patients with severe burns.

  5. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Lee, Yoo Jin; Min, Bo Ram; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok; Jeon, Seong Woo

    2016-01-01

    Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency that can be life threatening. This study evaluated predictive factors of 30-day mortality in patients with this condition. A prospective observational study was conducted at a single hospital between April 2010 and November 2012, and 336 patients with symptoms and signs of gastrointestinal bleeding were consecutively enrolled. Clinical characteristics and endoscopic findings were reviewed to identify potential factors associated with 30-day mortality. Overall, 184 patients were included in the study (men, 79.3%; mean age, 59.81 years), and 16 patients died within 30 days (8.7%). Multivariate analyses revealed that comorbidity of diabetes mellitus (DM) or metastatic malignancy, age ≥ 65 years, and hypotension (systolic pressure < 90 mmHg) during hospitalization were significant predictive factors of 30-day mortality. Comorbidity of DM or metastatic malignancy, age ≥ 65 years, and hemodynamic instability during hospitalization were predictors of 30-day mortality in patients with NVUGIB. These results will help guide the management of patients with this condition.

  6. Spontaneous evolution in bilirubin levels predicts liver-related mortality in patients with alcoholic hepatitis.

    Directory of Open Access Journals (Sweden)

    Minjong Lee

    Full Text Available The accurate prognostic stratification of alcoholic hepatitis (AH is essential for individualized therapeutic decisions. The aim of this study was to develop a new prognostic model to predict liver-related mortality in Asian AH patients. We conducted a hospital-based, retrospective cohort study using 308 patients with AH between 1999 and 2011 (a derivation cohort and 106 patients with AH between 2005 and 2012 (a validation cohort. The Cox proportional hazards model was constructed to select significant predictors of liver-related death from the derivation cohort. A new prognostic model was internally validated using a bootstrap sampling method. The discriminative performance of this new model was compared with those of other prognostic models using a concordance index in the validation cohort. Bilirubin, prothrombin time, creatinine, potassium at admission, and a spontaneous change in bilirubin levels from day 0 to day 7 (SCBL were incorporated into a model for AH to grade the severity in an Asian patient cohort (MAGIC. For risk stratification, four risk groups were identified with cutoff scores of 29, 37, and 46 based on the different survival probabilities (P<0.001. In addition, MAGIC showed better discriminative performance for liver-related mortality than any other scoring system in the validation cohort. MAGIC can accurately predict liver-related mortality in Asian patients hospitalized for AH. Therefore, SCBL may help us decide whether patients with AH urgently require corticosteroid treatment.

  7. Predictive validity of the Sødring Motor Evaluation of Stroke Patients (SMES).

    Science.gov (United States)

    Wyller, T B; Sødring, K M; Sveen, U; Ljunggren, A E; Bautz-Holter, E

    1996-12-01

    The Sødring Motor Evaluation of Stroke Patients (SMES) has been developed as an instrument for the evaluation by physiotherapists of motor function and activities in stroke patients. The predictive validity of the instrument was studied in a consecutive sample of 93 acute stroke patients, assessed in the acute phase and after one year. The outcome measures were: survival, residence at home or in institution, the Barthel ADL index (dichotomized at 19/20), and the Frenchay Activities Index (FAI) (dichotomized at 9/10). The SMES, scored in the acute phase, demonstrated a marginally significant predictive power regarding survival, but was a highly significant predictor regarding the other outcomes. The adjusted odds ratio for a good versus a poor outcome for patients in the upper versus the lower tertile of the SMES arm subscore was 5.4 (95% confidence interval 0.9-59) for survival, 11.5 (2.1-88) for living at home, 86.3 (11-infinity) for a high Barthel score, and 31.4 (5.2-288) for a high FAI score. We conclude that SMES has high predictive validity.

  8. Predictive value of lidocaine for treatment success of oxcarbazepine in patients with neuropathic pain syndrome.

    Science.gov (United States)

    Schipper, Sivan; Gantenbein, Andreas R; Maurer, Konrad; Alon, Eli; Sándor, Peter S

    2013-06-01

    Pharmacotherapy in patients with neuropathic pain syndromes (NPS) can be associated with long periods of trial and error before reaching satisfactory analgesia. The aim of this study was to investigate whether a short intravenous (i.v.) infusion of lidocaine may have a predictive value for the efficacy of oxcarbazepine. In total, 16 consecutive patients with NPS were studied in a prospective, uncontrolled, open-label study design. Each patient received i.v. lidocaine (5 mg/kg) within 30 min followed by a long-term oral oxcarbazepine treatment (900-1,500 mg/day). During an observation period of 28 days, treatment response was documented by a questionnaire including the average daily pain score documented on a numeric rating scale (NRS). A total of 6 out of 16 patients (38%) were lidocaine responders (defined as pain reduction >50% during the infusion), and 4 of 16 (25%) were oxcarbazepine responders. In total, 6 out of 16 participants (38%) discontinued oxcarbazepine treatment due to side effects. In an interim analysis predictive value of the lidocaine infusion was low with a Kendall's tau correlation coefficient of 0.29 and coefficient of determination R(2) of 0.119 (95% confidence interval -0.29 to 0.72). As a consequence of this low correlation, the study was discontinued for ethical reasons. In conclusion, lidocaine infusion has a low predictive value for effectiveness of oxcarbazepine-if at all.

  9. Quantitative prediction of oral cancer risk in patients with oral leukoplakia.

    Science.gov (United States)

    Liu, Yao; Li, Yicheng; Fu, Yue; Liu, Tong; Liu, Xiaoyong; Zhang, Xinyan; Fu, Jie; Guan, Xiaobing; Chen, Tong; Chen, Xiaoxin; Sun, Zheng

    2017-07-11

    Exfoliative cytology has been widely used for early diagnosis of oral squamous cell carcinoma. We have developed an oral cancer risk index using DNA index value to quantitatively assess cancer risk in patients with oral leukoplakia, but with limited success. In order to improve the performance of the risk index, we collected exfoliative cytology, histopathology, and clinical follow-up data from two independent cohorts of normal, leukoplakia and cancer subjects (training set and validation set). Peaks were defined on the basis of first derivatives with positives, and modern machine learning techniques were utilized to build statistical prediction models on the reconstructed data. Random forest was found to be the best model with high sensitivity (100%) and specificity (99.2%). Using the Peaks-Random Forest model, we constructed an index (OCRI2) as a quantitative measurement of cancer risk. Among 11 leukoplakia patients with an OCRI2 over 0.5, 4 (36.4%) developed cancer during follow-up (23 ± 20 months), whereas 3 (5.3%) of 57 leukoplakia patients with an OCRI2 less than 0.5 developed cancer (32 ± 31 months). OCRI2 is better than other methods in predicting oral squamous cell carcinoma during follow-up. In conclusion, we have developed an exfoliative cytology-based method for quantitative prediction of cancer risk in patients with oral leukoplakia.

  10. Efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer

    International Nuclear Information System (INIS)

    Liu Xiao; Wang Guiqi; He Shun

    2014-01-01

    Objective: To investigate the efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer (EC). Methods: A retrospective study was conducted in 358 EC patients who underwent radical surgery in our hospital from April 2003 to October 2010 and who had preoperative work-up including endoscopic esophageal ultrasound (EUS), esophagoscopy, thoracic CT scans,and contrast esophagography and had detailed information on postoperative pathological stages. The predictive value of preoperative clinical T/N stage based on EUS + CT for postoperative pathological stage was analyzed. The disease free survival (DFS) and overall survival (OS) were analyzed according to the UICC TNM classification (2002/ 2009) and the clinical stage based on imaging findings. Results: The median follow-up was 47 months.A total of 305 (85.2%) of all patients were analyzed by clinical stage based on EUS + CT.Among them, the predictive value of clinical T stage for pathological T stage was 0-88.6%, highest (88.6%) for T1 stage and lowest for T4 stage. The predictive value of clinical N stage (N 0 /N1) was 62.5-100%. The significant differences in OS and DFS rates based on both 2002 and 2009 UICC TNM classifications were noted (P=0.000 and 0.000). There were significant differences in OS between stage groups, except the comparison between two stage Ⅳ patients and other groups, according to 2002 UICC TNM classification. There were usually insignificant differences in OS between stage groups, according to 2009 UICC TNM classification. For the 305 patients staged clinically based on EUS and CT according to 2002 UICC TNM classification, significant differences in OS and DFS rates were noted (P=0.000 and 0.000). Conclusions: Imaging modalities show good predictive value for N stage (N0/N1),even though they cannot accurately provide the number of metastatic lymph nodes. The clinical stage based on EUS + CT can effectively predict the prognosis of non-surgical EC patients

  11. Prediction of Pathological Stage in Patients with Prostate Cancer: A Neuro-Fuzzy Model.

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    Georgina Cosma

    Full Text Available The prediction of cancer staging in prostate cancer is a process for estimating the likelihood that the cancer has spread before treatment is given to the patient. Although important for determining the most suitable treatment and optimal management strategy for patients, staging continues to present significant challenges to clinicians. Clinical test results such as the pre-treatment Prostate-Specific Antigen (PSA level, the biopsy most common tumor pattern (Primary Gleason pattern and the second most common tumor pattern (Secondary Gleason pattern in tissue biopsies, and the clinical T stage can be used by clinicians to predict the pathological stage of cancer. However, not every patient will return abnormal results in all tests. This significantly influences the capacity to effectively predict the stage of prostate cancer. Herein we have developed a neuro-fuzzy computational intelligence model for classifying and predicting the likelihood of a patient having Organ-Confined Disease (OCD or Extra-Prostatic Disease (ED using a prostate cancer patient dataset obtained from The Cancer Genome Atlas (TCGA Research Network. The system input consisted of the following variables: Primary and Secondary Gleason biopsy patterns, PSA levels, age at diagnosis, and clinical T stage. The performance of the neuro-fuzzy system was compared to other computational intelligence based approaches, namely the Artificial Neural Network, Fuzzy C-Means, Support Vector Machine, the Naive Bayes classifiers, and also the AJCC pTNM Staging Nomogram which is commonly used by clinicians. A comparison of the optimal Receiver Operating Characteristic (ROC points that were identified using these approaches, revealed that the neuro-fuzzy system, at its optimal point, returns the largest Area Under the ROC Curve (AUC, with a low number of false positives (FPR = 0.274, TPR = 0.789, AUC = 0.812. The proposed approach is also an improvement over the AJCC pTNM Staging Nomogram (FPR

  12. Predicting the need for massive transfusion in trauma patients: the Traumatic Bleeding Severity Score.

    Science.gov (United States)

    Ogura, Takayuki; Nakamura, Yoshihiko; Nakano, Minoru; Izawa, Yoshimitsu; Nakamura, Mitsunobu; Fujizuka, Kenji; Suzukawa, Masayuki; Lefor, Alan T

    2014-05-01

    The ability to easily predict the need for massive transfusion may improve the process of care, allowing early mobilization of resources. There are currently no clear criteria to activate massive transfusion in severely injured trauma patients. The aims of this study were to create a scoring system to predict the need for massive transfusion and then to validate this scoring system. We reviewed the records of 119 severely injured trauma patients and identified massive transfusion predictors using statistical methods. Each predictor was converted into a simple score based on the odds ratio in a multivariate logistic regression analysis. The Traumatic Bleeding Severity Score (TBSS) was defined as the sum of the component scores. The predictive value of the TBSS for massive transfusion was then validated, using data from 113 severely injured trauma patients. Receiver operating characteristic curve analysis was performed to compare the results of TBSS with the Trauma-Associated Severe Hemorrhage score and the Assessment of Blood Consumption score. In the development phase, five predictors of massive transfusion were identified, including age, systolic blood pressure, the Focused Assessment with Sonography for Trauma scan, severity of pelvic fracture, and lactate level. The maximum TBSS is 57 points. In the validation study, the average TBSS in patients who received massive transfusion was significantly greater (24.2 [6.7]) than the score of patients who did not (6.2 [4.7]) (p operating characteristic curve, sensitivity, and specificity for a TBSS greater than 15 points was 0.985 (significantly higher than the other scoring systems evaluated at 0.892 and 0.813, respectively), 97.4%, and 96.2%, respectively. The TBSS is simple to calculate using an available iOS application and is accurate in predicting the need for massive transfusion. Additional multicenter studies are needed to further validate this scoring system and further assess its utility. Prognostic study

  13. Serum microRNA-122 predicts survival in patients with liver cirrhosis.

    Directory of Open Access Journals (Sweden)

    Oliver Waidmann

    Full Text Available BACKGROUND: Liver cirrhosis is associated with high morbidity and mortality. MicroRNAs (miRs circulating in the blood are an emerging new class of biomarkers. In particular, the serum level of the liver-specific miR-122 might be a clinically useful new parameter in patients with acute or chronic liver disease. AIM: Here we investigated if the serum level of miR-122 might be a prognostic parameter in patients with liver cirrhosis. METHODS: 107 patients with liver cirrhosis in the test cohort and 143 patients in the validation cohort were prospectively enrolled into the present study. RNA was extracted from the sera obtained at the time of study enrollment and the level of miR-122 was assessed. Serum miR-122 levels were assessed by quantitative reverse-transcription PCR (RT-PCR and were compared to overall survival time and to different complications of liver cirrhosis. RESULTS: Serum miR-122 levels were reduced in patients with hepatic decompensation in comparison to patients with compensated liver disease. Patients with ascites, spontaneous bacterial peritonitis and hepatorenal syndrome had significantly lower miR-122 levels than patients without these complications. Multivariate Cox regression analysis revealed that the miR-122 serum levels were associated with survival independently from the MELD score, sex and age. CONCLUSIONS: Serum miR-122 is a new independent marker for prediction of survival of patients with liver cirrhosis.

  14. Esophageal stasis in achalasia patients without symptoms after treatment does not predict symptom recurrence.

    Science.gov (United States)

    van Hoeij, F B; Smout, A J P M; Bredenoord, A J

    2017-08-01

    After achalasia treatment, a subset of patients has poor esophageal emptying without having symptoms. There is no consensus on whether to pre-emptively treat these patients. We hypothesized that, if left untreated, these patients will experience earlier symptom recurrence than patients without stasis. 99 treated achalasia patients who were in clinical remission (Eckardt ≤3) at 3 months after treatment were divided into two groups, based on presence or absence of esophageal stasis on a timed barium esophagogram performed after 3 months. Two years after initial treatment, patients with stasis after treatment still had a wider esophagus (3 cm; IQR: 2.2-3.8) and more stasis (3.5 cm; IQR: 1.9-5.6) than patients without stasis (1.8 cm wide and 0 cm stasis; both Ptreatment also had a higher degree of stasis and a more dilated esophagus, compared to patients without stasis, they did not have a higher chance of requiring retreatment. We conclude that stasis in symptom-free achalasia patients after treatment does not predict treatment failure within 2 years and can therefore not serve as a sole reason for retreatment. © 2017 John Wiley & Sons Ltd.

  15. Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

    Science.gov (United States)

    Kaya, Cafer; Tam, Abbas Ali; Dirikoç, Ahmet; Kılıçyazgan, Aylin; Kılıç, Mehmet; Türkölmez, Şeyda; Ersoy, Reyhan; Çakır, Bekir

    2016-10-01

    Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and it may extend hospitalization durations. The purpose of this study is to determine the predictive factors related to the development of hypocalcemia and hungry bone syndrome (HBS) in patients who underwent parathyroidectomy for PHP. Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD, albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1st and 4th days postoperatively, and in the 6th postoperative month, and their neck ultrasound (US) and bone densitometry data were also recorded. Hypocalcemia was seen in 63 patients (38.4%) on the 1st day after parathyroidectomy. Ten patients (6.1%) had permanent hypocalcemia in the 6th month after surgery. Out of the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP, and BUN values were higher in those patients who developed HBS. Furthermore, HBS was more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who underwent thyroidectomy simultaneously with parathyroidectomy. As a result, patients who have the risk factors for development of hypocalcemia and HBS should be monitored more attentively during the perioperative period.

  16. Tuberculosis outbreaks predicted by characteristics of first patients in a DNA fingerprint cluster.

    Science.gov (United States)

    Kik, Sandra V; Verver, Suzanne; van Soolingen, Dick; de Haas, Petra E W; Cobelens, Frank G; Kremer, Kristin; van Deutekom, Henk; Borgdorff, Martien W

    2008-07-01

    Some clusters of patients who have Mycobacterium tuberculosis isolates with identical DNA fingerprint patterns grow faster than others. It is unclear what predictors determine cluster growth. To assess whether the development of a tuberculosis (TB) outbreak can be predicted by the characteristics of its first two patients. Demographic and clinical data of all culture-confirmed patients with TB in the Netherlands from 1993 through 2004 were combined with DNA fingerprint data. Clusters were restricted to cluster episodes of 2 years to only detect newly arising clusters. Characteristics of the first two patients were compared between small (2-4 cases) and large (5 or more cases) cluster episodes. Of 5,454 clustered cases, 1,756 (32%) were part of a cluster episode of 2 years. Of 622 cluster episodes, 54 (9%) were large and 568 (91%) were small episodes. Independent predictors for large cluster episodes were as follows: less than 3 months' time between the diagnosis of the first two patients, one or both patients were young (<35 yr), both patients lived in an urban area, and both patients came from sub-Saharan Africa. In the Netherlands, patients in new cluster episodes should be screened for these risk factors. When the risk pattern applies, targeted interventions (e.g., intensified contact investigation) should be considered to prevent further cluster expansion.

  17. Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver; Valenta, Ines; Schepis, Tiziano [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); Husmann, Lars; Scheffel, Hans; Desbiolles, Lotus; Leschka, Sebastian; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland)

    2008-06-15

    The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 {+-} 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 {+-} 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001). Similarly, obstructive lesions ({>=}50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis. (orig.)

  18. Clinical characterisation of Becker muscular dystrophy patients predicts favourable outcome in exon-skipping therapy.

    Science.gov (United States)

    van den Bergen, J C; Schade van Westrum, S M; Dekker, L; van der Kooi, A J; de Visser, M; Wokke, B H A; Straathof, C S; Hulsker, M A; Aartsma-Rus, A; Verschuuren, J J; Ginjaar, H B

    2014-01-01

    Duchenne and Becker muscular dystrophy (DMD/BMD) are both caused by mutations in the DMD gene. Out-of-frame mutations in DMD lead to absence of the dystrophin protein, while in-frame BMD mutations cause production of internally deleted dystrophin. Clinically, patients with DMD loose ambulance around the age of 12, need ventilatory support at their late teens and die in their third or fourth decade due to pulmonary or cardiac failure. BMD has a more variable disease course. The disease course of patients with BMD with specific mutations could be very informative to predict the outcome of the exon-skipping therapy, aiming to restore the reading-frame in patients with DMD. Patients with BMD with a mutation equalling a DMD mutation after successful exon skipping were selected from the Dutch Dystrophinopathy Database. Information about disease course was gathered through a standardised questionnaire. Cardiac data were collected from medical correspondence and a previous study on cardiac function in BMD. Forty-eight patients were included, representing 11 different mutations. Median age of patients was 43 years (range 6-67). Nine patients were wheelchair users (26-56 years). Dilated cardiomyopathy was present in 7/36 patients. Only one patient used ventilatory support. Three patients had died at the age of 45, 50 and 76 years, respectively. This study provides mutation specific data on the course of disease in patients with BMD. It shows that the disease course of patients with BMD, with a mutation equalling a 'skipped' DMD mutation is relatively mild. This finding strongly supports the potential benefit of exon skipping in patients with DMD.

  19. Electricity Consumption Forecasting Scheme via Improved LSSVM with Maximum Correntropy Criterion

    Directory of Open Access Journals (Sweden)

    Jiandong Duan

    2018-02-01

    Full Text Available In recent years, with the deepening of China’s electricity sales side reform and electricity market opening up gradually, the forecasting of electricity consumption (FoEC becomes an extremely important technique for the electricity market. At present, how to forecast the electricity accurately and make an evaluation of results scientifically are still key research topics. In this paper, we propose a novel prediction scheme based on the least-square support vector machine (LSSVM model with a maximum correntropy criterion (MCC to forecast the electricity consumption (EC. Firstly, the electricity characteristics of various industries are analyzed to determine the factors that mainly affect the changes in electricity, such as the gross domestic product (GDP, temperature, and so on. Secondly, according to the statistics of the status quo of the small sample data, the LSSVM model is employed as the prediction model. In order to optimize the parameters of the LSSVM model, we further use the local similarity function MCC as the evaluation criterion. Thirdly, we employ the K-fold cross-validation and grid searching methods to improve the learning ability. In the experiments, we have used the EC data of Shaanxi Province in China to evaluate the proposed prediction scheme, and the results show that the proposed prediction scheme outperforms the method based on the traditional LSSVM model.

  20. Utility of Eating Assessment Tool-10 in Predicting Aspiration in Patients with Unilateral Vocal Fold Paralysis.

    Science.gov (United States)

    Zuniga, Steven A; Ebersole, Barbara; Jamal, Nausheen

    2018-03-01

    Objective Examine the incidence of penetration/aspiration in patients with unilateral vocal fold immobility and investigate the relationship with self-reported perception of dysphagia. Study Design Case series with chart review. Setting Academic cancer center. Subjects and Methods Adult patients with unilateral vocal fold immobility diagnosed between 2014 and 2016 were reviewed. Patients were stratified into an aspiration group and a nonaspiration group using objective findings on flexible endoscopic evaluation of swallowing, as scored using Rosenbek's Penetration Aspiration Scale. Objective findings were compared to patient perception of dysphagia. Bivariate linear correlation analysis was performed to evaluate correlation between Eating Assessment Tool-10 scores and presence of aspiration. Tests of diagnostic accuracy were calculated to investigate the predictive value of Eating Assessment Tool-10 scores >9 on aspiration risk. Results Of the 35 patients with new-onset unilateral vocal fold immobility were evaluated, 25.7% (9/35) demonstrated tracheal aspiration. Mean ± SD Eating Assessment Tool-10 scores were 19.2 ± 13.7 for aspirators and 7.0 ± 7.8 for nonaspirators ( P = .016). A statistically significant correlation was demonstrated between increasing Eating Assessment Tool-10 scores and Penetration Aspiration Scale scores ( r = 0.511, P = .002). Diagnostic accuracy analysis for aspiration risk in patients with an Eating Assessment Tool-10 score >9 revealed a sensitivity of 77.8% and a specificity of 73.1%. Conclusion Patient perception of swallowing difficulty may have utility in predicting aspiration risk. An EAT-10 of >9 in patients with unilateral vocal fold immobility may portend up to a 5 times greater risk of aspiration. Routine swallow testing to assess for penetration/aspiration may be indicated in patients with unilateral vocal fold immobility.

  1. The precautionary principle as a rational decision criterion

    International Nuclear Information System (INIS)

    Hovi, Jon

    2001-12-01

    The paper asks if the precautionary principle may be seen as a rational decision criterion. Six main questions are discussed. 1. Does the principle basically represent a particular set of political options or is it a genuine decision criterion? 2. If it is the latter, can it be reduced to any of the existing criteria for decision making under uncertainty? 3. In what kinds of situation is the principle applicable? 4. What is the relation between the precautionary principle and other principles for environmental regulation? 5. How plausible is the principle's claim that the burden of proof should be reversed? 6. Do the proponents of environmental regulation carry no burden of proof at all? A main conclusion is that, for now at least, the principle contains too many unclear elements to satisfy the requirements of precision and consistency that should reasonably be satisfied by a rational decision criterion. (author)

  2. Study on the quantitative rod internal pressure design criterion

    International Nuclear Information System (INIS)

    Kim, Kyu Tae; Kim, Oh Hwan; Han, Hee Tak

    1991-01-01

    The current rod internal pressure criterion permits fuel rods to operate with internal pressures in excess of system pressure only if internal overpressure does not cause the diametral gap enlargement. In this study, the generic allowable internal gas pressure not violating this criterion is estimated as a function of rod power. The results show that the generic allowable internal gas pressure decreases linearly with the increase of rod power. Application of the generic allowable internal gas pressure for the rod internal pressure design criterion will result in the simplication of the current design procedure for checking the diametral gap enlargement caused by internal overpressure because according to the current design procedure the cladding creepout rate should be compared with the fuel swelling rate at each axial node at each time step whenever internal pressure exceeds the system pressure. (Author)

  3. Development of failure criterion for Kevlar-epoxy fabric laminates

    Science.gov (United States)

    Tennyson, R. C.; Elliott, W. G.

    1984-01-01

    The development of the tensor polynomial failure criterion for composite laminate analysis is discussed. In particular, emphasis is given to the fabrication and testing of Kevlar-49 fabric (Style 285)/Narmco 5208 Epoxy. The quadratic-failure criterion with F(12)=0 provides accurate estimates of failure stresses for the Kevlar/Epoxy investigated. The cubic failure criterion was re-cast into an operationally easier form, providing the engineer with design curves that can be applied to laminates fabricated from unidirectional prepregs. In the form presented no interaction strength tests are required, although recourse to the quadratic model and the principal strength parameters is necessary. However, insufficient test data exists at present to generalize this approach for all undirectional prepregs and its use must be restricted to the generic materials investigated to-date.

  4. A Joint Optimization Criterion for Blind DS-CDMA Detection

    Directory of Open Access Journals (Sweden)

    Sergio A. Cruces-Alvarez

    2007-01-01

    Full Text Available This paper addresses the problem of the blind detection of a desired user in an asynchronous DS-CDMA communications system with multipath propagation channels. Starting from the inverse filter criterion introduced by Tugnait and Li in 2001, we propose to tackle the problem in the context of the blind signal extraction methods for ICA. In order to improve the performance of the detector, we present a criterion based on the joint optimization of several higher-order statistics of the outputs. An algorithm that optimizes the proposed criterion is described, and its improved performance and robustness with respect to the near-far problem are corroborated through simulations. Additionally, a simulation using measurements on a real software-radio platform at 5 GHz has also been performed.

  5. A Joint Optimization Criterion for Blind DS-CDMA Detection

    Science.gov (United States)

    Durán-Díaz, Iván; Cruces-Alvarez, Sergio A.

    2006-12-01

    This paper addresses the problem of the blind detection of a desired user in an asynchronous DS-CDMA communications system with multipath propagation channels. Starting from the inverse filter criterion introduced by Tugnait and Li in 2001, we propose to tackle the problem in the context of the blind signal extraction methods for ICA. In order to improve the performance of the detector, we present a criterion based on the joint optimization of several higher-order statistics of the outputs. An algorithm that optimizes the proposed criterion is described, and its improved performance and robustness with respect to the near-far problem are corroborated through simulations. Additionally, a simulation using measurements on a real software-radio platform at 5 GHz has also been performed.

  6. The role of word choice and criterion on intentional memory.

    Science.gov (United States)

    Toyota, Hiroshi

    2015-02-01

    The relationship between the criterion for choosing and the self-choice effects (greater recall in a self-choice compared to a forced-choice condition) on intentional memory was examined. Thirty-three female nursing school volunteers were administered 24 word pairs in a 2 × 2 design to assess the influence of motivation upon free recall. When word pairs were presented to participants, they were asked to choose a word to-be-remembered, either in a self-choice condition or a forced-choice condition. Words chosen by the participants were recalled more often than those chosen by the experimenter (forced choice). Thus, the self-choice effect was greater for words chosen with a self-reference criterion compared to a metamemory criterion, supporting the integration hypothesis as the origin of the self-choice effect.

  7. SOCIO-PSYCHOLOGICAL CRITERIONS OF FAMILY LIFESTYLE TYPOLOGY

    Directory of Open Access Journals (Sweden)

    Yekaterina Anatolievna Yumkina

    2015-02-01

    Full Text Available The purpose of this article is to present socio-psychological criterions of family lifestyle typology, which were found during theoretical modelling and empirical research work. It is important in fundamental and practical aspects. St-Petersburg students (n = 116, from 19 to 21 years old were examined by special questionnaire «Family relationship and home» (Kunitsi-na V.N., Yumkina Ye.A., 2012 which measures different aspects of family lifestyle. We also used complex of methods that gave us information about personal values, self-rating and parent-child relationships. Dates were divided into six groups according to three main criterions of family lifestyle typology: social environment of family life, family activity, and family interpersonal relationships. There were found statistically significant differences between pairs of group from every criterions. The results can be useful in spheres dealing with family crisis, family development, family traditions etc.

  8. Judging Criterion of Controlled Structures with Closely Spaced Natural Frequencies

    International Nuclear Information System (INIS)

    Xie Faxiang; Sun Limin

    2010-01-01

    The structures with closely spaced natural frequencies widely exist in civil engineering; however, the judging criterion of the density of closely spaced frequencies is in dispute. This paper suggests a judging criterion for structures with closely spaced natural frequencies based on the analysis on a controlled 2-DOF structure. The analysis results indicate that the optimal control gain of the structure with velocity feedback is dependent on the frequency density parameter of structure and the maximum attainable additional modal damping ratio is 1.72 times of the frequency density parameter when state feedback is applied. Based on a brief review on the previous researches, a judging criterion related the minimum frequency density parameter and the required mode damping ratio was proposed.

  9. Probabilistic interpretation of the reduction criterion for entanglement

    International Nuclear Information System (INIS)

    Zhang, Zhengmin; Luo, Shunlong

    2007-01-01

    Inspired by the idea of conditional probabilities, we introduce a variant of conditional density operators. But unlike the conditional probabilities which are bounded by 1, the conditional density operators may have eigenvalues exceeding 1 for entangled states. This has the consequence that although any bivariate classical probability distribution has a natural separable decomposition in terms of conditional probabilities, we do not have a quantum analogue of this separable decomposition in general. The 'nonclassical' eigenvalues of conditional density operators are indications of entanglement. The resulting separability criterion turns out to be equivalent to the reduction criterion introduced by Horodecki [Phys. Rev. A 59, 4206 (1999)] and Cerf et al. [Phys. Rev. A 60, 898 (1999)]. This supplies an intuitive probabilistic interpretation for the reduction criterion. The conditional density operators are also used to define a form of quantum conditional entropy which provides an alternative mechanism to reveal quantum discord

  10. Predicting hospital mortality among frequently readmitted patients: HSMR biased by readmission

    Directory of Open Access Journals (Sweden)

    Kelder Johannes C

    2011-03-01

    Full Text Available Abstract Background Casemix adjusted in-hospital mortality is one of the measures used to improve quality of care. The adjustment currently used does not take into account the effects of readmission, because reliable data on readmission is not readily available through routinely collected databases. We have studied the impact of readmissions by linking admissions of the same patient, and as a result were able to compare hospital mortality among frequently, as opposed to, non-frequently readmitted patients. We also formulated a method to adjust for readmission for the calculation of hospital standardised mortality ratios (HSMRs. Methods We conducted a longitudinal retrospective analysis of routinely collected hospital data of six large non-university teaching hospitals in the Netherlands with casemix adjusted standardised mortality ratios ranging from 65 to 114 and a combined value of 93 over a five-year period. Participants concerned 240662 patients admitted 418566 times in total during the years 2003 - 2007. Predicted deaths by the HSMR model 2008 over a five-year period were compared with observed deaths. Results Numbers of readmissions per patient differ substantially between the six hospitals, up to a factor of 2. A large interaction was found between numbers of admissions per patient and HSMR-predicted risks. Observed deaths for frequently admitted patients were significantly lower than HSMR-predicted deaths, which could be explained by uncorrected factors surrounding readmissions. Conclusions Patients admitted more frequently show lower risks of dying on average per admission. This decline in risk is only partly detected by the current HSMR. Comparing frequently admitted patients to non-frequently admitted patients commits the constant risk fallacy and potentially lowers HSMRs of hospitals treating many frequently admitted patients and increases HSMRs of hospitals treating many non-frequently admitted patients. This misleading effect can

  11. Predicting hospital mortality among frequently readmitted patients: HSMR biased by readmission

    Science.gov (United States)

    2011-01-01

    Background Casemix adjusted in-hospital mortality is one of the measures used to improve quality of care. The adjustment currently used does not take into account the effects of readmission, because reliable data on readmission is not readily available through routinely collected databases. We have studied the impact of readmissions by linking admissions of the same patient, and as a result were able to compare hospital mortality among frequently, as opposed to, non-frequently readmitted patients. We also formulated a method to adjust for readmission for the calculation of hospital standardised mortality ratios (HSMRs). Methods We conducted a longitudinal retrospective analysis of routinely collected hospital data of six large non-university teaching hospitals in the Netherlands with casemix adjusted standardised mortality ratios ranging from 65 to 114 and a combined value of 93 over a five-year period. Participants concerned 240662 patients admitted 418566 times in total during the years 2003 - 2007. Predicted deaths by the HSMR model 2008 over a five-year period were compared with observed deaths. Results Numbers of readmissions per patient differ substantially between the six hospitals, up to a factor of 2. A large interaction was found between numbers of admissions per patient and HSMR-predicted risks. Observed deaths for frequently admitted patients were significantly lower than HSMR-predicted deaths, which could be explained by uncorrected factors surrounding readmissions. Conclusions Patients admitted more frequently show lower risks of dying on average per admission. This decline in risk is only partly detected by the current HSMR. Comparing frequently admitted patients to non-frequently admitted patients commits the constant risk fallacy and potentially lowers HSMRs of hospitals treating many frequently admitted patients and increases HSMRs of hospitals treating many non-frequently admitted patients. This misleading effect can only be demonstrated by an

  12. Comparison of different scoring systems for outcome prediction in patients with Fournier's gangrene: experience with 50 patients.

    Science.gov (United States)

    Tuncel, Altug; Keten, Tanju; Aslan, Yilmaz; Kayali, Mustafa; Erkan, Anil; Koseoglu, Ersin; Atan, Ali

    2014-08-01

    The aim of this study was to evaluate effective factors in the survival of patients with Fournier's gangrene (FG) and compare three different validated scoring systems for outcome prediction: Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI) and age-adjusted Charlson Comorbidity Index (ACCI). Fifty men who underwent surgery for FG between July 2005 and August 2012 were included in the study. Data were collected on medical history, symptoms, physical examination findings, vital signs, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic treatment used. The FGSI, UFGSI and ACCI were evaluated stratified by survival. Admission and final parameters were measured using the Mann-Whitney test. The results were evaluated for two groups: survivors (n = 43) and non-survivors (n = 7). Survivors were younger than non-survivors (median age 58 vs 68.5 years, p = 0.017). The median extent of body surface area involved in the necrotizing process in patients who survived and did not survive was 2.3% and 4.8%, respectively (p = 0.04). No significant differences in laboratory parameters were found between survivors and non-survivors at the time of admission, except for haemoglobin, haematocrit, serum urea and albumin levels. Only UFGSI, but not FGSI or ACCI, had any meaning or predictive value in disease severity or patients' survival. Only the UFGSI score could predict the disease severity and the patients' survival. The findings did not support previous findings that an UFGSI threshold of 9 is a predictor of mortality during initial evaluation.

  13. Decision tree-based learning to predict patient controlled analgesia consumption and readjustment

    Directory of Open Access Journals (Sweden)

    Hu Yuh-Jyh

    2012-11-01

    Full Text Available Abstract Background Appropriate postoperative pain management contributes to earlier mobilization, shorter hospitalization, and reduced cost. The under treatment of pain may impede short-term recovery and have a detrimental long-term effect on health. This study focuses on Patient Controlled Analgesia (PCA, which is a delivery system for pain medication. This study proposes and demonstrates how to use machine learning and data mining techniques to predict analgesic requirements and PCA readjustment. Methods The sample in this study included 1099 patients. Every patient was described by 280 attributes, including the class attribute. In addition to commonly studied demographic and physiological factors, this study emphasizes attributes related to PCA. We used decision tree-based learning algorithms to predict analgesic consumption and PCA control readjustment based on the first few hours of PCA medications. We also developed a nearest neighbor-based data cleaning method to alleviate the class-imbalance problem in PCA setting readjustment prediction. Results The prediction accuracies of total analgesic consumption (continuous dose and PCA dose and PCA analgesic requirement (PCA dose only by an ensemble of decision trees were 80.9% and 73.1%, respectively. Decision tree-based learning outperformed Artificial Neural Network, Support Vector Machine, Random Forest, Rotation Forest, and Naïve Bayesian classifiers in analgesic consumption prediction. The proposed data cleaning method improved the performance of every learning method in this study of PCA setting readjustment prediction. Comparative analysis identified the informative attributes from the data mining models and compared them with the correlates of analgesic requirement reported in previous works. Conclusion This study presents a real-world application of data mining to anesthesiology. Unlike previous research, this study considers a wider variety of predictive factors, including PCA

  14. Predicting CD4 count changes among patients on antiretroviral treatment: Application of data mining techniques.

    Science.gov (United States)

    Kebede, Mihiretu; Zegeye, Desalegn Tigabu; Zeleke, Berihun Megabiaw

    2017-12-01

    To monitor the progress of therapy and disease progression, periodic CD4 counts are required throughout the course of HIV/AIDS care and support. The demand for CD4 count measurement is increasing as ART programs expand over the last decade. This study aimed to predict CD4 count changes and to identify the predictors of CD4 count changes among patients on ART. A cross-sectional study was conducted at the University of Gondar Hospital from 3,104 adult patients on ART with CD4 counts measured at least twice (baseline and most recent). Data were retrieved from the HIV care clinic electronic database and patients` charts. Descriptive data were analyzed by SPSS version 20. Cross-Industry Standard Process for Data Mining (CRISP-DM) methodology was followed to undertake the study. WEKA version 3.8 was used to conduct a predictive data mining. Before building the predictive data mining models, information gain values and correlation-based Feature Selection methods were used for attribute selection. Variables were ranked according to their relevance based on their information gain values. J48, Neural Network, and Random Forest algorithms were experimented to assess model accuracies. The median duration of ART was 191.5 weeks. The mean CD4 count change was 243 (SD 191.14) cells per microliter. Overall, 2427 (78.2%) patients had their CD4 counts increased by at least 100 cells p